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Ictal asystole and ictal syncope: insights into clinical management.
Bestawros M, Darbar D, Arain A, Abou-Khalil B, Plummer D, Dupont WD, Raj SR
(2015) Circ Arrhythm Electrophysiol 8: 159-64
MeSH Terms: Adult, Anticonvulsants, Cardiac Pacing, Artificial, Disease-Free Survival, Electrocardiography, Electroencephalography, Female, Heart Arrest, Humans, Male, Middle Aged, Neurosurgical Procedures, Pacemaker, Artificial, Patient Selection, Predictive Value of Tests, Retrospective Studies, Risk Factors, Seizures, Syncope, Time Factors, Treatment Outcome, Video Recording
Show Abstract · Added January 20, 2015
BACKGROUND - Ictal asystole is a rare, serious, and often treatable cause of syncope. There are currently limited data to guide management. Characterization of ictal syncope predictors may aid in the selection of high-risk patients for treatments such as pacemakers.
METHODS AND RESULTS - We searched our epilepsy monitoring unit database from October 2003 to July 2013 for all patients with ictal asystole events. Clinical, electroencephalogram, and ECG data for each of their seizures were examined for their relationships with ictal syncope events. In 10 patients with ictal asystole, we observed 76 clinical seizures with 26 ictal asystole episodes, 15 of which led to syncope. No seizure with asystole duration≤6 s led to syncope, whereas 94% (15/16) of seizures with asystole duration>6 s led to syncope (P=0.02). During ictal asystole events, 4 patients had left temporal seizure onset, 4 patients had right temporal seizure onset, and 2 patients had both. Syncope was more common with left temporal (40%) than with right temporal seizures (10%; P=0.002). Treatment options included antiepileptic drug changes, epilepsy surgery, and pacemaker implantation. Eight patients received pacemakers. During follow-up of 72±95 months, all patients remained syncope free.
CONCLUSIONS - Ictal asystole>6 s is strongly associated with ictal syncope. Ictal syncope is more common in left than in right temporal seizures. A permanent pacemaker should be considered in patients with ictal syncope if they are not considered good candidates for epilepsy surgery.
© 2014 American Heart Association, Inc.
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22 MeSH Terms
Cardiac implanted electronic device-related infective endocarditis: clinical features, management, and outcomes of 80 consecutive patients.
Kim DH, Tate J, Dresen WF, Papa FC, Bloch KC, Kalams SA, Ellis CR, Baker MT, Lenihan DJ, Mendes LA
(2014) Pacing Clin Electrophysiol 37: 978-85
MeSH Terms: Aged, Defibrillators, Implantable, Endocarditis, Bacterial, Female, Humans, Male, Methicillin-Resistant Staphylococcus aureus, Middle Aged, Pacemaker, Artificial, Prosthesis-Related Infections, Retrospective Studies, Treatment Outcome
Show Abstract · Added January 20, 2015
BACKGROUND - The use of cardiac implantable electronic devices (CIEDs) has expanded dramatically over the past decade, but net clinical benefit has been curtailed by increasing infectious complications. In particular, CIED-related infectious endocarditis (IE) is a serious condition with significant morbidity and mortality.
METHODS - We performed a single-center, retrospective study between July 2006 and February 2011 with CIED-related IE, defined by either lead vegetations detected on echocardiography or by fulfilling Duke criteria for definite endocarditis. Clinical parameters and outcomes were detailed by electronic medical record review and vital status was confirmed by the Social Security Death Index.
RESULTS - Eighty patients (median age 67, interquartile range 56-75, 58 M/22 F) were diagnosed with CIED-related IE. Overall mortality was 36% with a median time to death of 95 days from presentation. Over half (52%) of the deaths were infection related with a median time to death of 29 days. Multivariate analysis showed methicillin-resistant Staphylococcus aureus (MRSA) infection (odds ratio [OR] 0.158; 95% confidence interval [CI], 0.047-0.534; P = .003) and concomitant valve endocarditis (OR 0.141, CI 0.041-0.491, P = .002) independently predicted mortality.
CONCLUSION - In this contemporary series, all-cause mortality in patients with CIED-related IE was high with a short time to death from onset of infection. MRSA and concomitant valve infection were the most powerful independent predictors of mortality.
©2014 Wiley Periodicals, Inc.
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12 MeSH Terms
2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.
