Cardiac Implantation Research Articles

Quadruple therapy for heart failure before and after electronic cardiac device implantation - are we hitting our targets?

Abstract Background Quadruple therapy is currently recommended pharmacological treatment for heart failure with reduced ejection fraction (HFrEF). It consists of beta-blockers, mineralocorticoid receptor antagonists (MRA), angiotensin converting enzyme inhibitors (ACE-I) – recently suggested to be replaced with angiotensin receptor/neprilysin inhibitor (ARNI), and sodium-glucose cotransporter-2 inhibitors (SGLT2-I). Patients eligible for implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy (CRT) implantation should have therapy titrated to evidence-based target doses prior to the procedure, whenever tolerable. Compliance with guidelines as well as distinction in prescription practice before and after device implantation in the era of quadruple HFrEF therapy has not yet been fully researched. Purpose The purpose of this study is to evaluate the use of disease-modifying drugs in corresponding target doses in patients with HFrEF eligible for ICD or CRT implantation, prior to and after the procedure. Methods This is a retrospective observational study which included patients with HFrEF hospitalized for ICD or CRT implantation in a single tertiary centre from January 2021 to January 2023. Data was collected through patients' medical history and phone calls. Results We collected data on a total of 107 patients with HFrEF and ICD or CRT implantation. Most patients received all four classes of guideline-directed therapy before ICD or CRT implantation: beta-blockers (91,6%), MRA (86,0%), ACE-I (31,8%) or ARNI (59,8%) and SGLT2-I (59,8%). Evidence-based target doses were reached for 10,2%, 52,2%, 11,8%, 32,8% and 100% patients receiving beta-blockers, MRA, ACE-I, ARNI and SGLT2i respectively. After hospitalization for device implantation, results pointed to an increase in prescription of beta-blockers (99,1%), MRA (97,2%), and most notably SGLT2-I (87,9%), while more ACE-I (19,6%) were replaced with ARNI (75,7%). Target doses were reached for 19,8%, 72,1%, 28,6%, 37,0%, and 100% patients receiving beta-blockers, MRA, ACE-I, ARNI, and SGLT2-I respectively. Conclusions Most of the examined patients have been receiving all four drug classes prior to device implantation. We noticed a rising trend in recruiting novel heart failure drugs, ARNI and SGLT2-I, after the procedure. However, drug titration was non-compliant with guidelines. There was a slight improvement in up-titration of therapy after the procedure, which could be explained by more common medication adjustments by electrophysiologists during device control sessions as well as better drug tolerability after device implantation. Regardless, a minority of patients received ACE-I, ARNI and beta blockers in target doses. Despite several objective obstacles to adequate administration of disease-modifying drugs, including intolerability and patients’ non-adherence, further effort in up-titrating guideline-directed medical therapy should be applied.Therapy administration practice

Contact allergy to medical devices

Abstract Background Medical devices are not subject to any legal obligation to declare ingredients. With an increasing number of available medical devices, increasing reports of contact allergies to these devices result in a more difficult, delayed or lack of diagnosis of the trigger. Methods Elaborate chemical methods, such as gas chromatography–mass spectroscopy, were able to detect novel contact allergens in medical devices. Results Diabetic patients requiring insulin benefit from sophisticated glucose sensor measurement systems and insulin pump systems, but are limited in their choices by the development of contact allergy. Potential contact allergens in medical adhesives, plasters, and wound dressings require extensive diagnostic testing. Contact allergic reactions to cardiac electronic implants are rare. The potential relevance of a contact allergic reaction to endoluminal stents to restenosis of the treated vascular territory is discussed. Contact dermatitis to medical gloves is usually due to the vulcanization accelerators. Mouth–nose protective or FFP2 mask-associated eczema is often irritant, very rarely allergic in origin. Conclusion With continued development of medical devices, new contact allergens are introduced. The declaration of their ingredients is necessary for rapid diagnosis and future prevention.

