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Advances in Heart Electrotherapy

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 18422

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Prof. Dr. Ewa Lewicka

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Chief Guest Editor

Department of Cardiology and Electrotherapy, Medical University of Gdansk, Debinki 7, 80-952 Gdansk, Poland
Interests: cardiac pacing; hemodynamics of cardiac pacing; cardiac resynchronization therapy; heart failure; pulmonary hypertension; atrial fibrillation; ventricular arrhythmias; cardio-oncology

Prof. Dr. Alicja Dąbrowska-Kugacka

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Assistant Guest Editor

Department of Cardiology and Electrotherapy, Medical University of Gdansk, Debinki 7, 80-952 Gdansk, Poland
Interests: electrotherapy; cardiac pacing; cardiac resynchronization therapy; heart failure; cardiomyopathies; pulmonary hypertension; atrial fibrillation; echocardiography

Dr. Aleksandra Liżewska-Springer

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Assistant Guest Editor

Department of Cardiology and Electrotherapy, Medical University of Gdansk, Debinki 7, 80-952 Gdansk, Poland
Interests: ventricular and atrial arrhythmias； sudden cardiac death； heart failure； cardiac electrotherapy； cardiac pacing； echocardiography； ultrasound imaging

Special Issue Information

Dear Colleagues,

The introduction of permanent cardiac pacing in the late 1950s began the era of cardiac electrotherapy. In the 1980s, implantable cardioverter defibrillators (ICDs) were introduced. These advances created new challenges for cardiac implantable electronic devices (CIEDs). Right ventricular pacing was the primary breakthrough; however, over the years, it has become apparent that it can induce cardiac contraction dyssynchrony. Biventricular pacing allowed for the alleviation of dyssynchrony and improved the survival of patients with heart failure and bundle branch block. In recent decades, His bundle pacing has become a new strategy for physiological ventricular activation. However, the use of CIEDs carries several risks and is associated with complications related to, for example, transvenous leads. This led to the development of percutaneous lead extraction techniques as well as the introduction of a subcutaneous ICD (S-ICD) and leadless pacing. Technological evolution promises an exciting future in the development of cardiac electrotherapy.

In this Special Issue, we invite researchers to submit high quality original or review papers on the clinical and hemodynamic aspects of atrial, right ventricular, His bundle, and biventricular pacing; ICD therapy; treatment of complications, and technological advances in cardiac electrotherapy.

Prof. Dr. Ewa Lewicka
Prof. Dr. Alicja Dąbrowska-Kugacka
Dr. Aleksandra Liżewska-Springer
Guest Editors

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Keywords

Cardiac pacing
Cardiac resynchronization therapy
Biventricular pacing
His bundle pacing
Implantable cardioverter-defibrillator
Subcutaneous cardioverter-defibrillator
Leadless pacing
Transvenous
Lead
Extraction
Management
Cardiac
Implantable
Electronic
Device
Infection
Indications
Complications

Published Papers (10 papers)

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9 pages, 2371 KiB

Open AccessArticle

Hemodynamic Effects of Permanent His Bundle Pacing Compared to Right Ventricular Pacing Assessed by Two-Dimensional Speckle-Tracking Echocardiography

by Jedrzej Michalik, Alicja Dabrowska-Kugacka, Katarzyna Kosmalska, Roman Moroz, Adrian Kot, Ewa Lewicka and Marek Szolkiewicz

Int. J. Environ. Res. Public Health 2021, 18(21), 11721; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182111721 - 08 Nov 2021

