Implantable Cardioverter Defibrillator Research Articles

Cardiac resynchronization therapy via left bundle branch pacing in heart failure with complete left bundle branch block: is the defibrillator needed?

AimsThis retrospective cohort study aimed to investigate the efficacy of dual-chamber left Bundle branch pacing (LBBP) as an alternative therapy for heart failure patients with complete left bundle branch block (CLBBB) and indications for defibrillator with cardiac resynchronization therapy (CRT-D).Methods34 patients met inclusion criteria were enrolled in the study. These criteria included a left ventricular ejection fraction (LVEF) of lower than 35%, a New York Heart Association functional class of II–IV, CLBBB meeting Strauss's criteria, intraventricular dyssynchrony, and confirmed correction of CLBBB during LBBP. Patients with ischemic cardiomyopathy, left ventricular noncompaction, significant late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR), and indications for an implantable cardioverter-defibrillator (ICD) as secondary prevention were excluded.ResultsPost-LBBP, the LVEF improved from 31.1 ± 4.0% to 61.0 ± 6.0% (P < 0.001). All patients exhibited a super-response to LBBP cardiac resynchronization therapy, achieving complete improvement in cardiac function with a LVEF exceeding 50%. Septal-to-posterior wall motion delay (SPWMD) and systolic dyssynchrony index (SDI) were indicators of intraventricular synchrony, SPWMD decreased from 271.4 ± 76.4 ms to 42.2 ± 22.9 ms (P < 0.001), and SDI decreased from 12.5 ± 5.3% to 1.9 ± 1.0% after implantation (P < 0.001).ConclusionsHeart failure patients meeting the following criteria may be considered for dual-chamber pacing as an alternative to CRT-D, potentially avoiding the need for ICD implantation: (1) CLBBB meeting Strauss's criteria, (2) presence of intraventricular dyssynchrony on echocardiogram, (3) exclusion of secondary prevention ICD indications, (4) absence of evident LGE on CMR, and (5) successful correction of CLBBB during LBBP.

Influence of radiotherapy on cardiac implantable devices and leads-asingle-institution analysis and critical evaluation of current guidelines.

Increasing life expectancy and advances in cancer treatment will lead to more patients needing both radiation therapy (RT) and cardiac implantable electronic devices (CIEDs). CIEDs, including pacemakers and defibrillators, are essential for managing cardiac arrhythmias and heart failure. Telemetric monitoring of CIEDs checks battery status, lead function, settings, and diagnostic data, thereby identifying software deviations or damage. This study evaluates the German Society for Radiation Oncology (DEGRO)/German Society for Cardiology (DGK) guideline, assessing real-world complications and risk factors and analyzing pacemaker and implantable cardioverter-defibrillator (ICD) lead function for their predictive value concerning device malfunction. Atotal of 54patients with pacemakers or ICDs who underwent radiation therapy were identified. Demographics, treatment courses, and device information from physical and digital records were extracted. DEGRO/DGK risk groups and pacemaker dependency at the start of RT were assessed. Delineation of the devices and lead insertion sites was performed in the treatment planning system. Dosimetric information from the treatment plans was then correlated with reports of standardized device checks. Over 80% of patients were treated with dual-chamber pacemakers or cardiac resynchronization therapy (CRT), and 16.7% had ICDs. One third of patients were pacemaker dependent. 59.3% of patients were in the low-risk category, 29.3% in the medium-risk, and 11.1% in the high-risk category. Thoracic irradiation resulted in the highest median dose to devices. Lead parameter deviations exceeding thresholds were found in 14.8% for the stimulation threshold and 13.5% for sensing. Device malfunctions occurred in 3.7% of cases, both involving electrical resets and neutron-producing radiation (beam energy 10megaelectron volt (MV) or higher). Collecting lead parameters in addition to secure malfunctions like electrical restarts and memory erasure revealed asignificant proportion of treatment courses with temporary changes, though no correlation with individual treatment plans or adverse events was found. The focus on reducing neutron-producing radiation could be further supported.

Late-gadolinium enhancement predicts appropriate device therapies in non-ischemic recipients of primary prevention implantable cardioverter-defibrillators.

