Advances in Cardiac Pacing and Defibrillation

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Electrophysiology and Cardiovascular Physiology".

Deadline for manuscript submissions: closed (30 April 2022) | Viewed by 6528

Special Issue Editors


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Guest Editor
Division of Cardiovascular Medicine, The Gill Heart & Vascular Institute, Lexington, KY 40536, USA
Interests: biventricular pacing; His bundle pacing; left bundle pacing

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Guest Editor
Mount Carmel Heart & Vascular Specialists North Meadows, Grove City, OH 43123, USA
Interests: CIEDs; heart failure; disparity; artificial intelligence; ablation; women's cardiovascular health

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Guest Editor
UK Albert B. Chandler Hospital-Pavilion G, Gill Heart & Vascular Institute, 800 Rose St. Lexington, KY 40536, USA
Interests: leadless pacing; basic science of defibrillation; new CRT leads/technologies

Special Issue Information

Dear Colleagues,

Since the first pacing system was implanted in 1958, there have been many evolutionary milestones in cardiac implantable electronic device therapy. The first implantable cardiac defibrillator was placed in 1980, and the first reported biventricular pacing in 1994. This field remains in constant evolution. The advancements have also created new challenges and drive device technology to overcome these limitations.

Lead complications account for most device complications, including acute dislodgement, lead-related vascular occlusion, infection, and lead malfunction. This has led to the development of leadless pacing through a femoral vein delivery system. This advancement has been superior to other pacing systems in patients with endocarditis, vascular occlusion, frail body habitus, and post-extraction. These systems have evolved as well now with acoustic atrial sensing to provide atrial ventricular synchrony. A clinical trial is currently utilizing a leadless device that will offer a future upgrade that will allow pacing in both atrial and ventricular. An implantable pacemaker placed at the time of cardiac surgery that fully dissolves has also been recently reported.

Implantable defibrillators can also be implanted fully subcutaneously. This provides an advantage in terms of avoiding the vascular space but is currently limited by lack of brady or anti-tachycardia pacing. The combined use of leadless pacing systems with a subcutaneous defibrillator may overcome these limitations.

Right ventricular pacing was the original ventricular pacing location; however, the risk of pacing-induced dyssynchrony and its deleterious effects has become evident. Biventricular pacing provides a viable way to mitigate dyssynchrony but primarily benefits patients with left bundle branch block and reduced ejection fraction. Recent advances have made His bundle pacing an option that may provide physiologic pacing for a wider patient population. His pacing can be utilized to provide resynchronization and has been shown to be superior to biventricular pacing in several recent studies. Implant success remains challenging, however, and has led to the development of left bundle pacing. These options should all be available to achieve cardiac resynchronization and serve as an alternative when the initial methodology is not successful.

Heart failure also remains an increasing health problem. The majority of heart failure candidates do not meet criteria for cardiac resynchronization. This important therapeutic gap of patients with reduced ejection fraction and normal or slightly widened QRS can now be treated with cardiac contractility modulation. This provides a biphasic high-voltage bipolar signal to the right ventricular septum during the absolute refractory period, eliciting an acute increase in global contractility and chronically producing improved ejection fraction exercise tolerance with improved quality of life and heart failure symptoms.

The ongoing progress in the field of cardiac device therapy is exciting. The aim of this Special Issue is to review cardiac device data more fully and discuss implant techniques, limitations, and success of current advances.

Dear colleagues, we are pleased to invite you to submit original research or reviews on these topics. We look forward to your contributions.