Cited by 7 | Viewed by 1766

Abstract

We compared the effects of right ventricular (RVP; n = 26) and His bundle (HBP; n = 24) pacing in patients with atrioventricular conduction disorders and preserved LVEF. Postoperatively (1D), and after six months (6M), the patients underwent global longitudinal strain (GLS) and peak systolic dispersion (PSD) evaluation with 2D speckle-tracking echocardiography, assessment of left atrial volume index (LAVI) and QRS duration (QRSd), and sensing/pacing parameter testing. The RVP threshold was lower than the HBP threshold at 1D (0.65 ± 0.13 vs. 1.05 ± 0.20 V, p < 0.001), and then it remained stable, while the HBP threshold increased at 6M (1.05 ± 0.20 vs. 1.31 ± 0.30 V, p < 0.001). The RVP R-wave was higher than the HBP R-wave at 1D (11.52 ± 2.99 vs. 4.82 ± 1.41 mV, p < 0.001). The RVP R-wave also remained stable, while the HBP R-wave decreased at 6M (4.82 ± 1.41 vs. 4.50 ± 1.09 mV, p < 0.02). RVP QRSd was longer than HBP QRSd at 6M (145.0 ± 11.1 vs. 112.3 ± 9.3 ms, p < 0.001). The absolute value of RVP GLS decreased at 6M (16.32 ± 2.57 vs. 14.03 ± 3.78%, p < 0.001), and HBP GLS remained stable. Simultaneously, RVP PSD increased (72.53 ± 24.15 vs. 88.33 ± 30.51 ms, p < 0.001) and HBP PSD decreased (96.28 ± 33.99 vs. 84.95 ± 28.98 ms, p < 0.001) after 6 months. RVP LAVI increased (26.73 ± 5.7 vs. 28.40 ± 6.4 mL/m², p < 0.05), while HBP LAVI decreased at 6M (30.03 ± 7.8 vs. 28.73 ± 8.7 mL/m², p < 0.01). These results confirm that HBP does not disrupt ventricular synchrony and provides advantages over RVP. Full article

(This article belongs to the Special Issue Advances in Heart Electrotherapy)

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13 pages, 358 KiB

Open AccessArticle

A Study of Major and Minor Complications of 1500 Transvenous Lead Extraction Procedures Performed with Optimal Safety at Two High-Volume Referral Centers

by Łukasz Tułecki, Anna Polewczyk, Wojciech Jacheć, Dorota Nowosielecka, Konrad Tomków, Paweł Stefańczyk, Jarosław Kosior, Krzysztof Duda, Maciej Polewczyk and Andrzej Kutarski

Int. J. Environ. Res. Public Health 2021, 18(19), 10416; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph181910416 - 03 Oct 2021

Cited by 13 | Viewed by 1452

Abstract

Background: Transvenous lead extraction (TLE) is the preferred management strategy for complications related to cardiac implantable electronic devices. TLE sometimes can cause serious complications. Methods: Outcomes of TLE procedures using non-powered mechanical sheaths were analyzed in 1500 patients (mean age 68.11 years; 39.86% females) admitted to two high-volume centers. Results: Complete procedural success was achieved in 96.13% of patients; clinical success in 98.93%, no periprocedural death occurred. Mean lead dwell time in the study population was 112.1 months. Minor complications developed in 115 (7.65%), major complications in 33 (2.20%) patients. The most frequent minor complications were tricuspid valve damage (TVD) (3.20%) and pericardial effusion that did not necessitate immediate intervention (1.33%). The most common major complication was cardiac laceration/vascular tear (1.40%) followed by an increase in TVD by two or three grades to grade 4 (0.80%). Conclusions: Despite the long implant duration (112.1 months) satisfying results without procedure-related death can be obtained using mechanical tools. Lead remnants or severe tricuspid regurgitation was the principal cause of lack of clinical and procedural success. Worsening TR(Tricuspid regurgitation) (due to its long-term consequences), but not cardiac/vascular wall damage; is still the biggest TLE-related problem; when non-powered mechanical sheaths are used as first-line tools. Full article

(This article belongs to the Special Issue Advances in Heart Electrotherapy)

17 pages, 670 KiB

Open AccessArticle

The Influence of Lead-Related Venous Obstruction on the Complexity and Outcomes of Transvenous Lead Extraction

by Marek Czajkowski, Wojciech Jacheć, Anna Polewczyk, Jarosław Kosior, Dorota Nowosielecka, Łukasz Tułecki, Paweł Stefańczyk and Andrzej Kutarski

Int. J. Environ. Res. Public Health 2021, 18(18), 9634; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18189634 - 13 Sep 2021