Better risk stratification is needed to evaluate patients with non-ischemic cardiomyopathy (NICM) for prophylactic implantable cardioverter-defibrillators (ICD). Growing evidence suggests cardiac magnetic resonance imaging (CMR) may be useful in this regard. We aimed to determine if late-gadolinium enhancement (LGE) seen on CMR (dichotomized as none/minimal <2% vs significant ≥2%) predicts appropriate ICD therapies (primary endpoint) and/or all-cause mortality/transplant/left-ventricular assist device (LVAD) implantation (secondary endpoint) in NICM patients. We identified 344 patients with NICM who underwent primary prevention ICD implantation at Cleveland Clinic between 2003-2021 with CMR within 12 months before implant. LGE was calculated as percentage myocardium with pixel intensity ≥5 standard deviations higher than that of reference myocardium. Endpoints were adjudicated retrospectively by chart review. 125 of 344 patients (36%) had none/minimal LGE and 219 (64%) had significant LGE. Over a median follow-up of 61 months, 53 patients (24%) with significant LGE vs 10 (8%) with none/minimal LGE met the primary endpoint, and 56 patients (26%) vs 21 (17%) met the secondary endpoint, respectively. Significant LGE predicted the primary outcome in multivariable competing-risks regression (hazard ratio 2.99, 95% CI 1.48-6.02, p=0.002), but did not predict the secondary outcome in multivariable Cox regression (hazard ratio 1.34, 95% CI 0.78-2.29, p=0.287). In patients with NICM and a primary prevention ICD, LGE ≥2% is predictive of appropriate device therapies but not all-cause mortality/LVAD/transplant. LGE may be a relatively specific predictor of sudden cardiac arrest risk and therefore could potentially be used during evaluation for prophylactic ICD implantation.

Elective Sternotomy With Fluoroscopic Guidance for the Removal of a Residual Implantable Cardioverter Defibrillator Lead: A Case Report and Literature Review

Elective Sternotomy With Fluoroscopic Guidance for the Removal of a Residual Implantable Cardioverter Defibrillator Lead: A Case Report and Literature Review

Cross-sectional study on the impact of adverse childhood experiences on psychological distress in patients with an implantable cardioverter-defibrillator.

Previous studies implied detrimental effects of adverse childhood experiences (ACE) on cardiovascular disease and mental health. Still, data on the influence of ACE on psychological distress in patients with an implantable cardioverter-defibrillator (ICD) are lacking. We prospectively recruited 423 patients with an ICD. To determine associations between ACE (ACE questionnaire, cut-off ≥4), depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder-7 scale), and post-traumatic stress disorder (PTSD) symptoms (Post-Traumatic Stress Diagnostic Scale), we conducted a binary logistic regression analysis. Regression models were adjusted for conventional risk factors of psychological distress in ICD patients. To identify indirect mediating effects of resilience (Resilience Scale) on ACE and psychological distress, we applied the PROCESS regression path analysis modeling tool. 49.1% of all patients reported at least one ACE, and 9.7% experienced even four or more ACE. A high-risk ACE profile (≥ 4) was associated with higher levels of anxiety (OR 3.68, 95% CI 1.37-9.84, p=0.009), depression (OR 4.08, 95% CI 1.67-9.97, p=0.002), and PTSD symptoms (OR 2.20, 95% CI 1.03-5.21, p=0.041). Greater resilience partially mediated the relationship between ACE and depression (indirect effect 0.11, 95% CI 0.01-0.26) as well as anxiety (indirect effect 0.08, 95% CI 0.008-0.19). The current study suggests an association between ACE and psychological distress in patients with an ICD. However, resilience could mitigate the adverse effects of ACE. Future studies should strive to unravel the complex mechanisms of ACE and its effects on cardiovascular and mental health in ICD patients.

Sonogenetics is a novel antiarrhythmic mechanism.

Arrhythmia of the heart is a dangerous and potentially fatal condition. The current widely used treatment is the implantable cardioverter defibrillator (ICD), but it is invasive and affects the patient's quality of life. The sonogenetic mechanism proposed here focuses ultrasound on a cardiac tissue, controls endogenous stretch-activated Piezo1 ion channels on the focal region's cardiomyocyte sarcolemma, and restores normal heart rhythm. In contrast to anchoring the implanted ICD lead at a fixed position in the myocardium, the size and position of the ultrasound focal region can be selected dynamically by adjusting the signals of every piezoelectric chip on the ultrasonic phased array, and it allows novel and efficient defibrillations. Based on the developed interdisciplinary electro-mechanical model of sonogenetic treatment, our analysis shows that the proposed ultrasound intensity and frequency will be safe and painless for humans and well below the limits established by the U.S. Food and Drug Administration.