Dr. Kristin E. Ellison
Dr. Laura M. Gravelin
Dr. Joseph J. Souza
Guest Editors

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Keywords

  • implantable cardiac device, pacing, defibrillation
  • leadless pacemaker
  • subcutaneous defibrillator
  • His bundle pacing
  • left bundle pacing
  • cardiac resynchronization
  • cardiac contractility modulation

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Published Papers (2 papers)

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Research

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11 pages, 1880 KiB  
Article
Impact of S-Wave Amplitude in Right Precordial Leads on Improvement in Mitral Regurgitation following Cardiac Resynchronization Therapy
by Naoya Kataoka, Teruhiko Imamura, Takahisa Koi, Shuhei Tanaka, Nobuyuki Fukuda, Hiroshi Ueno and Koichiro Kinugawa
J. Cardiovasc. Dev. Dis. 2022, 9(5), 159; https://doi.org/10.3390/jcdd9050159 - 16 May 2022
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Abstract
Background: The therapeutic strategy for mitral regurgitation (MR) in patients with advanced heart failure and wide QRS complex who are indicated for both intervention to MR and cardiac resynchronization therapy (CRT), remains unclear. Objective: We aimed to determine electrocardiogram parameters that associate with [...] Read more.
Background: The therapeutic strategy for mitral regurgitation (MR) in patients with advanced heart failure and wide QRS complex who are indicated for both intervention to MR and cardiac resynchronization therapy (CRT), remains unclear. Objective: We aimed to determine electrocardiogram parameters that associate with MR reduction following CRT implantation. Methods: Among the patients with advanced heart failure and functional MR who intended to receive CRT implantation, baseline QRS morphology, electrical axis, PR interval, QRS duration, and averaged S-wave in right precordial leads (V1 to V3) in surface electrocardiogram were measured. The impact of these parameters on MR reduction following CRT implantation, which was defined as a reduction in MR ≥1 grade six months later, was investigated. Results: In 35 patients (median 71 years old, 18 men), 17 (49%) achieved an MR reduction following CRT implantation. Among baseline characteristics, only the higher S-wave amplitude in right precordial leads was an independent predictor of MR reduction (odds ratio 14.00, 95% confidence interval 1.65–119.00, p = 0.016) with a cutoff of 1.3 mV calculated through the area under the curve. The cutoff significantly stratified the cumulative incidences of heart failure re-admission and percutaneous mitral valve repair following CRT implantation (p = 0.032 and p = 0.011, respectively). Conclusions: In patients with advanced heart failure and functional MR, the baseline higher amplitude of S-wave in the right precordial leads might be a good indicator of MR improvement following CRT. Full article
(This article belongs to the Special Issue Advances in Cardiac Pacing and Defibrillation)
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Review

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15 pages, 312 KiB  
Review
Implantable Cardioverter Defibrillator in Primary and Secondary Prevention of SCD—What We Still Don′t Know
by Andreea Maria Ursaru, Antoniu Octavian Petris, Irina Iuliana Costache, Ana Nicolae, Adrian Crisan and Nicolae Dan Tesloianu
J. Cardiovasc. Dev. Dis. 2022, 9(4), 120; https://doi.org/10.3390/jcdd9040120 - 16 Apr 2022
Cited by 3 | Viewed by 3688
Abstract
Implantable cardioverter defibrillators (ICDs) are the cornerstone of primary and secondary prevention of sudden cardiac death (SCD) all around the globe. In almost 40 years of technological advances and multiple clinical trials, there has been a continuous increase in the implantation rate. The [...] Read more.
Implantable cardioverter defibrillators (ICDs) are the cornerstone of primary and secondary prevention of sudden cardiac death (SCD) all around the globe. In almost 40 years of technological advances and multiple clinical trials, there has been a continuous increase in the implantation rate. The purpose of this review is to highlight the grey areas related to actual ICD recommendations, focusing specifically on the primary prevention of SCD. We will discuss the still-existing controversies strongly reflected in the differences between the international guidelines regarding ICD indication class in non-ischemic cardiomyopathy, and also address the question of early implantation after myocardial infarction in the absence of clear protocols for patients at high risk of life-threatening arrhythmias. Correlating the insufficient data in the literature for 40-day waiting times with the increased risk of SCD in the first month after myocardial infarction, we review the pros and cons of early ICD implantation. Full article
(This article belongs to the Special Issue Advances in Cardiac Pacing and Defibrillation)
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