Cardiac Pacing, Defibrillation and Cardiac Resynchronization Therapy: New Perspectives in the Diagnosis and Treatment of Arrhythmias and Heart Failure

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (20 December 2023) | Viewed by 3904

Special Issue Editors


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Guest Editor
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Modena University Hospital, University of Modena and Reggio Emilia, 41121 Modena, Italy
Interests: atrial fibrillation; arrhythmias; channellopathies; coronary artery disease; heart failure; cardiomyopathies; acute coronary syndrome

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Guest Editor
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Modena University Hospital, University of Modena and Reggio Emilia, 41121 Modena, Italy
Interests: arrhythmias-general; atrial fibrillation; device therapy; chronic heart failure; public health and health economics
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Special Issue Information

Dear colleagues,

Several groundbreaking innovations, made possible by technological progress, entered the field of cardiac pacing in recent years. However, their benefits have yet to fully emerge.

In addition to guideline-directed medical therapy, cardiac resynchronization therapy (CRT) is the cornerstone treatment for selected patients with heart failure (HF). About 30% of patients receiving CRT do not derive a detectable clinical or echocardiographic benefit, highlighting that there is room to improve candidates’ selection, CRT delivery, and device programming. Conduction system pacing has recently emerged as an alternative. However, data on cardiac remodeling and hard outcomes are still scant, especially in the long term. Remote monitoring of cardiac implantable electronic devices (CIEDs) is recommended as part of the individualized multidisciplinary follow-up of HF patients. Although useful in the early detection of CIEDs technical issues, cardiac arrhythmias, and impending HF decompensation, there is still uncertainty regarding its effectiveness in reducing mortality and hospitalizations.

With this Special Issue, we would like to explore the impact of leading-edge cardiac pacing technologies on patient outcomes including but not restricted to mortality, hospitalizations, quality of life, cardiac remodeling, device- or procedure-related complications, heart failure management, and arrhythmias diagnosis. In this regard, we encourage researchers to submit their work on the following key aspects of cardiac pacing: cardiac resynchronization therapy, conduction system pacing, leadless pacing, and ablate and pace strategies.

With this Special Issue, we would like to explore the impact of leading-edge cardiac pacing technologies on patient outcomes including but not restricted to mortality, hospitalizations, quality of life, cardiac remodeling, device- or procedure-related complications, heart failure management, and arrhythmias diagnosis. In this regard, we encourage researchers to submit their work on the following key aspects of cardiac pacing: cardiac resynchronization therapy, conduction system pacing, leadless pacing, and ablate and pace strategies.

Dr. Jacopo Francesco Imberti
Prof. Dr. Giuseppe Boriani
Guest Editors

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Keywords

  • atrial fibrillation
  • arrhythmias
  • channellopathies
  • coronary artery disease
  • heart failure
  • cardiomyopathies
  • acute coronary syndrome
  • device therapy

Published Papers (3 papers)

