| 1. |
- Borgquist, Rasmus, et al.
(författare)
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Diagnosis and treatment of the rare procedural complication of malpositioned pacing leads in the left heart: a single center experience
- 2022
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 56:1, s. 302-309
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. This study assessed the management approach and outcome of the pacemaker or implantable cardioverter-defibrillator (ICD) leads malpositioned in the left heart. Malpositioned leads (MPLs) may have deleterious consequences, and appropriate management remains uncertain. Methods. The study population included all patients referred to a single institution for MPL in the left side of the heart after pacemaker or ICD implantation during the period from 2015 to 2021. The approach and outcome of lead management were retrospectively assessed. Results. During the study period, 6887 patients underwent device implantation. MPL was diagnosed in five patients (0.07%). In four cases, the pacing lead was placed in a coronary sinus (CS) branch, while the pacing lead was inside the left ventricle (LV) in one case. Symptoms suggestive of lead malposition were reported by 2 patients (40%). One of the patients presented with recurrent TIAs. Another presented with inappropriate ICD shocks. In one asymptomatic case, an ICD lead changed position from the right ventricle to the CS, suggesting idiopathic lead migration. In 4/5 patients, the leads were removed or repositioned by percutaneous approach, with no major periprocedural complications. Conclusions. In this series of MPL in the left heart, two patients presented with thromboembolic events or inappropriate ICD shocks. These serious complications highlight the critical need for early correct diagnosis and proper management of MPL.
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| 2. |
- Borgquist, Rasmus, et al.
(författare)
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Repositioning and optimization of left ventricular lead position in non-responders to Cardiac Resynchronization Therapy is associated with improved ejection fraction, lower NT-ProBNP values and less heart failure symptoms
- 2022
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Ingår i: Heart Rhythm O2. - : Elsevier BV. - 2666-5018. ; 3:5, s. 457-463
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundObservational data suggests that an anterior or apical left ventricular (LV) position in Cardiac Resynchronization Therapy (CRT) is associated with worse outcome and higher likelihood of “non-response”. It is not known whether the benefits of optimizing LV lead position in a second procedure outweighs the procedural risks.ObjectiveTo evaluate the clinical effects of LV lead repositioning.MethodsDuring the period 2015-2020, we identified all patients where the indication for the procedure was LV lead repositioning due to “non-response” in combination with suboptimal LV lead position. All patients were followed with a structured visit 6-months post LV lead revision. Heart failure hospitalization and mortality data was gathered from the medical records and cross-checked with the population registry.ResultsA total of 25 patients were identified who fulfilled the inclusion criteria. All procedures were successful in establishing LV lead pacing in a lateral mid- or basal location. Median follow-up was 2.5 years [1.1-3.7]. There were improvements in NYHA class (mean -0.5±0.5 class, p<0.001), left ventricular ejection fraction (+5 [IQR 2-11] absolute %, p=0.01), QRS duration (-36 [-44 to -8], p<0.001) and NT-ProBNP (-615 [-2837 to +121] ng/L, p=0.03). Clinical outcome was similar to a reference population with CRT (p=ns).ConclusionIn non-responders to CRT with either an anterior or inferior LV lead position, it was feasible to perform LV lead repositioning in all cases, with a low complication rate. Changing the LV lead position was associated with improved LV ejection fraction, larger QRS-reduction and larger NT-ProBNP reduction.
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| 3. |
- Brandtvig, Tove Olsson, et al.
(författare)
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Association between left ventricular lead position and intrinsic QRS morphology with regard to clinical outcome in cardiac resynchronization therapy for heart failure
- 2023
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Ingår i: Annals of Noninvasive Electrocardiology. - 1082-720X. ; 28:4
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundLeft ventricular (LV) lead position may be an important factor for delivering effective cardiac resynchronization therapy (CRT). We therefore aimed to evaluate the effects of LV lead position, stratified by native QRS morphology, regarding the clinical outcome.MethodsA total of 1295 CRT-implanted patients were retrospectively evaluated. LV lead position was classified as lateral, anterior, inferior, or apical, and was determined using the left and right anterior oblique X-ray views. Kaplan Meier and Cox regression were performed to evaluate the effects on all-cause mortality and heart failure hospitalization, and the potential interaction between LV lead position and native ECG morphologies.ResultsA total of 1295 patients were included. Patients were aged 69 ± 7 years, 20% were female, 46% received a CRT-Pacemaker (vs. CRT-Defibrillator), mean LVEF was 25% ± 7%, and median follow-up was 3.3 years [IQR 1.6–5–7 years]. Eight hundred and eighty-two patients (68%) had a lateral LV lead location, 207 (16%) anterior, 155 (12%) apical, and 51 (4%) inferior. Patients with lateral LV lead position had larger QRS reduction (−13 ± 27 ms vs. −3 ± 24 ms, p ConclusionsIn patients treated with CRT, non-lateral LV lead positions (including apical, anterior, and inferior positions) were associated with worse clinical outcome and less reduction of QRS duration. This association was strongest for patients with native LBBB or RBBB.
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| 4. |
- Farouq, Maiwand, et al.
