848Ultrasound-guided axillary vein puncture feasibility for complex cardiac devices implantation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
S-S Bun ◽  
F Squara ◽  
D Scarlatti ◽  
G Theodore ◽  
D G Latcu ◽  
...  
Keyword(s):  
Insertion Time ◽  
Cardiac Resynchronization ◽  
Control Group ◽  
Axillary Vein ◽  
Icd Implantation ◽  
Cardiac Devices ◽  
Lidocaine Administration ◽  
Alternative Techniques ◽  
Pocket Hematoma

Abstract Background The axillary route use for cardiac devices implantation has recently expanded either with fluoroscopy or ultrasounds guidance. Few studies included defibrillators (ICD), cardiac resynchronization therapy (CRT) and upgrade procedures for ultrasound-guided axillary vein puncture (UGVP). Puropose To assess the feasibility/safety of UGVP for complex cardiac devices implantation including CRT/ICD. Methods Consecutive patients eligible for a pacemaker or ICD implantation were included. All procedures were performed by three operators (one experienced and two fellows). Guidewires insertion time (from lidocaïne administration), and complications were systematically studied. A group of patients implanted with alternative techniques was used for comparison (cephalic, subclavian). Results In 176 consecutive patients in whom UGVP was used, a total of 68 complex procedures were analyzed (74 ± 8 y, male 61 %) with 138 leads implanted including 42 ICD, 48 CRT and 16 upgrade procedures. A majority (83 %) was under anti-thrombotic therapy. UGVP was successful in 96.8 %. Mean insertion time for 1.78 guidewires per patient was 4.4 ± 4.4 min.  Guidewires insertion time reached its plateau after 10 patients. One pocket hematoma (1.4 %) was drained during a mean follow-up of 12 ± 5 months. The control group included 28 patients (12 subclavian, 16 cephalic; 15 ICD, 18 CRT, 4 upgrade procedures), with a mean insertion time of 10 ± 8 min, for 1.95 guidewires per patient (p < 0.0005). Conclusion UGVP is feasible and safe even for complex device implantations including CRT/ICD and upgrade procedures.

scholarly journals Are Electronic Cardiac Devices Still Evolving?

2014 ◽  
Vol 23 (01) ◽  
pp. 128-134 ◽  
Author(s):  
P. Mabo ◽  
G. Carrault
Keyword(s):  
Cardiac Resynchronization ◽  
Specific Patient ◽  
Hemodynamic Management ◽  
Cardiac Devices ◽  
Appropriate Therapy ◽  
Leadless Pacing ◽  
Cardiac Implants ◽  
Technological Improvements ◽  
Subcutaneous Implant

Summary Objectives: The goal of this paper is to review some important issues occurring during the past year in Implantable devices. Methods: First cardiac implantable device was proposed to maintain an adequate heart rate, either because the heart’s natural pacemaker is not fast enough, or there is a block in the heart’s electrical conduction system. During the last forty years, pacemakers have evolved considerably and become programmable and allow to configure specific patient optimum pacing modes. Various technological aspects (electrodes, connectors, algorithms diagnosis, therapies, ...) have been progressed and cardiac implants address several clinical applications: management of arrhythmias, cardioversion / defibrillation and cardiac resynchronization therapy. Results: Observed progress was the miniaturization of device, increased longevity, coupled with efficient pacing functions, multisite pacing modes, leadless pacing and also a better recognition of supraventricular or ventricular tachycardia’s in order to deliver appropriate therapy. Subcutaneous implant, new modes of stimulation (leadless implant or ultrasound lead), quadripolar lead and new sensor or new algorithm for the hemodynamic management are introduced and briefly described. Each times, the main result occurring during the two past years are underlined and repositioned from the history, remaining limitations are also addressed. Conclusion: Some important technological improvements were described. Nevertheless, news trends for the future are also considered in a specific session such as the remote follow-up of the patient or the treatment of heart failure by neuromodulation.

scholarly journals The impact of transvenous cardioverter-defibrillator implantation on quality of life, depression and optimism in dialysis patients: report on the secondary outcome of QOL in the randomized controlled ICD2 trial

