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Yang, Ying chi, Thein Tun Aung e Abdul Wase. "Inappropriate Defibrillator Shocks due to Mechanical Inference from an Investigational Device". Case Reports in Cardiology 2019 (6 gennaio 2019): 1–3. http://dx.doi.org/10.1155/2019/2810396.
Testo completoAbstract (sommario):
Cardiac contractility modulation (CCM) is an investigational device-based therapy to enhance ventricular contractility in systolic heart failure patients who are not candidates for cardiac resynchronization therapy (CRT) owing to the absence of wide QRS complexes or who have failed to respond on CRT. The principal mechanism is based on the stimulation of cardiac muscles by nonexcitatory electrical signals to augment the influx of calcium ions into the cardiomyocytes. The majority of patients receiving CCM therapy have concurrent implantable cardioverter defibrillators, and the manufacturer declares both devices can be used in parallel without any interactions. Nevertheless, proper lead positioning of both devices are crucial, and it is mandatory to check device-device interactions during each and every cardiac electronic implantable device-related procedure to prevent adverse outcomes.
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Eduardo Duarte, Carlos, e André Brambilla Sbaraini. "Rational Use of Leads in Artificial Cardiac Pacing". Journal of Cardiac Arrhythmias 32, n. 4 (16 aprile 2020): 262–74. http://dx.doi.org/10.24207/jca.v32n4.979_in.
Testo completoAbstract (sommario):
Introduction: Cardiovascular implantable electronic device (CIEDs) are a proven therapy for the treatment of bradyarrhythmias, prevention of sudden death or heart failure. Since the first transvenous pacemaker implantation more than 60 years ago, technological advances in devices and improvements in surgical techniques have occurred. However, this type of therapy is still associated with significant complications, most of them related to the implantation of transvenous leads. Objective: To present a reflection on how to practice the rational use of lead implantation and propose strategies and alternatives to delay or avoid it, based on the current knowledge in the various fields of artificial cardiac stimulation. Methods: Review of literature that used articles from 1995 to 2019, from several platforms and periodicals. Conclusion: There is an expectation that in the coming years there will be technological and knowledge advances in the field of leadless stimulation, allowing these devices to be incorporated into clinical practice in a routine manner. Currently, if the implantation of ventricular electrodes in cases of sinus node disease with preserved atrioventricular conduction is rationalized, the implantation of atrial electrodes in implantable cardioverter-defibrillators (ICD) without the necessity of antibradicardia stimulation or ventricular electrodes in cases without the necessity of antitachycardia stimulation (ATP) considering the subcutaneous ICD implantation, this article will have fulfilled its role.
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Rosenow, Joshua M., Howard Tarkin, Elias Zias, Carmine Sorbera e Alon Mogilner. "Simultaneous use of bilateral subthalamic nucleus stimulators and an implantable cardiac defibrillator". Journal of Neurosurgery 99, n. 1 (luglio 2003): 167–69. http://dx.doi.org/10.3171/jns.2003.99.1.0167.
Testo completoAbstract (sommario):
✓ Bilateral electrical stimulation of the subthalamic nucleus is being used with increasing frequency as a treatment for severe Parkinson disease (PD). Implantable cardiac defibrillators improve survival in certain high-risk patients with coronary artery disease and ventricular arrhythmias. Because of concern about possible interaction between these devices, deep brain stimulation (DBS) systems are routinely disconnected before defibrillators are implanted in patients with PD and arrhythmia. The authors report on a patient with bilateral subthalamic stimulators who underwent successful placement of an implantable defibrillator. Testing of the devices over a wide range of settings revealed no interaction. The patient subsequently underwent multiple episodes of cardioversion when the ventricular lead became dislodged. There was no evidence of adverse neurological effects, and interrogation of the DBS devices after cardioversion revealed no changes in stimulus parameters. The outcome in this case indicates that DBS systems may be safely retained in selected patients who require implantable cardiac defibrillators.
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Świerżyńska, Ewa, e Maciej Sterliński. "Decreases in biventricular pacing percentage in remote monitoring of patients with cardiac implantable electronic devices". In a good rythm 1, n. 62 (31 maggio 2022): 17–20. http://dx.doi.org/10.5604/01.3001.0015.9157.
Testo completoAbstract (sommario):
Heart failure is a serious disease and is one of the top causes of death in Poland. A proven method of treatment in some heart failure patients is resynchronization therapy using implantable devices such as cardioverter-defibrillators (CRT-D) or pacemakers (CRT-P). One of the conditions for the effectiveness of this therapy is achieving and maintaining a high biventricular pacing percentage. Remote monitoring of cardiac implantable electronic devices allows daily access to information about a device’s operating status. In patients with heart failure, access and treatment options based on remote monitoring data reduces hospitalization, mortality and treatment costs. This article discusses how information received via remote monitoring about the loss of resynchronization stimulation can be used to determine possible abnormalities and the need for treatment.
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Mabo, P., e G. Carrault. "Are Electronic Cardiac Devices Still Evolving?" Yearbook of Medical Informatics 23, n. 01 (agosto 2014): 128–34. http://dx.doi.org/10.15265/iy-2014-0021.
Testo completoAbstract (sommario):
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.
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Keqi, Su. "Implantable Triboelectric Nanogenerators in the Biomedical Field". Journal of Material Sciences & Manufacturing Research 5, n. 7 (31 luglio 2024): 1–9. http://dx.doi.org/10.47363/jmsmr/2024(5)183.
Testo completoAbstract (sommario):
Implantable Triboelectric Nanogenerators (TENGs) have revolutionized the biomedical field by providing innovative power solutions for medical devices and enhancing diagnostic and therapeutic applications. Internally implanted TENG transforms kinetic energy from the body into electrical power, providing a constant energy supply for Implantable Medical Devices (IMD). Their ability to generate high voltage and low current makes them particularly effective for applications in biosensing, patient monitoring, and therapeutic interventions. Therapeutically, TENGs power cardiac pacemakers, promote wound healing, enhance bone regeneration, and support muscle and nerve stimulation. They also enable controlled drug release, particularly in targeted cancer treatments.
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Cronin, Edmond M., Jennifer Gray, Bernard Abi-Saleh, Bruce L. Wilkoff e Kerry H. Levin. "Safety of repetitive nerve stimulation in patients with cardiac implantable electronic devices". Muscle & Nerve 47, n. 6 (21 aprile 2013): 840–44. http://dx.doi.org/10.1002/mus.23707.
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Grydz, Łukasz. "Infection risk factor for cardiac implantable devices". In a good rythm 3, n. 56 (21 ottobre 2020): 30–34. http://dx.doi.org/10.5604/01.3001.0014.4644.
Testo completoAbstract (sommario):
Each year, 1.2-1.4 million devices such as pacemakers, cardioverter-defibrillators and devices with the resynchronization function are implanted, and for some time also electrodes for stimulating the His bundle or the left bundle branch. One of the most serious complications of electrotherapy is infections of implantable systems (CIED infection). Knowing the risk factors give the option to choose other therapies and reduce the risk of infection. Important patient-related factors include: diabetes, heart and/or kidney failure or dysfunction, COPD, the presence of neoplastic disease and use of anticoagulation in the short term before the procedure. According to the research, the number of treatments performed in the implanting centre and by the operator, as well as the number of electrodes, the method of preparing the operating field, or the method of inserting the electrodes, also seems to be important in the development of CIED infection. It is better to prevent the infection than to cure it, as possible complications can be deadly for the patient and costly for the health system.
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Meyer zu Vilsendorf, Dorothee, Bert Hansky, Philipp Baumann e Christoph Stellbrink. "Troubleshooting bei Patienten mit Herzschrittmacher und ICD". DMW - Deutsche Medizinische Wochenschrift 143, n. 22 (30 ottobre 2018): 1608–16. http://dx.doi.org/10.1055/a-0560-3180.
Testo completoAbstract (sommario):
AbstractBecause of the growing number of implanted cardiac pacemakers and defibrillators and the ever-increasing complexity of these devices a fundamental knowledge of device malfunctions is of utmost importance even for the non-cardiology physician. Apart from hardware problems such as device infection, lead fracture or dislocation, basic knowledge of the pacemaker sensing and pacing algorithms is also necessary in order to judge the stimulation behavior in different clinical settings. With this respect, there are specific problems for antibradycardia and resynchronizing pacemakers as well as implantable defibrillators. This article gives an overview of the most common problems with cardiac pacemakers and defibrillators as well as the differential diagnostic and therapeutic management for the physician without specific training in arrhythmology.
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Gutiérrez-Martínez, Josefina, Cinthya Toledo-Peral, Jorge Mercado-Gutiérrez, Arturo Vera-Hernández e Lorenzo Leija-Salas. "Neuroprosthesis Devices Based on Micro- and Nanosensors: A Systematic Review". Journal of Sensors 2020 (7 ottobre 2020): 1–19. http://dx.doi.org/10.1155/2020/8865889.
