Rate‐responsive pacing and atrial high rate episodes in cardiac resynchronization therapy patients: Is low heart rate the key?

Biffi, Mauro; D’Onofrio, Antonio; Pignalberi, Carlo; Pisanó, Ennio; Iacopino, Saverio; Curnis, Antonio; Senatore, Gaetano; Capucci, Alessandro; Bella, Paolo Della; Calvi, Valéria; Zanotto, Gabriele; Caravati, Fabrizio; Maglia, Giampiero; Manzo, Michele; Santamaria, Matteo; Ziacchi, Matteo; Lissoni, Fabio; Giacopelli, Daniele; Gargaro, Alessio; Solimene, Francesco

doi:10.1002/clc.23227

Cited by 8 publications

(1 citation statement)

References 24 publications

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“…Careful analysis of unpaced and paced P wave duration and PR interval can unveil AP-induced dyssynchrony (Figure 1). Noteworthy, unnecessary atrial stimulation reproducibly increased new-onset AF both in ICD (Implantable Cardioverter-Defibrillator) and in CRTD (Cardiac Resynchronization Therapy Defibrillator) recipients [15,16].…”

Section: Atrial Pacing: Interatrial and Atrioventricular Couplingmentioning

confidence: 99%

Cardiac Stimulation in the Third Millennium: Where Do We Head from Here?

Biffi

Spadotto

Piemontese

et al. 2021

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Over the years, pacemakers have evolved from a life-saving tool to prevent asystole to a device to treat heart rhythm disorders and heart failure, aiming at improving both cardiac function and clinical outcomes. Cardiac stimulation nowadays aims to correct the electrophysiologic roots of mechanical inefficiency in different structural heart diseases. This has led to awareness of the concealed risks of customary cardiac pacing that can inadvertently cause atrioventricular and inter-/intra-ventricular dyssynchrony, and has promoted the development of new pacing modalities and the use of stimulation sites different from the right atrial appendage and the right ventricular apex. The perspective of truly physiologic pacing is the leading concept of the continued research in the past 30 years, which has made cardiac stimulation procedure more sophisticated and challenging. In this article, we analyze the emerging evidence in favor of the available strategies to achieve an individualized physiologic setting in bradycardia pacing.

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Section: Atrial Pacing: Interatrial and Atrioventricular Couplingmentioning

confidence: 99%

Cardiac Stimulation in the Third Millennium: Where Do We Head from Here?

Biffi

Spadotto

Piemontese

et al. 2021

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Defibrillation testing during implantation of the subcutaneous implantable cardioverter-defibrillator: a necessary standard or becoming redundant?

2020

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Since the publication of the SIMPLE and NORDIC trials, defibrillation testing (DFT) is rarely performed during routine implantation of transvenous implantable cardioverter-defibrillators (ICD). However, the results of these trials cannot be extrapolated to the later introduced subcutaneous ICD (S-ICD) and a class I recommendation to perform DFT during the implantation of these devices remains in the current guidelines. Due to the high conversion success rate of DFT on one hand, and the risk of complications on the other, a significant number of physicians omit DFT in S-ICD recipients. Several retrospective analyses have assessed the safety of the omission of DFT and report contradicting results and recommendations. It is known that implant position, as well as device factors and patient characteristics, influence defibrillation success. A better comprehension of these factors and their relationship could lead to more reliable and safer alternatives to DFT. An ongoing randomised clinical trial, which is expected to end in 2023, is the first study to implement a method that assesses implant position to identify patients who are likely to fail their DFT.

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