His bundle pacing capture threshold stability during long-term follow-up and correlation with lead slack

EP Europace ◽  
2020 ◽  
Author(s):  
Dominik Beer ◽  
Faiz A Subzposh ◽  
Shaun Colburn ◽  
Angela Naperkowski ◽  
Pugazhendhi Vijayaraman
Keyword(s):  
Confidence Interval ◽  
Delivery Systems ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Design Changes ◽  
Physiologic Form ◽  
Long Term Follow Up ◽  
Threshold Increase

Abstract Aims His bundle pacing (HBP) is the most physiologic form of pacing. Long-term HBP capture threshold stability and its relation to lead characteristics at the time of implantation have not been adequately described. The aim of this study was to characterize HB capture threshold in follow-up and to identify potential lead characteristics predictive of lead capture instability. Methods and results Consecutive patients with successful HBP for bradycardia indications were identified from the Geisinger HBP registry. His bundle capture thresholds, baseline comorbidities, and radiographic lead slack characteristics were analysed. An increase in HB capture threshold ≥1 V above implant values at any time during follow-up was tracked. Forty-four of the 294 studied (15%) experienced HB capture threshold increase by ≥ 1 V. Threshold increase was seen early (41% by 8 weeks, 66% by 1 year). Eighteen (6%) patients required lead revision in follow-up. Abnormal slack shape was associated with a trend toward capture threshold increase [hazard ratio (HR) 2.07; 95% confidence interval (CI) 0.9–4.6; P = 0.08]. Non-perpendicular angle of lead insertion on radiography was associated with the capture threshold increase (HR 2.81, 95% CI 1.4–5.8; P < 0.01). Conclusion His bundle capture threshold remains stable in the majority (85%) of patients. Implant characteristics may predict the threshold rise. Further evaluation of the aetiology of threshold increase and design changes in lead and delivery systems may lead to chronically stable capture thresholds.

scholarly journals Permanent His bundle pacing: Electrophysiological and echocardiographic observations from long-term follow-up

2017 ◽  
Vol 40 (7) ◽  
pp. 883-891 ◽  
Author(s):  
Pugazhendhi Vijayaraman ◽  
Gopi Dandamudi ◽  
Daniel Lustgarten ◽  
Kenneth A Ellenbogen
Keyword(s):  
His Bundle ◽  
His Bundle Pacing ◽  
Long Term Follow Up

Physiological Pacing: A New Road to Future

2021 ◽  
pp. 263246362097804
Author(s):  
Vanita Arora ◽  
Pawan Suri
Keyword(s):  
Side Effects ◽  
Fibrous Tissue ◽  
Cardiac Pacing ◽  
His Bundle ◽  
Anatomy And Physiology ◽  
Long Term Follow Up ◽  
Pacing Lead ◽  
The Right

Anatomy and physiology are the basis of human body functioning and as we have progressed in management of various diseases, we have understood that physiological intervention is always better than an anatomical one. For more than 50 years, a standard approach to permanent cardiac pacing has been an anatomical placement of transvenous pacing lead at the right ventricular apex with a proven benefit of restoring the rhythm. However, the resultant ventricular dyssynchrony on the long-term follow-up in patients requiring more than 40% ventricular pacing led to untoward side effects in the form of heart failure and arrhythmias. To counter such adverse side effects, a need for physiological cardiac pacing wherein the electrical impulse be transmitted directly through the normal conduction system was sought. His bundle pacing (HBP) with an intriguing alternative of left bundle branch pacing (LBBP) is aimed at restoring such physiological activation of ventricles. HBP is safe, efficacious, and feasible; however, localization and placement of a pacing lead at the His bundle is challenging with existing transvenous systems due to its small anatomic size, surrounding fibrous tissue, long-learning curve, and the concern remains about lead dislodgement and progressive electrical block distal to the HBP lead. In this article, we aim to take the reader through the challenging journey of HBP with focus upon the hardware and technique, selective versus nonselective HBP, indications and potential disadvantages, and finally the future prospects.

