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Clinical Application of Cardiac Pacemakers and Implantable Cardioverter Defibrillators

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (20 November 2023) | Viewed by 9150

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Special Issue Editor

Dr. Christian Grebmer

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Guest Editor

Department of Cardiology, Kantonsspital Lucerne, Heart Center Lucerne, Spitalstrasse 16, 6002 Lucerne, Switzerland
Interests: cardiac electrophysiology; cardiac resynchronisation therapy; left bundle area pacing; conduction system pacing; sudden cardiac death; lead extractions

Special Issue Information

Dear Colleagues,

What pulsed field ablation is to the treatment of atrial fibrillation is what conduction system pacing is to device therapy. Physiological pacing represents the way to a promising future in cardiac device therapy and will hopefully serve as the basis for numerous large-scale prospective and randomised studies in the next few years. In addition, thanks to the progress in leadless pacing, we now have the opportunity to expand the range of indications—here, too, we are looking forward to the first long-term results for the leadless dual-chamber pacemaker and procedure-related outcomes. In addition to the implantation of cardiac devices and leads, the number of lead extractions is also increasing along with the number of patients, the age of these patients, and the number of associated complication risks. These interventions, which still represent interventions with an increased complication risk for patients, have become much more relevant and are bound to centres due to their complexity and the need for expertise. Different extraction tools have steadily evolved over the last decade and significantly reduced the risk of mortality.

In summary, it can be said that in 2022, device therapy has increased in complexity though, of particular significance, also in the range of possible options for optimal patient care, and the outlook for the next 10 years is reason for excitement.

Dr. Christian Grebmer
Guest Editor

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Keywords

cardiac device therapy
cardiac resynchronisation therapy
sudden cardiac death
arrhythmia
electrophysiology
atrial fibrillation
ventricular tachycardia
heart failure
conduction system pacing

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Published Papers (5 papers)

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Research

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14 pages, 969 KiB

Open AccessArticle

Stepwise Approach for Transvenous Lead Extraction in a Large Single Centre Cohort

by Axel Kloppe, Julian Fischer, Assem Aweimer, Dominik Schöne, Ibrahim El-Battrawy, Christoph Hanefeld, Andreas Mügge and Fabian Schiedat

J. Clin. Med. 2023, 12(24), 7613; https://doi.org/10.3390/jcm12247613 - 11 Dec 2023

Viewed by 1209

Abstract

Background: Infection, lead dysfunction and system upgrades are all reasons that transvenous lead extraction is being performed more frequently. Many centres focus on a single method for lead extraction, which can lead to either lower success rates or higher rates of major complications. We report our experience with a systematic approach from a less invasive to a more invasive strategy without the use of laser sheaths. Methods: Consecutive extraction procedures performed over a period of seven years in our electrophysiology laboratory were included. We performed a stepwise approach with careful traction, lead locking stylets (LLD), mechanical non-powered dilator sheaths, mechanical powered sheaths and, if needed, femoral snares. Results: In 463 patients (age 69.9 ± 12.3, 31.3% female) a total of 780 leads (244 ICD leads) with a mean lead dwelling time of 5.4 ± 4.9 years were identified for extraction. Success rates for simple traction, LLD, mechanical non-powered sheaths and mechanical powered sheaths were 31.5%, 42.7%, 84.1% and 92.6%, respectively. A snare was used for 40 cases (as the primary approach for 38 as the lead structure was not intact and stepwise approach was not feasible) and was successful for 36 leads (90.0% success rate). Total success rate was 93.1%, clinical success rate was 94.1%. Rate for procedural failure was 1.1%. Success for less invasive steps and overall success for extraction was associated with shorter lead dwelling time (p < 0.001). Major procedure associated complications occurred in two patients (0.4%), including one death (0.2%). A total of 36 minor procedure-associated complications occurred in 30 patients (6.5%). Pocket hematoma correlated significantly with uninterrupted dual antiplatelet therapy (p = 0.001). Pericardial effusion without need for intervention was associated with long lead dwelling time (p = 0.01) and uninterrupted acetylsalicylic acid (p < 0.05). Conclusion: A stepwise approach with a progressive invasive strategy is effective and safe for transvenous lead extraction. Full article

(This article belongs to the Special Issue Clinical Application of Cardiac Pacemakers and Implantable Cardioverter Defibrillators)

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12 pages, 869 KiB

Open AccessArticle

Cardiologist-Directed Sedation Management in Patients Undergoing Transvenous Lead Extraction: A Single-Centre Retrospective Analysis

by Matthias Bock, Matthew O’Connor, Amir Chouchane, Philip Schmidt, Claudia Schaarschmidt, Katharina Knoll, Fabian Bahlke, Florian Englert, Theresa Storz, Marc Kottmaier, Teresa Trenkwalder, Tilko Reents, Felix Bourier, Marta Telishevska, Sarah Lengauer, Gabriele Hessling, Isabel Deisenhofer, Christof Kolb and Carsten Lennerz