2021 ◽  
Author(s):  
Rohit J. Timal ◽  
Veronique de Gucht ◽  
Joris I. Rotmans ◽  
Liselotte C. R. Hensen ◽  
Maurits S. Buiten ◽  
...  
Keyword(s):  
Mean Difference ◽  
Control Group ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Randomized Controlled ◽  
Score Difference ◽  
Sf 36 ◽  
The Impact

Abstract Rationale The impact of prophylactic implantable cardioverter-defibrillator (ICD) implantation on the psychological well-being of patients on dialysis is unknown. Objective We aimed to identify the effect of primary ICD implantation on quality of life (QoL), mood and dispositional optimism in patients undergoing dialysis. Methods and results We performed a prespecified subanalysis of the randomized controlled ICD2 trial. In total, 177 patients on chronic dialysis, with an age of 55–81 years, and a left ventricular ejection fraction of ≥ 35%, were included in the per-protocol analysis. Eighty patients received an ICD for primary prevention, and 91 patients received standard care. The Short Form-36 (SF-36), Geriatric Depression Scale-15 (GDS-15), Revised Life Orientation Test (LOT-R) questionnaires were administered prior to ICD implantation (T0), and at 1-year follow-up (T1) to assess QoL, depression and optimism, respectively. The patients were predominantly male (76.0%), with a median age of 67 years. Hemodialysis was the predominant mode of dialysis (70.2%). The GDS-15 score difference (T1 − T0) was 0.5 (2.1) in the ICD group compared with 0.3 (2.2) in the control group (mean difference − 0.3; 95% CI − 1.1 to 0.6; P = 0.58). The LOT-R score difference was − 0.2 (4.1) in the ICD group compared with − 1.5 (4.0) in the control group (mean difference − 1.1 (0.8); 95% CI − 2.6 to 0.4; P = 0.17). The mean difference scores of all subscales of the SF-36 were not significantly different between randomization groups. Conclusions In our population of patients on dialysis, ICD implantation did not affect QoL, mood or dispositional optimism significantly during 1-year follow-up. Clinical Trial Registration Unique identifier: ISRCTN20479861. http://www.controlled-trials.com.

Abstract 2285: Acute and Chronic Improvement in Left Ventricular Diastolic Function Following Cardiac Resynchronization Therapy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Glen Miske ◽  
Masaki Tanabe ◽  
Nini C Thomas ◽  
David Schwartzman ◽  
John Gorcsan
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Diastolic Function ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Control Group ◽  
Resynchronization Therapy ◽  
Beneficial Effects ◽  
Lv Diastolic Function ◽  
Deceleration Time

Background: Cardiac resynchronization therapy (CRT) has been shown to result in improvements in left ventricular (LV) systolic function, but its effects on diastolic function are not well understood. Our aim was to test the hypothesis that CRT acutely improves LV diastolic function and that these benefits are sustained in chronic follow-up. Methods: We studied 40 NYHA Class III–IV heart failure patients (65±10 yrs, ejection fraction 24±7%, QRS duration 166±26 ms, 62% ischemic) at baseline, 24 hours after CRT, and 6±3 mo. after CRT. A control group of 10 normal subjects were also studied. Quantitative pulsed wave and tissue Doppler measures of diastolic function included: mitral inflow peak E and A wave velocity, E deceleration time, mitral annular E′ velocity (septal and lateral sites) and estimation of LV filling pressure by E/E′. Results: All CRT patients had baseline diastolic dysfunction, as expected: Deceleration Time = 163±53 ms, E′ = 3.4±1.6 cm/sec, E/E′ = 40±20, peak E wave = 1.11±0.3 m/sec, peak A wave = 0.5±.3 m/sec, (all p < 0.05 vs. controls). Diastolic function acutely improved following CRT: Deceleration Time = 218±52 ms*, E′= 4.3±1.8 cm/sec*, and E/E′ = 29±19*, peak E wave = 1.01±0.26 m/sec*, peak A wave = 0.7±.34 m/sec* (all p < 0.05 vs. baseline). These beneficial effects of CRT were sustained 6±3 month following CRT (all p < 0.05 vs. baseline). Conclusion: CRT was associated with acute improvements in LV diastolic function. These improvements were sustained through chronic follow-up. These findings extend the understanding of beneficial effects of CRT on LV function.