scholarly journals Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block

Heart ◽  
2018 ◽  
Vol 105 (2) ◽  
pp. 137-143 ◽  
Author(s):  
Weijian Huang ◽  
Lan Su ◽  
Shengjie Wu ◽  
Lei Xu ◽  
Fangyi Xiao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Bundle Branch Block ◽  
Nyha Class ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Patients With Heart Failure

ObjectivesHis bundle pacing (HBP) can potentially correct left bundle branch block (LBBB). We aimed to assess the efficacy of HBP to correct LBBB and long-term clinical outcomes with HBP in patients with heart failure (HF).MethodsThis is an observational study of patients with HF with typical LBBB who were indicated for pacing therapy and were consecutively enrolled from one centre. Permanent HBP leads were implanted if the LBBB correction threshold was <3.5V/0.5 ms or 3.0 V/1.0 ms. Pacing parameters, left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV) and New York Heart Association (NYHA) Class were assessed during follow-up.ResultsIn 74 enrolled patients (69.6±9.2 years and 43 men), LBBB correction was acutely achieved in 72 (97.3%) patients, and 56 (75.7%) patients received permanent HBP (pHBP) while 18 patients did not receive permanent HBP (non-permanent HBP), due to no LBBB correction (n=2), high LBBB correction thresholds (n=10) and fixation failure (n=6). The median follow-up period of pHBP was 37.1 (range 15.0–48.7) months. Thirty patients with pHBP had completed 3-year follow-up, with LVEF increased from baseline 32.4±8.9% to 55.9±10.7% (p<0.001), LVESV decreased from a baseline of 137.9±64.1 mL to 52.4±32.6 mL (p<0.001) and NYHA Class improvement from baseline 2.73±0.58 to 1.03±0.18 (p<0.001). LBBB correction threshold remained stable with acute threshold of 2.13±1.19 V/0.5 ms to 2.29±0.92 V/0.5 ms at 3-year follow-up (p>0.05).ConclusionspHBP improved LVEF, LVESV and NYHA Class in patients with HF with typical LBBB.

Long Term Follow up of Patients with Immune Thrombocytopenia Receiving Rituximab

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4675-4675 ◽  
Author(s):  
Khalid Al-Habsi ◽  
Murtadha K. Al-Khabori ◽  
Muhanna Al-Muslahi ◽  
Anil Pathare ◽  
Khalil Al Farsi ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Median Time ◽  
Immune Thrombocytopenia ◽  
Response Rate ◽  
Age At Diagnosis ◽  
Second Line ◽  
Long Term Follow Up ◽  
Chronic Immune Thrombocytopenia

Abstract Abstract 4675 Introduction: Rituximab has been used in the management of chronic immune thrombocytopenia (ITP) with promising results. The risk of losing response, however, is yet to be determined with long term follow up. Method: We retrospectively analyzed 32 consecutive patients (20 females, 12 males) with ITP (including 6 patients with secondary ITP) treated with rituximab in two tertiary care hospitals in Oman between May 2006 and May 2011. Response criteria were based on the International Consensus report (Rodeghiero F et al. Blood 2009). Result: The median age at diagnosis was 25 years (range, 4 – 58). Clinical presentation ranged from mild echymosis to more severe central nervous system bleeding. Patients received a median of one line of therapy before rituximab (range, 1–4), including 3 patients who failed splenectomy. Patients received intravenous rituximab using 375 mg/m2 once weekly for 4 weeks. The median time from diagnosis to receiving rituximab was 21 months (range, 1– 177). Only one patient was positive for Hepatitis C virus, but no hepatitis B or HIV positive in this cohort. Anti nuclear antibody was positive in 34% (10/29) of patients. The median hemoglobin and platelet counts at diagnosis were 12 g/dl (range, 5–16) and 11×109/L (range, 1–60) respectively. The median follow up time after rituximab was 26 months (95% confidence interval: 11–40). The overall cumulative response rate was 59% (partial response of 15% and complete response of 44%). The median time to respond was 30 days (Standard error [SE] 49) with a response rate of 44% at 4 weeks (95% Confidence interval: 29–62%). The multivariable Cox model analysis (variables include: age at diagnosis, gender, number of previous therapies and primary vs. secondary) revealed none of the variables included to be statistically significant. The cumulative rate of loss of response was 32% (6/19) with a median time to lose response of 54 months (SE, 0.03). In patients who lost response, the median time to lose response was 17 months (SE, 14). Of the 6 patients who lost response, 4 received a second course of rituximab and all 4 achieved a full response. No major side effects to rituximab were reported during the follow up. Conclusion: Rituximab is an effective and a well tolerated second line therapy for ITP. The response to rituximab can be maintained for a long duration with a high rate of response after retreatment. None of the pretreatment variables studied carried a significant predictive value for response. The study was limited by the small sample size and further larger prospective studies are recommended. Disclosures: Off Label Use: Rituximab was used in our study as a second line for the management of chronic immune thrombocytopenia.