Cited by 14 | Viewed by 1515

Abstract

Background: Little is known about lead-related venous stenosis/occlusion (LRVSO), and the influence of LRVSO on the complexity and outcomes of transvenous lead extraction (TLE) is debated in the literature. Methods: We performed a retrospective analysis of venograms from 2909 patients who underwent TLE between 2008 and 2021 at a high-volume center. Results: Advanced LRVSO was more common in elderly men with a high Charlson comorbidity index. Procedure duration, extraction of superfluous leads, occurrence of any technical difficulty, lead-to-lead binding, fracture of the lead being extracted, need to use alternative approach and lasso catheters or metal sheaths were found to be associated with LRVSO. The presence of LRVSO had no impact on the number of major complications including TLE-related tricuspid valve damage. The achievement of complete procedural or clinical success did not depend on the presence of LRVSO. Long-term mortality, in contrast to periprocedural and short-term mortality, was significantly worse in the groups with LRSVO. Conclusions: LRVSO can be considered as an additional TLE-related risk factor. The effect of LRVSO on major complications including periprocedural mortality and on short-term mortality has not been established. However, LRVSO has been associated with poor long-term survival. Full article

(This article belongs to the Special Issue Advances in Heart Electrotherapy)

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13 pages, 647 KiB

Open AccessArticle

Analysis of Risk Factors for Major Complications of 1500 Transvenous Lead Extraction Procedures with Especial Attention to Tricuspid Valve Damage

Int. J. Environ. Res. Public Health 2021, 18(17), 9100; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18179100 - 28 Aug 2021

Cited by 18 | Viewed by 1732

Abstract

Background: Transvenous lead extraction (TLE) is a relatively safe procedure, but it may cause severe complications such as cardiac/vascular wall tear (CVWT) and tricuspid valve damage (TVD). Methods: The risk factors for CVWT and TVD were examined based on an analysis of data of 1500 extraction procedures performed in two high-volume centers. Results: The total number of major complications was 33 (2.2%) and included 22 (1.5%) CVWT and 12 (0.8%) TVD (with one case of combined complication). Patients with hemorrhagic complications were younger, more often women, less often presenting low left ventricular ejection fraction (LVEF) and those who received their first cardiac implantable electronic device (CIED) earlier than the control group. A typical patient with CVWT was a pacemaker carrier, having more leads (including abandoned leads and excessive loops) with long implant duration and a history of multiple CIED-related procedures. The risk factors for TVD were similar to those for CVWT, but the patients were older and received their CIED about nine years earlier. Any form of tissue scar and technical problems were much more common in the two groups of patients with major complications. Conclusions: The risk factors for CVWT and TVD are similar, and the most important ones are related to long lead dwell time and its consequences for the heart (various forms of fibrotic scarring). The occurrence of procedural complications does not affect long-term survival in patients undergoing lead extraction. Full article

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8 pages, 308 KiB

Open AccessArticle

Utilization of Subcutaneous Cardioverter-Defibrillator in Poland and Europe–Comparison of the Results of Multi-Center Registries

by Maciej Kempa, Andrzej Przybylski, Szymon Budrejko, Tomasz Fabiszak, Michał Lewandowski, Krzysztof Kaczmarek, Mateusz Tajstra, Marcin Grabowski, Przemysław Mitkowski, Stanisław Tubek, Ewa Jędrzejczyk-Patej, Radosław Lenarczyk, Dariusz Jagielski, Janusz Romanek, Anna Rydlewska, Zbigniew Orski, Joanna Zakrzewska-Koperska, Artur Filipecki, Marcin Janowski, Tatjana Potpara and Serge Boveda Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2021, 18(13), 7178; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18137178 - 05 Jul 2021

Cited by 3 | Viewed by 2272

Abstract

The implantation of a subcutaneous cardioverter-defibrillator (S-ICD) may be used instead of a traditional transvenous system to prevent sudden cardiac death. Our aim was to compare the characteristics of S-ICD patients from the multi-center registry of S-ICD implantations in Poland with the published results of the European Snapshot Survey on S-ICD Implantation (ESSS-SICDI). We compared data of 137 Polish S-ICD patients with 68 patients from the ESSS-SICDI registry. The groups did not differ significantly in terms of sex, prevalence of ischemic cardiomyopathy, concomitant diseases, and the rate of primary prevention indication. Polish patients had more advanced heart failure (New York Heart Association (NYHA) class III: 11.7% vs. 2.9%, NYHA II: 48.9% vs. 29.4%, NYHA I: 39.4% vs. 67.7%, p < 0.05 each). Young age (75.9% vs. 50%, p < 0.05) and no vascular access (7.3% vs. 0%, p < 0.05) were more often indications for S-ICD. The percentage of patients after transvenous system removal due to infections was significantly higher in the Polish group (11% vs. 1.5%, p < 0.05). In the European population, S-ICD was more frequently chosen because of patients’ active lifestyle and patients’ preference (both 10.3% vs. 0%, p < 0.05). Our analysis shows that in Poland, compared to other European countries, subcutaneous cardioverters-defibrillators are being implanted in patients at a more advanced stage of chronic heart failure. The most frequent reason for choosing a subcutaneous system instead of a transvenous ICD is the young age of a patient. Full article

