Usefulness of telemedicine in immediate postoperative follow-up after ICD and pacemaker implantation. A new tool for outpatient surgery

Abstract Introduction Alcohol septal ablation (PTSMA) was introduced as interventional alternative to surgical myectomy for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) 25 years ago. As gender differences in diagnosis and treatment of HOCM are still unclear we analyzed baseline characteristics and results of PTSMA in a large single center cohort with respect to gender. Methods and results Between 05/2000 and 06/2017 first PTSMA in our center was performed in 952 patients with symptomatic HOCM. We treated less 388 (40.8%) women and 564 (59.2%) men. All patients underwent clinical follow-up. At the time of the intervention women were older (61.2±14.9 vs. 51.9±13.7 years; p<0.0001) and suffered more often from NYHA grade III/IV dyspnea (80.9% vs. 68.1%; p<0.0001), whereas angina pectoris was comparable in women (62.4%) and men (59.9%). Echocardiographic baseline gradients were comparable in women (rest 65.0±38.1 mmHg and Valsalva 106.2±45.7 mmHg) and men (rest 63.1±38.3 mmHg and Valsalva 103.6±42.8 mmHg). But, women had smaller diameters of the left atrium (44.3±6.9 vs. 47.2±6.5 mm; p<0001), maximal septum thickness (20.4±3.9 vs. 21.4±4.5 mm; p<0.01), and maximal thickness of the left ventricular posterior wall (12.7±2.8 vs. 13.5±2.9 mm; p<0.0001). In women, more septal branches (1.3±0.6 vs. 1.2±0.5; p<0.05) had to be tested to identify the target septal branch. The amount of injected alcohol was comparable (2.0±0, 4 in women vs. 2.1±0.4 ml in men). The maximum CK increase was lower in women (826.0±489.6 vs. 903.4±543.0 U / l; p<0.05). During hospital stay one woman and one man died, each (n.s.). The frequency of total AV blocks in the cathlab showed no significant difference between women (41.5%) and men (38.3%). Furthermore, the rate of permanent pacemaker implantation during hospital stay did not differ (12.1% in women vs. 9.4% in men). Follow-up periods of all patients showed no significant difference between women (5.7±4.9 years) and men (6.2±5.0 years). Overall, 37 (9.5%) women died during this period compared to only 33 (5.9%) men (p<0.05). But, cardiovascular causes of death were not significantly different between women (2.8%) and men (1.6%). Furthermore, the rates of surgical myectomy after failed PTSMA (1.3% in women vs. 2.3% in men), ICD implantation for primary prevention of sudden cardiac death according to current guidelines (4.1% in women vs. 5.9% in men) or pacemaker implantation (3.6% in women vs. 2.0% in men) showed no significant differences. Summary PTSMA in women with HOCM was performed at more advanced age with more pronounced symptoms compared to men. While there were no differences in acute outcomes, overall long-term mortality was higher in women without differences in cardiovascular mortality. Therefore, women may require more intensive diagnostic approaches in order not to miss the correct time for gradient reduction treatment. Funding Acknowledgement Type of funding source: None

Download Full-text

Long-term outcomes in young patients with atrioventricular block of unknown aetiology

European Heart Journal ◽

10.1093/eurheartj/ehab060 ◽

2021 ◽

Author(s):

Johnni Resdal Dideriksen ◽

Morten K Christiansen ◽

Jens B Johansen ◽

Jens C Nielsen ◽

Henning Bundgaard ◽

...

Keyword(s):

