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Cardiac Device Therapy
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Cardiac Device Therapy

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Electrophysiology and Cardiovascular Physiology".

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 15102

Special Issue Editor

Dr. Michael Spartalis

E-Mail Website
Guest Editor
3rd Department of Cardiology, National and Kapodistrian University of Athens, 17674 Athens, Greece
Interests: cardiac electrophysiology; device therapy; atrial fibrillation; ventricular arrhythmias; sudden cardiac death; catheter ablation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The implantation of a cardiac device in patients with rhythm disturbances and heart failure is associated with a significant survival benefit and an improvement in cardiopulmonary exercise capacity, depending on the type of device. Because of technological advancements over the last two decades, there is a wide range of implantable cardiac device options for a wide range of clinical situations and indications. They range from pacemaker implantations for bradycardia and subsequent asymptomatic ventricular stimulation to implantable cardioverter–defibrillator (ICD) shock deliveries to heart-assisted devices (LVADs) that completely arrogate cardiac functions.

This Special Issue focuses on cardiac device therapy in a variety of interest areas: conduction system pacing in everyday clinical practice; implantable cardioverter defibrillator for the primary prevention of sudden cardiac death among patients with cancer; leadless pacemaker–defibrillator systems; the efficacy and safety of extravascular ICDs; the status of enabling strategies for patients with heart failure with reduced ejection fraction; and left bundle branch pacing versus biventricular pacing in cardiac resynchronization therapy.

Dr. Michael Spartalis
Guest Editor

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Keywords

  • device therapy
  • ICD
  • leadless
  • conduction
  • CRT
  • heart failure
  • arrhythmia
  • pacing

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Published Papers (7 papers)