Magna Ease versus Trifecta Early Hemodynamics

2018 ◽  
Vol 13 (4) ◽  
pp. 267-272 ◽  
Author(s):  
Bobby Yanagawa ◽  
Derrick Y. Tam ◽  
Kathryn Hong ◽  
Amine Mazine ◽  
Akshay Bagai ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Mean Difference ◽  
Effective Orifice Area ◽  
Orifice Area ◽  
Jude Medical ◽  
Long Term Follow Up

Objective This meta-analysis compares the early echocardiographic outcomes of aortic valve replacement using the two most commonly implanted stented bioprostheses. Methods We searched MEDLINE and EMBASE databases until 2017 for studies comparing Magna or Magna Ease (Edwards Lifesciences, Irvine, CA USA) versus Trifecta (St Jude Medical, St. Paul, MN USA) aortic bioprosthetic valves. A random-effects meta-analysis was performed for the primary outcome of mean gradient on echocardiography and secondary outcomes of effective orifice area, indexed effective orifice area, and in-hospital mortality. Results There were two randomized controlled trial, three matched, and six unmatched retrospective observational studies with 2119 patients [median reported follow-up = 6 months (interquartile range = 6 to 12)]. The Magna/Magna Ease valve was associated with higher early mean gradient (mean difference = 4.09, 95% confidence interval = 3.48 to 4.69, P < 0.0001) and smaller effective orifice area (mean difference = 0.30, 95% confidence interval = −0.38 to −0.22, P < 0.0001). There were no differences in 30-day mortality between Magna/Magna Ease and Trifecta (relative risk = 1.01, 95% confidence interval = 0.41 to 2.50, P = 1.0). Conclusions Trifecta may offer a small hemodynamic advantage compared with the Magna/Magna Ease valve with no differences in early mortality. Long-term follow-up is required to determine whether these differences persist and translate into differences in clinical outcomes.

Long-term performance and risk factors analysis after permanent His-bundle pacing and atrioventricular node ablation in patients with atrial fibrillation and heart failure

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii19-ii26
Author(s):  
Lan Su ◽  
Mengxing Cai ◽  
Shengjie Wu ◽  
Songjie Wang ◽  
Tiancheng Xu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrioventricular Node ◽  
Composite Endpoint ◽  
His Bundle ◽  
His Bundle Pacing ◽  
All Cause Mortality ◽  
Long Term Performance ◽  
Term Performance