Heart Failure ◽

Atrioventricular Block ◽

Ventricular Tachyarrhythmia ◽

Pacemaker Implantation ◽

Young Patients ◽

Composite Endpoint ◽

Unknown Aetiology ◽

Successful Resuscitation

Abstract Aims Atrioventricular block (AVB) of unknown aetiology is rare in the young, and outcome in these patients is unknown. We aimed to assess long-term morbidity and mortality in young patients with AVB of unknown aetiology. Methods and results We identified all Danish patients younger than 50 years receiving a first pacemaker due to AVB between January 1996 and December 2015. By reviewing medical records, we included patients with AVB of unknown aetiology. A matched control cohort was established. Follow-up was performed using national registries. The primary outcome was a composite endpoint consisting of death, heart failure hospitalization, ventricular tachyarrhythmia, and cardiac arrest with successful resuscitation. We included 517 patients, and 5170 controls. Median age at first pacemaker implantation was 41.3 years [interquartile range (IQR) 32.7–46.2 years]. After a median follow-up of 9.8 years (IQR 5.7–14.5 years), the primary endpoint had occurred in 14.9% of patients and 3.2% of controls [hazard ratio (HR) 3.8; 95% confidence interval (CI) 2.9–5.1; P < 0.001]. Patients with persistent AVB at time of diagnosis had a higher risk of the primary endpoint (HR 10.6; 95% CI 5.7–20.0; P < 0.001), and risk was highest early in the follow-up period (HR 6.8; 95% CI 4.6–10.0; P < 0.001, during 0–5 years of follow-up). Conclusion Atrioventricular block of unknown aetiology presenting before the age of 50 years and treated with pacemaker implantation was associated with a three- to four-fold higher rate of the composite endpoint of death or hospitalization for heart failure, ventricular tachyarrhythmia, or cardiac arrest with successful resuscitation. Patients with persistent AVB were at higher risk. These findings warrant improved follow-up strategies for young patients with AVB of unknown aetiology.

Download Full-text

AB0549 THE RELEVANCE OF AORTIC STENOSIS AND OUTCOME OF TAVI PROCEDURE FOR VALVE REPAIR IN SCLERODERMA PATIENTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6372 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1571.3-1571

Author(s):

A. Balbir-Gurman ◽

Y. Braun-Moscovici

Keyword(s):

Aortic Valve ◽

Valve Replacement ◽

Pacemaker Implantation ◽

Significant Coronary Artery Disease ◽

Heart Catheterization ◽

Long Term Outcome ◽

Aortic Valve Implantation ◽

Valve Pathology ◽

Valve Implantation

Background:Patients with systemic sclerosis (SSc) are at risk for developing aortic valve changes. The prevalence of aortic valve stenosis (AS) in SSc patients is unknown. Previously, patients with AS were treated with valve replacement; in recent years, Trans Catheter Aortic Valve Implantation (TAVI) is widely used in general population. The safety of Trans Catheter Aortic Valve Implantation (TAVI) in SSc has not been assessed.Objectives:A retrospective study on aortic valve pathology and treatments including TAVI performance.Methods:We reviewed 374 records of SSc patients at our site EUSTAR cohort and extracted cases with reported AS confirmed by ECHO cardiography and heart catheterization.Results:We found data on 13 (3.4%) patients with AS: 12 females (92.3%); mean age 70.3 (SD 7.7) years, disease duration 15.4 (SD 6.3) years. Ten patients had limited SSc (76.9%, all cared anti-centromere antibodies) and 3 diffuse SSc (1 patient had RNAP3 and 2 had anti-topoisomerase antibodies); 5 (38.5%) patients had significant coronary disease (3 underwent CABG, 2 had several PTCA). Eight (61.5%) patients dead during years 2004 - 2019. Aortic valve replacement was performed in 5 patients (4 – metal and 1 – biological); 2 patients did not undergo AS repair due to impaired general condition; 6 patients underwent TAVI between January 2013 and December 2019 (5 at Rambam Cardiology Institute). All SSc patients underwent trans femoral TAVI under conscious sedation. The procedure was successful in all patients. The length of hospitalization was 5-14 days (mean 8.2 days); 3 (50%) patients needed pacemaker implantation (they did not have previous conduction abnormalities). The follow-up duration after TAVI was between 5 and 67 months (mean 20.7). During follow-up one patient developed bacterial endocarditis related to pacemaker device two months after the procedure; the event resolved after removing the device and according antibiotics treatment; the same patient had transient ischemic attack two years later and another pacemaker implantation 3 years later due to complete AV block. One patients dead from urosepsis 11 months after TAVI, the death was not related to procedure. One patient developed anemia due to large hematoma after the procedure.Conclusion:Screening for aortic valve pathology is essential as AS is not rare in SSc patients especially in those with long standing limited disease and positivity to centromere antibodies. AS in SSc patients may be associated with clinically significant coronary artery disease. TAVI was safe in our SSc patients without in-hospital mortality and benign long-term outcome.Disclosure of Interests:Alexandra Balbir-Gurman Consultant of: Novartis, Yolanda Braun-Moscovici: None declared

