Pacing induced cardiomyopathy

Merchant, Faisal M.; Mittal, Suneet

doi:10.1111/jce.14277

Cited by 81 publications

(95 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients with AVNA typically have higher rate of RV pacing as compared with patients receiving LP who are not pacemaker dependent. High burden of RV pacing predisposes to heart failure and left ventricular dysfunction 17 . In this study, the median percentage of RV pacing was 99.7% (IQR 98.7%–99.9%) in the AVNA group as compared with 59.1% (IQR: 10.0%–97.2%) in the non‐AVNA group ( p < .001).…”

Section: Discussionmentioning

confidence: 58%

Leadless pacemaker implant with concomitant atrioventricular node ablation: Experience with the Micra transcatheter pacemaker

El‐Chami

Shinn²,

Bansal

et al. 2021

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Background The feasibility and outcomes of concomitant atrioventricular node ablation (AVNA) and leadless pacemaker implant are not well studied. We report outcomes in patients undergoing Micra implant with concomitant AVNA. Methods Patients undergoing AVNA at the time of Micra implant from the Micra Transcatheter Pacing (IDE) Study, Continued Access (CA) study, and Post‐Approval Registry (PAR) were included in the analysis and compared to Micra patients without AVNA. Baseline characteristics, acute and follow‐up outcomes, and electrical performance were compared between patients with and without AVNA during the follow‐up period. Results A total of 192 patients (mean age 77.4 ± 8.9 years, 72% female) underwent AVNA at the time of Micra implant and were followed for 20.4 ± 15.6 months. AVNA patients were older, more frequently female, and tended to have more co‐morbid conditions compared with non‐AVNA patients (N = 2616). Implant was successful in 191 of 192 patients (99.5%). The mean pacing threshold at implant was 0.58 ± 0.35 V and remained stable during follow‐up. Major complications within 30 days occurred more frequently in AVNA patients than non‐AVNA patients (7.3% vs. 2.0%, p < .001). The risk of major complications through 36‐months was higher in AVNA patients (hazard ratio: 3.81, 95% confidence interval: 2.33–6.23, p < .001). Intermittent loss of capture occurred in three AVNA patients (1.6%), all were within 30 days of implant and required system revision. There were no device macrodislodgements or unexpected device malfunctions. Conclusion Concomitant AVN ablation and leadless pacemaker implant is feasible. Pacing thresholds are stable over time. However, patient comorbidities and the risk of major complications are higher in patients undergoing AVNA.

show abstract

Section: Discussionmentioning

confidence: 58%

Leadless pacemaker implant with concomitant atrioventricular node ablation: Experience with the Micra transcatheter pacemaker

El‐Chami

Shinn²,

Bansal

et al. 2021

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…24 If MOC is mistakenly diagnosed as either NS-HBP or S-HBP, the patient may develop morbidity from heart failure due to pacing-induced cardiomyopathy, which also carries a mortality risk. [25][26][27] HBP seems to be highly effective at preventing and treating pacing-induced cardiomyopathy, albeit in nonrandomized studies. 28 Distinguishing MOC from NS-HBP…”

Section: Distinguishing Moc From Hbpmentioning

confidence: 99%

Discriminating electrocardiographic responses to His-bundle pacing using machine learning

Arnold¹,

Howard²,

Gopi

et al. 2020

Cardiovascular Digital Health Journal

View full text Add to dashboard Cite

BACKGROUND His-bundle pacing (HBP) has emerged as an alternative to conventional ventricular pacing because of its ability to deliver physiological ventricular activation. Pacing at the His bundle produces different electrocardiographic (ECG) responses: selective His-bundle pacing (S-HBP), non-selective His bundle pacing (NS-HBP), and myocardium-only capture (MOC). These 3 capture types must be distinguished from each other, which can be challenging and time-consuming even for experts. OBJECTIVE The purpose of this study was to use artificial intelligence (AI) in the form of supervised machine learning using a convolutional neural network (CNN) to automate HBP ECG interpretation. METHODS We identified patients who had undergone HBP and extracted raw 12-lead ECG data during S-HBP, NS-HBP, and MOC. A CNN was trained, using 3-fold cross-validation, on 75% of the segmented QRS complexes labeled with their capture type. The remaining 25% was kept aside as a testing dataset. RESULTS The CNN was trained with 1297 QRS complexes from 59 patients. Cohen kappa for the neural network's performance on the 17-patient testing set was 0.59 (95% confidence interval 0.30 to 0.88; P ,.0001), with an overall accuracy of 75%. The CNN's accuracy in the 17-patient testing set was 67% for S-HBP, 71% for NS-HBP, and 84% for MOC. CONCLUSION We demonstrated proof of concept that a neural network can be trained to automate discrimination between HBP ECG responses. When a larger dataset is trained to higher accuracy, automated AI ECG analysis could facilitate HBP implantation and follow-up and prevent complications resulting from incorrect HBP ECG analysis.

show abstract

“…Right ventricular pacing results in dyssynchronous ventricular activation, which may lead to right ventricular pacinginduced cardiomyopathy [44][45][46][47][48][49]. The risk is increased in patients with pre-existing impaired ventricular function and higher right ventricular pacing burden.…”

Section: Right Ventricular Pacing-induced Cardiomyopathymentioning

confidence: 99%

The Emerging Role of Cardiac Conduction System Pacing as a Treatment for Heart Failure

Ali

Shin

Whinnett

2020

Curr Heart Fail Rep

View full text Add to dashboard Cite

Purpose of Review The aim of cardiac resynchronization therapy (CRT) is to improve cardiac function by delivering more physiological cardiac activation to patients with heart failure and conduction abnormalities. Biventricular pacing (BVP) is the most commonly used method for delivering CRT; it has been shown in large randomized controlled trials to significantly improve morbidity and mortality in patients with heart failure. However, BVP delivers only modest reductions in ventricular activation time and is only beneficial in patients with prolonged QRS duration. In this review, we explore conduction system pacing as a method for delivering more effective ventricular resynchronization and to extend pacing therapy for heart failure to patients without left bundle branch block (LBBB). Recent Findings The aim of conduction system pacing is to provide physiological ventricular activation by directly stimulating the conduction system. Current modalities include His bundle and left conduction system pacing. His bundle pacing is the most established method; it has the potential to correct left bundle branch block and deliver more effective ventricular resynchronization than BVP. This translates into greater acute haemodynamic improvements and observational data suggests that His-CRT results in improvements in cardiac function and symptoms. AV-optimized His bundle pacing is being investigated in patients with heart failure and long PR interval without LBBB, to see if this improves exercise capacity. More recently, a technique for pacing the left bundle branch has been developed. Early studies show potential advantages including low and stable capture thresholds. Summary Conduction system pacing can deliver more effective ventricular resynchronization than BVP, which has the potential to deliver greater improvements in cardiac function. It may also provide the opportunity to extend pacing therapy for heart failure to patients who do not have LBBB. Further data is required from randomized trials to assess these promising pacing techniques.

show abstract

Pacing induced cardiomyopathy

Cited by 81 publications

References 65 publications

Leadless pacemaker implant with concomitant atrioventricular node ablation: Experience with the Micra transcatheter pacemaker

Leadless pacemaker implant with concomitant atrioventricular node ablation: Experience with the Micra transcatheter pacemaker

Discriminating electrocardiographic responses to His-bundle pacing using machine learning

The Emerging Role of Cardiac Conduction System Pacing as a Treatment for Heart Failure

Contact Info

Product

Resources

About