(författare)
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Age-stratified comparison of prognosis in cardiac resynchronization therapy with or without prophylactic defibrillator for non-ischemic cardiomyopathy – a nationwide cohort study
- 2023
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Ingår i: Europace. - 1532-2092. ; 25:7
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Tidskriftsartikel (refereegranskat)abstract
- Background and aimsPrior studies have suggested that the benefit from primary preventive defibrillator treatment for patients with non-ischemic cardiomyopathy primarily, treated with cardiac resynchronization therapy, may be age-dependent. We aimed to compare age-stratified mortality rates and mode of death in patients with non-ischemic cardiomyopathy who are treated with either primary preventive Cardiac Resynchronization Therapy-defibrillator (CRT-D) or CRT-pacemaker (CRT-P).MethodsAll patients with non-ischemic cardiomyopathy and CRT-P or primary preventive CRT-D who were implanted in Sweden during the period 2005-2020 were included. Propensity scoring was used to create a matched cohort. Primary outcome was all-cause mortality within five years.Results4027 patients were included, 2334 with CRT-P and 1693 with CRT-D. Crude 5-year mortality was 635 (27%) vs. 246 (15%), p ConclusionIn this nationwide registry-based study, patients with CRT-D have better five-year survival compared to patients with CRT-P. The interaction between age and mortality reduction not consistent, but patients with CRT-D aged
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| 5. |
- Farouq, Maiwand, et al.
(författare)
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Risk factors and incidence of new-onset heart failure with conventional pacemakerimplant – a nationwide study
- 2024
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Ingår i: Heart Rhythm O2. - 2666-5018.
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundStudies have shown that the risk of new-onset heart failure (HF) is higher post-implant for patients receiving right ventricular pacing.ObjectiveThis study aimed to investigate incidence, risk factors and implications for long-term prognosis of new-onset HF in patients after pacemaker-implant.MethodsPatients without preexisting HF who received a pacemaker in Sweden during the period 2005-2020 were identified via the nationwide Pacemaker Registry. Data was crossmatched with the population registry and national disease registries. Primary outcome was new-onset HF within 5 years, and a risk score for this was developed and validated..ResultsIn all, 65579 patients met the inclusion criteria (10351 single chamber ventricular and 55228 dual chamber pacemakers). 13792 (21.0%) patients were diagnosed with HF within five years post-implant. Of these, 6244 (45.3%) were hospitalized for HF. Patients with new-onset heart failure were more likely to die within five years (41.2% vs. 19.7%, p<0.0001). Risk factors for new-onset HF included increasing age, male sex, hypertension, diabetes, atrial fibrillation, chronic lung- and kidney disease, ischemic heart disease, and AV block. In a combined score using these variables, patients in the highest risk-score quartile had a hazard ratio of 5.36 [4.91-5.86] (p<0.001) and an absolute risk of 32% for developing HF.ConclusionPacemaker therapy is associated with >20% risk of new-onset HF within five years, and we identified nine risk factors associated with the diagnosis of new-onset HF. The proposed score based on these variables can be used to identify patients at high risk for new-onset heart failure
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| 6. |
- Farouq, Maiwand, et al.
(författare)
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Successful percutaneous extraction of malpositioned pacemaker lead in the left ventricle after proper dabigatran treatment
- 2022
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Ingår i: PACE - Pacing and Clinical Electrophysiology. - : Wiley. - 1540-8159 .- 0147-8389. ; 45:9, s. 1101-1105
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Tidskriftsartikel (refereegranskat)abstract
- Malpositioned pacemaker lead in the left ventricle (LV) is a rare procedural complication, which causes a special risk of thromboembolic events. Hence, prompt identification and early management of misplaced leads inside the LV is critical. Herein, we present a case of malpositioned pacemaker lead with transient ischemic attacks after the pacemaker implantation. The misplaced ventricular lead was discovered during regular echocardiography. Both leads were extracted percutaneously after dabigatran treatment. To our knowledge, this is the first report of uncomplicated percutaneous extraction of an inadvertently placed LV lead after dabigatran treatment. No neurologic events during a follow-up of 4 years.
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| 7. |
- Rorsman, Cecilia, et al.
(författare)
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Sex‐based differences in cardiac resynchronization therapy upgrade and outcome for patients with pacemaker and new‐onset heart failure
- 2023
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Ingår i: PACE - Pacing and Clinical Electrophysiology. - 1540-8159. ; , s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPatients with chronic right ventricular (RV) pacing are at an increased risk of heart failure. Previous studies have indicated that cardiac resynchronization therapy (CRT) is underused in this setting, and that there may be sex-based differences in both CRT use and clinical outcome.ObjectiveTo evaluate sex-based differences in CRT use and clinical outcome for patients with new-onset heart failure post RV pacing.MethodsData from the Swedish pacemaker registry was matched with data from the national death and disease registries. Patients with de novo pacemaker implant due to AV block during the period 2005–2020 were included. New-onset heart-failure within two years post-implant was evaluated, primary outcome was all-cause mortality.ResultsIn all, 30183 patients (37% female) were included. Women were on average 3 years older, but had less comorbidities than men. Median follow-up time was 4.5 [2.0–8.0] years. Women had better age- and comorbidity-adjusted survival (HR 0.78 [0.73–0.84], p < .001). For the 3560 patients (12.4% men and 10.7% women, p < .001) who were diagnosed with new-onset heart failure, 5-year mortality was similar for men and women (50% vs. 48%, p = .29). However, women were less likely to receive CRT-upgrade (3.8% vs. 9.1%, p < .001), and those who did were almost ten years younger than the men.ConclusionWomen with pacemaker due to AV block are older but have less comorbidities than men. They are less likely to develop new-onset heart failure, but also less likely to receive a CRT upgrade if they do develop heart failure. Increased awareness of the positive effects of CRT upgrade and potential sex- and age-based discrimination is warranted.
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