Download Full-text

P-391 Antibiotic prophylaxis for permanent pacemaker implantation with a single dose of cefazolin: Incidence of infective complications during long-term follow-up

EP Europace ◽

10.1016/eupace/4.supplement_2.b158-b ◽

2003 ◽

Vol 4 (Supplement_2) ◽

pp. B158-B158

Author(s):

F. Zerbo ◽

E. Bertaglia ◽

F. Zoppo ◽

P. Pascotto ◽

S. Zardo ◽

...

Keyword(s):

Single Dose ◽

Antibiotic Prophylaxis ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Permanent Pacemaker Implantation ◽

Long Term Follow Up ◽

Infective Complications

Download Full-text

Problems in the diagnosis of discordant atrioventricular with concordant ventriculo-arterial connections: anatomical considerations, surgical management, and long-term outcome

Cardiology in the Young ◽

10.1017/s1047951115000736 ◽

2015 ◽

Vol 26 (1) ◽

pp. 127-138 ◽

Cited By ~ 1

Author(s):

Daniela Laux ◽

Lucile Houyel ◽

Fanny Bajolle ◽

Francesca Raimondi ◽

Younes Boudjemline ◽

...

Keyword(s):

Surgical Management ◽

Heart Defects ◽

Pacemaker Implantation ◽

Heterotaxy Syndrome ◽

Term Outcome ◽

Long Term Outcome ◽

Atrial Switch ◽

Great Vessels

AbstractBackgroundDiscordant atrioventricular with concordant ventriculo-arterial connections is a rare cardiac defect. When isolated, the haemodynamics resemble transposition of the great arteries. In complex heart defects such as heterotaxy, haemodynamics guide the surgical approach.ObjectiveTo report a series of eight patients with discordant atrioventricular and concordant ventriculo-arterial connections focussing on anatomical and diagnostic difficulties, surgical management, and follow-up.MethodsA retrospective review was carried out from 1983 to 2013. Anatomical description was based on segmental analysis. Emphasis was placed on the venoatrial connections.ResultsSegmental arrangement was {I, D, S} in six patients, all with spiralling great vessels. There were two patients with parallel great vessels of whom one had {S, L, D} and the other had {S, L, A} arrangement. Of eight patients, five had heterotaxy syndrome. Median age at repair surgery was 1.4 years (with a range from 1.1 months to 8.1 years). The repair surgery finally performed was the atrial switch procedure in seven out of eight patients. The main post-operative complications were two cases of baffle obstruction and one sick sinus syndrome needing pacemaker implantation. There were two early post-operative deaths and six late survivors. Median follow-up was 4.2 years (with a range from 3.9 to 26.7 years) with good functional status in all survivors.DiscussionDiagnosing discordant atrioventricular with concordant ventriculo-arterial connections remains challenging. There are ongoing controversies about the definition of atrial morphology and heterotaxy syndrome animating the anatomic discussion of these complex heart defects. Haemodynamically, the atrial switch procedure is the surgical method of choice with an encouraging long-term follow-up despite rhythm disturbances and baffle obstruction.

Download Full-text

Are Prolonged Ventricular Pauses in Atrial Fibrillation a Marker of Poor Prognosis?