Heart failure with reduced ejection fraction and chronic kidney disease: a focus on therapies and interventions.

In heart failure with reduced ejection fraction (HFrEF), the presence of concomitant chronic kidney disease (CKD) predicts poorer cardiovascular outcomes, more aggravated heart failure (HF) status, and higher mortality. Physicians might be reluctant to initiate life-saving anti-HF medications out of fear of worsening renal function and a higher incidence of adverse events. Moreover, international guidelines do not give clear recommendations on managing this subgroup of patients as well as advanced CKD was always an exclusion criterion in most major HF trials. Nevertheless, in this review, we will highlight several recent clinical trials and post-hoc analyses of major trials that showed the safety and efficacy of the different therapies in HFrEF patients with CKD, besides several small-scale cohorts that tested guideline-directed medical therapies in End Stage Kidney Disease (ESKD). Regarding interventions in this subgroup of patients, we will provide up-to-date data on implantable cardioverter defibrillators, cardiac resynchronization therapy, and coronary revascularization, in addition to mitral valve transcatheter edge-to-edge repair and implantable pulmonary artery pressure sensors.

Storm Aborted by Automated Shock Polarity Reversal in Implantable-Cardioverter Defibrillator

Storm Aborted by Automated Shock Polarity Reversal in Implantable-Cardioverter Defibrillator

Arrhythmogenic Right Ventricular Cardiomyopathy: the importance of biventricular strain in risk-stratification.

Despite arrhythmogenic right ventricular cardiomyopathy (ARVC) being predominantly a right ventricular (RV) disease, concomitant left ventricular (LV) involvement has been recognized. ARVC is diagnosed by the RV-centric 2010 Task Force Criteria(TFC) using routine echocardiography, but previous studies have suggested that strain imaging may be more sensitive to detect RV and LV dysfunction. No data however are available regarding the additional value of combining biventricular strain for risk stratification. This study aims to assess the prognostic value of both LV global longitudinal strain (GLS) and RV free wall strain (FWLS) in patients with ARVC. To accomplish this, 204 patients who met the TFC for the ARVC spectrum were included. Patients (age 41±17 years,55% men) were divided into impaired(n=33), discordant (RV or LV impaired, n=70), and normal (n=101) strain groups based on a value of ≥18% for both ventricles. During a follow-up of 87 [24-136] months, 57 (28%) experienced the composite outcome of all-cause mortality, arrhythmic events, implantable cardioverter defibrillator therapy and heart failure events, and a significant difference in event-free survival was observed (p<0.001) between the 3 groups. In the multivariable analysis, the strain groups remained associated with outcomes (p=0.014) after adjusting for age, sex, history of syncope and definite ARVC diagnosis. A sub-analysis including only definite and borderline diagnosed ARVC confirmed that the strain groups were independently predictive of the endpoint (p=0.023). In conclusion, biventricular involvement by strain analysis may help risk stratification in ARVC patients, with the worst outcomes of patients with both RV and LV impaired strain.

Mitral valve prolapse in sudden cardiac arrest survivors - coincidence or causal relationship?

Sudden cardiac arrest (SCA) risk stratification in patients with mitral valve prolapse (MVP) may be complicated by other potential causes of arrhythmia. We aimed to characterize SCA survivors with isolated (iMVP) and non-isolated MVP (non-iMVP) and to assess their long-term follow-up. This ambispective study included 75 patients with MVP who experienced SCA and were treated in our center between 2009-2024. They were divided into three groups depending on probability of relation between SCA and comorbidities. The control group comprised 112 subjects with MVP but without a history of SCA. We analyzed all available electrocardiograms, Holter ECG monitoring and echocardiograms, including longitudinal strain. A novel parameter, the systolic atrial-directed notch (SADN) was tested. SCA survivors with iMVP (n=28) had higher prevalence of mitral annular disjunction (MAD) (80% vs. 35.7%, P=0.006), Pickelhaube sign (60% vs. 8.3%, P=0.008), SADN > 2 mm (69.6% vs. 14.3%, P=0.001) as well as higher absolute longitudinal strain values in basal and mid segments of inferior and inferolateral wall than patients with SCA and non-iMVP without other defined structural heart diseases (SHD(-)) (n=14). The differences were also observed in comparison to control group. The cumulative incidence of appropriate implantable cardioverter-defibrillator shocks within 6 years was 62% in patients with iMVP and 23% in the group with non-iMVP SHD(-). Echocardiographic findings such as MAD, SADN, Pickelhaube sign and increased segmental strain may be useful in the assessment of relation between SCA and MVP. Malignant arrhythmias often recur in SCA survivors with iMVP.