Testo completoAbstract (sommario):
Background. A neuroprosthesis (NP) is a medical device that compensates and restores functionality of neural dysfunctions affected by different pathologies and conditions. To this end, an implantable NP (INP) must monitor and electrically stimulate neuronal small structures in the peripheral and central nervous system. Therefore, one of the most important parts of INPs are the sensors and electrodes since their size, resolution, and material are key for their design and performance. Currently, most of the studies focus only on the INP application but do not show the technical considerations of the sensors. Objective. This paper is a systematic literature review that summarizes and synthesizes implantable micro- and nanosensors/electrodes used in INPs for sensing and stimulating tissues. Data Sources. Articles and patents published in English were searched from electronic databases. No restrictions were made in terms of country or journal. Study Selection. All reports related to sensors/electrodes applied in INPs were included, focusing on micro- and nanotechnologies. Main Outcome Measures. Performance and potential profit. Results. There was a total of 153 selected articles from the 2010 to June 2020 period, of which 16 were about cardiac pacemakers, 15 cochlear implants, 13 retinal prosthesis, 31 deep brain stimulation, 6 bladder implants, and 18 implantable motor NPs. All those INPs are used for support or recovery of neural functions for hearing, seeing, pacing, and motor control, as well as bladder and bowel control. Micro- and nanosensors for signal stimulation and recording have four special requirements to meet: biocompatibility, long-term reliability, high selectivity, and low-energy consumption. Current and future considerations in sensor/electrode design should focus on improving efficiency and safety. This review is a first approximation for those who work on INP design; it offers an idea of the complexity on the matter and can guide them to specific references on the subject.
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Correa Soares, Braulio, e Norberto Blanco. "Systemic Review of CIED extractions in the Argentinean Population". SCT Proceedings in Interdisciplinary Insights and Innovations 1 (18 novembre 2023): 160. http://dx.doi.org/10.56294/piii2023160.
Testo completoAbstract (sommario):
Background: Implantable cardiac stimulation devices (CIEDs) are commonly used to treat cardiac rhythm disorders. However, certain circumstances may require the removal of these devices. The aim of this study is to investigate the outcomes and challenges related to CIED removal. Material and methods: A systematic review and retrospective analysis were conducted on a group of patients who underwent device removal at El Cruce Hospital. Demographic data, information about the type of device, reasons for removal, and complications were collected. Results: A total of 41 patients (average age: 50 years; 63% male) who underwent CIED removal were included in the study. The main reasons for extraction were endocarditis, generator pocket erosion, generator pocket infection, and lead failures (cables, catheter, electrode, and sensing). Complications, including technical failures, were recorded in 17% of cases. Short-term clinical outcomes were evaluated based on age, gender, device type, and reason for removal. Conclusion: In this patient community, short-term removal of cardiac devices is an effective and safe procedure with few complications. This study, based on data from a group of individuals who received treatment, while not conclusive, these findings contribute to improving the understanding of clinical practice and enhancing the quality of care received by patients in this context
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Fadoum, Hassan, Ibrahim Idriss Deka, Chikhi Lalla Fatima, Fellat Ibtissam e Cherti Mohamed. "STRANGE DUAL CHAMBER STIMULATION". International Journal of Advanced Research 10, n. 02 (28 febbraio 2022): 646–51. http://dx.doi.org/10.21474/ijar01/14249.
Testo completoAbstract (sommario):
Implantable cardiac devices (pacemaker, ICD, resynchronisation) are increasingly indicated in recent years. Complications secondary to these implants are encountered more frequently.We report the case of a 60 year old patient with a double chamber pacing device, implanted 6 months before her consultation date for a complete AVB.She was referred by her attending physician for exertional dyspnea and lipothymic discomfort following the implantation of the device.Clinical examination revealed no abnormalities. The ECG showed a spontaneous sinus rhythm at 60cpm.The interrogation of the device showed a DDDR pacing mode with the most frequent pacing mode in ASVS found at 80%.The EGMs listed were not consistent with the programmed dual chamber mode. The atrial endocavitary signals are labelled VS and the ventricular ones AP. The change of mode to VVI which should generate a ventricular drive showed us a spontaneous atrial signal coded VS. The AAI mode produces ventricular pacing with AP coded ventriculograms.A reversal of the lead connection at the box level was evoked.The patient has undergone a correct reconnection of the leads to the box with a rhythm at the end of the procedure in DDD.Follow-up telemetry 1 month after reconnection showed atrial and ventricular EGM signals appropriate to the paced and detected chamber.
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Sanchis-López, Nerea. "Medical Device Related Pressure Injury in the Treatment of Chronic Pain: An Early Sign of Explantation in Suspected Infection". January 2018 1, n. 21;1 (15 maggio 2018): E235—E246. http://dx.doi.org/10.36076/ppj.2018.3.e235.
Testo completoAbstract (sommario):
Background Chronic back pain is a prevalent disease and has a high impact in daily life. Implantable devices (IDs) for chronic pain management include spinal cord stimulation (SCS) systems and intrathecal drug delivery (ITDD) pumps. The number of ITDD implants have increased exponentially in the last decade. The number of complications, such as infections, are also more prevalent. Infection management guidelines are needed to standarize our clinical practice and define protocols of explantation. Objectives: The primary outcome is to define the likelihood of device explantation regarding some covariates related to the patient, antibiotic therapy or surgerical procedures. The secondary outcome is to evaluate performance compared to the results published in the literature. Study Design: Retrospective study. Setting: Hospital General of Valencia. Valencia. Spain. Methods: A retrospective study of 288 implantable device surgeries was conducted at the Hospital General Universitary of Valencia (Spain) from 1994 to 2015. Demographical and infection data were collected. We have followed the “guidelines for the diagnosis, prevention and management of implantable electronic cardiac device infection” due to the lack of a specific guideline in our field. Results: Forty-three out of 288 procedures were identified as suspected device-infected interventions. Half of the patients had microbiologically confirmed infection after wound, blood or lumbar fluid culture. The odds ratio (OR) for explantation of the device was 19 for the presence of decubitus, a sign of medical device related pressure injury (P < 0.0005) and 5 for positive wound culture (P < 0.0452). Medical indication leading to device implantation and the antibiotics on discharge also played a role in the decision of device explantation. Limitations: Lack of external validity and others. Conclusion: In this study, presence of decubitus is the defining variable for device explantation when a infection is suspected rather than waiting to culture results. Due to a high variability in infection rates, multidisciplinary guidelines are needed to provide an approach that focuses on accurate data monitoring, rigurous implantation technique and standardized protocols. Key Words: Chronic pain, spinal cord stimulation infection, neurostimulator, intrathecal drug delivery pump, complication, infection, explantation
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Tabatabai, Grace M., Peter Karempelis e Jennifer C. Hsia. "Hypoglossal nerve stimulator generator migration: INSPIRE device reimplantation with parallels to cardiac implantable electronic devices". American Journal of Otolaryngology 39, n. 5 (settembre 2018): 639–41. http://dx.doi.org/10.1016/j.amjoto.2018.06.011.
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Morava, Jan, Aneta Lhotová e Aleš Richter. "INFLUENCE OF PACEMAKER TIMING ON DETECTION OF ATRIAL TACHYCARDIAS AND SIGNALS OF DIFFERENT FREQUENCIES". Lékař a technika - Clinician and Technology 51, n. 1-4 (31 dicembre 2021): 49–52. http://dx.doi.org/10.14311/ctj.2021.1.07.
Testo completoAbstract (sommario):
The pacemaker (PCM) timing is a basic feature of the stimulation system. The device tries to bring the function of the heart with the conduction system disorder as close as possible to its original physiologically correct state. The main function of the PCM is a bradyarrhythmia therapy. Current devices are programmable and can adequately respond to any fluctuations in a heart rate from required values. Common parts of these devices are algorithms for the atrial tachycardias detection such as atrial fibrillation. The interpretation of a fast heart rate is affected by the pacemaker timing and different refractory intervals, especially in the case of tachycardias of lower frequencies. In this paper we discuss the effect of different atrial event frequencies to the adequate PCM response according to the timing behavior of the device. We prove our hypotheses by an experimental verification on the phantom of the pacemaker system by the in vitro method. The obtained results are compared with the case report from clinical practice. We set limit intervals for the detection of atrial tachycardias and verify the rate of the activation of the PCM program response for different frequencies. Finally, we discuss the behavior of cardiac implantable electronic devices (CIEDs) during the detection of signals of higher frequencies.
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Tagliari, Ana Paula, Adriano Nunes Kochi, Bernardo Mastella, Rodrigo Petersen Saadi, Andres di Leoni Ferrari, Luiz Henrique Dussin, Leandro de Moura, Márcio Rodrigo Martins, Eduardo Keller Saadi e Carisi Anne Polanczyk. "Ultrasound-guided Axillary Vein Puncture in Cardiac Lead Implantation: Time to Move to a New Standard Access?" Arrhythmia & Electrophysiology Review 9, n. 2 (13 agosto 2020): 78–82. http://dx.doi.org/10.15420/aer.2020.17.