Cardiology ◽

10.1159/000520183 ◽

2021 ◽

Author(s):

Dorte Marie Stavnem ◽

Rakin Hadad ◽

Bjørn Strøier Larsen ◽

Olav Wendelboe Nielsen ◽

Mark Aplin Frederiksen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Poor Prognosis ◽

Pacemaker Implantation ◽

Real Life ◽

Increased Risk ◽

All Cause Mortality ◽

Long Term Prognosis ◽

Rate Limiting

Background: In patients with atrial fibrillation (AF), the long-term prognosis of long electrocardiographic pauses in the ventricular action is not well-studied. Methods: Consecutive Holter recordings in patients with AF (n=200) between 2009-2011 were evaluated, focusing on pauses of at least 2.5 s. Outcomes of interest were all-cause mortality and pacemaker implantation. Results: Forty-three patients (21.5%) had pauses with a mean of 3.2 s and SD of 0.9 s. After a median follow-up of 99 months (ranging 89-111), 47% (20/43) of the patients with, and 45% (70/157) without pauses were deceased. Pauses of ≥ 2.5 s did not constitute a risk of increased mortality: HR = 0.75; (95% CI: 0.34 - 1.66); p = 0.48. Neither did pauses of ≥ 3.0 s: HR = 0.43; (95% CI: 0.06 - 3.20); p = 0.41. Sixteen percent of patients with pauses underwent pacemaker implantation during follow-up. Only pauses in patients referred to Holter due to syncope and/or dizzy spells were associated with an increased risk of pacemaker treatment: HR = 4.7 (95% CI: 1.4-15.9), p = 0.014, adjusted for age, sex and rate-limiting medication. Conclusion: In patients with AF, prolonged electrocardiographic pauses of ≥ 2.5 s or ≥ 3.0 s are not a marker for increased mortality in this real-life clinical study.

Download Full-text

Pacemaker use for the treatment of reflex-mediated syncope: 40-year experience at a single paediatric institution

Cardiology in the Young ◽

10.1017/s1047951121004340 ◽

2021 ◽

pp. 1-6

Author(s):

Thomas Huang ◽

Edward O’Leary ◽

Mark E. Alexander ◽

Laura Bevilacqua ◽

Francis Fynn-Thompson ◽

...

Keyword(s):

Young Adults ◽

Atrioventricular Block ◽

Sinus Bradycardia ◽

Pacemaker Implantation ◽

Complication Rates ◽

Single Centre Experience ◽

Procedural Complications ◽

Children And Young Adults ◽

Dual Chamber Pacemakers

Abstract Introduction: Reflex-mediated syncope occurs in 15% of children and young adults. In rare instances, pacemakers are required to treat syncopal episodes associated with transient sinus pauses or atrioventricular block. This study describes a single centre experience in the use of permanent pacemakers to treat syncope in children and young adults. Materials and methods: Patients with significant pre-syncope or syncope and pacemaker implantation from 1978 to 2018 were reviewed. Data collected included the age of presentation, method of diagnosis, underlying rhythm disturbance, age at implant, type of pacemaker implanted, procedural complications and subsequent symptoms. Results: Fifty patients were identified. Median age at time of the first syncopal episode was 10.2 (range 0.3–20.4) years, with a median implant age of 14.9 (0.9–34.3) years. Significant sinus bradycardia/pauses were the predominant reason for pacemaker implant (54%), followed by high-grade atrioventricular block (30%). Four (8%) patients had both sinus pauses and atrioventricular block documented. The majority of patients had dual-chamber pacemakers implanted (58%), followed by ventricular pacemakers (38%). Median follow-up was 6.7 (0.4–33.0) years. Post-implant, 4 (8%) patients continued to have syncope, 7 (14%) had complete resolution of their symptoms, and the remaining reported a decrease in their pre-syncopal episodes and no further syncope. Twelve (24%) patients had complications, including two infections and eight lead malfunctions. Conclusions: Paediatric patients with reflex-mediated syncope can be treated with pacing. Complication rates are high (24%); as such, permanent pacemakers should be reserved only for those in whom asystole from sinus pauses or atrioventricular block has been well documented.

Download Full-text

Application of mini-invasive surgical instruments in transaortic myectomy for hypertrophic obstructive cardiomyopathy: A single-center experience with 168 cases

10.21203/rs.3.rs-41879/v1 ◽

2020 ◽

Author(s):

Qiang Ji ◽

YuLin Wang ◽

Ye Yang ◽

Hao Lai ◽

WenJun Ding ◽

...