Clinical characteristics and risk factors of in-hospital mortality among patients undergoing percutaneous pericardiocentesis

Abstract Background Percutaneous pericardiocentesis (PP) belongs to life-saving procedures in cardiac tamponade, while it may also serve as diagnostic procedure in patients with recurrent pericardial effusion. Purpose The aim of the study was to evaluate the clinical characteristics and predictors of in-hospital mortality among patients subject to PP. Methods This single-center retrospective study comprised consecutive patients who underwent PP between 2011 and 2021 regardless of primary diagnosis. Among 132 456 patients screened, 208 patients were subject to PP [109 women, 52.4%; median age of 66 (58; 76) years] who underwent 231 procedures. Exclusion criteria involved data incompleteness regarding the etiology and outcome. The primary endpoint was in-hospital mortality. Results The most common indications for PP were neoplastic disease (23.1%), idiopathic effusion (14.42%), coronary artery perforation during percutaneous coronary intervention (PCI; 13.9%), viral pericarditis (11.1%), cardiac electronic device implantation (10.6%), catheter ablation (8.7%) and post-pericardiotomy syndrome (5.8%). Overall, iatrogenic cause was the most common indication for PP (41.8%). The median volume of pericardial fluid was 550 (330; 850) ml. In-hospital death was reported in 11 patients (5.3%). Univariate analysis revealed that in-hospital death was predicted by PCI-related etiology (p<0.0001), history of pulmonary embolism (p=0.007) and sudden cardiac arrest (p=0.032), lower pericardial drainage volume (p=0.037), right bundle branch block (p=0.007), cardiogenic shock (p=0.003), packed red blood cells transfusion (p=0.023). Logistic regression indicated that PCI-related etiology (OR 76.1, p<0.001), history of pulmonary embolism (OR 17.9, p=0.03) and recurrent/persistent cardiogenic shock in the course of in-hospital stay (OR 14.7, p=0.004) were independently associated with in-hospital mortality (AUC 0.895; Figure 1). Conclusion Iatrogenic etiology represents the most frequent indication for PP. PCI-related coronary perforation confers the greatest risk of in-hospital death.

Complications according to intrathoracic versus extrathoracic venous access for cardiac device implantation: results from the PLACE (Planning Lead Access for Cardiac Electrostimulation) study

Abstract Background and Aims The choice of the vascular access for cardiac pacing devices (CIED) implant may impact on patients outcome. Recent studies and consensus documents encourage the use of an extra-thoracic access to prevent adverse events. In this large, multicenter, retrospective study we report the impact of leads access on post-procedural outcome. Methods Consecutive patients receiving a CIED from 2008 to 2019 in 4 high-volume Italian hospitals were enrolled. Short- and long-term complications (i.e. pneumothorax, cardiac tamponade, pocket decubitus, pocket hematoma, lead dislodgement, lead failure) were collected and their relationship with the type of vascular access (extra- vs intra-thoracic, i.e. cephalic vein/extra-thoracic axillary vein vs subclavian vein puncture) was analyzed. Primary endpoint was the occurrence of at least one complication during follow-up. Results A total of 4,443 patients were enrolled; 3,374 (75.9%) received a pacemaker (PM) and 1,069 (24.1%) an implantable cardioverter defibrillator (ICD). Mean follow-up was 1,630±1,010 days. At least one complication occurred in 7.6% of patients. At multivariate Cox regression analysis, adjusted for baseline confounders, the presence of structural heart disease (HR 1.59, 95%CI 1.21-2.10; p=0.001), anticoagulant therapy at implantation [HR 1.31, 95%CI 1.0004-1.71; p=0.05) and female gender (HR 0.78, 95%CI 0.63-0.98; p=0.03) were associated with the primary outcome measure. Extra-thoracic access did not reduce the risk of complications compared to intra-thoracic access (HR 0.97, 95%CI 0.76-1.25 p=0.81). The use of both accesses in the same patient conferred a significant increase in the risk of complications (HR vs single approach:1.95, 95%CI 1.41-2.69; p <0.001). Conclusions The choice of a different vascular access (intra- vs extra-thoracic) does not impact on post-procedural complications in patients receiving CIED. In particular, the intra-thoracic subclavian vein puncture by experienced operators is not related to a poorer outcome. The need for both types of access in the same patient (i.e. increased procedure complexity) increases the risk of post-procedural complications.Graphical abstract

Simulating and Predicting the Mechanical Behavior of Electrospun Scaffolds for Cardiac Patches Fabrication.