(This article belongs to the Special Issue Advances in Heart Electrotherapy)

20 pages, 2922 KiB

Open AccessArticle

Prognostic Value of Preoperative Echocardiographic Findings in Patients Undergoing Transvenous Lead Extraction

by Dorota Nowosielecka, Wojciech Jacheć, Anna Polewczyk, Łukasz Tułecki, Andrzej Kleinrok and Andrzej Kutarski

Int. J. Environ. Res. Public Health 2021, 18(4), 1862; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18041862 - 14 Feb 2021

Cited by 7 | Viewed by 1858

Abstract

(1) Background: In patients referred for transvenous lead extraction (TLE) transesophageal echocardiography (TEE) often reveals abnormalities related to chronically indwelling endocardial leads. The purpose of this study was to determine whether the results of pre-operative TEE might influence the long-term prognosis. (2) Methods: We analyzed data from 936 TEE examinations performed at a high volume center in patients referred for TLE from 2015 to 2019. The follow-up was 566.2 ± 224.5 days. (3) Results: Multivariate analysis of TEE parameters showed that vegetations (HR = 2.631 [1.738–3.983]; p < 0.001) and tricuspid valve (TV) dysfunction unrelated to the endocardial lead (HR = 1.481 [1.261–1.740]; p < 0.001) were associated with increased risk for long-term mortality. Presence of fibrous tissue binding sites between the lead and the superior vena cava (SVC) and/or right atrium (RA) wall (HR = 0.285; p = 0.035), presence of penetration or perforation of the lead through the cardiac wall up to the epicardium (HR = 0.496; p = 0.035) and presence of excessive lead loops (HR = 0.528; p = 0.026) showed a better prognosis. After adjustment the statistical model with recognized poor prognosis factors only vegetations were confirmed as a risk factor (HR = 2.613; p = 0.039). A better prognosis was observed in patients with fibrous tissue binding sites between the lead and the superior vena cava (SVC) and/or right atrium (RA) wall (HR = 0.270; p = 0.040). (4) Conclusions: Non-modifiable factors may have a negative influence on long-term survival after TLE. Various forms of connective tissue overgrowth and abnormal course of the leads modifiable by TLE can be a factor of better prognosis after TLE. Full article

(This article belongs to the Special Issue Advances in Heart Electrotherapy)

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12 pages, 3941 KiB

Open AccessArticle

Regional Strain Pattern Index—A Novel Technique to Predict CRT Response

by Michał Orszulak, Artur Filipecki, Wojciech Wróbel, Adrianna Berger-Kucza, Witold Orszulak, Dagmara Urbańczyk-Swić, Wojciech Kwaśniewski, Edyta Płońska-Gościniak and Katarzyna Mizia-Stec

Int. J. Environ. Res. Public Health 2021, 18(3), 926; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18030926 - 21 Jan 2021

Cited by 2 | Viewed by 1962

Abstract

Background: Cardiac resynchronization therapy (CRT) improves outcome in patients with heart failure (HF) however approximately 30% of patients still remain non-responsive. We propose a novel index—Regional Strain Pattern Index (RSPI)—to prospectively evaluate response to CRT. Methods: Echocardiography was performed in 49 patients with HF (66.5 ± 10 years, LVEF 24.9 ± 6.4%, QRS width 173.1 ± 19.1 ms) two times: before CRT implantation and 15 ± 7 months after. At baseline, dyssynchrony was assessed including RSPI and strain pattern. RSPI was calculated from all three apical views across 12 segments as the sum of dyssynchronous components. From every apical view, presence of four components were assessed: (1) contraction of the early-activated wall; (2) prestretching of the late activated wall; (3) contraction of the early-activated wall in the first 70% of the systolic ejection phase; (4) peak contraction of the late-activated wall after aortic valve closure. Each component scored 1 point, thus the maximum was 12 points. Results: Responders reached higher mean RSPI values than non-responders (5.86 ± 2.9 vs. 4.08 ± 2.4; p = 0.044). In logistic regression analysis value of RSPI ≥ 7 points was a predictor of favorable CRT effect (OR: 12; 95% CI = 1.33–108.17; p = 0.004). Conclusions: RSPI could be a valuable predictor of positive outcome in HF patients treated with CRT. Full article