Imaging for electrophysiological procedures

2021 ◽  
pp. 303-314
Author(s):  
Louisa O’Neill ◽  
Iain Sim ◽  
John Whitaker ◽  
Steven Williams ◽  
Henry Chubb ◽  
...  
Keyword(s):  
Sudden Death ◽  
Rapid Development ◽  
Imaging Modalities ◽  
Cardiac Resynchronization ◽  
Cardiac Devices ◽  
Electrophysiological Procedures ◽  
Implantable Cardiac Devices ◽  
Sudden Death Prevention

Electrophysiology is one of the most rapidly growing area of cardiology. Currently >50,000 catheter ablations are performed in Europe every year and >200,000 patients receive a device for arrhythmia treatment, sudden death prevention, or cardiac resynchronization. The advantages and limitations of fluoroscopy are well known. The rapid development of implantable cardiac devices therapies and ablation procedures all depend on accurate and reliable imaging modalities for preprocedural assessments, intraprocedural guidance, detection of complications, and post-procedural assessment for the longitudinal follow-up of patients. Therefore, over the last decades, imaging become an integral part of electrophysiological procedures.

scholarly journals Normality Index of Ventricular Contraction Based on a Statistical Model from FADS

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Luis Jiménez-Ángeles ◽  
Raquel Valdés-Cristerna ◽  
Enrique Vallejo ◽  
David Bialostozky ◽  
Verónica Medina-Bañuelos
Keyword(s):  
Radionuclide Angiography ◽  
Normal Subjects ◽  
Cardiac Resynchronization ◽  
Control Group ◽  
Clinical Environment ◽  
Ventricular Contraction ◽  
Clinical Criteria ◽  
Dynamic Structures ◽  
Dynamic Series

Radionuclide-based imaging is an alternative to evaluate ventricular function and synchrony and may be used as a tool for the identification of patients that could benefit from cardiac resynchronization therapy (CRT). In a previous work, we used Factor Analysis of Dynamic Structures (FADS) to analyze the contribution and spatial distribution of the 3 most significant factors (3-MSF) present in a dynamic series of equilibrium radionuclide angiography images. In this work, a probability density function model of the 3-MSF extracted from FADS for a control group is presented; also an index, based on the likelihood between the control group's contraction model and a sample of normal subjects is proposed. This normality index was compared with those computed for two cardiopathic populations, satisfying the clinical criteria to be considered as candidates for a CRT. The proposed normality index provides a measure, consistent with the phase analysis currently used in clinical environment, sensitive enough to show contraction differences between normal and abnormal groups, which suggests that it can be related to the degree of severity in the ventricular contraction dyssynchrony, and therefore shows promise as a follow-up procedure for patients under CRT.

scholarly journals ICD implantation and device therapy: Fabry vs hypertrophic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Vijapurapu ◽  
A Zegard ◽  
F Leyva ◽  
W Bradlow ◽  
A Jovanovic ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Primary Prevention ◽  
Shock Therapy ◽  
Left Ventricular ◽  
Device Therapy ◽  
Icd Implantation ◽  
Device Implantation ◽  
Cardiac Devices ◽  
Lv Mass

