scholarly journals Cardioneuroablation for Treatment of Atrioventricular Block

2021 ◽  
Author(s):  
Tolga Aksu ◽  
Rakesh Gopinathannair ◽  
Serdar Bozyel ◽  
Kivanc Yalin ◽  
Dhiraj Gupta
Keyword(s):  
Atrioventricular Block ◽  
Vasovagal Syncope ◽  
Pacemaker Implantation ◽  
Holter Monitoring ◽  
High Grade ◽  
Structural Factors ◽  
Transseptal Puncture ◽  
Medium Term ◽  
Procedural Success

Background: The contribution of autonomic influences to atrioventricular block (AVB) is unclear. Although cardioneuroablation has been used to treat cardioinhibitory vasovagal syncope, its role in treating functional paroxysmal and persistent AVB has not been formally evaluated. Methods: We used a stepwise protocol in 241 consecutive patients presenting with symptomatic AVB to identify 31 (12.9%) patients with functional or vagally mediated AVB. All patients had episode(s) of syncope in previous 12 months, and AVB was persistent in 17 (54.8%) patients. All 31 patients received targeted catheter-based cardioneuroablation, and their follow-up outcomes were evaluated with serial Holter monitoring. Results: Twenty-eight patients received biatrial or left-sided cardioneuroablation while 3 received only right-sided cardioneuroablation because of structural factors that precluded safe attempts at transseptal puncture. Procedural success, as defined as acute reversal of AVB and complete abolition of atropine response, was achieved in 30 (96.7%) cases, while the remaining patient received a pacemaker. Over a mean follow-up of 19.3±15 months, AVB episodes were observed in 2 (6.7%) of 30 cases, and 3 (9.6%) patients required pacemaker implantation during follow-up. Conclusions: Functional AVB can be identified in a minority of patients presenting with high-grade AVB. Cardioneuroablation for these patients results in encouraging medium-term outcomes.

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

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.

Anatomical predictors of high grade atrioventricular conduction disorders in patients with specific pacemaker implanted after TAVI

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
P Frey ◽  
A Brochier ◽  
N Nezzouhairi ◽  
D Irles
Keyword(s):  
Atrioventricular Block ◽  
Pacemaker Implantation ◽  
Atrioventricular Conduction ◽  
High Grade ◽  
Av Block ◽  
Conduction Disorders ◽  
Transcatheter Aortic Valve ◽  
The Difference ◽  
Valve Implantation ◽  
Membranous Septum

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf STIM TAVI-MS study Background  The evolution of atrioventricular conduction disorders after transcatheter aortic valve implantation (TAVI) remains poorly understood. Recent studies have identified short membranous septum (MS) length, deep implantation depth (ID) or their relation as anatomic risk of high-grade AV block and permanent pacemaker implantation. Purpose : We sought to examine whether the atrioventricular (AV) membranous septum (MS) measured by computed tomography (CT) and the depth of valve implantation measured from the final aortic angiogram could predict high-grade atrioventricular block (HG AVB) after TAVI, based on specific pacemaker memory data. Methods STIM-TAVI-MS was a prospective, multicentre observational study that enrolled patients implanted with a specific dual chamber pacemaker after TAVI, with the SafeR algorithm activated, allowing continuous monitoring of atrioventricular conduction. The primary endpoint was the occurrence of late (after Day 7) high-grade atrioventricular block(s) during the year after TAVI. We measured on CT scans the coronal MS lenght, infra-annular MS lenght and the quantification of calcifications, on the final angiogram after TAVI we measured the implant depth (ID) to identifie ΔID-MS corresponding to the difference between implant depth and MS length. The variables were compared with the occurrence of late HG-AVB on PM memory data. Results : Among 82 patients, (mean age 84,5 years ± 4,8, self-expending valve n = 24, 29,3%), n = 47 (57.3%) had ≥1 late high-grade atrioventricular block. Mean coronal MS length was 8,1 ± 2,5 mm, mean infra annular MS was 3,4 ± 3.1 mm, mean calcification volume was 93.0 ± 88, 85,5± 104 and 141,5 ± 137,5 mm3 for the noncoronary, right coronary and left coronary cusp respectively. Mean implant depth was 7,3 ± 3,3mm, and mean ΔID-MS = -0,7 ± 4,1mm. There were no association between MS length (OR = 1,06; CI 0,91 to 1,24), ID (OR = 1,6; CI 0,85 to 2,9), nor ΔID-MS (OR = 0,67; CI 0,37 to 1,23) and late HG AVB. Calcification volume were not associated with late HG AVB. Conclusion In an high risk high grade AV block population after TAVI, anatomical analysis of MS length, degree of calcification, implant depth and ΔID-MS did not predict occurrence of late (> day 7 after TAVI ) high grade AV Blocks. Abstract Figure. CT scan A : aortic plane, B : MS lenght

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

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.