J. Clin. Med. 2023, 12(15), 4900; https://doi.org/10.3390/jcm12154900 - 26 Jul 2023

Cited by 1 | Viewed by 1439

Abstract

Background: The demand for transvenous lead extraction (TLE) has increased. In line with this, the safety of such procedures has also increased. Traditionally, TLE is performed under resource-intensive general anaesthesia. This study aims to evaluate the safety and outcomes of Cardiologist-lead deep sedation for TLE. Methods: We retrospectively analysed 328 TLE procedures performed under deep sedation from 2016 to 2019. TLE procedures were performed by experienced electrophysiologists. Sedation was administered by a specifically trained cardiologist (bolus midazolam/fentanyl and propofol infusion). Procedural sedation data including blood pressure, medication administration and sedation time were collected. Complications related to sedation and the operative component of the procedure were analysed retrospectively. Results: The sedation-associated complication rate during TLE was 22.0%. The most common complication (75% of complications) was hypotension requiring noradrenaline, followed by bradycardia requiring atropine (13% of complications). Additionally, the unplanned presence of an anaesthesiologist was needed in one case (0.3%). Deep sedation was achieved with midazolam (mean dose 42.9 ± 26.5 µg/kg), fentanyl (mean dose 0.4 ± 0.6 µg/kg) and propofol (mean dose 3.5 ± 1.2 mg/kg/h). There was no difference in medication dosage between those with a sedation-associated complication and those without. Sedation-associated complications appeared significantly more in patients with reduced LVEF (p = 0.01), renal impairment (p = 0.01) and a higher American Society of Anaesthesiologists (ASA) class (p = 0.01). Conclusion: Deep sedation for TLE can be safely performed by a specifically trained cardiologist, with a transition to general anaesthesia required in only 0.3% of cases. We continue to recommend the on-call availability of an anaesthesiologist and cardiac surgeon in case of major complications. Full article

(This article belongs to the Special Issue Clinical Application of Cardiac Pacemakers and Implantable Cardioverter Defibrillators)

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12 pages, 641 KiB

Open AccessArticle

Incidence and Predictors of Ventricular Arrhythmias in Transthyretin Amyloid Cardiomyopathy

by Katharina Knoll, Patrick Fuchs, Isabel Weidmann, Fatih Altunkas, Stephanie Voss, Carsten Lennerz, Christof Kolb, Thorsten Kessler, Heribert Schunkert, Wibke Reinhard, Stefan Groß and Teresa Trenkwalder

J. Clin. Med. 2023, 12(14), 4624; https://doi.org/10.3390/jcm12144624 - 11 Jul 2023

Cited by 4 | Viewed by 1795

Abstract

Background: Wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM) is characterized by heart failure, conduction abnormalities and arrhythmias. The incidence of ventricular arrhythmias, particularly ventricular tachycardias (VTs), in wtATTR-CM is unclear. With the development of targeted therapies and improved overall prognosis, there is an unmet need to identify patients at high risk for VTs who might benefit from ICD therapy. Methods: Between 2017 and 2022, 72 patients diagnosed with wtATTR-CM were prospectively evaluated for the presence of ventricular arrhythmias using a Holter ECG. VTs were defined as >3 consecutive beats with a heart rate > 100 beats per minute originating from a ventricle. Results: The incidence of VTs was 44% (n = 32/72) in unselected wtATTR-CM patients. Patients with VT showed significantly more severe left ventricular (LV) hypertrophy (septum diameter 21 ± 2.6 vs. 19 ± 3.0 mm, p = 0.006), reduced LV ejection fraction (47 ± 8 vs. 52 ± 8%, p = 0.014) and larger left atria (32 ± 7 vs. 28 ± 6 mm², p = 0.020), but no differences in cardiac markers such as NTproBNP and troponin. In a multivariable model, LV hypertrophy (LV mass indexed, OR = 1.02 [1.00–1.03], p = 0.031), LV end-diastolic diameter (OR = 0.85 [0.74–0.98], p = 0.021) and LV end-systolic diameter (OR = 1.19 [1.03–1.349], p = 0.092) were predictive for VT occurrence with an area under the receiver operating characteristic of 0.76 [0.65–0.87]. Conclusions: The incidence of ventricular arrhythmia in wtATTR-CM is high and is associated with an advanced stage of left ventricular disease. Further studies are needed evaluating the role of VTs in predicting sudden cardiac death and the benefit of ICD therapy in wtATTR-CM. Full article