Testo completoAbstract (sommario):
Cardiac stimulation therapy has evolved significantly over the past 30 years. Currently, cardiac implantable electronic devices (CIED) are the mainstream therapy for many potentially lethal heart conditions, such as advanced atrioventricular block or sustained ventricular tachycardia or fibrillation. Despite sometimes being lifesaving, the implant is surgical and therefore carries all the inevitable intrinsic risks. In the process of technology evolution, one of the most important factors is to make it safer for the patient. In the context of CIED implants, complications include accidental puncture of intrathoracic structures. Alternative strategies to intrathoracic subclavian vein puncture include cephalic vein dissection or axillary vein puncture, which can be guided by fluoroscopy, venography or, more recently, ultrasound. In this article, the authors analyse the state of the art of ultrasound-guided axillary vein puncture using evidence from landmark studies in this field.
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Ziacchi, Matteo, Angelo Placci, Andrea Angeletti, Fabio Quartieri, Cristina Balla, Santo Virzi, Matteo Bertini, Roberto De Ponti, Mauro Biffi e Giuseppe Boriani. "Vascular Accesses in Cardiac Stimulation and Electrophysiology: An Italian Survey Promoted by AIAC (Italian Association of Arrhythmias and Cardiac Pacing)". Biology 11, n. 2 (8 febbraio 2022): 265. http://dx.doi.org/10.3390/biology11020265.
Testo completoAbstract (sommario):
Cardiac implantable electronic device (CIED) implants and electrophysiological procedures share a common step: vascular access. On behalf of the AIAC Ricerca Investigators’ Network, we conducted a survey to outline Italian common practice regarding vascular access in EP-lab. All Italian physicians with experience in CIED implantation and electrophysiology were invited to answer an online questionnaire (from May 2020 to November 2020) featuring 20 questions. In total, 103 cardiologists (from 92 Italian hospitals) answered the survey. Vascular access during CIED implants was considered the most complex step following lead placement by 54 (52.4%) respondents and the most complex for 35 (33.9%). In total, 54 (52.4%) and 49 (47.6%) respondents considered the cephalic and subclavian vein the first option, respectively (intrathoracic and extrathoracic subclavian/axillary vein by 22 and 27, respectively). In total, 45 (43.7%) respondents performed close arterial femoral accesses manually; only 12 (11.7%) respondents made extensive use of vascular closure devices. A total of 46 out of 103 respondents had experience in ultrasound-guided vascular accesses, but only 10 (22%) used it for more than 50% of the accesses. In total, 81 (78.6%) respondents wanted to increase their ultrasound-guided vascular access skills. Reducing complications is a goal to reach in cardiac stimulation and electrophysiological procedures. Our survey shows the heterogeneity of the vascular approaches used in Italian centres. Some vascular accesses were proved to be superior to others in terms of complications, with ultrasound-guided puncture as an emerging technique. More effort to produce the standardization of vascular accesses could be made by scientific societies.
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Chaiban, Gassan M. "Evaluation of Interaction between a Spinal Cord Stimulator and Implanted CardioverterDefibrillator in a Swine Model". Pain Physician 5;16, n. 5;9 (14 settembre 2013): 489–96. http://dx.doi.org/10.36076/ppj.2013/16/489.
Testo completoAbstract (sommario):
Background: Spinal cord stimulators (SCS) have been used for many years to treat a myriad of chronic pain conditions using electrical signals to diminish the perception of a painful stimulus. Because of the electrical nature of the devices, there is a concern about the potential for electromagnetic interaction between the device and lifesaving cardiac implantable cardiovertersdefibrillators (ICVD). Objective: The purpose of this study was to use a swine model to evaluate the potential for interaction between an implanted SCS and ICVD using the closest possible proximity, highest stimulation settings, and most sensitive ICVD settings. Methods: A pig was anesthetized and subsequently an ICVD and ICVD lead (Cogni 100-D and Endotak Reliance®, Boston Scientific, Natick, MA) were placed into the right prepectoral region and the right ventricle, respectively. An SCS (50 cm linear ST Precision Plu octad electrode lead [Boston Scientific, Valencia, CA] with 3 mm wide contacts spaced one mm apart) was implanted using fluoroscopic guidance into the posterior epidural space. Remote interrogation and programming of the ICVD were performed while the SCS lead was placed in as close proximity as possible, using fluoroscopy to guide the final position of the SCS electrode. After confirming that both systems were working, appropriately 9 stimulating configurations of varying current, pulse width, and frequency, including maximal settings, were delivered through the SCS. The effects on the ICVD were recorded at 2 sensitivity settings. Results: None of the tested SCS configurations caused interference with the proper functioning of the ICVD. Limitations: The anatomical proximity of the posterior epidural space and right ventricle of the swine is different from humans. While the entire pacer, including generator, was imbedded in a subcutaneous pocket, an implantable pulse generator for the SCS was not implanted, which did not allow us to study if any damage or a resetting of settings had occurred to the generator. Only one manufacturer was used in this study. Also, this study was performed in an anesthetized pig and the anatomical positions remained static. Realistically, changes in position of the devices would occur in patients who perform activities of daily living, and this can potentially shorten the distance between the 2 leads causing adverse interaction. Conclusion: This study clearly demonstrated the feasibility of the 2 devices coexisting and functioning appropriately in an animal model using an ICVD and SCS donated by Boston Scientific. Further studies are needed to elucidate restrictions, optimal settings and parameters in a human setting. Key words: Spinal cord stimulator, interaction, implantable cardioverter defibrillator, pacemaker, swine model, cross-talk.
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Hanafy, Dicky Armein. "Dealing with Sudden Cardiac Death: Who Deserves Device Implantation". ACI (Acta Cardiologia Indonesiana) 5, n. 1 (P) (18 luglio 2019): 12. http://dx.doi.org/10.22146/aci.47675.
Testo completoAbstract (sommario):
Sudden cardiac death is one of the leading causes of death in the western industrial nations. Most people are affected by coronary heart disease (coronary heart disease, CHD) or heart muscle (cardiomyopathy). These can lead to life-threatening cardiac arrhythmias. If the heartbeat is too slow due to impulse or conduction disturbances, cardiac pacemakers will be implanted. High-frequency and life-threatening arrhythmias of the ventricles (ventricular tachycardia, flutter or fibrillation) cannot be treated with a pacemaker. In such cases, an implantable cardioverter-defibrillator (ICD) is used, which additionally also provides all functions of a pacemaker. The implantation of a defibrillator is appropriate if a high risk of malignant arrhythmias has been established (primary prevention). If these life-threatening cardiac arrhythmias have occurred before and are not caused by a treatable (reversible) cause, ICD implantation will be used for secondary prevention. The device can stop these life-threatening cardiac arrhythmias by delivering a shock or rapid impulse delivery (antitachycardic pacing) to prevent sudden cardiac death. Another area of application for ICD therapy is advanced heart failure (heart failure), in which both main chambers and / or different wall sections of the left ventricle no longer work synchronously. This form of cardiac insufficiency can be treated by electrical stimulation (cardiac resynchronization therapy, CRT). Since the affected patients are also at increased risk for sudden cardiac death, combination devices are usually implanted, which combine heart failure treatment by resynchronization therapy and the prevention of sudden cardiac death by life-threatening arrhythmia of the heart chambers (CRT-D device). An ICD is implanted subcutaneously or under the pectoral muscle in the area of the left collarbone. Like pacemaker implantation, ICD implantation is a routine, low-complication procedure today.
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Park, Seung-Jung. "Device treatment of heart failure". Journal of the Korean Medical Association 65, n. 1 (10 gennaio 2022): 26–36. http://dx.doi.org/10.5124/jkma.2022.65.1.26.
Testo completoAbstract (sommario):
Background: The incidence of heart failure (HF) is rapidly increasing, introducing a significant burden and challenges in clinical practice. Non-pharmacological cardiac device therapy has been established as an essential component of optimal HF management, particularly for the prevention of sudden cardiac death and the improvement of HF symptoms, left ventricular (LV) systolic function, quality of life, and eventually survival.Current Concepts: Cardiac resynchronization therapy (CRT) can correct atrioventricular or inter/intraventricular dyssynchrony, thereby improving LV systolic function. Recently, the concept of CRT is being expanded, including His bundle (HB), HB-optimized LV, left bundle branch (LBB), and LBB optimized LV pacing CRTs. Newly introduced CRT approaches by stimulating the cardiac conduction system are expected to correct dyssynchrony better and consequently exhibit better CRT outcomes than the conventional biventricular pacing CRT. The current versions of implantable cardioverter-defibrillators (ICDs) or CRT devices can continuously monitor multiple biosignals. CRT/ICD can calculate a single index by combining these multiple bio-signal data for early detection of HF aggravation. Recently, subcutaneous and transvenous ICDs showed comparable safety and efficacy in HF patients. In drug-refractory HF patients without LV dyssynchrony, cardiac contractility modulation therapy provides some promising results.Discussion and Conclusion: Recent technological advancements have improved the efficacy and safety of cardiac device therapy. Therefore, cardiac device therapy should be used more actively to manage HF patients better.
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Cesarano, E., M. Casula, G. Tola, F. Perra, B. Schintu, A. Setzu e M. Corda. "INAPPROPRIATE S–ICD SHOCK RELATED TO ATRIO–VENTRICULAR BLOCK: WHEN THE TRUE CULPRIT IS NOT OVERT". European Heart Journal Supplements 26, Supplement_2 (aprile 2024): ii37. http://dx.doi.org/10.1093/eurheartjsupp/suae036.083.