Fabricating helical scaffolds using electrospinning is a common approach for cardiac implantation, aiming to achieve properties similar to native tissue. However, this process requires multiple experimental attempts to select suitable electrospun properties and validate resulting mechanical responses. To overcome the time and cost constraints associated with this iterative procedure, Finite Element Analysis (FEA) can be applied using stable hyperelastic and viscoelastic models that describe the response of electrospun scaffolds under different conditions. In this study, we aim to create accurate simulations of the viscoelastic behavior of electrospun helical scaffolds. We fabricated helical fibers from Poly (3-caprolactone) (PCL) using the electrospinning process to achieve this. The electrospun samples were subjected to uniaxial deformation, and their response was modelled using existing hyperelastic and stress relaxation models. The simulations were built on experimental data for specific deformation speed and maximum strain conditions. The FEM results were evaluated by accounting for the stress-softening phenomenon, which significantly impacted the models. The electrospun scaffolds' predictions were performed in other than the initial experimental conditions to verify our simulations' accuracy and reliability.

Abstract 12912: Effect of Real-Time Ambulatory Electrocardiography on Time-to-Intervention

Background: Mobile cardiac telemetry (MCT) and event monitors are ambulatory electrocardiography (AECG) monitors to aid in the detection/diagnosis of arrhythmias. They are unique in their real-time alerts to clinicians. This contrasts with Holter monitoring, which is continuous but where results are not available until after completion of the exam, uploading, and clinician over-read. There is limited data on relative benefit for time to electrophysiology procedure and interventions. Hypothesis: Does real-time monitoring of AECG reduce the time to cardiac implantable electronic device procedure, ablation procedure, or healthcare encounter when compared to AECG without real-time monitoring? Methods: This is a retrospective observational analysis of University of Utah Health patients who underwent AECG studies from 2010-2022. The study cohort was stratified by patients with an ambulatory ECG that provides real-time event notification (CEM and MCT; hereafter Non-holter) versus those that do not (Holter). The outcomes of interest were cardiac device implantation, ablation procedure, and ER/hospitalization within 12 months, analyzed based on time-to-event using log-rank tests. Results: We identified 50 patients in the Holter group and 137 for the Non-holter group. The groups had similar baseline characteristics in terms of age, gender, and co-morbidities. The mean number of days to device implant was 68.1 and 66.36, to ablation procedure was 77.68 and 67.77, and to ER/hospital visit was 61.12 and 55.38 in the Holter and Non-holter groups respectively (Figure). Conclusion: There was not a statistically significant difference between AECG monitoring in real-time (Non-holter) and those without (Holter), however, there was a trend toward decreased time to intervention in the Non-holter group for each of the three outcomes. Future, larger cohorts may provide adequate power to determine if real-time monitoring does reduce time to the studied interventions.

Abstract 13098: Worsening Tricuspid Regurgitation Associated With Permanent Pacemaker and Implantable Cardioverter-Defibrillator Implantation: A Systematic Review and Meta-Analysis of Over 66,000 Patients