(This article belongs to the Special Issue Advances in Heart Electrotherapy)

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15 pages, 4522 KiB

Open AccessCase Report

Practical Approaches to Transvenous Lead Extraction Procedures—Clinical Case Series

by Paul-Mihai Boarescu, Iulia Diana Popa, Cătălin Aurelian Trifan, Adela Nicoleta Roşian and Ştefan Horia Roşian

Int. J. Environ. Res. Public Health 2023, 20(1), 379; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20010379 - 26 Dec 2022

Viewed by 1084

Abstract

Transvenous lead extraction (TLE) is regarded as the first-line strategy for the management of complications associated with cardiac implantable electronic devices (CIEDs), when lead removal is mandatory. The decision to perform a lead extraction should take into consideration not only the strength of the clinical indication for the procedure but also many other factors such as risks versus benefits, extractor and team experience, and even patient preference. TLE is a procedure with a possible high risk of complications. In this paper, we present three clinical cases of patients who presented different indications of TLE and explain how the procedures were successfully performed. In the first clinical case, TLE was necessary because of device extravasation and suspicion of CIED pocket infection. In the second clinical case, TLE was necessary because occlusion of the left subclavian vein was found when an upgrade to cardiac resynchronization therapy was performed. In the last clinical case, TLE was necessary in order to remove magnetic resonance (MR) non-conditional leads, so the patient could undergo an MRI examination for the management of a brain tumor. Full article

(This article belongs to the Special Issue Advances in Heart Electrotherapy)

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6 pages, 1583 KiB

Open AccessCase Report

Right Ventricular Endocardial Mapping and a Potential Arrhythmogenic Substrate in Cardiac Amyloidosis—Role of ICD

by Aleksandra Liżewska-Springer, Tomasz Królak, Karolina Dorniak, Maciej Kempa, Alicja Dąbrowska-Kugacka, Grzegorz Sławiński and Ewa Lewicka

Int. J. Environ. Res. Public Health 2021, 18(21), 11631; https://doi.org/10.3390/ijerph182111631 - 05 Nov 2021

Cited by 3 | Viewed by 1426

Abstract

Patients with cardiac amyloidosis (CA) have an increased risk of sudden cardiac death. (SCD). However, the role of an implantable cardioverter-defibrillator in the primary prevention of SCD in this group of patients is still controversial. We present a case with CA with recurrent syncope and non-sustained ventricular tachycardia. In order to further stratify the risk of SCD, an electrophysiological study with endocardial electroanatomic voltage mapping was performed prior to the ICD placement. Full article

(This article belongs to the Special Issue Advances in Heart Electrotherapy)

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6 pages, 1167 KiB

Open AccessCase Report

Successful Catheter Ablation of the “R on T” Ventricular Fibrillation

by Zofia Lasocka, Alicja Dąbrowska-Kugacka, Ewa Lewicka, Aleksandra Liżewska-Springer and Tomasz Królak

Int. J. Environ. Res. Public Health 2021, 18(18), 9587; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18189587 - 11 Sep 2021

Cited by 4 | Viewed by 2205

Abstract

In patients with idiopathic ventricular fibrillation (VF), recurrent implantable cardioverter-defibrillator (ICD) shocks might increase mortality risk and reduce patients’ quality of life. Catheter ablation of triggering ectopic beats is considered to be an effective method. We present a patient with recurrent VF, caused by the “R on T” premature ventricular complexes. In the presented case radiofrequency catheter ablation efficiently eliminated arrhythmia trigger, which was possible to detect thanks to the intracardiac electrocardiograms (ECG’s) stored in the ICD. Full article

(This article belongs to the Special Issue Advances in Heart Electrotherapy)

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