Testo completoAbstract (sommario):
Abstract Subcutaneous implantable cardiac defibrillator (S–ICD) is a well–established alternative to transvenous defibrillator in patients with an indication for an ICD without the concomitant need of pacing. Despite the overall excellent performance of S–ICD, oversensing of cardiac and non–cardiac signals is still the main cause of inappropriate shocks (IS). We present a case of IS due to F–wave oversensing and QRS morphological variability related to compete atrio–ventricular (AV) block. A 77–year–old man was admitted to the Emergency Room reporting two episodes of defibrillator shock, identified by remote monitoring as IS due to F–wave oversensing during paroxysmal atrial flutter (Figure 1). His past medical history included paroxysmal atrial fibrillation and post–ischemic left ventricular (LV) dysfunction with left bundle branch block, treated in 2012 with cardiac resynchronization therapy and implantable defibrillator (CRT–D) with subsequent normalization of LV ejection fraction (EF). The LV stimulation was later deactivated due to phrenic capture unavoidable with device reprogramming; afterwards, the occurrence of aortic valve and lead endocarditis resulted in CRT–D system extraction. At that time, considering the persistence of normal LVEF even without LV stimulation, an S–ICD was then implanted in primary prevention. The ECG at the time of admission presented with a complete AV block (Figure 2A), not clearly evident at the remote monitoring report. Few hours later a new episode of atrial flutter occurred, reveling a variable QRS morphologies of ventricular rhythm (Figure 2B). A more careful analysis of device memory reveals a previous episode of AV block with variable QRS morphologies leading to SMART Pass filter disabling (Figure 3). A transvenous ICD with left bundle branch area stimulation was then successfully implanted and the patient was discharged at home after two days. To the best of our knowledge, this is the first described case of inappropriate S–ICD shock related to AV block. The unpredictable QRS morphology of an escape rhythm and the inability of S–ICD to store diagnostic data regarding bradyarrhythmia may limit our knowledge on the behavior of S–ICD in case of AV block. The occurrence of an IS should always prompt careful analysis of all available S–ECGs. Previous events of QRS morphology change and/or disabling of the SMART Pass filter should be regarded with suspicion, even if an AV bock is not overt evident.
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Nsimbi Lubenga, Yves, Christian Mabiza Kutoloka, Marc Balekelayi Tshilanda, Eric Piqueras, Noel Onembo Otshudi, Yannick Mundedi Samafundu, David Ipungu Gondele et al. "Implantation of pacemakers and defibrillators: feedback of the first Congolese experience of an analytic case series". Annales Africaines de Medecine 18, n. 1 (18 dicembre 2024): e5775-e5787. https://doi.org/10.4314/aamed.v18i1.4.
Testo completoAbstract (sommario):
Context and objective. Cardiac stimulation is a widespread and vital treatment worldwide for major conduction and excitability disorders. However, its practice in the Democratic Republic of Congo (DRC) is recent. The aim of this work was to present the first cases of cardiac pacing performed by a local team in the DRC. Methods. This multicenter analytical case series study described the implantation procedures and the characteristics of patients who benefited from pacemakers (PM) or implantable cardioverter defibrillators (ICD) in the Democratic Republic of Congo. Results. A total of 88 patients underwent the PM or ICD implantation procedures. Their average age was 69.5±9.3 years with 54.5% men. Dyspnea (47%) and syncope (28%) were their major complaints and 3rd degree atrioventricular block (AVB) (68.3%) their main reason for implantation. The cephalic approach was the most used (56.8%) and 74% of PMs were dual chamber. Acute complications (19.3% of cases) consisted of bleeding (6%), convulsions (5%) and probe repositioning (3%); post-operative (8%) with pacemaker syndrom (2%), lead displacement (1%) and infection requiring complete extraction of the material (1%). Chronic kidney disease (OR=1.3[95% CI: 0.87-9.04];p=0.16) and hypertension (2.45[1.13-8.9]; p=0.01) increased the risk of acute complications, while age ≥65 years (1.78[1.11-16.2];p=0.02), male gender (2.49 [1.74-46.1];p=0.001), the use of anticoagulants/antiplatelets (1.66 [1.16-18.6];p=0.028) and an LVEF≤35% (3.08[1. 10-36.03];p=0.024) those of subacute complications. Conclusion. The practice of cardiac stimulation in the DRC is effective. The cephalic approach is the most practiced; dual-chamber devices are the most used and complications are rarely encountered. Received: July 8th, 2024 Accepted: October 16th, 2024 https://dx.doi.org/10.4314/aamed.v18i1.4
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Adam, Cristina, Magda Mitu, Dana Mîndru, Ana-Karina Gîlcă, Radu Sebastian Gavril, Mihai Roca e Florin Mitu. "Particularities in Cardiovascular Recovery by Physical Training in a Patient with Prosthetic Valve, Permanent Electrical Cardiac Stimulation and Aortocoronary Bypass". Internal Medicine 16, n. 5 (1 ottobre 2019): 85–95. http://dx.doi.org/10.2478/inmed-2019-0088.
Testo completoAbstract (sommario):
AbstractIntroduction: Going through a complete cardiac rehabilitation is essential for all cardiac patients undergoing complex surgery, including those who wear intracardiac devices. Determining the effort capacity after the surgical intervention might provide satisfactory results with the improvement of the quality of life.Case presentation: We present the case of a male patient, 44 years old, known with aortic bicuspid valve, aortic mechanical valve evolved with prosthesis mismatch and aortocoronary bypass (right coronary artery), followed by total atrioventricular block which required cardiac pacemaker VVI, who is admitted in the Cardiovascular Rehabilitation Clinic to continue the second phase of the rehabilitation program. The ergospirometry test (which was performed in order to evaluate the impairment of the effort capacity) showed a moderate-severe decrease of effort capacity (42% of maximal oxygen consumption, class C Weber), effort hypotension and chronotropic incompetence which led to pausing cardiopulmonary test before anaerobic threshold. Stepper exercise or climbing stairs did not cause the lowering of blood pressure and heart rate, which led to the idea of controlling and adjusting the stimulation parameters. Within cardiopulmonary testing in patients with pacemaker special regards should be paid towards: parameters assessment during effort (heart rate during the test in pacemakers without adaptation to exercise, heart rate during the test in pacemakers with adaptation to exercise, evaluation of the effort response in patients undergoing resynchronization therapy) and diagnosis of exercise-induced arrhythmia (atrial fibrillation, ventricular extrasystoles, ventricular tachycardia, as well as identification of arrhythmias in patients with implantable cardioverter defibrillator).Conclusion: The cardiopulmonary stress test in patients with cardiostimulation should respect certain conditions in conducting the test in order to obtain realistic results of functional capacity. Due to the position of the piezoelectric crystal and the immobilization of the limbs during the cycle ergometer test it is recommended testing using the treadmill.
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Kotsoeva, O. T., A. V. Koltsov, V. V. Tyrenko e A. A. Ialovets. "Surgical methods of treatment of chronic heart failure and their place in modern clinical recommendations". Bulletin of the Russian Military Medical Academy 22, n. 4 (15 dicembre 2020): 183–91. http://dx.doi.org/10.17816/brmma62826.
Testo completoAbstract (sommario):
This review discusses a number of aspects of surgical methods for treating severe chronic heart failure: resynchronizing therapy, mechanical circulatory support systems, and heart transplantation. Surgical methods for the treatment of heart failure are a rapidly developing field of modern cardiology and cardiac surgery. The main surgical method of treatment was and remains orthotopic transplantation of a donor heart. The advent of implantable systems has affected the problem of heart transplantation. Over the past decade, the use of mechanical circulatory support systems has grown significantly. At the moment, there are 3 main directions: creating devices for auxiliary blood circulation, various modes and methods of electrical stimulation of the myocardium, creating devices that mechanically remodel the heart chambers (left ventricle). All of these directions to some extent (depending on the evidence base) have found their place in modern recommendations for the treatment of chronic heart failure. The use of mechanical left ventricular remodeling shows good results in patients suffering from symptomatic heart failure, which leads to a significant and persistent decrease in the volume of the left ventricle and improvement of its function, symptoms and quality of life. Despite the fact that at the moment the geography and prevalence of their use is small, the number of implanted devices will only grow. Thus, given the need for frequent hospitalizations and high treatment costs, it is necessary to improve modern methods of surgical treatment of severe and terminal heart failure, make them more accessible, which will affect the duration and quality of life of these patients.
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Huttelmaier, Moritz T., Sascha Münsterer, Caroline Morbach, Floran Sahiti, Nina Scholz, Judith Albert, Alexander Gabel et al. "Activated rate-response is associated with increased mortality risk in cardiac device carriers with acute heart failure". PLOS ONE 19, n. 4 (18 aprile 2024): e0302321. http://dx.doi.org/10.1371/journal.pone.0302321.
