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

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Ancona, gestione innovativa per assistenza meccanica al circolo

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 A13327-A13327, November 6, 2023. Introduction:Sinoatrial node (SAN) dysfunction commonly occurs in atrial cardiomyopathy (ACM: “tachy-brady syndrome”), often requiring pacemaker implantation, but mechanisms are unknown. Atrial-selective myosin light chain-4 (MYL-4) mutations cause familial ACM with a high rate of early SAN dysfunction and pacemaker requirement. We studied rats engineered with a knock-in MYL-4 clinical E11K mutation and addressed mechanisms of SAN dysfunction.Methods:Atrial electrical properties were assessed within vivoelectrophysiology (EPS),ex vivooptical mapping, SAN single-cell voltage and current clamp, Ca2+-handling with Ca2+-sensitive dye microscopy. Gene expression was assessed by qPCR and fibrosis with Masson-Trichrome stain.Results:E11K rats showed progressive SAN recovery-time increases (Fig. A) and conduction-slowing (Fig. B). SAN cells showed slowed phase-4 depolarization (Fig. C) and reduced pacemaker “funny” current (If) (Fig. D). Ca2+homeostasis was also affected, showing decreased Ca2+-transients (Fig. E). SAN also displayed remodeling with increased collagen deposition (Fig. F).Conclusions:ACM resulting from E11K mutation induces multimodal electrical and structural remodeling of the SAN region, worsening with age. These observations provide new insights into mechanisms of the clinically important tachy-brady syndrome associated with ACM.

Circulation, Volume 148, Issue Suppl_1, Page A12729-A12729, November 6, 2023. Introduction:Increased age is associated with increased frailty and often worse postoperative outcomes. We aim to assess the safety of leadless pacemaker (LPM) insertion in the very elderly population.Methods:We queried the National Readmission Database years 2017-2020 for patients who underwent LPM insertion with the ICD10 code 02HK3NZ. Patients with age 90 or more were included in the nonagenarians group. Patient comorbidities were queried through the appropriate ICD 10 codes. We compared outcomes using multivariate logistic and linear regression, adjusting for patient comorbidities.Results:At baseline, nonagenarians had a higher prevalence of hypertension, history of stroke, A fib./A. flutter, dementia and hypothyroidism. The control group had more of diabetes, coronary disease, chronic kidney disease, chronic pulmonary disease, oxygen use, coagulopathy, anemia, obesity, substance abuse and chronic liver disease (Table 1).Compared to controls, nonagenarians were found to have shorter length of stay (-2.486 days, 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

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 A11516-A11516, November 6, 2023. Background:Leadless pacemakers (LP) represent an emerging modality for treating bradyarrhythmias. We performed a meta-analysis and systematic review comparing safety and efficacy outcomes of Micra LP and transvenous pacemakers (TVP).Methods:A literature search was performed. The primary efficacy endpoints were successful implantation rate and acceptable capture threshold of

Circulation, Volume 148, Issue Suppl_1, Page A13903-A13903, November 6, 2023. Background:Leadless pacemakers have gained popularity in providing permanent pacing in select patient populations. Pacemaker mediated tachycardia and arrhythmias have been well described in patients with dual chamber pacemakers, but up to this point not in leadless pacing.Case Description:A 91-year-old female with symptomatic bradycardia and 2:1 AV block underwent implantation of a Micra AV pacemaker programmed VDD 60-100 bpm. Five months later, she presented with decompensated heart failure with a heart rate of 88 bpm and a newly reduced left ventricular ejection fraction of 30%. Device interrogation showed 95% ventricular pacing, with 91% AV synchrony. The Micra was found to be tracking an atrial rhythm between 80-100 bpm more than 80% of the time (Figure 1A). RV pacing induced cardiomyopathy was suspected and she underwent placement of a bi-ventricular pacemaker. During implant, a short VA time was noted and changes in the V-V cycle length predicted changes in the A-A cycle length (Figure 1B). Micra ventricular pacing was held resulting in an AV paced rhythm from the CRT system and a drop in rate to 60 bpm (Figure 1C). These results indicate that the Micra pacemaker was tracking the atrial mechanical contraction (AM) from a retrograde conducted P-wave resulting in elevated heart rates from a pacemaker-driven arrhythmia.Discussion:In patients with poor AV conduction, intact VA conduction, and SA node dysfunction, Micra AV may create pacemaker mediated arrhythmia by tracking the AM of the retrograde conducted P-wave. Careful patient selection to avoid Micra AV placement in patients with SA node dysfunction, and close attention to the rate histogram on device interrogation may prevent development and facilitate recognition of this unique cause of pacemaker-mediated arrhythmia.

Circulation, Volume 148, Issue Suppl_1, Page A15725-A15725, November 6, 2023. Background:Despite being an essential procedure with rising use in the United States, the availability and accessibility of procedural care for a permanent pacemaker are not known. We investigated access to pacemaker implantation among Medicare beneficiaries.Methods:US Medicare physician claims from 2020, and county population characteristic data from AHRQ were used to evaluate the density of providers and beneficiaries across states and counties. For each US zip code, we determined the closest pacemaker implantation center using the haversine formula, then assessed the travel duration for each route using the Google Maps API.Results:There was a median of 5 providers performing pacemaker placement per 100,000 individuals over 65 years across all states, with an IQR of 4.5 to 6. At the county level, only 20% of counties in the US had a center offering transvenous pacemaker implantation, and 4% had a center offering leadless pacemakers. Individuals in metropolitan counties drove a median 29 (IQR 18 – 47) minutes to reach a center for pacemaker implantation, while those in non-metropolitan counties drove a median of 72 (IQR 52 – 102) minutes. In counties where >25% of the population is ≥65 years old, the median drive time to a pacemaker center is 86 (IQR 57 – 126) minutes. Residents of counties with a lower median household income (Spearman’s r = 0.45, p < 0.001) and a higher percentage of residents using public insurance had longer drive time to a pacemaker center (r = 0.23, p < 0.001). Out of the estimated 55,356,000 individuals ≥65 years old in the United States, 20,000,000 (36%) had to drive more than one hour, and 4,383,955 (8%) had to drive more than two hours to a site where a pacemaker implantation procedure is performed.Conclusion:Over one-third of the population in the United States has significant access issues to basic electrophysiologic care, highlighting the need for increased resources and improved accessibility.