Introduction: Worsening TR following either PPM or ICD implantation is an emerging clinical challenge. Early recognition of this entity is essential in guiding treatment. Hypothesis: Despite many technological advances in electrophysiology, transvenous lead placement currently remains an integral part of cardiac device implantation procedures. While worsening of TR post-device does not seem to be surprising, it is counter-intuitive and eventually leads to right-sided heart failure symptoms. Methods: We searched electronic databases from inception to January 2023 for published studies that reported incidence of TR worsening post-device implantation. Log odds ratio was used to summarize group differences. Results: Our analysis included 29 studies with 66,590 participants. Patients with device implantation (n=1,008) were significantly more likely to develop worsening TR as compared to controls (n=58,605) (OR: 3.18, p<0.01). Amongst a total of 7,777 patients, pooled incidence of at least one-degree worsening of TR post-implantation was 23%. Worsening TR significantly increases mortality (HR 1.42, p=0.02). Larger right atrial area (OR 1.11, p<0.01) is significantly associated with an increased risk of worsening TR, while males are less likely to develop this complication as compared to females (OR 0.74, p<0.01). Importantly, there is no statistically significant difference between the type of implanted device (ICD vs PPM) and post-device TR. Further, RV dysfunction, pulmonary artery pressure, baseline mitral regurgitation, LVEF, baseline atrial fibrillation, and age have no association with worsening TR. Conclusions: A substantial number of patients undergoing PPM or ICD implantation are at an increased risk of worsening TR. Importantly, in this largest review to date incorporating over 66,000 patients, this significantly increases mortality by greater than 140%, accordingly deserving more recognition and clinical attention in the current era.

Abstract 16146: A Scoping Review of Adverse Outcomes Associated With Cardiac Resynchronization Therapy Device Implantation: Implications for Informed Consent

Background/Objectives: Cardiac Resynchronization Therapy (CRT) is a treatment option for many adults with heart failure with reduced ejection fraction (HFrEF). While the benefits of CRT are well-established, the downstream implications of adverse events are not well-characterized. We sought to better understand the ramifications of CRT-related adverse events on length of hospital stay (LOS) and mortality—information relevant for patients and clinicians to make informed decisions about pursuing CRT. Design: Scoping Review Methods: We conducted an initial PubMed search using terms including “Congestive Heart Failure” or “Heart Failure” and "Cardiac resynchronization" or "Cardiac re-synchronization" or "Biventricular pacing.” We reviewed resulting articles that were written in English, studied CRT devices, and outlined adverse events related to CRT device placement. We separately searched PubMed for additional articles outlining individual adverse events identified using search terms “event name,” “mortality,” and “hospital stay.” We read articles and summarized data regarding the impact of reported adverse events on hospital LOS and mortality. Results: Our search identified 18 full length articles with relevant data. The most common adverse events included device implant failure/non-response, lead dislodgment, coronary sinus dissection, and pocket hematoma. The LOS and mortality rates of each event are shown in Table 1. Of note, LOS for implantation in the ambulatory setting is up to 1 day; LOS for uncomplicated implantation during hospitalization is 4.6 days. Implantation during hospitalization with complication is mean 13.6 days. Conclusion: While absolute risks for adverse events associated with CRT implantation are low, several have important implications on hospital LOS and mortality. These findings warrant inclusion in discussion regarding the risks of CRT when clinicians and patients engage in informed decision making related to CRT.

Abstract 12653: Plasma LTBP-2 is Associated With Myocardial LTBP-2 and Poor Prognosis in Dilated Cardiomyopathy

Introduction: Cardiac extracellular matrix proteins provide structural support to the heart function and are associated with fibrosis in dilated cardiomyopathy (DCM). Latent transforming growth factor beta-binding protein 2 (LTBP-2) is a type of extracellular matrix protein, but the significance of LTBP-2 in patients with dilated cardiomyopathy is still unclear. Objective: To elucidate the significance of LTBP-2 in dilated cardiomyopathy. Methods: Plasma LTBP-2 levels were measured by Enzyme-linked immunosorbent assay in 131 DCM patients who underwent endomyocardial biopsy and 44 controls who had no history of cardiac diseases. Immunohistochemistry for LTBP-2, LTBP-1 (another LTBP family member), and Elastica-Masson staining were performed in endomyocardial biopsy specimens. DCM patients were followed up for cardiac death or ventricular assist device (VAD) implantation. Results: DCM patients had elevated plasma LTBP-2 levels compared to controls (104 vs. 57 ng/mL, P < 0.001). Plasma LTBP-2 levels were positively correlated with LTBP-2-positive fraction in the myocardium from the biopsy specimen (R = 0.311, P < 0.001). Myocardial LTBP-2-positive fraction was positively correlated with myocardial LTBP-1-positive fraction (R = 0.444, P = 0.014) and fibrosis fraction estimated by Elastica-Masson staining (R = 0.387, P < 0.001). In the Kaplan-Meier analysis, the high plasma LTBP-2 concentration group and the high myocardial LTBP-2-positive fraction group had more cardiac deaths or VAD implantations than low groups (P = 0.008 and P < 0.001, respectively). Multivariable Cox proportional hazard analysis showed that plasma LTBP-2 and myocardial LTBP-2-positive fraction were independently associated with cardiac death or VAD implantation. Conclusion: Plasma LTBP-2 reflects myocardial LTBP-2 and can be a biomarker to predict adverse outcomes in DCM patients.