Testo completoAbstract (sommario):
Aims This study investigated whether an activated R-mode in patients carrying a cardiac implantable electronic device (CIED) is associated with worse prognosis during and after an episode of acutely decompensated heart failure (AHF). Methods Six hundred and twenty-three patients participating in an ongoing prospective cohort study that phenotypes and follows patients admitted for AHF were studied. We compared CIED carriers with activated R-mode stimulation (CIED-R) to CIED carriers not in R-mode (CIED-0) and patients without CIEDs (no-CIED). The independent impact of R-mode activation on 12-month all-cause death was examined using uni- and multivariable Cox proportional hazards regression taking into account potential confounders, and hazard ratios (HR) with their 95% confidence intervals (CI) were reported. Results Mean heart rate on admission was lower in CIED-R (n = 37, 16% women) vs. CIED-0 (n = 64, 23% women) or no-CIED (n = 511, 43% women): 70 bpm vs. 80 bpm or 82 bpm; both p<0.001. In-hospital mortality was similar across groups, but age- and sex-adjusted all-cause 12-month mortality risk was differentially affected by R-mode activation; CIED-R vs. CIED-0: HR 2.44, 95%CI 1.25–4.74; CIED-R vs. no-CIED: HR 2.61, 95%CI 1.59–4.29. These effects persisted after multivariable adjustment for potential confounders. Within CIED-R, mortality risk was similar in patients with pacemakers vs. ICDs and in subgroups with left ventricular ejection fraction (LVEF) <50% vs. ≥50%. Conclusion In patients admitted with AHF, R-mode stimulation was associated with a significantly increased 12-month mortality risk. Our findings shed new light on “admission heart rate” as a potentially treatable target in AHF. Our data are compatible with the concept that chronotropic incompetence contributes to an adverse outcome in these patients and may not be adequately treated through accelerometer-based R-mode stimulation.
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Zarra, S. "CASE PRESENTATION: A COMPLEX CLINICAL SCENARIO IN A 43–YEAR–OLD MALE WITH DEVICE–RELATED COMPLICATIONS". European Heart Journal Supplements 26, Supplement_2 (aprile 2024): ii36—ii37. http://dx.doi.org/10.1093/eurheartjsupp/suae036.081.
Testo completoAbstract (sommario):
Abstract A 43 yo male presented with an exposed pocket of his ICD in the right prepectoral and axillary region, along with total exposure of the lead electrodes up to the fixation sleeves.The patient, a known carrier of double–outlet right ventricle, underwent surgical correction. At the age of one, he received a dual–chamber pacemaker in the left prepectoral region due to AVB. Due to recurrent sustained ventricular tachycardias an ICD was implanted in the right prepectoral region, with removal of the left–sided pacemaker and concurrent abandonment of the ventricular pacing lead. In October 2019, he was admitted for a recurrence of pocket erosion.Device extraction was proposed but declined by the patient. Subsequently, he was referred to our institution for device removal. After heart team discussion, the patient was offered a transvenous lead extraction, with potential cardiothoracic surgical intervention if transvenous extraction proved to be challenging.An attempt was made to extract the leads using a transvenous approach. The procedure proceeded without complications, and the leads were released from adhesions up to the superior vena cava. However, there was an adhesion point at this location that was not overcome by mechanical dilation.Due to this limitation, a few days later, a cardiothoracic surgical intervention was performed to complete the lead wires‘ extraction using an invasive approach. In this context, a cardiac resynchronization device CRT–P was reimplanted in the left prepectoral region with epicardial electrodes. The patient underwent submuscular subclavian implantation of a SCID.The patient presented with a new pocket erosion of the CRT–P.Considering the high infection risk, It was therefore decided to implant a leadless device following electroanatomic mapping of the right ventricle, as there were surgical patches in the septal region. This approach aimed to identify the optimal anchoring site for the device. Subsequently, he will go extraction of the generator of the CRT–P.The decision to forgo biventricular stimulation was made, because of the elevated infectious risk.Complications associated with implantable devices pose an increasingly significant challenge in managing young patients with cardiac arrhythmias. Only through an integrated approach and proactive sharing of knowledge and expertise can we significantly improve clinical outcomes and the quality of life for this increasingly relevant population.
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Di Terlizzi, V., M. Corbo, R. Barone, G. Goffredo, V. Manuppelli, P. Pellegrino, R. Ieva, N. Brunetti e M. Iacoviello. "P274 LEFT ATRIAL STRAIN RESPONSE TO HEART RATE IN PATIENTS AFFECTED OR NOT BY CHRONIC HEART FAILURE: CLINICAL CORRELATES". European Heart Journal Supplements 25, Supplement_D (maggio 2023): D146—D147. http://dx.doi.org/10.1093/eurheartjsupp/suad111.348.
Testo completoAbstract (sommario):
Abstract Background and aim of the study. Left atrium (LA) is poorly understood in many pathological conditions and it is often considered a passive bystander of these pathophysiologic alterations. In the setting of impaired heart rate related LV response, the LA function could play a relevant role. The relevance of LA has been also recently demonstrated by studies which have evaluated its function by using new echocardiographic techniques such as two–dimensional speckle tracking evaluation (2D–STE). The aim of this study was to evaluate the relationship between changes in LV and LA function, assessed by 2D–STE, in response to the increase of heart rate (HR) in a group of patients carrying a pacemaker (PM) or an implantable cardioverter defibrillator (ICD). Methods We enrolled 45 patients. Among them, 38 were evaluated with LA strain. 31 patients were affected by CHF, among whom 18 with implanted cardioverter defibrillator (ICD), 13 with ICD and cardiac resynchronization therapy (ICD–CRT) and 7 without CHF who had a PM implanted. All were in clinically stable conditions for at least 30 days and in conventional medical therapy. Starting from basal values, HR was increased by 10 beats/min programming the implantable devices at higher atrial stimulation frequencies to max 90 beats/min. At each HR, echocardiography was performed and for left atrium the strain of reservoir (LAr), strain of conduit (LAcd) and contraction (LAct) were calculated (figure 1). Changes in left ventricle global longitudinal strain (LVGLS) were also calculated. Results The LAr shows a significant reduction from baseline at a heart rate of 90 bpm in conjunction with a significant change in the LAcd. No variation in LAct was observed at the various frequencies. Among the 38 patients, 29 showed a worsening of LVGLS and 9 no worsening with increasing heart rate. We demonstrated a close relationship between LV and LA function assessed by longitudinal strain measures (figure 2). A significant decrease in LAr was observed in patients with worsening LV–GLS that was not evident in patients with no or improvement. Conclusions Our study demonstrates that, in chronic HF outpatients, HR increase has different and heterogeneous effects on the LA function, assessed by STI and this response is more frequent among patients with LV systolic dysfunction. These results could be useful for guiding the optimal heart rate responsiveness of the implanted devices.
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Bean, Steven, e Venkata Mukkavilli. "1160 Examining Criteria in Hypoglossal Nerve Stimulation: A Case Insight". SLEEP 47, Supplement_1 (20 aprile 2024): A497. http://dx.doi.org/10.1093/sleep/zsae067.01160.
Testo completoAbstract (sommario):
Abstract Introduction Introduced in 2001, the hypoglossal nerve stimulator (HGNS) is an implantable device designed to treat moderate to severe obstructive sleep apnea (OSA). FDA-approved on May 1, 2014, it offers an alternative for patients unable to benefit from continuous positive airway pressure (CPAP) therapy. However, not all patients may benefit, leading to the establishment of exclusion criteria based on factors such as body mass index, central and/or mixed apnea index >25%, complete concentric palatal collapse, patient age, and certain comorbidities such as neuromuscular and cardiac diseases. It is important to consider these criteria when screening patients to ensure the appropriate use of the device. Here, we present a case illustrating a patient who received a HGNS device according to established criteria but may not have been an ideal candidate.123 Report of case(s) A 55-year-old male with a history of hyperlipidemia, depression, and hypothyroidism status post (s/p) thyroidectomy to treat multinodular goiter, moderate OSA (AHI 16.2 events/hr) s/p uvulopalatopharyngoplasty and failed CPAP tolerance, underwent HGNS implantation. Post-procedure, an abnormal electrocardiogram led to a referral to cardiology, where he was found to have heart failure with a reduced ejection fraction of 20%. A follow-up titration polysomnography showed central events, presumed treatment emergent, following HGNS implantation. He is currently being monitored by cardiology for the optimization of his heart failure. Upon re-evaluation of his initial pre-implantation study, we felt that several of the hypopnea events may have been central hypopneas. Although his OSA is controlled with the HGNS, the patient still has central sleep apnea that is not being treated. Conclusion There is a lack of routine differentiation between central and obstructive hypopneas in current assessments, which poses a potential oversight in patient selection, impacting treatment planning. Central hypopneas should be included when assessing the 25% threshold of central events that would otherwise exclude a patient from receiving treatment. This case highlights the need for more stringent scoring criteria, specifically incorporating central hypopneas, to better screen high-risk patients and identify optimal candidates for hypoglossal nerve stimulation. Support (if any)
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Corbo, M., V. Di Terlizzi, R. Barone, G. Goffredo, M. Correale, P. Pellegrino, R. Ieva, N. Brunetti e M. Iacoviello. "P276 LEFT ATRIAL STRAIN RESPONSE TO HEART RATE IN PATIENTS AFFECTED OR NOT BY CHRONIC HEART FAILURE: HEMODYNAMIC CORRELATES". European Heart Journal Supplements 25, Supplement_D (maggio 2023): D148. http://dx.doi.org/10.1093/eurheartjsupp/suad111.350.
