P514Externalised pacemakers are valuable in treatment of brady as well as tachyarrhythmias - a single tertiary non device extraction cardiac center experience

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
G Panchal ◽  
S Ahmad ◽  
C Spencer ◽  
C Barr ◽  
A Arya ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Medical Condition ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Level Of Evidence ◽  
Published Evidence ◽  
Node Disease ◽  
Overdrive Pacing ◽  
Device Extraction ◽  
Cardiac Center

Abstract Introduction Temporary transvenous pacing (TPW) is a very useful procedure to control symptoms and/or correct significant hemodynamic compromise secondary to acute bradycardia as well as ventricular arrhythmias. It can be associated with significant complications (14-40%) e.g., loss of capture, displacement, infection, perforation, venous thrombosis, pulmonary embolism, or rarely, even death. The 2018 ACC/AHA/HRS guidelines on the management of bradycardia give a Class IIa indication for externalised pacemakers (ExPPM) in patients requiring prolonged TPW support while the 2015 ESC guidelines on ventricular arrhythmias and sudden cardiac death give a Class IIa indication for overdrive pacing in the setting of acute coronary syndromes. However, published evidence for the former indication is modest (Level of evidence: B-NR) and lacking for the latter (Level of evidence: C).  Aim To describe the experience of use of ExPPM in a high volume single tertiary non device extraction cardiac center over 45 months.  Methods   Retrospective study of medical records from January 2016 - September 2019.   Results  N = 34 during which the centre undertook 1341 new simple and complex device implants. Mean age: 73 ± 12 years, 20/34 (58.8%) males. Indication: symptomatic sinus node disease: 7/34 (20.6%), AV node disease: 23/34 (67.6%%), overdrive pacing for ventricular arrhythmias: 4/34 (11.8%) - late monomorphic VT secondary ST elevation myocardial infarction 2/4, polymorphic VT secondary to methadone toxicity 1/4, ventricular fibrillation secondary to bradyarrhythmia 1/4. Majority (27/34, 79.4%) had an ExPPM  because of sepsis (pneumonia 12/27; unknown focus 3/27,  TPW site infection 2/27, biliary sepsis, necrotising fasciitis, urinary tract infection, sternal wound infection, endocarditis, thrombophlebitis 1 each. Mean duration of implantation: 13.9 ± 11 days. Right internal jugular vein was the most common site (22/34, 64.7%) for introduction of the active fixation lead. Type of ExPPM: single chamber (VVI): 32/34 (94.1%), dual chamber (DDD): 2/34 (5.9%). 13/15 (38.2%) underwent permanent pacemaker implantation and 2/15 (13.3%) cardiac resynchronisation therapy - defibrillator following an ExPPM. Complications: 1/34 (2.9%) bleeding from the puncture site requiring transfusion. Six patients died during the course with deterioration in co-existing medical condition. Conclusion In our experience, ExPPM are not only a very useful intervention in patients who require prolonged support for bradyarrhythmias but can also be used to stabilise patients with recurrent tachyarrhythmias who need overdrive suppression, buying vital time before proceeding to definite therapy. They are associated with a low complication rate. We recommend that centers should have a low threshold for implanting such devices at the outset, in preference to TPW, in those patients where prolonged stabilisation of the heart rhythm is anticipated.

scholarly journals Characteristics, indications and complications in patients undergoing permanent pacemaker implantation: a single centre study

2018 ◽  
Vol 6 (12) ◽  
pp. 4053
Author(s):  
Sanjeev Bhat ◽  
Dharminder Kumar ◽  
Aditi Parimoo
Keyword(s):  
Sinus Node ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Single Chamber ◽  
Common Indication ◽  
Permanent Pacemaker Implantation ◽  
Pacing Mode ◽  
Node Disease ◽  
Sinus Node Disease ◽  
Pacemaker Insertion