MSSA Infection Due to Cardiac Device

Background: we present a 67-year-old male with a history of coronary artery disease and congestive heart failure. He had undergone implantation of an ICD one year ago. Around a year later, he presented with localized discharge, erythema, and swelling around the ICD pocket site. He denied fever, fatigue, and increased shortness of breath. Infectious disease service performed US guided fluid aspirate and culture which tested positive for MSSA. He started him on prolong regimen of cephalexin for a month without improvement. Recommendations were made then for device removal. Case Report: After explanation, the patient’s symptoms improved with antibiotic therapy and the wound showed signs of healing. The infection was successfully eradicated, and the patient’s cardiac function stabilized. The patient was discharged on oral antibiotics for an additional four weeks and scheduled for regular follow-up visits. Conclusion: This case report highlights the occurrence of a cardiac implants pocket infection. Early diagnosis, prompt removal of the infected device, and targeted antibiotic therapy were crucial in achieving successful treatment outcomes. Surgical debridement and wound irrigation played a vital role in preventing further complications. Close monitoring and follow-up are essential to ensure complete resolution of the infection and prevent recurrence.

Intra-pocket ultrasound-guided axillary vein puncture vs. cephalic vein cutdown for cardiac electronic device implantation: the ACCESS trial.

Intra-pocket ultrasound-guided axillary vein puncture (IPUS-AVP) for venous access in implantation of transvenous cardiac implantable electronic devices (CIED) is uncommon due to the lack of clinical evidence supporting this technique. This study investigated the efficacy and early complications of IPUS-AVP compared to the standard method using cephalic vein cutdown (CVC) for CIED implantation. ACCESS was an investigator-led, interventional, randomized (1:1 ratio), monocentric, controlled superiority trial. A total of 200 patients undergoing CIED implantation were randomized to IPUS-AVP (n = 101) or CVC (n = 99) as a first assigned route. The primary endpoint was the success rate of insertion of all leads using the first assigned venous access technique. The secondary endpoints were time to venous access, total procedure duration, fluoroscopy time, X-ray exposure, and complications. Complications were monitored during a follow-up period of three months after procedure. IPUS-AVP was significantly superior to CVC for the primary endpoint with 100 (99.0%) vs. 86 (86.9%) procedural successes (P = .001). Cephalic vein cutdown followed by subclavian vein puncture was successful in a total of 95 (96.0%) patients, P = .21 vs. IPUS-AVP. All secondary endpoints were also significantly improved in the IPUS-AVP group with reduction in time to venous access [3.4 vs. 10.6 min, geometric mean ratio (GMR) 0.32 (95% confidence interval, CI, 0.28-0.36), P < .001], total procedure duration [33.8 vs. 46.9 min, GMR 0.72 (95% CI 0.67-0.78), P < .001], fluoroscopy time [2.4 vs. 3.3 min, GMR 0.74 (95% CI 0.63-0.86), P < .001], and X-ray exposure [1083 vs. 1423 mGy.cm², GMR 0.76 (95% CI 0.62-0.93), P = .009]. There was no significant difference in complication rates between groups (P = .68). IPUS-AVP is superior to CVC in terms of success rate, time to venous access, procedure duration, and radiation exposure. Complication rates were similar between the two groups. Intra-pocket ultrasound-guided axillary vein puncture should be a recommended venous access technique for CIED implantation.