МЕДИКАМЕНТОЗНАЯ И СЕРДЕЧНАЯ РЕСИНХРОНИЗИРУЮЩАЯ ТЕРАПИЯ В ЛЕЧЕНИИ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ (ОБЗОР ЛИТЕРАТУРЫ)

The article deals with the role of pharmacological agents and implantable devices in the treatment of chronic heart failure (CHF) with different ejection fraction: preserved ejection fraction, mildly reduced ejection fraction and reduced ejection fraction (HFpEF, CHFmrEFV, CHFrFV). The authors emphasise that despite the widespread introduction of angiotensin receptor and neprilysin inhibitor (ARNI), beta-blockers, mineralocorticoid receptor antagonists (MCRAs) and sodium-glucose cotransporter inhibitors (SGLT2) into practice, there is still a high residual risk of unfavorable outcomes in patients with both HFpEF and CHFmrEFV, CHFrFV. Therefore, therapies using implantable cardioverter-defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) are evolving. The review is based on data from PubMed and Google Scholar databases for the last 5 years.

Defibrillation Testing in Patients Undergoing Replacement of the S-ICD Generator: Is There Still a Need?

Noninferiority of omitting intraoperative defibrillation threshold (DFT) testing has been documented for transvenous implantable cardioverter defibrillators (ICD) whereas data for the subcutaneous-ICD (S-ICD) regarding the need for DFT testing, especially during S-ICD generator replacement, is not available. A total of 112 consecutive patients who underwent S-ICD generator replacement and routine testing were included in this retrospective single-center study and analyzed regarding the outcome of intraoperative DFT. The majority of patients (87.3%) were successfully tested during generator replacement with no major adverse events. PREATORIAN score was generally lower, while high voltage (HV) impedance increased compared to first implantation. The risk of conversion failure increased with the PRAETORIAN risk class, whereas patient characteristics did not impact conversion rates. PRAETORIAN score and HV impedance were shown to be the most accurate factors when predicting conversion failure. In all patients with an HV impedance <70Ohm and a PREATORIAN score <90 at the time of initial implantation DFT was successfully performed during generator replacement. General omittance of DFT in S-ICD generator replacement is not advisable. New algorithms for low impedance DFT measurements during S-ICD query and PREATORIAN score at first implantation can be used to predict conversion failure. An impedance <70Ohm and a PRAETORIAN score <90 show a very low risk of conversion failure. In patients with a PRAETORIAN score >150 DFT testing should be performed when the S-ICD generator is replaced until randomized data is available.

Real-world outcomes in cardiac resynchronization therapy patients: Primary results of the SMART registry.

Cardiac resynchronization therapy (CRT) is guideline recommended for the treatment of symptomatic heart failure (HF) with reduced left ventricular ejection fraction and prolonged QRS. However, patients with common comorbidities, such as persistent/permanent atrial fibrillation (AF), are often under-represented in clinical trials. The Strategic Management to Optimize Response to Cardiac Resynchronization Therapy (SMART) registry (NCT03075215) was a global, multicentre, registry that enrolled de novo CRT implants, or upgrade from pacemaker or implantable cardioverter defibrillator to CRT-defibrillator (CRT-D), using a quadripolar left ventricular lead in real-world clinical practice. The primary endpoint was CRT response between baseline and 12month follow-up defined as a clinical composite score (CCS) consisting of all-cause mortality, HF-associated hospitalization, New York Heart Association (NYHA) class and quality of life global assessment. The registry enrolled 2035 patients, of which 1558 had completed CCS outcomes at 12months. The patient cohort was 33.0% female, mean age at enrolment was 67.5±10.4years and the mean left ventricular ejection fraction was 29.6±7.9%. Notably, there was a high prevalence of mildly symptomatic patients (NYHA class I/II 51.3%), non-left bundle branch block (LBBB) morphology (38.0%), AF (37.2%) and diabetes mellitus (34.7%) at baseline. CCS at 12months improved in 58.9% (n=917) of patients; 20.1% (n=313) of patients stabilized and 21.0% (n=328) worsened. Several patient characteristics were associated with a lower likelihood of response to CRT including older age, ischaemic aetiology, renal dysfunction, AF, non-LBBB morphology and diabetes. Higher HF hospitalization (P<0.001) and all-cause mortality (P<0.001) were observed in patients with AF. These patients also had lower percentages of ventricular pacing than patients in sinus rhythm at baseline and follow-up (P<0.001, both). A further association between AF and non-LBBB was observed with 81.4% of AF non-LBBB patients experiencing an HF hospitalization compared with 92.5% of non-AF LBBB patients (P<0.001). Mortality between subgroups was also statistically significant (P=0.019). This large, global registry enrolled a CRT-D population with higher incidence of comorbidities that have been historically underrepresented in clinical trials and provides new insight into factors influencing response to CRT. As defined by CCS, 58.9% of patients improved and 20.1% stabilized. Patients with AF had particularly worse clinical outcomes, higher HF hospitalization and mortality rates and lower percentages of ventricular pacing. High incidence of HF hospitalization in patients with AF and non-LBBB in this real-world cohort suggests that ablation may play an important role in increasing future CRT response rates.