Background: To determine the demographic details, indications, type of pacemakers and complications in patients undergoing the permanent pacemaker implantation.Methods: This was a single-center, retrospective study conducted in at a tertiary-care center in India. The records of 200 patients who had undergone implantation of permanent pacemakers in the period of May 2016 to April 2018 were reviewed.Results: Total 200 patients with mean age of 67 years were paced. Of these 120 (60%) were males. The mean duration of hospital stay was 6.5 days. Sinus node disease (105 patients, 52.5%) was the most common indication for permanent pacemaker insertion. Single chamber (VVIR) pacing mode (125 patients, 62.5%) was found to be the most common pacing mode used for pacemaker insertion. Among the 200 patients complications were observed in 8 patients (4%). Of these 8 patients, pneumothorax (4 patients, 2%) was found to be the most common complication for permanent pacemaker implantation followed by local site infection (1 patient, 0.5%). Only 1 patient (0.5%) died during the observation period of the study.Conclusions: Geriatric population with male predominance have observed to commonly undergo permanent pacemaker implantation. Sinus node disease in the elderly patients is the most common indication for cardiac pacing followed by atrioventricular block. Single chamber (VVIR) pacing mode is commonly used followed by dual chamber (DDDR) due to economic reasons in India. Pacemaker implantation is a relatively safe procedure with a low complication rate.

scholarly journals Corrigendum to “Falls and Fractures in the Elderly with Sinus Node Disease: The Impact of Pacemaker Implantation”

2017 ◽  
Vol 2017 ◽  
pp. 1-1
Author(s):  
Nazmi Krasniqi ◽  
Diana Segalada ◽  
Thomas F. Lüscher ◽  
Kurt Lippuner ◽  
Laurent Haegeli ◽  
...  
Keyword(s):  
Sinus Node ◽  
Pacemaker Implantation ◽  
The Elderly ◽  
Node Disease ◽  
Sinus Node Disease ◽  
The Impact

scholarly journals Atrial standstill in sinus node disease due to extensive atrial fibrosis: impact on dual chamber pacemaker implantation

EP Europace ◽  
2015 ◽  
Vol 18 (2) ◽  
pp. 238-245 ◽  
Author(s):  
Barbara Bellmann ◽  
Mattias Roser ◽  
Bogdan Muntean ◽  
Verena Tscholl ◽  
Patrick Nagel ◽  
...  
Keyword(s):  
Sinus Node ◽  
Pacemaker Implantation ◽  
Atrial Fibrosis ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Node Disease ◽  
Sinus Node Disease

New onset atrial fibrillation after dual chamber pacemaker implantation: long term predictors

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Ferreira ◽  
G Portugal ◽  
A Viveiros Monteiro ◽  
M Oliveira ◽  
P Silva Cunha ◽  
...  
Keyword(s):  
Cox Regression ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Dual Chamber ◽  
All Cause Mortality ◽  
Node Disease ◽  
Rv Pacing ◽  
New Onset

Abstract Background Preserving atrioventricular synchrony has been accepted as a significant advantage of atrial and dual-chamber (DDD) pacing. However, little is known about the incidence of atrial fibrillation (AF) after DDD implantation and its prognostic predictors in long term. Purpose To determine the incidence of new AF episodes and to identify risk factors and prognostic predictors for new-onset AF and all-cause mortality after implantation of dual-chamber pacemakers. Population and methods 713 consecutive patients (P) who underwent colocation of DDD pacemaker, due to AV block (AVB) or sinus node disease (SND), with no prior history of AF, from 2011 to 2015. Through periodic PM interrogation, occurrence of AF (“automatic mode switch” episodes with documented AF), switch to ventricular pacing (VVIR), pacing site (apical or septal) and cumulative right ventricular (RV) pacing % were analysed. Results Follow-up data was available for 669 patients (93.8%) for a mean follow-up (FU) time of 47.8±22.7 months. Mean age was 72.9±10.8 years with 60.1% male. New occurrence of AF was observed in 345 P (51.6%) during the FU period; 45.7% of them were consequently anticoagulated (59.0% with NOACs). Median time to 1st AF episode since implantation was 21.6 months and in 50.9% of the cases it lasted ≥1h. In univariate analysis, 1st AF episode lasting more than 1 hour and existence of at least one episode longer than 24 hours were directly related to switch to VVIR (p<0.0005; p<0.0005; p<0.0005) as well as prescription of anticoagulation (p=0.001; p=0.011; p<0.0005). Compared to non-AF P, those with AF were older (74.0±9.9 vs. 71.8±11.7 years; p=0.008), had higher prevalence of SND (50.0% vs 40.20%; p=0.015), had superior % of RV pacing (65.9±39.3% vs. 58.3±44.3%; p=0.021) and more frequently had RV apical pacing (70.1% vs 57.3%; p=0.001). The prevalence of hypertension, diabetes mellitus and dyslipidemia were similar in the two groups. With multivariable Cox-regression, age (HR 1.02; p=0.017), SND (HR 1.49; p=0.010), admission for HF (HR 1.55; p=0.012) and % RV pacing (HR 1.01; p=0.003) were significantly associated with the incidence of FA. Predictors of all-cause mortality in Cox regression were the occurrence of AF in 1st of FU (HR 1.67; p=0.018) and % RV pacing (HR 1.01; p=0.043). Conclusions New onset AF is a frequent finding after DDD pacemaker implantation and is associated with all-cause mortality in long term. Age, admission for heart failure, sinus node disease and % of RV pacing were independent predictors for AF during follow-up. Funding Acknowledgement Type of funding source: None