The Balance of CD8-Positive T Cells and PD-L1 Expression in the Myocardium Predicts Prognosis in Lymphocytic Fulminant Myocarditis

Plain Language SummaryMyocarditis is a heart condition caused by inflammation of the heart muscle. Fulminant myocarditis (FM) is a severe form that can lead to sudden heart failure, shock, or dangerous heart rhythms. Understanding how the immune system is involved in FM is crucial for finding better treatments. In this study, we examined heart tissue from 16 patients with lymphocytic FM to understand the role of specific immune cells (T cells) and molecules (PD-1 and PD-L1) in the disease. We followed the patients for about 5 months to track their outcomes. We found that patients with more CD8+ T cells (a type of immune cell) in their heart tissue had a higher risk of cardiac events such as heart failure. Furthermore, when a specific molecule called PD-L1 was more abundant in heart cells, it indicated a poorer prognosis. This suggests that high levels of CD8+ T cells and PD-L1 in the heart tissue can predict a worse outcome for patients with lymphocytic FM. Understanding these markers may help doctors identify patients at higher risk and tailor treatments to improve their prognosis. However, more research with larger groups of patients is needed to confirm these findings and guide treatment decisions.

The Interaction Between Tricuspid Regurgitation and Cardiac Resynchronization Therapy Response in Patients with Congestive Heart Failure

Background: Aggravation of tricuspid regurgitation (TR) is a predictable issue following cardiac device implantation, while its clinical importance is subject to debate. Objectives: We aimed to recognize the alteration of TR following cardiac resynchronization therapy (CRT) and its effect on the response to CRT. Methods: In this prospective study, 70 candidates were recruited for CRT from those who visited two university hospitals in Tehran and Ahvaz (Iran) from January 2012 to March 2013. Baseline specifications were recorded for all the participants. All the patients underwent echocardiography before and 6 months after CRT administration. They were then divided into two categories for further comparison: (1) Patients with no or mild TR and (2) patients with moderate-to-severe TR. The echocardiographic response to CRT was defined as a left ventricular end-systolic volume (LVESV) decrease of &gt;15% or left ventricular ejection fraction (LVEF) advancement of &gt;5%. The clinical response to CRT was one class improvement based on the New York Heart Association (NYHA) class. Results: Of the patients, 24 had moderate-to-severe TR. Although the increase in cases with moderate-to-severe TR after CRT was not significant, the aggravation of TR degree after the procedure was significant (P = 0.002). Moreover, the NYHA class significantly improved after the CRT (P = 0.02). The number of cases with a clinical response to CRT based on improvement of the NYHA class was significantly greater in patients with no TR or mild TR at baseline (P = 0.003). There was no significant variation in response to CRT among patients who experienced TR exacerbation after CRT compared with those who had no change or a reduction in TR. Conclusions: This study demonstrated that TR severity was exacerbated following CRT, but this alternation in TR severity had no significant effect on the response to CRT. Therefore, the presence and development of TR before and after CRT must not affect the criteria for choosing cardiac resynchronization therapy for appropriate patients.

Temporary cardiac pacing: 50 years old and still young

Temporary cardiac pacing (TCP) is a 50-year-old technique but it is still young. It is used in all cardiology departments for saving lives of patients with bradycardia and hemodynamic instability. The know-how of TCP cannot miss in clinical competence of cardiologists that work in the cardiac intensive care unit. However, despite its wide diffusion, the scientific evidence supporting TCP is not so strong and in Italian hospitals the management of some aspects of TCP is highly variable, including indications as well as antibiotic and anticoagulant prophylaxis. Due to the high risk of TCP-related complications, the 2021 European guidelines on cardiac pacing recommend whenever possible to avoid TCP before cardiac implantable electronic device implantation and, in all cases, TCP duration should be as short as possible. In the last years, if on the one hand, TCP indications have gradually decreased, on the other hand high-frequency TCP during aortic valvuloplasty or transcatheter aortic valve implantation procedures have progressively increased.