A Tale of Two Conditions: Pediatric Brugada Syndrome Unveiled-Navigating the Challenges of Coexisting Arrhythmia and Fever-Induced ECG Pattern.

Brugada syndrome (BrS) is an inherited channelopathy characterized by right precordial ST-segment elevation. This study investigates the clinical and genetic characteristics of children with BrS in Hong Kong. A retrospective review was conducted at the only tertiary pediatric cardiology center in Hong Kong from 2002 to 2022, including all pediatric BrS patients under 18 years old. The diagnosis of BrS was established with a type 1 ECG pattern detected spontaneously or induced by flecainide, excluding secondary causes. Eight probands of mean age 10 years old were identified. Male dominance was observed (6 boys vs. 2 girls). The mean follow-up duration was 4.6 years (Median 3.5 years). Patients had type 1 ECG pattern either spontaneously (n = 4) or provoked by flecainide (n = 4). Fever was present in seven patients at the initial presentation, and two patients experienced aborted cardiac arrest and one had symptomatic ventricular tachycardia. All symptomatic patients received implantable cardioverter-defibrillator placement. Five asymptomatic patients (62.5%) were diagnosed with BrS through ECG during febrile illness, and they remained asymptomatic following conservative management involving strict fever control and medication avoidance. Two patients with mixed phenotype (one with long QT syndrome and another with ectopic atrial tachycardia) required antiarrhythmics and one patient received transcatheter ablation for atrial tachycardia to achieve optimal arrhythmia control. Fever plays a significant role in unmasking BrS in children. Asymptomatic children with BrS managed conservatively have a favorable prognosis. Difficult arrhythmia control was found in patients with mixed phenotype.

Correlation between genotype and clinical phenotype in hypertrophic cardiomyopathy families with MYH7-R453C mutation

Objective: To analyze the relationship between genotype and clinical phenotype of the MYH7-R453C mutation in five Chinese hypertrophic cardiomyopathy (HCM) families. Methods: A retrospective cohort study was conducted on 527 unrelated HCM probands who were first diagnosed at the First Affiliated Hospital of Air Force Medical University (Xijing Hospital) from February 2014 to July 2018, and the high-throughput whole exome targeted sequencing of 96 genes related to hereditary cardiovascular disease was performed on the probands. The probands carrying the MYH7-R453C mutation were screened out, and their family members carrying the mutation were verified using Sanger sequencing. Healthy individuals without family history of genetic diseases from the same period and ethnicity were recruited as controls. Clinical data such as echocardiography, 12-lead electrocardiogram, and cardiac magnetic resonance imaging of the probands and their family members were collected, and the correlation between patient genotype and clinical phenotype was analyzed. Endpoint or key events were recorded through hospital re-examination or telephone follow-up. Results: The MYH7-R453C mutation was detected in 5 HCM probands, and clinical data and genetic results of 20 family members, including probands, were collected. Among them, 13 carried the MYH7-R453C mutation, of which 12 were diagnosed with HCM, and one child (F1Ⅲ5) experienced early changes of HCM. The seven family members who did not carry the MYH7-R453C mutation had normal echocardiograms and 12-lead electrocardiograms. Among the 12 patients diagnosed with HCM, 2 experienced (F2Ⅱ7, F5Ⅰ2) sudden cardiac death, 2 experienced (F1Ⅲ1, F3Ⅲ3) events of sudden cardiac death survival, 2(F1Ⅱ2, F3Ⅱ1) died from heart failure during the follow-up period. Combined with the initial visit and follow-up, 4 families (F1, F2, F3, F5) had a family history of sudden death, among which 3 families probands or multiple family members experiencing sudden death before the age of 30 and adverse outcomes such as implantation of implantable cardioverter-defibrillators after sudden death survival. Conclusions: In the five families with HCM carrying MYH7-R453C mutations, genotype is highly correlated with clinical phenotype, and patients have a high risk of sudden death and poor prognosis. Early diagnosis of individuals carrying the MYH7-R453C gene mutation, both within the patient's family and in the patients themselves, is crucial for initiating early treatment, preventing sudden death, and assessing prognosis.