Abstract Aims His-bundle pacing (HBP) combined with atrioventricular node (AVN) ablation has been demonstrated to be effective in patients with atrial fibrillation (AF) and heart failure (HF) during medium-term follow-up and there are limited data on the risk analysis of adverse prognosis in this population. In this study, we aimed to evaluate the long-term performance of HBP following AVN ablation in AF and HF. Methods and results From August 2012 to December 2017, consecutive AF patients with HF and narrow QRS who underwent AVN ablation and HBP were enrolled. The clinical and echocardiographic data, pacing parameters, all-cause mortality, and heart failure hospitalization (HFH) were tracked. A total of 94 patients were enrolled (age 70.1 ± 10.5 years; male 57.4%). Acute HBP were achieved in 89 (94.7%) patients with successful permanent HBP combined with AVN ablation in 81 (86.2%) patients. Left ventricular ejection fraction (LVEF) improved from 44.9 ± 14.9% at baseline to 57.6 ± 12.5% during a median follow-up of 3.0 (IQR: 2.0–4.4) years (P &lt; 0.001). Heart failure hospitalization or all-cause mortality occurred in 21 (25.9%) patients. The LVEF ≤ 40%, pulmonary artery systolic pressure (PASP) ≥40 mmHg, or serum creatinine (Scr) ≥97 μmol/L at baseline was significantly associated with higher composite endpoint of HFH or death (P &lt; 0.05). The His capture threshold was 1.0 ± 0.7 V/0.5 ms at implant and remained stable during follow-up. Conclusion His-bundle pacing combined with AVN ablation was effective in patients with AF and drug-refectory HF. High PASP, high Scr, or low LVEF at baseline was independent predictors of composite endpoint of all-cause mortality or HFH.

scholarly journals Cryosurgical ablation of the atrioventricular node-His bundle: long-term follow-up and properties of the junctional pacemaker.

Circulation ◽  
1980 ◽  
Vol 61 (1) ◽  
pp. 8-15 ◽  
Author(s):  
G J Klein ◽  
W C Sealy ◽  
E L Pritchett ◽  
L Harrison ◽  
D B Hackel ◽  
...  
Keyword(s):  
Atrioventricular Node ◽  
His Bundle ◽  
Long Term Follow Up ◽  
Cryosurgical Ablation

scholarly journals Percutaneous cervical coblation as therapeutic technique in the treatment of algo-dysfunctional pain of discal herniation

2021 ◽  
Author(s):  
Marco Pandolfi ◽  
Federica Galli ◽  
Anna Borelli ◽  
Martina Gurgitano ◽  
Alessandro Liguori ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Therapeutic Option ◽  
Discogenic Pain ◽  
Total Pain ◽  
Procedural Complication ◽  
Long Term Follow Up ◽  
Discal Herniation ◽  
The Mean

Abstract Objective To confirm the validity of coblation nucleoplasty in reduction of cervical discogenic nature. Study design In a monocentric prospective clinical observational study recruiting 20 patients, treated with percutaneous coblation for cervical discogenic pain in 16 months in our hospital, we have clinically evaluated 18 patients. The pain was scored with the Visual Analogic Scale (VAS) in a pre-procedural questionary, 3/4 monthly follow-up from treatment and, finally, in a long-term follow-up 2 years after procedure. Results The mean pre-procedural VAS score was 7.9 ± 1.6 (95%—Confidence Interval 7.198–8.634), while the mean post-procedural score after 3–4 months has been 2.5 ± 3.1 (95%—Confidence Interval 1.089–3.965) and 2.5 ± 2.5 (95%—Confidence Interval 1.367–3.687) after 2 years. Among 18 patients, in the shortly post-treatment follow-up, nine had a complete pain relief, four had a > 50% VAS reduction, two hada < 50% VAS reduction, three did not have any variation of VAS; after 2 years, six patients had a total pain resolution, eight had a > 50% VAS reduction, two hada < 50% VAS reduction, two did not have any benefit. No peri- and post-procedural complication has been observed. Conclusions In a spite of a little sample, our results showed coblation as a valid therapeutic option to reduce cervical discogenic pain in medicine-refractory patients, as an alternative or a previous choice before a more invasive surgical treatment.

scholarly journals Impact of renal cadaveric transplantation on survival in end-stage renal failure: evidence for reduced mortality risk compared with hemodialysis during long-term follow-up.