Keyword(s):

New York ◽

Pacemaker Implantation ◽

Heart Association ◽

Technical Difficulty ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Surgical Instruments ◽

Septal Myectomy ◽

Refractory Symptoms ◽

Early Results

Abstract Background: Septal myectomy has been a standard treatment option for patients with hypertrophic obstructive cardiomyopathy (HOCM) and drug refractory symptoms. However, there are only a few experienced myectomy centers in the world so far, mainly because of high technical difficulty of myectomy. From our clinical experience, the use of the mini-invasive surgical instruments during myectomy may be beneficial to reduce the technical difficulty. This study reports the preliminary experience regarding transaortic septal myectomy using mini-invasive surgical instruments for the treatment of patients with HOCM and drug refractory symptoms, and evaluates the early results following myectomy.Methods Between March 2016 and March 2019, consecutive HOCM patients were included in this analysis who underwent isolated transaortic septal myectomy using the mini-invasive surgical instruments. Intraoperative, in-hospital and follow-up results were analyzed.Results A total of 168 eligible patients (83 males, mean 56.8 ± 12.3 years) were included. Midventricular obstruction was recorded in 7 (4.2%) patients. All included patients underwent transaortic septal myectomy with a mean aortic cross-clamping time of 36.0 ± 8.1 minutes. Nine (5.4%) patients received repeat aortic cross-clamping during surgery. Surgical mortality was 0.6%. Five (3.0%) patients developed complete atrioventricular block and required permanent pacemaker implantation. The median follow-up time was 6 months. No follow-up deaths occurred with a significant improvement in New York Heart Association functional status. The maximum gradients decreased sharply from the preoperative value (11.6 ± 7.4 mmHg vs. 94.4 ± 2 2.6 mmHg, p<0.001). The median degree of mitral regurgitation fell to 1.0 (vs. 3.0 preoperatively, p<0.001) with a significant reduction in the proportion of moderate or more regurgitation (1.2% vs. 57.7%, p<0.001).Conclusions The use of the mini-invasive surgical instruments may be beneficial to reduce the technical difficulty of transaortic septal myectomy procedure. Transaortic septal myectomy using the mini-invasive surgical instruments may be associated with favorable results.

Download Full-text

Atrial High-Rate Event Incidence and Predictors in Patients With Permanent Pacemaker Implantation

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.728885 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jian Hua Chen ◽

Guo Yao Chen ◽

Hong Zheng ◽

Quan He Chen ◽

Fa Yuan Fu ◽

...

Keyword(s):

Cox Regression ◽

Previous History ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

High Rate ◽

Atrial Pacing ◽

Patient Age ◽

Cox Regression Analysis ◽

Patient Âgé

Objective: The present study aims to investigate the incidence and predictors of atrial high-rate events (AHREs) in patients with permanent pacemaker implants.Methods: A total of 289 patients who were implanted with a dual-chamber pacemaker due to complete atrioventricular block or symptomatic sick sinus syndrome (SSS) and had no previous history of atrial fibrillation were included in the present study. AHREs are defined as events with an atrial frequency of ≥175 bpm and a duration of ≥5 min. The patients were divided into two groups according to whether or not AHREs were detected during the follow-up: group A (AHRE+, n = 91) and group N (AHRE–, n = 198).Results: During the 12-month follow-up period, AHREs were detected in 91 patients (31.5%). The multivariate Cox regression analysis revealed that patient age [odds ratio [OR] = 1.041; 95% confidence interval [CI], 1.018–1.064; and P < 0.001], pacemaker implantation due to symptomatic SSS (OR = 2.225; 95% CI, 1.227–4.036; and P = 0.008), and the percentage of atrial pacing after pacemaker implantation (OR = 1.010; 95% CI, 1.002–1.017; and P = 0.016) were independent AHRE predictors.Conclusion: The AHRE detection rate in patients with pacemaker implants was 31.5%. Patient age, pacemaker implantation due to symptomatic SSS, and the percentage of atrial pacing after pacemaker implantation were independent AHRE predictors.

Download Full-text