Abstract Background Cardiac involvement of Fabry disease (FD) includes left ventricular hypertrophy (LVH), inflammation, arrhythmia and sudden death. There are limited data regarding potential risk predictors and no definitive criteria exist to guide implantation of cardiac devices for primary prevention. Despite phenotypic similarities between FD and hypertrophic cardiomyopathy (HCM), FD is specifically excluded from the ESC sudden cardiac death risk prediction tool used for HCM. Purpose To evaluate differences in device implantation and arrhythmic burden between advanced Fabry cardiomyopathy and HCM. Methods This multi-centre, retrospective study including genetically confirmed FD and age/gender-matched HCM patients all of whom had an implantable cardioverter defibrillator (ICD). Data was collected prior to device implantation on disease characteristics, biomarkers and CMR imaging. Arrhythmia burden and changes in therapy were captured following implantation. Results Of the UK FD population under follow-up, 50/880 had an ICD implanted (80% males, 51% non-classical mutation, mean age at device implantation 57±12 years). A comparator group included 64 age- and gender-matched HCM patients (67% males, mean age at implant 46±39 years). Baseline LV mass was greater in FD (291±97g/m2 vs 218±78g/m2, p=0.012). FD patients had higher troponin (95 vs 19ng/l, p&lt;0.001) but similar NT-pro-BNP (1687 vs 888ng/l, p=0.086) levels. Indications for ICD insertion in FD included: presumed HCM dual pathology 14%, symptomatic NSVT 18%, asymptomatic NSVT 24%, co-existing long QT 2%, CRT-D 14%, no clear indication (primary prevention in the presence of multiple potential arrhythmic risk factors) 28%. All HCM patients were risk stratified and underwent device implantation based on an estimated 5-year SCD risk &gt;4%. All FD patients had a SCD risk &gt;4% using this risk calculator. Arrhythmia were more common in FD over shorter follow-up (37/50, 74% over 4.3±3.0 years vs 28/64 in HCM, 44% over 6.5±2.9 years, p=0.001). Notably, VT requiring anti-tachycardia pacing (ATP) +/− defibrillation therapy from the ICD was more frequent (FD: 14/50, 28% vs HCM: 8/64, 12%, p=0.055), as was immediate shock therapy for sustained VT (p=0.009, figure panel B). FD patients with arrhythmia were often older, had greater LV mass, a larger left atrium and a broader QRS duration. These clinical features tended to occur more frequently in FD than in the HCM group. Conclusion This study has shown that delivery of device therapy in Fabry cardiomyopathy is higher than in HCM. Despite similar rates of asymptomatic NSVT, a higher rate of ventricular arrhythmia requiring ATP/defibrillation therapy occurred in FD. Although both FD and HCM had similar risk percentages according to the ESC calculator, active troponitis in FD was double that of HCM. Funding Acknowledgement Type of funding source: None

P988Implantable cardioverter defibrillators in patients with electrical heart disease and hypertrophic cardiomyopathy - data from the German device Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Frommeyer ◽  
F Reinke ◽  
D Andresen ◽  
T Klemann ◽  
S G Spitzer ◽  
...  
Keyword(s):  
Heart Disease ◽  
Hypertrophic Cardiomyopathy ◽  
Secondary Prevention ◽  
Real Life ◽  
Control Group ◽  
Icd Implantation ◽  
Large Patient ◽  
Electrical Heart Disease ◽  
One Year

Abstract Background Implantable cardioverter- defibrillator (ICD) therapy is established for prevention of sudden cardiac death (SCD) in different entities. However, data from large patient cohorts on patients with electrical heart disease of hypertrophic cardiomyopathy (HCM) is rare. Therefore, we investigated these patients by analysing registry data from a multi-center “real-life” registry. Methods The German Device Registry (DEVICE) is a nationwide, prospective registry with one-year follow-up investigating 5450 patients receiving device implantations in 50 German centres. The present analysis of DEVICE focussed on patients with electrical heart disease or HCM who received an ICD for primary or secondary prevention. Results 174 patients with HCM and 112 patients with electrical heart disease were compared with 5164 other ICD patients. Median follow-up was 17.0 months. Patients in the control group were significantly older. Of note, overall mortality after one year was 1.8% in HCM patients, 6.6% in patients with electrical heart disease and 7.3% in the control group. Patients in the control group presented significantly more severe comorbidities. In contrast to HCM patients and the control group where primary prevention was the major indication for ICD implantation 77.5% of patients with electrical heart disease received an ICD for secondary prevention. The number of surgical revisions was higher in patients with electrical heart disease. Conclusion Data from the present registry display a surprisingly high mortality in patients with electrical heart disease equivalent to the control group. A high proportion of patients who received an ICD for secondary prevention may be regarded as a major determinant for these results while severe comorbidities such as diabetes, hypertension and renal failure are major determinants for mortality in the control cohort.