Impact of comorbid heart failure among hospitalized patients with sarcoidosis: A United States population-based cohort study

BackgroundThere is paucity of data regarding the impact of concomitant heart failure (HF) on the in-hospital outcomes among hospitalized sarcoidosis patients. We aim to investigate the factors associated with concomitant HF and its impact on in-hospital outcomes among hospitalized sarcoidosis patients. MethodsWe utilized the 2018–2020 National Inpatient Sample (NIS) Database in conducting this study. Multivariable logistic and linear regression models were used to examine the factors associated with HF and hospital-associated outcomes among patients with sarcoidosis. ResultsA total of 36,864 hospitalized patients with sarcoidosis were identified, of which 24.78 % (n = 9135/36,864) had concomitant HF. Factors associated with concomitant HF were age (aOR 1.03; 95 % CI: 1.02–1.03, p value ≤ 0.001), black race (aOR 1.74; 95 % CI: 1.47–2.05, p value ≤ 0.001), not being female (aOR 0.79; 95 % CI: 0.69–0.91, p value ≤ 0.001), and arrhythmias (aOR 2.50; 95 % CI: 2.10–2.98, p value ≤ 0.001) specifically atrial fibrillation and ventricular tachycardia. Comorbidities associated with concomitant HF in this population were hyperlipidemia, obesity, coronary artery disease, cardiac device implantation history, and chronic kidney disease stage 1–4. Concomitant HF was not an independent predictor of in-hospital mortality or length of stay (LOS). However, age (aOR 1.04; 95 % CI, 1.03–1.06; p ≤ 0.001) and arrhythmia burden (aOR 2.08; 95 % CI, 1.47–2.95; p ≤ 0.001), specifically ventricular tachycardia and fibrillation, were independently associated with in-hospital mortality among sarcoidosis patients. ConclusionTraditional cardiovascular risk factors were associated with concomitant HF among hospitalized sarcoidosis patients. Moreover, concomitant HF among sarcoidosis patients was not significantly associated with in-hospital mortality or LOS.

LC-MS/MS assisted biomonitoring of ropivacaine and 3-OH-ropivacaine after plane block anesthesia for cardiac device implantation.

Introduction: Ropivacaine is a popular local anesthetic used for regional anesthesia or for pain management. Although designed as an enantiomerically pure drug, an aspect that reduces the adverse effects, its toxicological effects are still a risk. As such, biomonitoring to assure appropriate dosage and bioavailability are essential to avoid complications during or post-surgery. Methods: The study focused on developing a sensitive, selective, and accurate liquid chromatography-mass spectrometry (LCMS/MS) method which facilitates the biomonitoring of ropivacaine and its main metabolite in plasma after regional anesthesia using ropivacaine. Results and Discussion: The method was validated with regards to all relevant parameters, such as sensitivity, selectivity, accuracy, precision, and the effect of sample matrix. The method was successfully used in a pilot study, which included one patient undergoing plane block anesthesia for cardiac device implantation. The results showed the method is appropriate for its intended purpose and could even be used in other, similar applications.

Survival after a heart attack with subsequent cardiac arrest: a 1-year patient case report

BackgroundCardiac events have become a common occurrence worldwide and especially in India, more so after the coronavirus disease (COVID) pandemic. Apparently healthy and young individuals suffering from cardiac disorders are on the rise. In most cases, there is no clearly established cause/risk factor for the cardiac disorder. Once someone has suffered a cardiac event, the rehabilitation team is expected to keep a constant watch on the prognosis and any complications that might arise, especially during the first year after the cardiac event.Case presentationThis case report describes the sequence of events that occurred in a 44-year-old male patient who had a heart attack, survived a cardiac arrest, was implanted with a cardioverter defibrillator (ICD), and was on rehabilitation. The report throws some insights into what happened with this patient since his heart attack, and it also discusses the possible signs that could have helped identify the cardiac event before the actual occurrence.ConclusionThe rehabilitation post heart attack, angioplasty, and cardiac implants have to be individualized and tailor-made. Appropriate alterations to the rehabilitation would give the necessary direction to achieve maximum recovery and well-being of the patient. Constantly watching for any complications that might arise and addressing them immediately are vital to the prognosis. Physiotherapy rehabilitation plays a major role in giving a positive reinforcement and better prognosis.