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12 pages, 1029 KiB  
Article
Long-Term Atrioventricular Block Following Valve Surgery: Electrocardiographic and Surgical Predictors
by Jacopo Farina, Mauro Biffi, Gianluca Folesani, Luca Di Marco, Sofia Martin, Corrado Zenesini, Carlo Savini, Matteo Ziacchi, Igor Diemberger, Cristian Martignani and Davide Pacini
J. Clin. Med. 2024, 13(2), 538; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13020538 - 17 Jan 2024
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Abstract
Background: Bradyarrhythmia requiring pacemaker implantation among patients undergoing valve surgery may occur even after several years, with unclear predictors. Our aim was to investigate the incidence of pacemaker implantation at different follow-up times and identify associated predictors. Methods: We conducted a retrospective study [...] Read more.
Background: Bradyarrhythmia requiring pacemaker implantation among patients undergoing valve surgery may occur even after several years, with unclear predictors. Our aim was to investigate the incidence of pacemaker implantation at different follow-up times and identify associated predictors. Methods: We conducted a retrospective study evaluating 1046 consecutive patients who underwent valve surgery at the Cardiac Surgery Division of Bologna University Hospital from 2005 to 2010. Results: During 10 ± 4 years of follow-up, 11.4% of these patients required pacemaker implantation. Interventions on both atrioventricular valves independently predicted long-term pacemaker implantation (SHR 2.1, 95% CI 1.2–3.8, p = 0.014). Preoperative atrioventricular conduction disease strongly predicted long-term atrioventricular block, with right bundle branch block as the major predictor (SHR 7.0, 95% CI 3.9–12.4, p < 0.001), followed by left bundle branch block (SHR 4.9, 95% CI 2.4–10.1, p < 0.001), and left anterior fascicular block (SHR 3.9, 95% CI 1.8–8.3, p < 0.001). Conclusion: Patients undergoing valvular surgery have a continuing risk of atrioventricular block late after surgery until the 12-month follow-up, which was clearly superior to the rate of atrioventricular block observed at long-term. Pre-operative atrioventricular conduction disease and combined surgery on both atrioventricular valves are strong predictors of atrioventricular block requiring pacemaker implantation. Full article
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12 pages, 905 KiB  
Article
Low Occurrence of Infections and Death in a Real-World Cohort of Patients with Cardiac Implantable Electronic Devices
by Jacopo Francesco Imberti, Davide Antonio Mei, Riccardo Fontanesi, Luigi Gerra, Niccolò Bonini, Marco Vitolo, Vincenzo Turco, Edoardo Casali and Giuseppe Boriani
J. Clin. Med. 2023, 12(7), 2599; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12072599 - 30 Mar 2023
Cited by 3 | Viewed by 1275
Abstract
Background. The incidence of infections and death in patients implanted with cardiac implantable electronic devices (CIEDs) is not fully known yet. Aim. To describe the incidence of CIED-related infection and death, and their potential predictors in a contemporary cohort of CIED patients. Methods. [...] Read more.
Background. The incidence of infections and death in patients implanted with cardiac implantable electronic devices (CIEDs) is not fully known yet. Aim. To describe the incidence of CIED-related infection and death, and their potential predictors in a contemporary cohort of CIED patients. Methods. All consecutive patients implanted with a CIED at our institution were prospectively enrolled. Follow-up visits were performed 2 weeks after CIED implantation for all patients, and then every 6 months for implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy (CRT) patients and every 12 months for pacemaker (PM) patients. The adjudication of CIED-related infections was performed by two independent investigators and potential disagreement was resolved by a senior investigator. Results. Between September 2016 and August 2020, a total of 838 patients were enrolled (34.6% female; median age 77 (69.6–83.6); median PADIT score 2 (2–4)). PMs were implanted in 569 (68%) patients and ICD/CRT in 269 (32%) patients. All patients had pre-implant antibiotic prophylaxis and 5.5% had an antibiotic-eluting envelope. Follow-up data were available for 832 (99.2%) patients. After a median follow-up of 42.3 (30.2–56.4) months, five (0.6%) patients had a CIED-related infection and 212 (25.5%) patients died. Using multivariate Cox regression analysis, end-stage chronic kidney disease (CKD) requiring dialysis and therapy with corticosteroids was independently associated with a higher risk of infection (hazard ratio (HR): 14.20; 95% confidence interval (CI) 1.48–136.62 and HR: 14.71; 95% CI 1.53–141.53, respectively). Age (HR: 1.07; 95% CI 1.05–1.09), end-stage CKD requiring dialysis (HR: 6.13; 95% CI 3.38–11.13) and history of atrial fibrillation (HR: 1.47; 95% CI 1.12–1.94) were independently associated with all-cause death. Conclusions. In a contemporary cohort of CIED patients, mortality was substantially high and associated with clinical factors depicting a population at risk. On the other hand, the incidence of CIED-related infections was low. Full article
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12 pages, 12294 KiB  
Systematic Review
Efficacy and Safety of Leadless Pacemakers for Atrioventricular Synchronous Pacing: A Systematic Review and Meta-Analysis
by Sijin Wu, Yuanhao Jin, Wenzhao Lu, Zhongli Chen, Yan Dai and Keping Chen
J. Clin. Med. 2023, 12(7), 2512; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12072512 - 27 Mar 2023
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Abstract
Leadless pacemakers with an atrioventricular synchrony algorithm represent a novel technology for patients qualified for VDD pacing. The current evidence of their performance is limited to several small-scale observational studies. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of [...] Read more.
Leadless pacemakers with an atrioventricular synchrony algorithm represent a novel technology for patients qualified for VDD pacing. The current evidence of their performance is limited to several small-scale observational studies. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of this new technology. We systematically searched the PubMed, Embase, and Cochrane library databases from their inception to 12 September 2022. The primary efficacy outcome was atrioventricular synchrony after implantation, whereas the secondary efficacy outcome was the change in cardiac output represented by the left ventricular outflow tract velocity time integral (LVOT-VTI). The primary safety outcome was major complications related to the procedures and the algorithm. Means or mean differences with 95% confidence interval (95% CI) were combined using a random-effects model or a fixed-effects model. Finally, 8 published studies with 464 participants were included in the qualitative analysis. The pooled atrioventricular synchrony proportion was 78.9% (95% CI 71.9–86.0%), and a further meta-regression did not screen factors that contributed significantly to the heterogeneity. Additionally, a significant increase in atrioventricular synchrony of 11.3% (95% CI 7.0–15.7%, p < 0.01) was achieved in patients experiencing programming optimization. LVOT-VTI was significantly increased by 1.9 cm (95% CI 1.2–2.6, p < 0.01), compared with the VVI pacing mode. The overall incidence of complications was approximately 6.3%, with major complications related to the algorithm being extremely low. Overall, leadless pacemakers with atrioventricular synchronous pacing demonstrated favorable safety and efficacy. Future data on their long-term performance are required to facilitate their widespread adoption in clinical practice. Full article
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