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Research

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10 pages, 976 KiB  
Article
Risk of Cardiac Implantable Electronic Device Infection after Early versus Delayed Lead Repositioning
by Noemi Schvartz, Arian Haidary, Reza Wakili, Florian Hecker, Jana Kupusovic, Elod-Janos Zsigmond, Marton Miklos, Laszlo Saghy, Tamas Szili-Torok, Julia W. Erath and Mate Vamos
J. Cardiovasc. Dev. Dis. 2024, 11(4), 117; https://doi.org/10.3390/jcdd11040117 - 9 Apr 2024
Viewed by 1415
Abstract
(1) Background: Early reintervention increases the risk of infection of cardiac implantable electronic devices (CIEDs). Some operators therefore delay lead repositioning in the case of dislocation by weeks; however, there is no evidence to support this practice. The aim of our study was [...] Read more.
(1) Background: Early reintervention increases the risk of infection of cardiac implantable electronic devices (CIEDs). Some operators therefore delay lead repositioning in the case of dislocation by weeks; however, there is no evidence to support this practice. The aim of our study was to evaluate the impact of the timing of reoperation on infection risk. (2) Methods: The data from consecutive patients undergoing lead repositioning in two European referral centers were retrospectively analyzed. The odds ratio (OR) of CIED infection in the first year was compared among patients undergoing early (≤1 week) vs. delayed (>1 week to 1 year) reoperation. (3) Results: Out of 249 patients requiring CIED reintervention, 85 patients (34%) underwent an early (median 2 days) and 164 (66%) underwent a delayed lead revision (median 53 days). A total of nine (3.6%) wound/device infections were identified. The risk of infection was numerically lower in the early (1.2%) vs. delayed (4.9%) intervention group yielding no statistically significant difference, even after adjustment for typical risk factors for CIED infection (adjusted OR = 0.264, 95% CI 0.032–2.179, p = 0.216). System explantation/extraction was necessary in seven cases, all being revised in the delayed group. (4) Conclusions: In this bicentric, international study, delayed lead repositioning did not reduce the risk of CIED infection. Full article
(This article belongs to the Special Issue Cardiac Device Therapy)
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12 pages, 3581 KiB  
Article
A Comparative Assessment of Myocardial Work Performance during Spontaneous Rhythm, His Bundle Pacing, and Left Bundle Branch Area Pacing: Insights from the EMPATHY Study
by Giorgia Azzolini, Nicola Bianchi, Francesco Vitali, Michele Malagù, Cristina Balla, Martina De Raffele and Matteo Bertini
J. Cardiovasc. Dev. Dis. 2023, 10(11), 444; https://doi.org/10.3390/jcdd10110444 - 27 Oct 2023
Viewed by 1870
Abstract
Background: Physiological pacing has gained significant interest due to its potential to achieve optimal hemodynamic response. This study aimed to assess left ventricular performance in terms of electrical parameters, specifically QRS duration and mechanical performance, evaluated as myocardial work. We compared His Bundle [...] Read more.
Background: Physiological pacing has gained significant interest due to its potential to achieve optimal hemodynamic response. This study aimed to assess left ventricular performance in terms of electrical parameters, specifically QRS duration and mechanical performance, evaluated as myocardial work. We compared His Bundle Pacing (HBP) and Left Bundle Branch Area Pacing (LBBAP) to evaluate their effects. Methods: Twenty-four patients with class I or IIa indications for pacing were enrolled in this study, with twelve patients undergoing HBP implantation and another twelve undergoing LBBAP implantation. A comprehensive analysis of myocardial work was conducted. Results: Our findings indicate that there were no major differences in terms of spontaneous and HBP activation in myocardial work, except for global wasted work (217 mmHg% vs. 283 mmHg%; p 0.016) and global work efficiency (87 mmHg% vs. 82 mmHg%; p 0.049). No significant differences were observed in myocardial work between spontaneous activation and LBBAP. Similarly, no significant differences in myocardial work were found between HBP and LBBAP. Conclusions: Both pacing modalities provide physiological ventricular activation without significant differences when compared to each other. Moreover, there were no significant differences in QRS duration between HBP and LBBAP. However, LBBAP demonstrated advantages in terms of feasibility, as it achieved better lead electrical parameters compared to HBP ([email protected] ms 0.6 V vs. 1 V; p = 0.045—sensing 9.4 mV vs. 2.4 mV; p < 0.001). Additionally, LBBAP required less fluoroscopy time (6 min vs. 13 min; p = 0.010) and procedural time (81 min vs. 125 min; p = 0.004) compared to HBP. Full article
(This article belongs to the Special Issue Cardiac Device Therapy)
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14 pages, 1527 KiB  
Article
Shared Decision Making and Cardioneuroablation Allow Discontinuation of Permanent Pacing in Patients with Vagally Mediated Bradycardia
by Sebastian Stec, Antoni Wileczek, Agnieszka Reichert, Janusz Śledź, Jarosław Kosior, Dariusz Jagielski, Anna Polewczyk, Magdalena Zając, Andrzej Kutarski, Dariusz Karbarz, Dorota Zyśko, Łukasz Nowarski and Edyta Stodółkiewicz-Nowarska
J. Cardiovasc. Dev. Dis. 2023, 10(9), 392; https://doi.org/10.3390/jcdd10090392 - 11 Sep 2023
Cited by 6 | Viewed by 1595
Abstract
Background: Safe discontinuation of pacemaker therapy for vagally mediated bradycardia is a dilemma. The aim of the study was to present the outcomes of a proposed diagnostic and therapeutic process aimed at discontinuing or not restoring pacemaker therapy (PPM) in patients with vagally [...] Read more.
Background: Safe discontinuation of pacemaker therapy for vagally mediated bradycardia is a dilemma. The aim of the study was to present the outcomes of a proposed diagnostic and therapeutic process aimed at discontinuing or not restoring pacemaker therapy (PPM) in patients with vagally mediated bradycardia. Methods: The study group consisted of two subgroups of patients with suspected vagally mediated bradycardia who were considered to have PPM discontinued or not to restore their PPM if cardioneuroablation (CNA) would successfully treat their bradycardia. A group of 3 patients had just their pacemaker explanted but reimplantation was suggested, and 17 patients had preexisting pacemakers implanted. An invasive electrophysiology study was performed. If EPS was negative, extracardiac vagal nerve stimulation (ECVS) was performed. Then, patients with positive ECVS received CNA. Patients with an implanted pacemaker had it programmed to pace at the lowest possible rate. After the observational period and control EPS including ECVS, redo-CNA was performed if pauses were induced. The decision to explant the pacemaker was obtained based on shared decision making (SDM). RESULTS: After initial clinical and electrophysiological evaluation, 17 patients were deemed eligible for CNA (which was then performed). During the observational period after the initial CNA, all 17 patients were clinically asymptomatic. The subsequent invasive evaluation with ECVS resulted in pause induction in seven (41%) patients, and these patients underwent redo-CNA. Then, SDM resulted in the discontinuation of pacemaker therapy or a decision to not perform pacemaker reimplantation in all the patients after CAN. The pacemaker was explanted in 12 patients post-CNA, while in 2 patients explantation was postponed. During a median follow-up of 18 (IQR: 8–22) months, recurrent syncope did not occur in the CNA recipients. Conclusions: Pacemaker therapy in patients with vagally mediated bradycardia could be discontinued safely after CNA. Full article
(This article belongs to the Special Issue Cardiac Device Therapy)
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12 pages, 2040 KiB  
Article
Biventricular or Conduction System Pacing for Cardiac Resynchronization Therapy: A Strategy for Cardiac Resynchronization Based on a Hybrid Approach
by Amato Santoro, Federico Landra, Carmine Marallo, Simone Taddeucci, Nicolò Sisti, Andrea Pica, Andrea Stefanini, Maria Cristina Tavera, Antonio Pagliaro, Claudia Baiocchi and Matteo Cameli
J. Cardiovasc. Dev. Dis. 2023, 10(4), 169; https://doi.org/10.3390/jcdd10040169 - 14 Apr 2023
Cited by 5 | Viewed by 1788
Abstract
Background: Cardiac resynchronization therapy (CRT) is usually performed with biventricular pacing (BiVP), but recently, conduction system pacing (CSP) has been proposed as an alternative in case of BiVP failure. The aim of this study is to define an algorithm to choose between BiVP [...] Read more.
Background: Cardiac resynchronization therapy (CRT) is usually performed with biventricular pacing (BiVP), but recently, conduction system pacing (CSP) has been proposed as an alternative in case of BiVP failure. The aim of this study is to define an algorithm to choose between BiVP and CSP resynchronization using the interventricular conduction delays (IVCD) as a guide. Methods: Consecutive patients from January 2018 to December 2020 with an indication for CRT were prospectively enrolled in the study group (delays-guided resynchronization group, DRG). A treatment algorithm based on IVCD was used to decide whether to leave the left ventricular (LV) lead to perform BiVP or pull it out and perform CSP. Outcomes from the DRG group were compared to a historical cohort of CRT patients who underwent CRT procedures between January 2016 and December 2017 (resynchronization standard guide group, SRG). The primary endpoint was a composite of cardiovascular mortality, heart failure (HF) hospitalization, or HF event at 1 year after the date of intervention. Results: The study population consisted of 292 patients, of which 160 (54.8%) were in the DRG and 132 (45.2%) in the SRG. In the DRG, 41 of 160 patients underwent CSP based on the treatment algorithm (25.6%). The primary endpoint was significantly higher in the SRG (48/132, 36.4%) compared to the DRG (35/160, 21.8%) (hazard ratio (HR): 1.72; 95% confidence interval (CI): 1.12–2.65; p = 0.013). Conclusions: A treatment algorithm based on IVCD shifted one patient out of every four from BiVP to CSP, with consequent reduction in the primary endpoint after implantation. Therefore, its application could be useful to determine whether to perform BiVP or CSP. Full article
(This article belongs to the Special Issue Cardiac Device Therapy)
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Review

