Risultati per: Il pacemaker si ricarica con il battito del cuore

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Circulation, Volume 148, Issue 21, Page 1725-1727, November 21, 2023.

L’ad Nepi: ‘impegno per portare lo sport a tutti’

I dati dello studio Prevasc: “evitabili 150 mila decessi l’anno”

Intervento su un paziente affetto da cardiomiopatia dilatativa

Usata per la prima volta in pediatria una nuova macchina Ecmo

Intervento ‘straordinario’ nel reparto Gravidanze a rischio

Circulation, Volume 148, Issue Suppl_1, Page A14799-A14799, November 6, 2023. Introduction:Leadless pacemakers (LPM) were introduced to address rates of pocket and lead-related complications associated with transvenous pacemakers (TPM) and to improve clinical outcomes in those who may be at high risk for TPM placement. Limited data exists on in-hospital outcomes and temporal trends of LPM placement.Methods:National Inpatient Sample 2016-2020 was used to query pacemaker (PM) placements and these were grouped into LPM and TPM cases using appropriate ICD procedure codes. Logistic regression was used to compare baseline characteristics and in-hospital outcomes.Results:740,240 PM placements were observed between 2016 and 2020, with 3.9% (29,015) LPM cases and 96.1% (711,225) TPM cases. As shown in Table 1, there was an increasing temporal trend in LPM placement from 2016 with an overall stable trend in TPM during the same time. The LPM group had a higher proportion of cases that underwent extraction of an old pacemaker (8.9% -vs- 6.9%, p=0.004). A majority of procedures in both groups were performed in the Southern United States and predominantly in large bedsize, urban teaching hospital systems. As shown in Table 2, LPM group had higher proportions of atrial fibrillation, CKD (stage 3 or greater), and ESRD. Length of stay (LOS, 9.7 -vs- 5.9 days) and overall mortality (5.0% -vs- 1.5%, p=0.001) were also higher in the LPM group.Conclusions:There has been a significant increase in LPM placement from 2016 through 2020 as seen with an increasing temporal trend. Use of LPM in medically complex cases or in cases that are high risk for TPM placement continues to increase. Further research needs to be performed to analyze long-term outcomes in this group.

Circulation, Volume 148, Issue Suppl_1, Page A18762-A18762, November 6, 2023. Introduction:Pacemaker pocket erosion is an uncommon delayed complication of the cardiac implantable electronic device (CIED) implantation that most frequently occurs in frail and elderly patients. We present a case of such a patient who developed pacemaker pocket erosion after being initiated on hormonal therapy for advanced prostate cancer.Case presentation:The patient is a ninety-three-year-old male with a history of persistent atrial fibrillation and dual chamber pacemaker in situ with last generator change two years prior presented with a two-week history of pacemaker wound dehiscence and exposed pacemaker. Six months earlier, the patient was diagnosed with advanced prostate cancer, was initiated on gonadotropin-releasing hormone agonist, leuprolide, and subsequently developed unintentional weight loss of 30 pounds. For two months prior to the current presentation, the patient noticed subjective discomfort at the site of the pacemaker pocket which he did not report to his cardiologist and eventually developed an erosive wound overlying the pacemaker pocket exposing the device (Image 1). He was admitted to the hospital and found to be hemodynamically stable, without leukocytosis and, negative blood cultures. Transthoracic and transesophageal echocardiograms showed no evidence of vegetation. He was empirically treated with daptomycin and was referred for pacing system extraction. He underwent pacing system replacement with leads and device extraction followed by leadless Micra VR (Medtronic, Minneapolis, MN) pacemaker implantation. Following a 4-week antibiotic course post pacemaker system extraction, the pacemaker pocket wound was fully healed.Conclusions:Aging and weight loss are known major risk factors for device-pocket erosion and externalization of the CIED. It highlights the importance of improving awareness of this entity and that initiation of hormonal therapy can be a contributing factor to such complications.