Testo completoAbstract (sommario):
Abstract Background and aim of the study. Previous studies evaluated the effects of heart rate (HR) increase on the left ventricular (LV) function, by two–dimensional longitudinal strain, but many authors also assessed the left atrium (LA) function based on speckle tracking imaging (STI). The LA and LV are connected through the mitral annulus and the LA modulates LV filling and performance. The interaction between LA and LV functions during the cardiac cycle (LA–LV coupling) is crucial. We aimed to evaluate the changes in LA strain in response to increases in HR. Methods We enrolled 45 patients. 38 were evaluated with LA strain. 31 patients were affected by chronic heart failure (CHF), among whom 18 with implanted cardioverter defibrillator (ICD), 13 with ICD and cardiac resynchronization therapy (ICD–CRT) and 7 without CHF who had a PM implanted. All were in clinically stable conditions for at least 30 days and in conventional medical therapy. Starting from basal values, HR was increased by 10 beats/min programming the implantable devices at higher atrial stimulation frequencies to max 90 beats/min. At each HR, echocardiography was performed and main functional parameters were calculated, including those for LV filling evaluation (i.e. E/e’ ratio). Changes in LA strain measures, i.e. the strain of reservoir (LAr), conduit (LAcd) and contraction (LAct), and in LV global longitudinal strain (LVGLS) were calculated. The ratio between LAr and septal E/e’ was evaluated to estimate LV filling pressures. Results No significant variation was found in the measurements of E/e‘s and the LAr/E/e‘s ratio when all patients were analysed. However, there was a significant reduction in LA/E/e‘s in patients who did not show HR–dependent worsening in LV–GLS and a significant increase in the other group (figure 1). These results underline the relationship between LA and LV functions and consequently show the AV uncoupling at higher HR. Interestingly, the worsening of both LA and LV function assessed by strain was more evident at the rate of 90 bpm (figure 2). Conclusions The increase of HR was associated with both worsening of LA and LV function assessed by STI. This response is associated with an increase in LV filling pressures. These results offer new data about HR related LA–LV coupling and could be useful for guiding the optimal HR responsiveness of the implanted devices.
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Ng, G. Andre, Amar Mistry, Michelle Newton, Fernando Soares Schlindwein, Craig Barr, Matthew GD Bates, Jane Caldwell et al. "Rationale and study design of the MINERVA study: Multicentre Investigation of Novel Electrocardiogram Risk markers in Ventricular Arrhythmia prediction—UK multicentre collaboration". BMJ Open 12, n. 1 (gennaio 2022): e059527. http://dx.doi.org/10.1136/bmjopen-2021-059527.
Testo completoAbstract (sommario):
IntroductionThe purpose of this study is to assess the ability of two new ECG markers (Regional Repolarisation Instability Index (R2I2) and Peak Electrical Restitution Slope) to predict sudden cardiac death (SCD) or ventricular arrhythmia (VA) events in patients with ischaemic cardiomyopathy undergoing implantation of an implantable cardioverter defibrillator for primary prevention indication.Methods and analysisMulticentre Investigation of Novel Electrocardiogram Risk markers in Ventricular Arrhythmia prediction is a prospective, open label, single blinded, multicentre observational study to establish the efficacy of two ECG biomarkers in predicting VA risk. 440 participants with ischaemic cardiomyopathy undergoing routine first time implantable cardioverter-defibrillator (ICD) implantation for primary prevention indication are currently being recruited. An electrophysiological (EP) study is performed using a non-invasive programmed electrical stimulation protocol via the implanted device. All participants will undergo the EP study hence no randomisation is required. Participants will be followed up over a minimum of 18 months and up to 3 years. The first patient was recruited in August 2016 and the study will be completed at the final participant follow-up visit. The primary endpoint is ventricular fibrillation or sustained ventricular tachycardia >200 beats/min as recorded by the ICD. The secondary endpoint is SCD. Analysis of the ECG data obtained during the EP study will be performed by the core lab where blinding of patient health status and endpoints will be maintained.Ethics and disseminationEthical approval has been granted by Research Ethics Committees Northern Ireland (reference no. 16/NI/0069). The results will inform the design of a definitive Randomised Controlled Trial (RCT). Dissemination will include peer reviewed journal articles reporting the qualitative and quantitative results, as well as presentations at conferences and lay summaries.Trial registration numberNCT03022487.
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Regeer, Madelien V., Olga Bondarenko, Katja Zeppenfeld e Anastasia D. Egorova. "Anomalous left coronary artery from the pulmonary artery: a rare cause of an out-of-hospital cardiac arrest in an adult—a case report". European Heart Journal - Case Reports 4, n. 3 (17 aprile 2020): 1–5. http://dx.doi.org/10.1093/ehjcr/ytaa061.
Testo completoAbstract (sommario):
Abstract Background Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital disorder resulting in ischaemia and myocardial infarction which can act as a potential substrate for life-threatening arrhythmias and sudden cardiac death. Case summary A 19-year-old man was admitted to the hospital after successful resuscitation from an out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation occurring during jogging. In the diagnostic work-up of the OHCA, computed tomography identified an ALCAPA. The patient was referred to our tertiary hospital for surgical correction. Direct reimplantation of the left coronary artery in the aorta was performed. During follow-up, 24-h electrocardiogram revealed short episodes of non-sustained ventricular tachycardia (VT). The magnetic resonance imaging at initial admission showed focal wall thinning and transmural late gadolinium enhancement consistent with a previous anterolateral myocardial infarction. Therefore, the aetiology of the OHCA could be due to a scar-related mechanism and not necessarily due to a reversible cause and an implantable cardioverter-defibrillator (ICD) was considered indicated. Given the young age and the lower complication rates, a subcutaneous device was preferred over a transvenous ICD. However, as a subcutaneous ICD (S-ICD) lacks the possibility of anti-tachycardia pacing, programmed electrical stimulation (PES) was performed to test for inducibility of monomorphic, re-entrant VT. After a negative PES, an S-ICD was implanted. Discussion ALCAPA is a potential cause of OHCA in young patients. Some of these patients keep an irreversible substrate for ventricular arrhythmias despite full surgical revascularization and might be candidates for (subcutaneous) ICD implantation.
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Parikh, Valay, Erica Thaler, Masanari Kato, M. Boyd Gillespie, Shaun Nguyen, Kirk Withrow, David Calhoun et al. "Early feasibility of hypoglossal nerve upper airway stimulator in patients with cardiac implantable electronic devices and continuous positive airway pressure-intolerant severe obstructive sleep apnea". Heart Rhythm 15, n. 8 (agosto 2018): 1165–70. http://dx.doi.org/10.1016/j.hrthm.2018.04.016.
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Iemma, Domenico. "A Novel Mini-invasive Approach to the Treatment of Neuropathic Pain: The PENS Study". Pain Physician 1;19, n. 1;1 (14 gennaio 2016): E121—E128. http://dx.doi.org/10.36076/ppj/2016.19.e121.
Testo completoAbstract (sommario):
Background: Peripheral neuromodulation is often used as chronic neuropathic pain treatment. Percutaneous electrical nerve stimulation (PENS) is generally utilized with several probes at the same time and repeated treatments. Objectives: Evaluate the short- and long-term efficacy of a single probe and single shot PENS approach. Study Design: Multicenter, prospective, observational study. Setting: Four Italian pain therapy centers. Methods: Inclusion criteria were age ≥ 18 and ≤ 80 years, presence of severe peripheral neuropathic pain lasting more than 3 months, localized and refractory to pharmacological therapies. Patients with infection, coagulopathies, psychiatric disorders, pacemakers, or implantable cardiac defibrillators were excluded. Patients: Seventy-six patients (47 women, 29 men), mean age 62 ± 14 years, affected by neuralgia (21 herpes zoster infection, 31 causalgia, 24 postoperative pain) were enrolled in the study. Intervention: After localization of trigger point and/or allodynic/hyperalgesic area, PENS therapy was achieved with a single 21 gauge conductive probe tunneled percutaneously and a neurostimulator device. Measurement: Numerical Rating Scale (NRS) and Neuropathic Pain Scale (NPS) were assessed at baseline, 60 minutes after PENS, at one week, after one, 3, and 6 months; perceived health outcome was measured with Euroqol-5 dimension (EQ-5D) questionnaire at baseline and at 6 months. Adverse events and patient satisfaction were reported. Results: NRS and NPS decreased significantly after 60 minutes and the reduction remained constant over time at follow-up. EQ-5D increased significantly with respect to the baseline. Two nonclinically significant adverse events (one contralateral dysestesia and one self-resolving hematoma) were observed. Limitations: Small sample size and non-randomized observational study; high prevalence of post-herpetic and occipital neuralgias. Conclusion: PENS therapy produced significant and long-lasting pain relief in chronic peripheral neuropathic pains of different etiology. The present study confirms the feasibility, safety, and repeatability of this minimally invasive technique. Key words: Neuropathic pain, neuromodulator, peripheral nerve, percutaneous stimulation
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Winters, Stephen L., Marc Cohen, Steven Greenberg, Bernardo Stein, Jay Curwin, Elena Pe e J. Anthony Gomes. "Sustained ventricular tachycardia associated with sarcoidosis: Assessment of the underlying cardiac anatomy and the prospective utility of programmed ventricular stimulation, drug therapy and an implantable antitachycardia device". Journal of the American College of Cardiology 18, n. 4 (ottobre 1991): 937–43. http://dx.doi.org/10.1016/0735-1097(91)90750-4.