Sinus node disease: pathophysiology and natural history

ESC CardioMed ◽  
2018 ◽  
pp. 1945-1949
Author(s):  
Jonathan M. Kalman ◽  
Gwilym M. Morris
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Natural History ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Atrial Arrhythmia ◽  
Current Understanding ◽  
Exercise Limitation ◽  
Node Disease ◽  
Sinus Node Disease

Sinus node disease is the commonest bradyarrhythmia, often presenting as syncope or exercise limitation and is an important reason for pacemaker implantation. It is usually idiopathic and a disease of ageing with a peak incidence in the seventh decade of life, but may develop secondary to other conditions including heart failure and chronic endurance exercise. The detailed pathophysiology of sinus node disease remains unknown, studies have found evidence of widespread atrial electrical remodelling, and contemporary research suggests that cellular electrical and fibrotic changes may be important mediators of this remodelling. There is an important association between sinus node disease and atrial fibrillation, and the two arrhythmias often coexist, but the nature of this interaction remains a source of debate. This chapter will summarize the current understanding of the natural history and pathophysiology of sinus node disease, with a focus on remodelling and including discussion of theories that may explain the development of coexistent atrial arrhythmia in these patients.

Partial Anomalous Pulmonary Venous Connection: Forty-Six Years of Follow-Up

2021 ◽  
Vol 12 (1) ◽  
pp. 70-75
Author(s):  
Anne Kathrine M. Nielsen ◽  
Vibeke E. Hjortdal
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Sinus Node ◽  
Vena Cava ◽  
Node Disease ◽  
Sinus Node Disease ◽  
Patch Technique ◽  
Anomalous Pulmonary Venous Connection

Background: Surgical repair of partial anomalous pulmonary venous connection (PAPVC) may disturb the electrical conduction in the atria. This study documents long-term outcomes, including the late occurrence of atrial tachyarrhythmia and bradyarrhythmia. Methods: This retrospective study covers all PAPVC operations at Aarhus University Hospital between 1970 and 2010. Outcome measures were arrhythmias, sinus node disease, pacemaker implantation, pathway stenosis (pulmonary vein(s), intra-atrial pathway, and/or superior vena cava), and mortality. Data were collected from databases, surgical protocols, and hospital records until May 2018. Results: A total of 83 patients were included with a postoperative follow-up period up to 46 years. Average age at follow-up was 43 ± 21 years. During follow-up, new-onset atrial fibrillation or atrial flutter appeared in four patients (5%). Sinus node disease was present in nine patients (11%). A permanent pacemaker was implanted in seven patients (8%) at an average of 12.7 years after surgery. Pulmonary venous and/or superior vena cava obstruction was seen in five patients (6%). Stenosis was most prevalent in the two-patch technique, and arrhythmia was most prevalent in the single-patch technique. Sixty-seven (81%) of 83 patients had neither bradyarrhythmias nor tachyarrhythmias or pacemaker need. Conclusions: This study contributes important long-term data concerning the course of patients who have undergone repair of PAPVC. It confirms that PAPVC can be operated with low postoperative morbidity. However, late-onset stenosis, bradyarrhythmias and tachyarrhythmias, and need for pacemaker call for continued follow-up.

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