January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW, American College of Cardiology/American Heart Association Task Force on Practice Guidelines
(2014) J Am Coll Cardiol 64: e1-76
MeSH Terms: Anti-Arrhythmia Agents, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Autonomic Nervous System, C-Reactive Protein, Cardiac Output, Low, Catheter Ablation, Comorbidity, Defibrillators, Implantable, Echocardiography, Transesophageal, Electric Countershock, Electrocardiography, Fibrinolytic Agents, Heart Atria, Heart Conduction System, Humans, Inflammation, Natriuretic Peptide, Brain, Oxidative Stress, Pacemaker, Artificial, Platelet Aggregation Inhibitors, Renin-Angiotensin System, Risk Assessment, Risk Factors, Septal Occluder Device, Stroke, Thromboembolism, Ventricular Remodeling
Added May 27, 2014
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29 MeSH Terms
Comparison of ventilation and voice outcomes between unilateral laryngeal pacing and unilateral cordotomy for the treatment of bilateral vocal fold paralysis.
Li Y, Pearce EC, Mainthia R, Athavale SM, Dang J, Ashmead DH, Garrett CG, Rousseau B, Billante CR, Zealear DL
(2013) ORL J Otorhinolaryngol Relat Spec 75: 68-73
MeSH Terms: Adult, Aged, Cordotomy, Dysphonia, Female, Humans, Larynx, Male, Middle Aged, Pacemaker, Artificial, Pulmonary Ventilation, Retrospective Studies, Treatment Outcome, Vocal Cord Paralysis, Voice
Show Abstract · Added February 12, 2015
BACKGROUND/AIMS - Rehabilitation of the bilaterally paralyzed human larynx remains a complex clinical problem. Conventional treatment generally involves surgical enlargement of the compromised airway, but often with resultant dysphonia and risk of aspiration. In this retrospective study, we compared one such treatment, posterior cordotomy, with unilateral laryngeal pacing: reanimation of vocal fold opening by functional electrical stimulation of the posterior cricoarytenoid muscle.
METHODS - Postoperative peak inspiratory flow (PIF) values and overall voice grade ratings were compared between the two surgical groups, and pre- and postoperative PIF were compared within the pacing group.
RESULTS - There were 5 patients in the unilateral pacing group and 12 patients in the unilateral cordotomy group. Within the pacing group, postoperative PIF values were significantly improved from preoperative PIF values (p = 0.04) without a significant effect on voice (grade; p = 0.62). Within the pacing group, the mean postoperative PIF value was significantly higher than that in the cordotomy group (p = 0.05). Also, the mean postoperative overall voice grade values in the pacing group were significantly lower (better) than those of the cordotomy group (p = 0.03).
CONCLUSION - Unilateral pacing appears to be an effective treatment superior to posterior cordotomy with respect to postoperative ventilation and voice outcome measures.
Copyright © 2013 S. Karger AG, Basel.
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15 MeSH Terms
Use of an antibacterial envelope is associated with reduced cardiac implantable electronic device infections in high-risk patients.
Kolek MJ, Dresen WF, Wells QS, Ellis CR
(2013) Pacing Clin Electrophysiol 36: 354-61
MeSH Terms: Aged, Anti-Bacterial Agents, Female, Humans, Male, Multivariate Analysis, Pacemaker, Artificial, Prospective Studies, Prosthesis-Related Infections, Risk Factors
Show Abstract · Added February 28, 2014
INTRODUCTION - The incidence of cardiac implantable electronic device (CIED) infections has risen rapidly since 2004. A commercially available minocycline and rifampin impregnated antibacterial envelope has been associated with a low CIED infection rate. We performed a retrospective cohort study analyzing CIED infection rates in patients receiving an antibacterial envelope.
METHODS - Prospectively applied criteria for use of the antibacterial envelope included ≥2 of the following: diabetes, renal insufficiency, anticoagulation, chronic corticosteroid use, fever or leukocytosis at the time of implantation, prior CIED infection, ≥3 leads (cardiac resynchronization therapy or abandoned leads), pacemaker dependence, or early pocket reentry. CIED infection rate was compared to a cohort of patients with matched risk factors and a CIED implanted prior to use of the antibacterial envelope.
RESULTS - A total of 260 antibacterial envelopes were implanted from November 1, 2009 to April 30, 2012. The mean number of CIED infection risk factors was 2.8 ± 1.2. The control cohort (N = 639) was matched for mean number of CIED infection risk factors (2.8 ± 1.2), though individual risk factors differed. After a minimum of 90 days of follow-up, there was one CIED infection among patients who received an antibacterial envelope (0.4%), compared to 19 (3%) in controls (odds ratio [95% confidence interval] 0.13 [0.02-0.95], P = 0.04). This difference persisted after adjustment for covariates (0.09 [0.01-0.73], P = 0.02) and propensity score matching (0.11 [0.01-0.85], P = 0.04).
CONCLUSIONS - In patients prospectively identified at high risk for CIED infection, use of a commercially available antibacterial envelope was associated with a marked reduction in CIED infections when compared to a matched control cohort.
©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.
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10 MeSH Terms
Risk factors for bradycardia requiring pacemaker implantation in patients with atrial fibrillation.