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Hou, Zhi-wei, Hai-bo Yu, Yan-chun Liang, Yang Gao, Guo-qing Xu, Min Wu, Zhu Mei et al. "Circulating Soluble ST2 Predicts All-Cause Mortality in Severe Heart Failure Patients with an Implantable Cardioverter Defibrillator". Cardiology Research and Practice 2020 (17 novembre 2020): 1–7. http://dx.doi.org/10.1155/2020/4375651.
Testo completoAbstract (sommario):
Background. Heart failure (HF) is the terminal stage of all cardiovascular events. Although implantable cardioverter defibrillator (ICD) therapies have reduced mortality among the high-risk HF population, it is necessary to determine whether certain factors can predict mortality even after cardiac device implantation. Growth stimulation expressed gene 2 (ST2) is an emerging biomarker for HF patient stratification in different clinical settings. Aims. This study aimed to investigate the relationship between baseline soluble ST2 (sST2) levels in serum and the clinical outcomes of high-risk HF patients with device implantation. Methods. Between January 2017 and August 2018, we prospectively recruited consecutive patients implanted with an ICD for heart failure, with LVEF ≤35% as recommended, and analyzed the basic characteristics, baseline serum sST2, and NT-proBNP levels, with at least 1-year follow-up. All-cause mortality was the primary endpoint. Results. During a 643-day follow-up, all-cause mortality occurred in 16 of 150 patients (10.67%). Incidence of all-cause mortality increased significantly in patients with sST2 levels above 34.98846 ng/ml (16.00% vs. 5.33%, P = 0.034 ). After adjusting the model (age, gender, device implantation, prevention of sudden death, LVEDD, LVEF, WBC and CLBBB, hsTNT, etiology, and eGFR) and the model combined with NT-proBNP, the risk of all-cause death was increased by 2.5% and 1.9%, respectively, per ng/ml of sST2. The best sST2 cutoff for predicting all-cause death was 43.42671 ng/ml (area under the curve: 0.72, sensitive: 0.69, and specificity: 0.69). Compared to patients with sST2 levels below 43.42671 ng/ml, the risk of all-cause mortality was higher in those with values above the threshold (5.1% vs. 21.2%, P = 0.002 ). ST2 level ≥43.42671 ng/ml was an independent predictor of all-cause mortality (HR: 3.30 [95% CI 1.02–10.67]). Age (HR: 1.06 [95% CI: 1.01–1.12]) and increased NT-proBNP per 100 (HR: 1.02 [95% CI: 1.01–1.03]) were also associated with all-cause mortality in ICD patients. Conclusions. sST2 level was associated with risk of all-cause mortality, and a threshold of 43.43 ng/ml showed good distinguishing performance to predict all-cause mortality in patients with severe heart failure, recommended for ICD implantation. Patients with sST2 levels more than 43.42671 ng/ml even after ICD implantation should therefore be monitored carefully.
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Rehorn, Michael R., Rahul S. Loungani, Eric Black-Maier, Amanda C. Coniglio, Ravi Karra, Sean D. Pokorney e Michel G. Khouri. "Cardiac Implantable Electronic Devices". JACC: Clinical Electrophysiology 6, n. 9 (settembre 2020): 1144–54. http://dx.doi.org/10.1016/j.jacep.2020.04.020.
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Thakur, Ranjan K., e Andrea Natale. "Cardiac Implantable Electronic Devices". Cardiac Electrophysiology Clinics 10, n. 1 (marzo 2018): xiii. http://dx.doi.org/10.1016/j.ccep.2017.12.001.
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Ferrick, Aileen M. "Cardiac Implantable Electronic Devices". AACN Advanced Critical Care 26, n. 4 (2015): 309–11. http://dx.doi.org/10.1097/nci.0000000000000115.
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Margey, Ronan. "Cardiac Implantable Electronic Devices". Archives of Internal Medicine 171, n. 20 (14 novembre 2011): 1829. http://dx.doi.org/10.1001/archinternmed.2011.446.
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Al-Khatib, Sana M. "Cardiac Implantable Electronic Devices". New England Journal of Medicine 390, n. 5 (1 febbraio 2024): 442–54. http://dx.doi.org/10.1056/nejmra2308353.
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Asad, Muhammad, Qurban Hussain Khan, Azmat Hayat, Waheed ur Rehman, Muhammad Shabbir, Amer Naseem, Noor Shah e Rehana Khadim. "TRICUSPID VALVE REGURGITATION IN PATIENTS UNDERGOING ENDOCARDIAL LEADS PLACEMENT". Pakistan Armed Forces Medical Journal 70, Suppl-4 (5 gennaio 2021): S721–25. http://dx.doi.org/10.51253/pafmj.v70isuppl-4.6007.
Testo completoAbstract (sommario):
Objective: To assess prospectively the presence and degree of tricuspid regurgitation (TR) after right ventricular (RV) lead placement utilizing 2-dimensional and doppler echocardiography in a group of patients implanted with Permanent pace-maker or implantable cardioverter defibrillator (ICD).
Study Design: Descriptive cross sectional study.
Place and Duration of Study: Study was conducted at OPD of AFIC/NIHD Rawalpindi from Jan to Jun 2019.
Methodology: One hundred patients after cardiac stimulation system implantation were included in this study. Patients with severe valve disease, heart failure, congenital heart disease, pre-existing pulmonary hypertension and presence of moderate or severe tricuspid regurgitation were excluded. M-mode, 2 –dimensional and doppler echocardiographic studies were performed. Continuous-wave doppler measurements were made from apical four-chamber view in order to obtain maximum tricuspid flow velocities. A complete echocardiographic study was performed following device implantation. Echocardiographic measurements were repeated at 6-months of follow-up period. Those patients who developed tricuspid regurgitation were further assessed by color doppler, taking into account density and contour of the jet on continuous-wave doppler. Tricuspid regurgitation severity was classified into three groups: mild, moderate and severe according to the recommendations for non-invasive evaluation of native valvular regurgitation by the American Society of Echocardiography. The collected data was analysed by using SPSS-23.
Results: Out of 100 patients, 67 (67%) were males and 33(33%) were females with the mean age of 65.29 ± 12.02 years. All the patients had normal chambers dimensions before the procedure. 65 (65%) had leads screwed to RV apex while 35 (35%) had through RV septum. 83 (83%) patients received a dual chamber device, while 17 (17%) patients got single chamber (ventricular) device implanted. Following device implantation after 6 months mild TR was noted in 4 (4%), moderate TR in 4 (4%) and severe TR 2 (2%) in cases.
Conclusion: Tricuspid incompetence following endocardial leads implantation is not rare and occurred in approximately 10% of our patients. This complication may be preventable, because it is likely due to the interference of the endocardial lead with the TV.
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Hayes, David L. "Cardiac arrhythmias and implantable devices". Journal of the American College of Cardiology 42, n. 2 (luglio 2003): 392–93. http://dx.doi.org/10.1016/s0735-1097(03)00673-9.
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Furman, Seymour. "Sensors in Implantable Cardiac Devices". Pacing and Clinical Electrophysiology 14, n. 7 (luglio 1991): 1087–88. http://dx.doi.org/10.1111/j.1540-8159.1991.tb02837.x.
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Goh, Eui Kyung, e Kyong Myong Chon. "Temporal Bone Stimulation Implantable Hearing Devices". Journal of Clinical Otolaryngology Head and Neck Surgery 1, n. 1 (maggio 1990): 13–21. http://dx.doi.org/10.35420/jcohns.1990.1.1.13.
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Sepúlveda López, Fabio Alejandro, Luz María Jiménez Muñoz, Juan Fernando Agudelo Uribe e Jorge Alberto Castro Pérez. "Patient with an implantable cardiac electrical stimulation device. What should the anesthesiologist know?" Colombian Journal of Anesthesiology, 24 marzo 2021. http://dx.doi.org/10.5554/22562087.e976.
Testo completoAbstract (sommario):
Patients with implantable electric stimulation devices are challenging to the anesthesiologist since these cases demand a comprehensive knowledge about how the device operates, the indications for the implant and the implications that must be addressed during the perioperative period . This article is intended to provide the reader with clear and structured information so that the anesthesiologist will be able to safely deal with the situation of a patient with an implantable cardiac stimulation device, who has been programmed for emergent surgery. A search for the scientific evidence available was conducted in Pubmed / Medline, ScienceDirect, OVID, SciELO), for a non-systematic review. The incidence of the use of cardiac electric stimulation devices has been growing. Their operation is increasingly complex, and demands being constantly updated on the knowledge in the area.