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20 pages, 1730 KiB  
Review
Progress in Cardiac Resynchronisation Therapy and Optimisation
by Zaki Akhtar, Mark M. Gallagher, Christos Kontogiannis, Lisa W. M. Leung, Michael Spartalis, Fadi Jouhra, Manav Sohal and Nesan Shanmugam
J. Cardiovasc. Dev. Dis. 2023, 10(10), 428; https://doi.org/10.3390/jcdd10100428 - 17 Oct 2023
Viewed by 1995
Abstract
Cardiac resynchronisation therapy (CRT) has become the cornerstone of heart failure (HF) treatment. Despite the obvious benefit from this therapy, an estimated 30% of CRT patients do not respond (“non-responders”). The cause of “non-response” is multi-factorial and includes suboptimal device settings. To optimise [...] Read more.
Cardiac resynchronisation therapy (CRT) has become the cornerstone of heart failure (HF) treatment. Despite the obvious benefit from this therapy, an estimated 30% of CRT patients do not respond (“non-responders”). The cause of “non-response” is multi-factorial and includes suboptimal device settings. To optimise CRT settings, echocardiography has been considered the gold standard but has limitations: it is user dependent and consumes time and resources. CRT proprietary algorithms have been developed to perform device optimisation efficiently and with limited resources. In this review, we discuss CRT optimisation including the various adopted proprietary algorithms and conduction system pacing. Full article
(This article belongs to the Special Issue Cardiac Device Therapy)
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13 pages, 698 KiB  
Review
Outcomes of Atrioventricular Node Ablation and Pacing in Patients with Heart Failure and Atrial Fibrillation: From Cardiac Resynchronization Therapy to His Bundle Pacing
by Ioanna Koniari, Andreas Gerakaris, Nicholas Kounis, Dimitrios Velissaris, Archana Rao, Mark Ainslie, Ahmed Adlan, Panagiotis Plotas, Ignatios Ikonomidis, Virginia Mplani, Ming-Yow Hung, Cesare de Gregorio, Theofilos Kolettis and Dhiraj Gupta
J. Cardiovasc. Dev. Dis. 2023, 10(7), 272; https://doi.org/10.3390/jcdd10070272 - 26 Jun 2023
Cited by 2 | Viewed by 4127
Abstract
Objective: To review the relevant literature on the use of atrioventricular node ablation and pacing in patients with heart failure and atrial fibrillation. Methods: APubMed/MEDLINE and SCOPUS search was performed in order to assess the clinical outcomes of atrioventricular node ablation and pacemaker [...] Read more.
Objective: To review the relevant literature on the use of atrioventricular node ablation and pacing in patients with heart failure and atrial fibrillation. Methods: APubMed/MEDLINE and SCOPUS search was performed in order to assess the clinical outcomes of atrioventricular node ablation and pacemaker implantation, as well as the complications that may occur. Results: Several clinical trials, observational analyses and meta-analyses have shown that the “pace and ablate” strategy not only improves symptoms but also can enhance cardiac performance in patients with heart failure and atrial fibrillation. Although this procedure is effective and safe, some complications may occur including worsening of heart failure, permanent fibrillation, arrhythmias and sudden death. Regarding pacemaker implantation, cardiac resynchronization therapy is shown to be the optimal choice compared to right ventricle apical pacing. His bundle pacing is a promising alternative to cardiac resynchronization therapy and has shown beneficial effects, while left bundle branch pacing is an innovative modality. Conclusions: Atrioventricular node ablation and pacemaker implantation is shown to have beneficial effects on clinical outcomes of patients with atrial fibrillation ± heart failure who do not respond or are intolerant to medical treatment. Cardiac resynchronization therapy is the treatment of choice and His bundle pacing seems to be an effective alternative way of pacing in these patients. Full article
(This article belongs to the Special Issue Cardiac Device Therapy)
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Other