(This article belongs to the Special Issue Clinical Application of Cardiac Pacemakers and Implantable Cardioverter Defibrillators)

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13 pages, 997 KiB

Open AccessArticle

Safety and Efficacy of Excimer Laser Powered Lead Extractions in Obese Patients: A GALLERY Subgroup Analysis

by Niklas Schenker, Da-Un Chung, Heiko Burger, Lukas Kaiser, Brigitte Osswald, Volker Bärsch, Herbert Nägele, Michael Knaut, Hermann Reichenspurner, Nele Gessler, Stephan Willems, Christian Butter, Simon Pecha and Samer Hakmi

J. Clin. Med. 2023, 12(12), 4096; https://doi.org/10.3390/jcm12124096 - 16 Jun 2023

Cited by 1 | Viewed by 1558

Abstract

Background: The incidence of cardiac implantable electronic device (CIED)-related complications, as well as the prevalence of obesity, is rising worldwide. Transvenous laser lead extraction (LLE) has grown into a crucial therapeutic option for patients with CIED-related complications but the impact of obesity on LLE is not well understood. Methods and Results: All patients (n = 2524) from the GermAn Laser Lead Extraction RegistrY (GALLERY) were stratified into five groups according to their body mass index (BMI, <18.5; 18.5–24.9; 25–29.9; 30–34.9; ≥35 kg/m²). Patients with a BMI ≥ 35.0 kg/m² had the highest prevalence of arterial hypertension (84.2%, p < 0.001), chronic kidney disease (36.8%, p = 0.020) and diabetes mellitus (51.1%, p < 0.001). The rates for procedural minor (p = 0.684) and major complications (p = 0.498), as well as procedural success (p = 0.437), procedure-related (p = 0.533) and all-cause mortality (p = 0.333) were not different between groups. In obese patients (BMI ≥ 30 kg/m²), lead age ≥10 years was identified as a predictor of procedural failure (OR: 2.99; 95% CI: 1.06–8.45; p = 0.038). Lead age ≥10 years (OR: 3.25; 95% CI: 1,31–8.10; p = 0.011) and abandoned leads (OR: 3.08; 95% CI: 1.03–9.22; p = 0.044) were predictors of procedural complications, while patient age ≥75 years seemed protective (OR: 0.27; 95% CI: 0.08–0.93; p = 0.039). Systemic infection was the only predictor for all-cause mortality (OR: 17.68; 95% CI: 4.03–77.49; p < 0.001). Conclusions: LLE in obese patients is as safe and effective as in other weight classes, if performed in experienced high-volume centers. Systemic infection remains the main cause of in-hospital mortality in obese patients. Full article

(This article belongs to the Special Issue Clinical Application of Cardiac Pacemakers and Implantable Cardioverter Defibrillators)

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Review

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18 pages, 340 KiB

Open AccessReview

Do Implantable Cardioverter-Defibrillators Prevent Sudden Cardiac Death in End-Stage Renal Disease Patients on Dialysis?

by Beata Franczyk, Jacek Rysz, Robert Olszewski and Anna Gluba-Sagr

J. Clin. Med. 2024, 13(4), 1176; https://doi.org/10.3390/jcm13041176 - 19 Feb 2024

Cited by 4 | Viewed by 2537

Abstract

Chronic kidney disease patients appear to be predisposed to heart rhythm disorders, including atrial fibrillation/atrial flutter, ventricular arrhythmias, and supraventricular tachycardias, which increase the risk of sudden cardiac death. The pathophysiological factors underlying arrhythmia and sudden cardiac death in patients with end-stage renal disease are unique and include timing and frequency of dialysis and dialysate composition, vulnerable myocardium, and acute proarrhythmic factors triggering asystole. The high incidence of sudden cardiac deaths suggests that this population could benefit from implantable cardioverter-defibrillator therapy. The introduction of implantable cardioverter-defibrillators significantly decreased the rate of all-cause mortality; however, the benefits of this therapy among patients with chronic kidney disease remain controversial since the studies provide conflicting results. Electrolyte imbalances in haemodialysis patients may result in ineffective shock therapy or the appearance of non-shockable underlying arrhythmic sudden cardiac death. Moreover, the implantation of such devices is associated with a risk of infections and central venous stenosis. Therefore, in the population of patients with heart failure and severe renal impairment, periprocedural risk and life expectancy must be considered when deciding on potential device implantation. Harmonised management of rhythm disorders and renal disease can potentially minimise risks and improve patients’ outcomes and prognosis. Full article

(This article belongs to the Special Issue Clinical Application of Cardiac Pacemakers and Implantable Cardioverter Defibrillators)

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