Circulation, Volume 148, Issue Suppl_1, Page A15691-A15691, November 6, 2023. BackgroundSurgery for infective endocarditis (IE) is associated with a high risk of receiving a new permanent pacemaker. The clinical impact of permanent pacemaker implantation in these patients is unknown.Research questionDoes permanent pacemaker implantation after aortic valve surgery for IE affect long-term clinical outcomes?AimsTo analyze the risk of mortality, heart failure hospitalization, and prosthetic valve endocarditis in patients who received a permanent pacemaker within 30 days of aortic valve surgery for IE.Methods:In this nationwide, population-based, observational cohort study based on the SWEDEHEART register, we included all patients who underwent primary aortic valve replacement for IE in Sweden from 1997 to 2022. Patients with a preoperative cardiac implantable electronic device were excluded. The primary outcome was all-cause mortality. Secondary outcomes were heart failure hospitalization and prosthetic valve endocarditis. Follow-up was complete. Inverse probability of treatment weighting was used to account for intergroup differences and flexible parametric models were used to estimate cause-specific hazards and cumulative incidences.Results:Among 2110 patients, 131 patients (6%) received a new permanent pacemaker, and 1979 patients (94%) did not. The mean age was 59 years, and 433 patients (21%) were female. During a mean follow-up time of 8.5 years (maximum 26 years), 873 patients (41%) died. The cumulative incidence of all-cause mortality and heart failure hospitalization at 20 years was 66% (95% CI 46%-79%) versus 61% (95% CI 58%-64%) and 45% (95% CI 33%-58%) versus 32% (95% CI 29%-34%) in the pacemaker versus the non-pacemaker group, respectively. After adjustment, there was no difference in the risk of mortality (HR 1.14, 95% CI: 0.82-1.59) or reinfection (HR 1.00, 95% CI 0.63-1.59), but the risk of heart failure was increased in the pacemaker group (HR 1.67, 95% CI: 1.11-2.52).ConclusionPermanent pacemaker implantation after aortic valve surgery for IE was associated with an increased risk of heart failure, but there was no difference in the risk of long-term mortality or prosthetic valve endocarditis. These results suggest that patients who receive a pacemaker after surgery for IE warrant careful observation.

Circulation, Volume 148, Issue Suppl_1, Page A12623-A12623, November 6, 2023. Introduction:Compared to conventional single-chamber pacemakers, leadless pacemakers (LPM) had a higher risk of pericardial effusion and/or perforation, but decreased risk of other delayed device related complications. Pulmonary hypertension patients often have higher pressures in the adjacent right ventricle, possibly increasing the risk of perforation and pericardial complications.Methods:The National Readmission Database years 2017 to 2020 were queried for the patients who underwent LPM placement with the ICD10 code (02HK3NZ). Patient comorbidities were identified using the appropriate ICD10 codes. Multivariate logistic regression was used to compare outcomes in patients with and without pulmonary hypertension, adjusting for patient comorbidities shown in Table 1.Results:We identified 26,084 patients who underwent LPM placement, 4114 (15.77%) of whom had pulmonary hypertension. There was no statistically significant difference in the primary outcomes of 30-day readmission (aOR 1.01, p 0.37, 95% CI 0.936 – 1.193), or mortality (aOR 0.973, p 0.82, 95% CI 0.769 – 1.232).There was no difference in the composite outcome of pericardial complications (aOR 0.729, p 0.17, 95% CI 0.462 – 1.149) which included hemopericardium, tamponade, or the need for pericardiocentesis. However, patients with pulmonary hypertension had a higher risk of postprocedure bleed (aOR 1.182, p 0.036), hemothorax (aOR 2.493, p 0.003), and cardiogenic shock (aOR 2.447, p

Circulation, Volume 148, Issue Suppl_1, Page A16204-A16204, November 6, 2023. Introduction:Device related infective endocarditis (IE) is associated with high morbidity and mortality resulting in a growing emphasis on identifying and managing comorbidities that increase the risk of IE in these patients. Psoriasis, a chronic inflammatory skin disorder with multifactorial etiology, is increasingly being identified as having multiple cardiovascular manifestations. However, little is known about the impact of psoriasis on IE risk in patients with permanent pacemaker (PPM).Hypothesis:Psoriasis patients with PPM have an increased risk of developing IE.Methods:Patients with a history of PPM implantation were sampled from the National Inpatient Sample Database (2016 – 2018). Comorbidities were identified using ICD-10 codes. Individuals with age < 18, history of endocarditis, immunosuppression, central line associated infections, intravenous drug use, and implantable cardiac defibrillators were excluded. Patients were stratified into two groups based on the presence of psoriasis. A univariate analysis followed by a multivariate analysis adjusting for age, gender valvular disease, dental infections, coronary artery disease, and sixteen other comorbidities was performed. Furthermore, 1:10000 propensity score matching was performed between the psoriasis and non-psoriasis groups and rates of IE were calculated.Results:Out of the 437,728 patients included in the study, 45 (4.4%) had psoriasis. Psoriasis patients were older and had more coronary artery disease. Psoriasis patients had significantly higher rates of endocarditis (4.4% vs 0.6%; p