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7 pages, 1745 KiB  
Case Report
Optimal Cardiac Resynchronization Therapy with Conduction System Pacing Guided by Electro-Anatomical Mapping: A Case Report
by Catalin Pestrea, Roxana Enache, Ecaterina Cicala and Radu Vatasescu
J. Cardiovasc. Dev. Dis. 2023, 10(11), 456; https://doi.org/10.3390/jcdd10110456 - 9 Nov 2023
Viewed by 1483
Abstract
Introduction: Biventricular pacing has been the gold standard for cardiac resynchronization therapy in patients with left bundle branch block and severely reduced left ventricular ejection fraction for decades. However, in the past few years, this role has been challenged by the promising results [...] Read more.
Introduction: Biventricular pacing has been the gold standard for cardiac resynchronization therapy in patients with left bundle branch block and severely reduced left ventricular ejection fraction for decades. However, in the past few years, this role has been challenged by the promising results of conduction system pacing in these patients, which has proven non-inferior and, at times, superior to biventricular pacing regarding left ventricular function outcomes. One of the most important limitations of both procedures is the long fluoroscopy times. Case description: We present the case of a 60-year-old patient with non-ischemic dilated cardiomyopathy and left bundle branch block in whom conduction system pacing was chosen as the first option for resynchronization therapy. A 3D electro-anatomical mapping system was used to guide the lead to the His bundle region, where correction was observed at high amplitudes, and afterward to the optimal septal penetration site. After reaching the left endocardium, left bundle branch pacing achieved a narrow, paced QRS complex with low fluoroscopy exposure. The three-month follow-up showed a significant improvement in clinical status and left ventricular function. Conclusion: Since conduction system pacing requires a great deal of precision, targeting specific, narrow structures inside the heart, 3D mapping is a valuable tool that increases the chances of success, especially in patients with complex anatomies, such as those with indications for cardiac resynchronization therapy. Full article
(This article belongs to the Special Issue Cardiac Device Therapy)
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