1998 ◽  
Vol 9 (11) ◽  
pp. 2135-2141 ◽  
Author(s):  
P Schnuelle ◽  
D Lorenz ◽  
M Trede ◽  
F J Van Der Woude
Keyword(s):  
Confidence Interval ◽  
End Stage Renal Disease ◽  
Waiting List ◽  
Long Term Follow Up ◽  
Transplantation Center ◽  
Stage Renal Disease ◽  
End Stage ◽  
Cadaveric Transplantation

Despite a superior quality of life and a favorable cost effectiveness, it has not been well established thus far whether renal cadaveric transplantation contributes to superior survival probability of end-stage renal disease patients in Europe, because the mortality rate on dialysis is lower compared with the United States. This analysis was undertaken to compare the mortality of wait-listed patients and transplant recipients during long-term follow-up, including the possibility of a retransplant in a single-center study. The study cohort included 309 consecutive patients, ages 17 to 72 yr, being registered on the waiting list of the Renal Transplantation Center of Mannheim since the initiation of the transplantation program on June 3, 1989. Follow-up was terminated on September 30, 1997, with a mean of 4.15 yr. A total of 144 renal cadaveric transplants (four retransplants) was performed during the follow-up period. A Cox regression model considering the time-dependent exposure to the different therapy modalities was applied for statistical analysis. Patients being removed from the waiting list or coming back to dialysis after transplantation were censored at time of withdrawal or graft failure. Transplantation resulted in a lower hazard ratio, which was 0.36 (95% confidence interval, 0.15 to 0.87) when the hazard of the wait-listed group was taken as 1.00. The underlying incidence rate of death was 0.026 per patient-year (0.032 on dialysis versus 0.016 with functioning graft). Performing the evaluation on an intention-to-treat basis without censoring the lower risk of the transplanted group was still pronounced according to a hazard ratio of 0.44 (95% confidence interval, 0.22 to 0.89). Thus, patients receiving a renal cadaveric transplantation have a substantial survival advantage over corresponding end-stage renal disease patients on the waiting list even in the setting of a single transplantation center where mortality on regular dialysis therapy was comparatively low.

Comparison of the surgical and follow-up costs associated with microsurgical resection and stereotactic radiosurgery for vestibular schwannoma

2008 ◽  
Vol 108 (6) ◽  
pp. 1220-1224 ◽  
Author(s):  
Ritesh Banerjee ◽  
James P. Moriarty ◽  
Robert L. Foote ◽  
Bruce E. Pollock
Keyword(s):  
Confidence Interval ◽  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Mayo Clinic ◽  
Long Term Follow Up ◽  
Patient Groups ◽  
Microsurgical Resection ◽  
Mean Cost

Object The best approach to the management of vestibular schwannoma (VS) remains controversial. The aim of this study is to analyze the initial and follow-up costs of resection and stereotactic radiosurgery for patients with VS. Methods Initial and follow-up costs in 53 cases in which patients with unilateral, previously unoperated VSs > 3 cm underwent resection (21 cases) or radiosurgery (32 cases) at the Mayo Clinic from June 2000 until July 2002 were analyzed for 36 months. Follow-up treatment-specific utilization records were gathered prospectively for patients not returning to the Mayo Clinic after treatment. Six-month moving averages of incremental follow-up costs were calculated for the 2 patient groups. Results The mean cost of surgery in the microsurgery group was $23,788 (95% confidence interval $22,280–$24,842) compared with $16,143 (95% confidence interval $15,277–$17,545) for the radiosurgical group. Mean incremental follow-up costs per month for patients in the microsurgery group started just > $1000 per month, decreased steadily, and remained < $70 per month by the 10th month of follow-up. Mean incremental follow-up costs per month for patients in the radiosurgery group were <$10 per month for the first few months and thereafter increased to as much as $200 per month. Conclusions Although the total cost of microsurgery is higher due to the costs of hospitalization, follow-up costs for radiosurgery are greater in general. From a societal perspective, radiosurgery is less expensive than microsurgical resection provided that the rate of tumor progression after radiosurgery remains low with long-term follow-up.

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