Abstract 11478: Excellent Clinical Courses of Autologous Skeletal Myoblast Sheet Transplantation Compared to a Propensity Score-Matched Cardiac Resynchronization Therapy (Best of Basic Science Abstract)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Teruhiko Imamura ◽  
Koichiro Kinugawa ◽  
Yasushi Sakata ◽  
Shigeru Miyagawa ◽  
Yoshiki Sawa ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cardiac Resynchronization Therapy ◽  
Nyha Class ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Reverse Remodeling ◽  
Control Group ◽  
Resynchronization Therapy ◽  
Skeletal Myoblast

Introduction: We recently reported a multi-center, single-arm, phase II study that evaluated the efficacy and safety of autologous skeletal myoblast sheet (TCD-51073) transplantation. The advantage of this procedure over a control group has not yet been analyzed. Hypothesis: TCD-51073 has better clinical outcome compared with background-matched control group. Methods: Seven patients with advanced heart failure due to ischemic etiology (TCD-51073 group, New York Heart Association [NYHA] class III; left ventricular ejection fraction (LVEF) <35%) refractory to optimal medical and coronary revascularization therapy, received TCD-51073 at 3 study centers between 2012 and 2013 with a 2-year follow-up period. As previously reported, 112 patients received cardiac resynchronization therapy (CRT) with follow-up at the University of Tokyo Hospital between 2007 and 2014. Results: Of them, 21 patients were selected for the control group by propensity score matching. No significant difference in baseline variables between the groups was observed. LVEF and NYHA class improved significantly in the TCD-51073 group during the 6-month study period (p<0.05). During the 2-year follow-up, 7 patients (33%) in the CRT group and no patient in the TCD-51073 group died due to cardiac disease or received VAD implantation (p=0.128 by the log-rank test). Conclusions: Transplantation of TCD-51073 is clinically advantageous in facilitating LV reverse remodeling, improving HF symptoms, and preventing cardiac death in patients with ischemic etiology when compared to background-matched patients receiving CRT.

P4772Role of anticoagulation in patients with subclinical AF and its association with cardiovascular events: a SILENT sub study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Martinelli Filho ◽  
S F Siqueira ◽  
G A T Athayde ◽  
K M Dias ◽  
A O Pinheiro ◽  
...  
Keyword(s):  
Previous History ◽  
Intervention Group ◽  
High Rate ◽  
Control Group ◽  
Thromboembolic Events ◽  
Short Term ◽  
Cardiac Devices ◽  
Increased Risk

Abstract Background Atrial fibrillation (AF) is a well-established thromboembolic event risk factor. Episodes of subclinical AF (SCAF) recorded in implantable electronic cardiac devices (IECD) have been related to clinical AF and increased risk of stroke. However, there is no scientific evidence regarding the role of anticoagulation in this population. Objective: Our objective is to assess the association of SCAF with clinical AF and rate of systemic thromboembolic events, in a short-term follow-up. Methods This is a sub-study of SILENT, a prospective, randomized, unicentric study which included patients with sinus rhythm, IECD, with CHA2DS2-VASc ≥2, without previous history of AF. Patients were randomized to the Intervention Group and to the Control Group in the 1: 1 ratio. Patients of the Intervention Group with SCAF episodes (>6 min) received anticoagulation, as well as those with clinical AF in both groups. The primary end point was systemic thromboembolic phenomena and the secondary endpoints were SCAF rate, total and cardiovascular mortality, cardiovascular hospitalization and bleeding. Results A total of 758 patients were evaluated, with a mean age of 72.81 years (± 9.73), of which 461 (60.8%) were female. The mean follow-up was 19.59±4.24 months. Baseline characteristics were similar in both groups. Only 3 patients presented the primary outcome (two of them from Intervention Group). There were 16 deaths (2,1%) and 44 cardiovascular hospitalizations (5,8%), with no difference between groups. Atrial high rate episodes (AHRE) and clinical AF were more prevalent in Control Group, leading to an equal rate of anticoagulation between groups. Clinical AF was statistically associated to previous atrial high rate episodes of any duration (p=0.001) and correlated with SCAF (p<0.01 and R: 0,60) previously recorded in the device. Conclusion This sub study showed that, in a short term follow-up, SCAF has a good correlation with clinical AF occurrence with low rate of thromboembolic events. The Silent study will evaluate in an extended population the role of anticoagulation, in the long term. Acknowledgement/Funding None

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