Health-related quality of life in a large cohort of patients with cardiac implantable electronic devices A registry-based study

Aim The association of cardiac implantable electronic devices (CIED), namely pacemaker (PM), implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy with (CRT-D) or without defibrillator (CRT-P) with health-related quality of life (HRQoL) is lacking. Methods and results Data from the Swedish Pacemaker and ICD Registry collected from January 2019 to February 2022 was used to analyze the responses to the European Quality of Life-5 Dimension questionnaire (EQ-5D) before and after one year of the CIED implant. Descriptive analysis was performed using Pearson’s chi-square test, the analysis of variance ANOVA, the Kruskal-Wallis test and Wilcoxon signed-rank test when appropriate. A multivariable regression analysis was used to compare the EQ-5D index and EQ-VAS variation after 1 year. Of 1,479 who completed the EQ-5D, 80% had a PM, 10% an ICD, 5% a CRT-P and 6% a CRT-D. The median age was 77 years with females constituting 38% of the PM group and 17% of the ICD group. The EQ-VAS and the EQ-5D index significantly increased after one year from the PM and CRT-P implant (EQ-VAS +2.8, standard deviations (SD) 23 and +5.8, SD 24.9; EQ-5D index +0.019, SD 0.114 and +0.051, SD 0.125) while only the EQ-5D index increased after one year from the ICD implant (+0.002, SD 0.104). After adjusting for age, sex and HRQoL at baseline, the presence of defibrillator was associated with lower EQ-VAS (ICD EQ-VAS variation: -3.4, 95% confidence intervals (CI) -6.7; -0.1 and CRT-D EQ-VAS variation -4.8, 95% CI -8.8;-0.7) and EQ-5D index (ICD EQ-5D index variation: -0.018, 95% CI -0.035; -0.0003 and CRT-D EQ-5D index variation -0.025 95% CI 0.046;0.004) after one year compared to PM. Conclusion These findings, showing the HRQoL associated with CIED, are important to support physicians’ and pacemaker nurses’ care after device implantation by embracing the patients’ perspectives.

Wearable Cardioverter Defibrillator Causing Wound Dehiscence After Subcutaneous Implantable Cardioverter Defibrillator Removal

Summary We present a case of a wound dehiscence after subcutaneous implantable cardioverter defibrillator (S-ICD) removal caused by a wearable cardioverter defibrillator (WCD). A WCD is a temporary device used to prevent sudden cardiac death and is recommended as a bridge to implantable cardioverter defibrillator (ICD) reimplantation. In our case, between the removal of S-ICD and the implantation of the transvenous ICD, a too tight WCD shoulder strap would cause wound dehiscence. We should pay attention to the size of the vest, and careful observation could reduce the damage to the wound.

A Comprehensive Review of Catheter-Related Thrombosis.