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Wörmann, Jonas, David Duncker, Till Althoff, Christian Heeger, Roland Tilz, Heidi Estner, Andreas Rillig et al. "Lead placement in cardiac implantable electronic devices". Herzschrittmachertherapie + Elektrophysiologie, 15 maggio 2024. http://dx.doi.org/10.1007/s00399-024-01019-9.
Testo completoAbstract (sommario):
ZusammenfassungDie Implantation von Elektroden aktiver Herzrhythmusimplantate („cardiac implantable electronic devices“, CIED) erfordert tiefgehendes technisches Verständnis und eine präzise Ausführung. Die Platzierung der Elektroden im rechten Ventrikel und Vorhof hat signifikante Auswirkungen auf die Patientensicherheit und die Effektivität der CIED-Therapie. Insbesondere bei der ventrikulären Platzierung wird dabei der Fokus auf die Unterscheidung zwischen apikaler und septaler Stimulation gelegt. Basierend auf der aktuellen Datenlage, stellt dieser Artikel eine praxisorientierte Anleitung dar, die Implantierende durch die einzelnen Schritte der Elektrodenplatzierung führt. Die Implantation von Elektroden zur physiologischen Stimulation („cardiac resynchronization therapy“, CRT und „conduction system pacing“, CSP) werden an anderer Stelle adressiert und sind nicht Gegenstand dieses Artikels.
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Thaitirarot, Chokanan, Shirley Sze, Tim Hodson, Ravi Pathmanathan e Harshil Dhutia. "Compatibility of Transvenous Implantable Cardioverter Defibrillator and Vagus Nerve Stimulation Device: A Case Report". European Heart Journal - Case Reports, 23 aprile 2024. http://dx.doi.org/10.1093/ehjcr/ytae214.
Testo completoAbstract (sommario):
Abstract Background Vagus nerve stimulation (VNS) is an established therapy for drug-resistant epilepsy and depression. While VNS coexistence with cardiac pacemakers is considered safe, its interaction with implantable cardioverter defibrillators (ICDs) remains poorly understood. The concern revolves around the potential for VNS stimulation to interfere with ICD function, potentially resulting in inappropriate therapy or changes in cardiac pacing. Case Summary We present the case of a 50-year-old woman with drug-resistant epilepsy who underwent VNS device implantation and subsequent transvenous ICD placement for primary prevention post-myocardial infarction. These devices were thoughtfully situated contralaterally, with a minimum 10 cm separation. Comprehensive testing and follow-up demonstrated no interactions during device programming or serial assessments. Simultaneous interrogation of both devices with their respective telemetry wands caused chaotic artifacts in all channels on the ICD, likely due to electromagnetic interference. Importantly, this interference did not affect ICD sensing. Discussion The coexistence of VNS and ICD in a patient is an emerging scenario with limited previous reports, yet our findings align with prior cases involving VNS and pacemakers. Emphasizing the need for optimal device separation and meticulous evaluation, particularly at maximum VNS output and ICD sensitivity settings, ensures their safe and feasible coexistence. Conclusion As the use of VNS alongside cardiac implantable electronic devices (CIEDs) becomes more common, a diligent evaluation for potential interactions is imperative. Our case highlights the successful coexistence of VNS and ICD, underscoring the importance of careful monitoring and evaluation to guarantee the safe utilization of these two devices.
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Araújo, Camilla Silva, Carla Liz Barbosa Silva, Antônio da Silva Menezes Júnior, Vinícius Araújo Barbosa, Tiago de Almeida Laranjeira, Joaquim Ferreira Fernandes, Lucas Cândido Gonçalves e Antonio Márcio Cordeiro Silva. "Efficacy and Complications of Subcutaneous versus Conventional Cardioverter Defibrillators: A Systematic Review and Meta-analysis". Current Cardiology Reviews 18, n. 3 (maggio 2022). http://dx.doi.org/10.2174/1573403x17666211208100151.
Testo completoAbstract (sommario):
Background/Objectives: Implantable cardioverter defibrillators are used to prevent sudden cardiac death. The subcutaneous implantable cardioverter-defibrillator was newly developed to overcome the limitations of the conventional implantable cardioverter defibrillator-transvenous device. The subcutaneous implantable cardioverter defibrillator is indicated for young patients with heart disease, congenital heart defects, and poor venous access, who have an indication for implantable cardioverter defibrillator without the need for anti-bradycardic stimulation. We aimed to compare the efficacy and complications of subcutaneous with transvenous implantable cardioverter- defibrillator devices. Methodology: A systematic review was conducted using different databases. The inclusion criteria were observational and clinical randomized trials with no language limits and no publication date limit that compared subcutaneous with transvenous implantable cardioverter-defibrillators. The selected patients were aged > 18 years with complex ventricular arrhythmia. Results: Five studies involving 2111 patients who underwent implantable cardioverter defibrillator implantation were included. The most frequent complication in the subcutaneous device group was infection, followed by hematoma formation and electrode migration. For the transvenous device, the most frequent complications were electrode migration and infection. Regarding efficacy, the total rates of appropriate shocks were 9.04% and 20.47% in the subcutaneous and transvenous device groups, respectively, whereas inappropriate shocks to the subcutaneous and transvenous device groups were 11,3% and 10,7%, respectively. Conclusion: When compared to the transvenous device, the subcutaneous device had lower complication rates owing to lead migration and less inappropriate shocks due to supraventricular tachycardia; nevertheless, infection rates and improper shocks due to T wave oversensing were comparable for both devices CRD42021251569.
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Mitacchione, Gianfranco, Gianmarco Arabia, Luca Bontempi, Manuel Cerini, Francesca Salghetti, Antonino Milidoni, Ashraf Ahmed, Ludovica Bognoni, Mohamed Aboelhassan e Antonio Curnis. "714 Effects of direct irradiation on cardiac implantable electronic devices". European Heart Journal Supplements 23, Supplement_G (1 dicembre 2021). http://dx.doi.org/10.1093/eurheartj/suab127.022.
Testo completoAbstract (sommario):
Abstract Aims Cardiac implantable electronic devices (CIEDs) may sustain damages during a course of radiation therapy, especially when the beam is directed onto the pulse generator, with device electrical reset and/or sudden battery drain. 2010 HRS/ASA expert consensus, and all CIEDs manufacturers, recommend to avoid devices direct irradiation with an accumulated dose that exceed five grays (Gy). In our prospective study, we tested the effects of direct irradiation on CIEDs with different radiation doses, also higher than 5 Gy. Methods and results Thirty-seven CIEDs of Medtronic, Abbott, Biotronik, and Boston Scientific were collected during system upgrading or lead extraction procedures. All devices were considered if they had at least 80% of residual battery capacity. All CIEDs were programmed with same default electrical parameters. Depending by CIED type, pacing mode was configured in VVI, VVIR, VDDR, or DDDR, and biventricular stimulation was activated, if present. ICDs electrical therapies were set-up with a pre-determined configuration. All devices were singularly placed in a 30 cm × 30 cm plastic bowl containing 2 l of deionized water that was placed over 5 cm Rockwool to simulate the backscatter and irradiated by a linear accelerator (Elekta Synergy®). CIEDs were divided into two groups depending on irradiation dose delivered: 5 Gy and 10 Gy. No significant differences in battery drainage were observed after irradiation respect to baseline in 5 Gy as well 10 Gy group [7.9 ± 3.1 vs. 7.5 ± 2.1 (years) battery longevity, P = 0.693; 7.7 ± 3.1 vs. 7.4 ± 2.1 (years) battery longevity, P = 0.677, respectively) (Figure). Moreover, all CIEDS saved the baseline program setting, without device reset events (Table). Conclusions Our data confirm that CIEDs direct irradiation of 5 Gy is safe, of note, direct irradiation up to 10 Gy seems to be similarly safe concerning the risk of CIEDs electrical reset and/or unexpected battery drain.
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Madrid, Micah K., Jaclyn A. Brennan, Rose T. Yin, Helen S. Knight e Igor R. Efimov. "Advances in Implantable Optogenetic Technology for Cardiovascular Research and Medicine". Frontiers in Physiology 12 (5 ottobre 2021). http://dx.doi.org/10.3389/fphys.2021.720190.
Testo completoAbstract (sommario):
Optogenetic technology provides researchers with spatiotemporally precise tools for stimulation, sensing, and analysis of function in cells, tissues, and organs. These tools can offer low-energy and localized approaches due to the use of the transgenically expressed light gated cation channel Channelrhodopsin-2 (ChR2). While the field began with many neurobiological accomplishments it has also evolved exceptionally well in animal cardiac research, both in vitro and in vivo. Implantable optical devices are being extensively developed to study particular electrophysiological phenomena with the precise control that optogenetics provides. In this review, we highlight recent advances in novel implantable optogenetic devices and their feasibility in cardiac research. Furthermore, we also emphasize the difficulties in translating this technology toward clinical applications and discuss potential solutions for successful clinical translation.