Barrett TW, Abraham RL, Jenkins CA, Russ S, Storrow AB, Darbar D
(2012) Am J Cardiol 110: 1315-21
MeSH Terms: Age Distribution, Aged, Aged, 80 and over, Atrial Fibrillation, Bradycardia, Cardiac Pacing, Artificial, Case-Control Studies, Confidence Intervals, Electrocardiography, Female, Follow-Up Studies, Humans, Incidence, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Pacemaker, Artificial, Retrospective Studies, Risk Factors, Severity of Illness Index, Sex Distribution, Survival Analysis, Treatment Outcome
Show Abstract · Added January 20, 2015
Symptomatic bradycardia may complicate atrial fibrillation (AF) and necessitate a permanent pacemaker. Identifying patients at increased risk for symptomatic bradycardia may reduce associated morbidities and health care costs. The aim of this study was to investigate predictors for developing bradycardia requiring a permanent pacemaker in patients with AF. The records of all patients treated for AF or atrial flutter in an academic hospital's emergency department from August 1, 2005, to July 31, 2008, were reviewed. Survival and the presence of a pacemaker as of November 1, 2011, were determined. Cases were defined as patients with pacemakers placed for bradycardia after their AF diagnoses. Patients without pacemakers who were followed constituted the control group. Variables for the logistic regression analysis were identified a priori. A post hoc model was fit adjusting for AF type and atrioventricular nodal blocker use. Of the 362 patients in the cohort, 119 cases had permanent pacemakers implanted for bradycardia after AF diagnosis, and 243 controls were alive without pacemakers. The median follow-up time was 4.5 years (interquartile range 3.8 to 5.4). Odds ratios were determined for age at the time of AF diagnosis (1.02, 95% confidence interval [CI] 1 to 1.04), female gender (1.58, 95% CI 0.95 to 2.63), previous heart failure (2.72, 95% CI 1.47 to 5.01), and African American race (0.33, 95% CI 0.12 to 0.94). The post hoc model identified permanent AF (odds ratio 2.99, 95% CI 1.61 to 5.57) and atrioventricular nodal blocker use (odds ratio 1.43, 95% CI 0.85 to 2.4). In conclusion, in patients with AF, heart failure and permanent AF each nearly triple the odds of developing bradycardia requiring a permanent pacemaker; although not statistically significant, our results suggest that women are more likely and African Americans less likely to develop bradycardia requiring pacemaker implantation.
Copyright © 2012 Elsevier Inc. All rights reserved.
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25 MeSH Terms
Relation of QRS width in healthy persons to risk of future permanent pacemaker implantation.
Cheng S, Larson MG, Keyes MJ, McCabe EL, Newton-Cheh C, Levy D, Benjamin EJ, Vasan RS, Wang TJ
(2010) Am J Cardiol 106: 668-72
MeSH Terms: Adult, Aged, Aged, 80 and over, Bundle-Branch Block, Cardiac Pacing, Artificial, Case-Control Studies, Cohort Studies, Electrocardiography, Female, Humans, Incidence, Male, Middle Aged, Pacemaker, Artificial, Proportional Hazards Models, Risk Assessment, Severity of Illness Index, Young Adult
Show Abstract · Added April 15, 2014
In the setting of acute myocardial infarction, prolongation of the QRS interval on electrocardiography identifies patients at risk for needing permanent pacemaker implantation. However, the implications of prolonged QRS intervals in healthy subjects are unclear, especially given that the QRS prolongation encountered in this setting is typically mild. The aim of this study was to assess the relation between QRS duration and incident pacemaker implantation in a community-based cohort of 8,311 subjects (mean age 54 years, 55% women) who attended 17,731 routine examinations with resting 12-lead electrocardiography. QRS duration was analyzed as a continuous and a categorical variable (<100, 100 to <120, and > or =120 ms). During up to 35 years of follow-up, 157 participants (56 women) developed need for permanent pacemakers. In multivariable Cox regression models adjusting for cardiovascular risk factors and previous myocardial infarction or heart failure, mild QRS prolongation was associated with a threefold risk for pacemaker implantation (adjusted hazard ratio 2.90, 95% confidence interval 1.81 to 4.66, p <0.0001), and bundle branch block was associated with a fourfold risk for pacemaker implantation (hazard ratio 4.43, 95% confidence interval 2.94 to 6.68, p <0.0001). Each standard deviation increment in QRS duration (11 ms) was associated with an adjusted hazard ratio of 1.14 (95% confidence interval 1.11 to 1.18, p <0.0001) for pacemaker placement. This association remained significant after excluding subjects with QRS durations > or =120 ms. In conclusion, subjects with prolonged QRS durations, even without bundle branch block, are at increased risk for future pacemaker implantation. Such individuals may warrant monitoring for progressive conduction disease.
2010 Elsevier Inc. All rights reserved.
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18 MeSH Terms
Complete superior vena cava obstruction.