TP5.2.5 The utility of ‘kissing’ common iliac artery stents in the management of occlusive atherosclerotic arterial disease of the aortic bifurcation

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jenna Delaney ◽  
Joshua Templeman ◽  
Keith Hussey
Keyword(s):  
Arterial Disease ◽  
Aortic Bifurcation ◽  
Technical Success ◽  
Medium Term ◽  
Major Morbidity ◽  
Number Of Patients ◽  
Co Morbidity ◽  
Procedural Success ◽  
Good Medium

Abstract Introduction A systematic review published in 2017 concluded that ‘kissing’ iliac stents to treat occlusive disease of the aortic bifurcation was associated with high technical procedural success and good medium-term patency. We have explored this in a regional vascular unit. Methods Retrospective review of patients managed with endovascular treatment of aorto-iliac segment (March 2015 to September 2020). The median follow-up was 2-years. Key outcome variables included the patency of the reconstruction and requirement for secondary intervention. Results There were 1,348 iliac endovascular procedures performed for occlusive atherosclerotic arterial disease of the aorto-iliac segment of which 56 were ‘kissing’ iliac stents. Intervention was performed for chronic limb threatening ischaemia in 29 cases. In 37 cases patients had unilateral symptoms only and in 41 cases patients had either TASC A or B lesions. Technical success was achieved in 55 cases and the median duration of admission was 1-day. At follow-up there was clinical patency in 54 cases, although there were 3 major extremity amputations performed (all on the index admission). Conclusion As with much of the work on ‘kissing’ iliac stents the number of patients is small and the group of patients variable in terms of medical co-morbidity, presenting clinical features and morphology of iliac disease. The procedure appears to have high technical success and can be achieved with little in the way of major morbidity. Medium term durability is good.

scholarly journals Indications and predictors for pacemaker implantation after isolated aortic valve replacement with bioprostheses: the CAREAVR study

2020 ◽  
Vol 31 (3) ◽  
pp. 398-404
Author(s):  
Samuli J Salmi ◽  
Tuomo Nieminen ◽  
Juha Hartikainen ◽  
Fausto Biancari ◽  
Joonas Lehto ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Atrioventricular Block ◽  
Sick Sinus Syndrome ◽  
Pacemaker Implantation ◽  
Left Ventricular Ejection ◽  
Surgical Aortic Valve Replacement

Abstract OBJECTIVES We sought to study the indications, long-term occurrence, and predictors of permanent pacemaker implantation (PPI) after isolated surgical aortic valve replacement with bioprostheses. METHODS The CAREAVR study included 704 patients (385 females, 54.7%) without a preoperative PPI (mean ± standard deviation age 75 ± 7 years) undergoing isolated surgical aortic valve replacement at 4 Finnish hospitals between 2002 and 2014. Data were extracted from electronic patient records. RESULTS The follow-up was median 4.7 years (range 1 day to 12.3 years). Altogether 56 patients received PPI postoperatively, with the median 507 days from the operation (range 6 days to 10.0 years). The PPI indications were atrioventricular block (31 patients, 55%) and sick sinus syndrome (21 patients, 37.5%). For 4 patients, the PPI indication remained unknown. A competing risks regression analysis (Fine–Gray method), adjusted with age, sex, diabetes, coronary artery disease, preoperative atrial fibrillation (AF), left ventricular ejection fraction, New York Heart Association class, AF at discharge and urgency of operation, was used to assess risk factors for PPI. Only AF at discharge (subdistribution hazard ratio 4.34, 95% confidence interval 2.34–8.03) was a predictor for a PPI. CONCLUSIONS Though atrioventricular block is the major indication for PPI after surgical aortic valve replacement, >30% of PPIs are implanted due to sick sinus syndrome during both short-term follow-up and long-term follow-up. Postoperative AF versus sinus rhythm conveys >4-fold risk of PPI. Clinical trial registration clinicaltrials.gov Identifier: NCT02626871

P2834Diagnostic yield of holter recording after atrial fibrillation ablation - detection of asymptomatic recurrences during a one-year follow-up period

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S P G Van Vugt ◽  
R H J A Volleberg ◽  
S W Westra ◽  
J Thannhauser ◽  
R Evertz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Diagnostic Yield ◽  
Holter Monitoring ◽  
Implantable Devices ◽  
Cryoballoon Ablation ◽  
Procedural Success ◽  
One Year ◽  
The One