Catheter-related thrombosis (CRT) is a frequent and potentially serious complication associated with the widespread use of intravascular devices such as central venous catheters, including peripherally inserted central catheters and implantable port systems, pacemakers or implantable cardioverter-defibrillators. Although CRT management has been informed by guidelines extrapolated from lower extremity deep vein thrombosis (DVT), unique challenges remain due to the distinct anatomical, pathophysiological, and clinical characteristics of upper extremity DVT. Risk factors for CRT are multifactorial, encompassing patient-related characteristics such as cancer, prior venous thromboembolism, and infection, as well as catheter-specific factors like device type, lumens, and insertion site. The diagnosis of CRT relies primarily on ultrasonography; however, computed tomography angiography and magnetic resonance imaging play a complementary role, particularly in anatomically challenging cases or when complications such as pulmonary embolism or superior vena cava syndrome are suspected. Treatment strategies for CRT include anticoagulation, catheter removal when feasible, and, in select cases, local thrombolysis or catheter-directed interventions. Anticoagulation remains the cornerstone of therapy, with direct oral anticoagulants increasingly favored due to their safety profile and efficacy. This article provides a detailed review of CRT, focusing on clinical features, diagnostic methods, and treatment strategies while addressing specific challenges in managing pacemaker and hemodialysis catheter-related thrombosis.

The impact of shock therapy on depression development and remote prognosis in cardiac resynchronization therapy recipients.

The aim of this study was to assess the incidence and clinical significance of depression in patients with cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D). The study was also to evaluate the impact of shock therapy on depression development and long-term prognosis. The prospective study encompassed 396 consecutive heart failure (HF) patients implanted with CRT-D. All patients completed the Beck Depression Inventory (BDI-II) and underwent a psychiatric examination at baseline. 221 patients free of depressive symptoms at baseline were included into the final analysis. The assessment of psychiatric status was routinely repeated every 6 months as well as after the shock delivery. The primary outcome was a composite endpoint of death or hospitalization for HF. During long-term observation (median 37.1 months) 52 (23.5%) patients suffered from an implantable cardioverter-defibrillator (ICD) shock, whereas 48 (21.8%) subjects developed depression. The incidence of new-onset depression was significantly higher in patients after shock delivery (Shock Group), CRT non-responders and subjects with atrial fibrillation. The risk for a composite endpoint was higher in the Shock Group than subjects without an ICD intervention: 57.7% vs. 25.4% and in patients with new-onset depression compared to the population free of this disorder: 62.5% vs. 24.9% (all p < 0.001). New-onset depression (HR 1.7) and an ICD shock (HR 2.1) were strong independent predictors of poor prognosis. Depression is a common mental disorder in CRT-D recipients, that adversely affects long-term prognosis. Subjects suffering from ICD shocks and those with HF progression are at higher risk of experiencing depressive symptoms.

Magnetic Resonance Imaging in the Assessment of the Risk of Sudden Death in Cardiac Sarcoidosis: What Is Extensive or Significant Late Gadolinium Enhancement?

Cardiac sarcoidosis involves a significant but difficult-to-define risk of sudden cardiac death (SCD). Current guidelines recommend consideration of an implantable cardioverter defibrillator for patients with extensive or significant myocardial late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging. However, extensive/significant LGE is not defined. A nationwide cardiac sarcoidosis registry was screened for patients entered before 2020 with cardiac magnetic resonance imaging done before or <3 months after diagnosis. Available studies were re-analyzed for LGE mass as a percentage of left ventricular (LV) mass and the number of LGE-positive LV segments in a 17-segment model. The occurrence of fatal or aborted SCD and ventricular tachycardia (VT) prompting therapy was recorded until the end of 2020 and subjected to cumulative incidence analyses, including competing events (LV assist device implantations, heart transplantations, and fatalities other than SCD). The predictors of SCD/VT were assessed using Fine and Gray modeling and time-dependent receiver operating characteristic analysis. Altogether, 305 patients (66% women, median age 51) with clinically manifest, definite (45%) or probable cardiac sarcoidosis (55%) were analyzed. On follow-up (median, 4.0 years), 21 SCDs, 60 VTs, and 14 competing events were noted. Both LGE mass and the number of LGE segments predicted the composite of SCD/VT (P<0.001), with receiver operating characteristic analyses identifying LGE mass ≥9.9% and ≥6 LGE segments as discriminative thresholds. At presentation, 70 patients were free of class I and class IIa implantable cardioverter defibrillator indications unrelated to LGE. Their 5-year rate of SCD/VT was 6.3% (0.0-14.8%) with LGE mass <9.9% versus 21.5% (6.5-36.6%) with higher LGE mass, and 6.9% (0.0-16.3%) with <6 LGE segments versus 20.5% (5.9-35.2%) with ≥6 segments. In cardiac sarcoidosis, myocardial LGE making up ≥9.9% of LV mass or affecting ≥6 LV segments may suggest prognostically significant LV involvement and a high risk of SCD. However, prospective validation of the thresholds is needed.