Raj SR, Dendy JM, Rottman JN
(2010) J Am Coll Cardiol 55: e139
MeSH Terms: Abnormalities, Multiple, Female, Humans, Imaging, Three-Dimensional, Magnetic Resonance Imaging, Interventional, Pacemaker, Artificial, Phlebography, Risk Assessment, Severity of Illness Index, Subclavian Vein, Superior Vena Cava Syndrome, Treatment Failure
Added December 22, 2010
0 Communities
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12 MeSH Terms
Long-term outcomes in individuals with prolonged PR interval or first-degree atrioventricular block.
Cheng S, Keyes MJ, Larson MG, McCabe EL, Newton-Cheh C, Levy D, Benjamin EJ, Vasan RS, Wang TJ
(2009) JAMA 301: 2571-7
MeSH Terms: Adult, Aged, Atrial Fibrillation, Atrioventricular Block, Cause of Death, Disease Progression, Electrocardiography, Female, Humans, Longitudinal Studies, Male, Middle Aged, Pacemaker, Artificial, Prognosis, Proportional Hazards Models, Risk Factors
Show Abstract · Added April 15, 2014
CONTEXT - Prolongation of the electrocardiographic PR interval, known as first-degree atrioventricular block when the PR interval exceeds 200 milliseconds, is frequently encountered in clinical practice.
OBJECTIVE - To determine the clinical significance of PR prolongation in ambulatory individuals.
DESIGN, SETTING, AND PARTICIPANTS - Prospective, community-based cohort including 7575 individuals from the Framingham Heart Study (mean age, 47 years; 54% women) who underwent routine 12-lead electrocardiography. The study cohort underwent prospective follow-up through 2007 from baseline examinations in 1968-1974. Multivariable-adjusted Cox proportional hazards models were used to examine the associations of PR interval with the incidence of arrhythmic events and death.
MAIN OUTCOME MEASURES - Incident atrial fibrillation (AF), pacemaker implantation, and all-cause mortality.
RESULTS - During follow-up, 481 participants developed AF, 124 required pacemaker implantation, and 1739 died. At the baseline examination, 124 individuals had PR intervals longer than 200 milliseconds. For those with PR intervals longer than 200 milliseconds compared with those with PR intervals of 200 milliseconds or shorter, incidence rates per 10 000 person-years were 140 (95% confidence interval [CI], 95-208) vs 36 (95% CI, 32-39) for AF, 59 (95% CI, 40-87) vs 6 (95% CI, 5-7) for pacemaker implantation, and 334 (95% CI, 260-428) vs 129 (95% CI, 123-135) for all-cause mortality. Corresponding absolute risk increases were 1.04% (AF), 0.53% (pacemaker implantation), and 2.05% (all-cause mortality) per year. In multivariable analyses, each 20-millisecond increment in PR was associated with an adjusted hazard ratio (HR) of 1.11 (95% CI, 1.02-1.22; P = .02) for AF, 1.22 (95% CI, 1.14-1.30; P < .001) for pacemaker implantation, and 1.08 (95% CI, 1.02-1.13; P = .005) for all-cause mortality. Individuals with first-degree atrioventricular block had a 2-fold adjusted risk of AF (HR, 2.06; 95% CI, 1.36-3.12; P < .001), 3-fold adjusted risk of pacemaker implantation (HR, 2.89; 95% CI, 1.83-4.57; P < .001), and 1.4-fold adjusted risk of all-cause mortality (HR, 1.44, 95% CI, 1.09-1.91; P = .01).
CONCLUSION - Prolongation of the PR interval is associated with increased risks of AF, pacemaker implantation, and all-cause mortality.
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16 MeSH Terms
A phased-array stimulator system for studying planar and curved cardiac activation wavefronts.
Abbas RA, Lin SF, Mashburn D, Xu J, Wikswo JP
(2008) IEEE Trans Biomed Eng 55: 222-9
MeSH Terms: Cardiac Pacing, Artificial, Electric Stimulation, Equipment Design, Equipment Failure Analysis, Heart Conduction System, Lasers, Pacemaker, Artificial, Transducers
Show Abstract · Added September 26, 2013
Wavefront propagation in cardiac tissue is affected greatly by the geometry of the wavefront. We describe a computer-controlled stimulator system that creates reproducible wavefronts of a predetermined shape and orientation for the investigation of the effects of wavefront geometry. We conducted demonstration experiments on isolated perfused rabbit hearts, which were stained with the voltage-sensitive dye, di-4-ANEPPS. The wavefronts were imaged using a laser and a charge-coupled device (CCD) camera. The stimulator and imaging systems have been used to characterize the relationship between wavefront velocity and fiber orientation. This approach has potential applications in investigating curvature effects, testing numerical models of cardiac tissue, and creating complex wavefronts using one-, two-, or three-dimensional electrode arrays.
1 Communities
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8 MeSH Terms