Abstract Background Strategies to detect recurrences after atrial fibrillation (AF) catheter ablation vary widely. Whereas a symptom-based approach may overestimate procedural success due to asymptomatic recurrences, continuous invasive monitoring with implantable devices may be refused by patients and is not routinely recommended. In trial settings, Holter monitoring is recommended at one year after ablation, though more frequent and intensive follow-up is encouraged for more accurate detection of arrhythmia recurrences. Purpose To study the diagnostic yield of Holter monitoring in the detection of asymptomatic recurrent arrhythmias after cryoballoon catheter ablation for AF. Methods Prospective registry on AF patients who underwent cryoballoon ablation with subsequent follow-up in our centre. Follow-up comprised routine (i.e. at 3, 6, and 12 months) and symptom-driven electrocardiographic (ECG) registrations after a three-month blanking period. In addition, patients were scheduled for six-day Holter monitoring shortly after the blanking period, at six months and at the end of the one-year follow-up period. For the current analysis, we studied the Holter recordings of the patients without previously detected arrhythmia recurrence and determined the proportion of asymptomatic recurrences at each respective monitoring period. Results We studied 364 patients with a median age of 60 years (IQR 54–66) and a median CHA2DS2-VASc score of 1 (IQR 1–2). One-year recurrences were documented in 119 (32.7%) patients, of which 90 were initially detected on Holter recording and 39 on ECG registrations (Table). A total of 34 patients did not report symptoms during the documentation of recurrent arrhythmia and comprised 28.6% (34/119) of all recurrences and 37.8% (34/90) of the Holter-detected recurrences. At the three-month Holter registration, 33.3% of the patients with recurrences did not report symptoms, which was 29.4% and 62.5% at the six- and twelve-month registrations, respectively (Figure). Timing and detection of recurrences Time after ablation 3 months 3–6 months 6 months 6–12 months 12 months Patients with Holter-detected recurrences 57/119 (47.9%) 17/119 (14.3%) 16/119 (13.4%) Patients with ECG-documented recurrences 18/119 (15.1%) 11/119 (9.2%) Proportions of asymptomatic recurrences Conclusions In this cohort of AF patients with serial six-day Holter monitoring after cryoballoon ablation, up to one-third of the patients had asymptomatic recurrences. Whereas Holter monitoring shortly after the blanking period detected nearly half of all one-year recurrences, the proportion of asymptomatic detected recurrences was higher in recordings at one year and seems therefore important in the detection of asymptomatic recurrences after catheter ablation.

scholarly journals Medium-term results of undersized angioplasty and stenting for symptomatic high-grade intracranial atherosclerotic stenosis with Enterprise

2019 ◽  
Vol 25 (5) ◽  
pp. 484-490 ◽  
Author(s):  
Aysun Erbahceci Salik ◽  
Hatem H Selcuk ◽  
Hasanagha Zalov ◽  
Fatih Kilinc ◽  
Musa Cirak ◽  
...  
Keyword(s):  
Success Rate ◽  
Balloon Angioplasty ◽  
High Grade ◽  
Intracranial Artery ◽  
Technical Success ◽  
Medium Term ◽  
Stent Deployment ◽  
Technical Success Rate ◽  
Angioplasty And Stenting

Purpose The aim of this retrospective study is to evaluate medium-term results of undersized balloon angioplasty and stenting for symptomatic high-grade (70–99%) stenosis of a major intracranial artery with Enterprise stent. Methods This study included 68 consecutive symptomatic (recurrent transient ischemic attack (TIA) or ischemic stroke under dual antiplatelet treatment) patients with high-grade (70–99%) stenosis of a major intracranial artery who were endovascularly treated with undersized balloon angioplasty and Enterprise stent deployment between July 2012 and December 2017. Primary outcomes were any stroke or death within 30 days after procedure. Secondary outcomes were technical success rates, stroke and restenosis during the follow-up period. Results A total of 68 lesions in 68 patients (mean age: 62 ± 7 years) were treated with a technical success rate of 99%. The degree of pre-procedural stenosis was 92 ± 6% and dropped to 12 ± 10% after stent deployment. No patient developed any stroke or death during the periprocedural period. Intracranial hemorrhage was observed in 1 (1.5%) patient. In 60 (88%) patients with available imaging follow-up in-stent restenosis was observed in 2 patients. Mean follow-up period was 22 ± 17 months (range 6–72) and none of the patients experienced recurrent TIA or stroke during the follow-up period. Conclusion In this retrospective single-center study undersized balloon angioplasty and deployment of a self-expandable stent with relatively low radial force was safe and effective for endovascular treatment of high-grade intracranial arterial stenosis with high technical success rate, low periprocedural complication rates and favorable medium-term follow-up results.

scholarly journals Medium-term follow-up and modes of failure following epicardial pacemaker implantation in young children†

EP Europace ◽  
2007 ◽  
Vol 9 (2) ◽  
pp. 94-97 ◽  
Author(s):  
Farhad Bakhtiary ◽  
Omer Dzemali ◽  
Christian K. Bastanier ◽  
Anton Moritz ◽  
Peter Kleine
Keyword(s):  
Young Children ◽  
Pacemaker Implantation ◽  
Medium Term ◽  
Modes Of Failure
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