New Developments in Cardiac Pacemakers

Vardas, Panos; Simantirakis, Emmanuel N.; Kanoupakis, Emmanuel M.

doi:10.1161/circulationaha.112.000086

Cited by 16 publications

(15 citation statements)

References 87 publications

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“…Regulation of SAN activity has great therapeutic potential for a rapidly aging population where SAN disease affects 1 in 600 heart patients over the age of 65 [6]. The only effective treatment for patients with chronic symptomatic sinus node dysfunction is pacemaker implantation [7].…”

Section: Introductionmentioning

confidence: 99%

Synchronization of Pacemaking in the Sinoatrial Node: A Mathematical Modeling Study

et al. 2018

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Computational studies using mathematical models of the sinoatrial node (SAN) cardiac action potential (AP) have provided important insight into the fundamental nature of cell excitability, cardiac arrhythmias, and potential therapies. While the impact of ion channel dynamics on SAN pacemaking has been studied, the governing dynamics responsible for regulating spatial and temporal control of SAN synchrony remain elusive. Here, we attempt to develop methods to explore cohesion in a network of coupled spontaneously active SAN cells. We present the updated version of a previously published graphical user interface LongQt: a cross-platform, threaded application for advanced cardiac electrophysiology studies that does not require advanced programming skills. We incorporated additional features to the existing LongQt platform that allows users to (1) specify heterogeneous gap junction conductivity across a multicellular grid, and (2) set heterogeneous ion channel conductance across a multicellular grid. We developed two methods of characterizing the synchrony of SAN tissue based on alignment of activation in time and similarity of voltage peaks among clusters of functionally related cells. In pairs and two-dimensional grids of coupled cells, we observed a range of conductivities (0.00014-0.00033 1/ -cm) in which the tissue was more susceptible to developing asynchronous spontaneous pro-arrhythmic behavior (e.g., spiral wave formation). We performed parameter sensitivity analysis to determine the relative impact of ion channel conductances on cycle length (CL), diastolic and peak voltage, and synchrony measurements in isolated and coupled cell pairs. We also defined measurements of evaluating synchrony based on peak AP voltage and the rate of wave propagation. Cell-to-cell coupling had a non-linear effect on the relationship between ion channel conductances, AP properties, and synchrony measurements. Our simulations demonstrate that conductivity plays an important role in regulating synchronous firing of heterogeneous SAN tissue, and demonstrate how to evaluate the role of coupling and ion channel conductance in pairs and grids of SAN cells. We anticipate that the approach outlined here will facilitate identification of key cell-and tissue-level factors responsible for cardiac disease.

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Section: Introductionmentioning

confidence: 99%

Synchronization of Pacemaking in the Sinoatrial Node: A Mathematical Modeling Study

et al. 2018

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“…During the early 1990s physiological pacing and the use of adaptive pacing frequencies with dual chamber systems (DDD(R)) were increasingly used compared with single chamber systems (VVI(R)). From the more recent World Society of Arrhythmias (WSA) surveys it appeared that indeed virtually all countries had increased percentages of DDDR pacemaker implantations [15–17, 22]. A modest increase of implantation for bundle branch block is visible over the period 2000 to 2005, especially in men.…”

Section: Discussionmentioning

confidence: 99%

“…CRT devices with ICD function (CRT-D) were not registered in this database and are therefore not included in the current analysis. Internationally, an increase of non-bradyarrhythmic indications for cardiac pacing was projected, however remained a minor indication with approximately 5 % or less in most countries [15–17, 22]. In the Netherlands this percentage remained less than 5 % for a long time, but started increasing in the early 2000s.…”

Section: Discussionmentioning

confidence: 99%

Utilisation of cardiac pacemakers over a 20-year period: Results from a nationwide pacemaker registry

et al. 2016

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The implantation of cardiac pacemakers has become a well-established therapy for conduction disorders and sinus node dysfunction. In many countries pacemaker registries have been initiated in order to collect information on patient characteristics, trends in numbers and the types of pacemakers used, to identify problematic devices, and for safety monitoring. For this utilisation study the Central Pacemaker Patients Registration (CPPR) from the Netherlands Pacemaker Registry Foundation (CPPR-SPRN) containing data collected for more than 20 years was used. During this period nearly 97,000 first pacemakers were implanted. Analyses show an increase in the rate of implanted devices. The change in pacemaker type from VVI to DDD, followed by biventricular stimulation, is reflected by the number of simultaneously implanted leads, which is partly a consequence of cardiac resynchronisation therapy. Our data demonstrate that indications for implantation and type of pacemaker are comparable with other European countries.

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“…In patients with symptomatic atrioventricular block (AVB), the dual chamber mode is once again the one of choice, especially because it maintains the AV sequence, although in specific patient profiles, as well as in chronic atrial fibrillation (AF) with slow ventricular response, VVI pacing offers similar results [ 7 , 8 ] . Less often, in 1 st degree AVB with a very prolonged PR interval (PRi) (>300 ms), dual chamber ACP is employed to correct the dyssynchrony due to the AV decoupling [ 2 - 5 , 9 - 11 ] .…”

Section: Introductionmentioning

confidence: 99%

Cardiac Pacing Induced Cardiomyopathy: Mith or Reality Sustained by Evidence?

Ferrari¹,

Borges²,

Albuquerque³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

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Implantable cardiac pacing systems are a safe and effective treatment for symptomatic irreversible bradycardia. Under the proper indications, cardiac pacing might bring significant clinical benefit. Evidences from literature state that the action of the artificial pacing system, mainly when the ventricular lead is located at the apex of the right ventricle, produces negative effects to cardiac structure (remodeling, dilatation) and function (dissinchrony). Patients with previously compromised left ventricular function would benefit the least with conventional right ventricle apical pacing, and are exposed to the risk of developing higher incidence of morbidity and mortality for heart failure. However, after almost 6 decades of cardiac pacing, just a reduced portion of patients in general would develop these alterations. In this context, there are not completely clear some issues related to cardiac pacing and the development of this cardiomyopathy. Causality relationships among QRS widening with a left bundle branch block morphology, contractility alterations within the left ventricle, and certain substrates or clinical (previous systolic dysfunction, structural heart disease, time from implant) or electrical conditions (QRS duration, percentage of ventricular stimulation) are still subjecte of debate. This review analyses contemporary data regarding this new entity, and discusses alternatives of how to use cardiac pacing in this context, emphasizing cardiac resynchronization therapy.

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New Developments in Cardiac Pacemakers

Abstract: Several studies have shown that patients with bundle-branch block and severely reduced ejection fraction are at increased risk for sudden cardiac death and are candidates for cardioverter-defibrillator implantation.

Cited by 16 publications

References 87 publications

Synchronization of Pacemaking in the Sinoatrial Node: A Mathematical Modeling Study

Synchronization of Pacemaking in the Sinoatrial Node: A Mathematical Modeling Study

Utilisation of cardiac pacemakers over a 20-year period: Results from a nationwide pacemaker registry

Cardiac Pacing Induced Cardiomyopathy: Mith or Reality Sustained by Evidence?

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