Venous thoracic outlet syndrome, as a pitfall for cardiac implantable electronic device implantations.

The subclavian vein is typically used in cardiovascular implantable electronic device (CIED) implantations. External stress on the subclavian vein can lead to lead-related complications. There are several causes of this stress, such as frequent upper extremity movements or external injury. Venous thoracic outlet syndrome (TOS) can also become the cause of external lead stress. However, the diagnosis of venous TOS can be challenging because subclavian venography can appear normal at first glance. We present a unique case of a device infection in a patient with venous TOS. A careful observation of the imaging studies is vital for diagnosing venous TOS and a leadless pacemaker implantation could be an alternative therapeutic option.

Trends and Challenges in the Development of 3D-Printed Heart Valves and Other Cardiac Implants: A Review of Current Advances.

This article provides a comprehensive review of the current trends and challenges in the development of 3D-printed heart valves and other cardiac implants. By providing personalized solutions and pushing the limits of regenerative medicine, 3D printing technology has revolutionized the field of cardiac healthcare. The use of several organic and synthetic polymers in 3D printing heart valves is explored in this article, with emphasis on both their benefits and drawbacks. In cardiac tissue engineering, stem cells are essential, and their potential to lessen immunological rejection and thrombogenic consequences is highlighted. In the clinical applications section, the article emphasizes the importance of 3D printing in preoperative planning. Surgery results are enhanced when surgeons can visualize and assess the size and placement of implants using patient-specific anatomical models. Customized implants that are designed to match the anatomy of a particular patient reduce the likelihood of complications and enhance postoperative results. The development of physiologically active cardiac implants, made possible by 3D bioprinting, shows promise by eliminating the need for artificial valves. In conclusion, this paper highlights cutting-edge research and the promise of 3D-printed cardiac implants to improve patient outcomes and revolutionize cardiac treatment.

Cardiac implantable electronic device implantation and device-related infection.

Cardiac implantable electronic devices (CIED) are important tools for managing arrhythmias, improving hemodynamics, and preventing sudden cardiac death. Device-related infections (DRI) remain a significant complication of CIED and are associated with major adverse outcomes. We aimed to assess the trend in CIED implantations, and the burden and morbidity associated with DRI. The 2011-2018 National Inpatient Sample database was searched for admissions for CIED implantation and DRI. A total of 1 604 173 admissions for CIED implantations and 71 007 (4.4%) admissions for DRI were reported. There was no significant change in annual admission rates for DRI (3.96-4.59%, P value for trend = 0.98). Those with DRI were more likely to be male (69.3 vs. 57%, P < 0.001) and have a Charlson comorbidity index score ≥3 (46.6 vs. 36.8%, P < 0.001). The prevalence of congestive heart failure (CHF) increased in those admitted with DRI over the observation period. Pulmonary embolism, deep vein thrombosis, and post-procedural hematoma were the most common complications in those with DRI (4.1, 3.6, and 2.90%, respectively). Annual in-hospital mortality for those with DRI ranged from 3.9 to 5.8% (mean 4.4%, P value for trend = 0.07). Multivariate analysis identified CHF [odds ratio (OR) = 1.67; 95% confidence interval (CI) = 1.35-2.07], end-stage renal disease (OR = 1.90; 95% CI = 1.46-2.48), coagulopathy (OR = 2.94; 95% CI = 2.40-3.61), and malnutrition (OR = 2.50; 95% CI = 1.99-3.15) as the predictors of in-hospital mortality for patients admitted with DRI. Device-related infection is relatively common and continues to be associated with high morbidity and mortality. The prevalence of DRI has not changed significantly despite technical and technological advances in cardiac devices and their implantation.