Circulation, Volume 148, Issue Suppl_1, Page A17573-A17573, November 6, 2023. Background:Invasive arterial catheter (IAC) placement can lead to hematoma, vessel occlusion, pain and & procedure delay. The ClearSight System™ (CSS) is a non-invasive blood pressure (NIBP) device that measures beat-to-beat arterial pressures (AP) via a finger cuff. The validity of CSS during cardiac ablation & transvenous pacemaker lead removal has not been described. Therefore, we performed a single center observational study to validate AP monitoring by CSS compared to IAC in such patients (pts).Methods:Pts undergoing cardiac ablation or lead removal from June-November 2022 were included. AP was simultaneously measured via CSS & IAC. Measurements were compared using Bland-Altman analysis. Acceptable bias & precision (standard deviation) were defined as

Circulation, Volume 148, Issue Suppl_1, Page A12681-A12681, November 6, 2023. Introduction:Permanent pacemaker (PPM) remains a common complication after transcatheter aortic valve implantation (TAVI). Despite recognition of sex-specific differences in the electrophysiological structure of the heart, there is a paucity of data examining whether predictors for PPM after TAVI differs among women and men to facilitate a precision medicine approach.Hypothesis:To examine incidence rates and predictors of PPM after TAVI according to sex.Methods:We retrospectively examined incidence rates and characteristics of women and men requiring PPM within 30-days after TAVI between 2012 to 2021. Predictors of PPM were identified using logistic regression.Results:A total of 3323 patients underwent TAVI, of which 407 (12.3%) required PPM within 30-days after TAVI. A PPM was required in 12.3% (170/1377) of women and in 12.2% (237/1946) of men (p=0.89). Baseline characteristics are shown in the Table. Compared to women, men requiring a PPM were more likely to have a history of myocardial infarction (MI), prior bypass surgery, reduced systolic function, first degree atrioventricular block (1stAVB), normal renal function, balloon expandable prosthesis, and larger prosthesis size. In multivariable analysis, right bundle branch block and self-expandable prosthesis were significant predictors for both sexes (Figure). Men had relatively more exclusive predictors (age, prior MI, atrial fibrillation, 1stAVB, left bundle branch block, prosthesis size) compared to women (Figure).Conclusions:PPM incidence rates after TAVI are similar for women and men however, sex-specific predictors for PPM exist and may be used guide pre- and post-procedural management.

Circulation, Volume 148, Issue Suppl_1, Page A18855-A18855, November 6, 2023. Introduction:Sick sinus syndrome refers to degenerative fibrosis of the sinoatrial node, leading to bradyarrhythmias with or without tachyarrhythmias. Pacemaker implantation is a common therapeutic intervention in patients with symptomatic sick sinus syndrome (SSS). We aimed to analyze the periprocedural outcomes for patients with SSS who undergo pacemaker implantation.Hypothesis:Pacemaker implantation is associated with lower odds of mortality in patients with sick sinus syndome.Methods:Retrospective cohort study with data from 2016-18 combined National Inpatient Sample database. ICD-10 codes used to include admissions with SSS and dichotomized based on permanent dual chamber pacemaker implantation. The primary and secondary outcomes were studies between the two cohorts. Multivariate linear and logistic regression were used to adjust for confoundersResults:Out of 190,625 sick sinus syndrome, admissions in 2016-18 NIS database, 115,195 (60%) received a permanent pacemaker. Permanent pacemaker implantation in SSS patients was associated with lower adjusted odds of inpatient mortality (aOR 0.22, 95% CI 0.17-0.29, p

Circulation, Volume 148, Issue Suppl_1, Page A13098-A13098, November 6, 2023. Introduction:Worsening TR following either PPM or ICD implantation is an emerging clinical challenge. Early recognition of this entity is essential in guiding treatment.Hypothesis:Despite many technological advances in electrophysiology, transvenous lead placement currently remains an integral part of cardiac device implantation procedures. While worsening of TR post-device does not seem to be surprising, it is counter-intuitive and eventually leads to right-sided heart failure symptoms.Methods:We searched electronic databases from inception to January 2023 for published studies that reported incidence of TR worsening post-device implantation. Log odds ratio was used to summarize group differences.Results:Our analysis included 29 studies with 66,590 participants. Patients with device implantation (n=1,008) were significantly more likely to develop worsening TR as compared to controls (n=58,605) (OR: 3.18, p