Evaluation of early results of patients with permanent peacemakers implantation at Bai Chay Hospital from 2016 to 2020

Objectives: Review the results of pacing and some early complications of patients Who implanted pacemaker at Bai Chay Hospital from 2016 to 2020. Subjects and research methods: A descriptively prospective study longitudinal follow-up study on 31 bradyarrhythmia patients who were permanently paced at Bai Chay Hospital from 2016 to October 2020. Results: After implantation of pacemaker, the rate of symptoms improved markedly, the change was statistically significant with p = 0.0001. Medium heart rate before and after implantation (47.84 ± 7.712 with 65.61 ± 4.425, 95%CI: 17.77 ± 7.173, p = 0.000). Change in QRS width after implantation (153.52 ± 11,963ms vs 91.81 ± 10,882ms, 95%CI 61.71 ± 12,947, p = 0.000). Pacing threshold changed after 6 months (0.68 ± 0.146V; 0.73 ± 0.149; p=0.001). Received R wave and electrode wire impedance did not changing after 6 months of follow-up. The rate of complications right after the procedure accounted for a total of 6.45%. The rate of complications after 6 months of follow-up accounted for 6.45%. Complications were all minor complications and were well managed. The successful rate of the procedure reached 100%, the pacing parameter was assessed as good, accounting for 70.97%. Conclusion: The method is considered effectively in the symptom improvement, safety, low complication rate and should be applied and deployed for patients with bradyarrhythmias with indications for permanent pacemaker implantation.

Implantálható kardioverter-defibrillátor által sikeresen megszüntetett malignus kamrai ritmuszavar dystrophia myotonicában szenvedő betegben

Összefoglaló. A dystrophia myotonica (DM) multiszisztémás, autoszomális domináns módon öröklődő, többségében felnőttkori izombetegség, melynek incidenciája 1 : 8000. A betegség kapcsán fellépő izomszöveti degeneráció a harántcsíkolt izomszövet átépülése mellett a szívizomszövetet is érinti, ami fontos oki szerepet játszik az érintett betegek csökkent várható élettartamában. A DM-ben szenvedők halálozásának közel egyharmadáért a cardiovascularis okok tehetők felelőssé. Esetriportunkban egy 52 éves, korábban kritikus bradycardia és I. fokú atrioventricularis blokk miatt pacemakerimplantáción átesett, DM-mel diagnosztizált nőbeteg kardiológiai utánkövetését mutatjuk be. A hirtelen szívhalál rizikóstratifikációja céljából elvégzett invazív elektrofiziológiai vizsgálat során kamrafibrilláció lépett fel, így a korábban implantált pacemakerelektródák mellé sokkelektróda került beültetésre, a pacemakerkészüléket implantálható kardioverter-defibrillátorra (ICD) cseréltük. Az 1 éves ICD-kontrollvizsgálat során azt találtuk, hogy a beültetés óta 22, tartós kamrai tachycardiával járó epizód lépett fel, melyek közül a készülék valamennyit sikeresen terminálta. Az eset bemutatásával szeretnénk rámutatni arra, hogy a magas cardiovascularis rizikócsoportba tartozó DM-betegek azonosítása kiemelkedő fontosságú lehet a hirtelen szívhalál megelőzése érdekében. Orv Hetil. 2021; 162(46): 1856–1858. Summary. Myotonic dystrophy (DM) is one of the most frequent adulthood diseases of the skeletal muscles, which develops multisystemic features and shows autosomal dominant trait. In DM, tissue degeneration affects not only the skeletal, but the cardiac muscle, too. In one third of the patients, the cause of death is of cardiac origin. We report on our patient’s case, who was diagnosed with DM at the age of 52, in whom episodes of critical bradycardia with first-degree atrioventricular block was detected, resulting in a pacemaker implantation. Invasive cardiac electrophysiological study was performed, during which ventricular fibrillation was registered. A shock electrode was added to the previously implanted pacemaker, enabling defibrillation in case of detection of a sustained ventricular arrhythmia. During the 1-year follow-up, 22 episodes of sustained ventricular tachycardia were identified, with the device successfully terminating the malignant arrhythmias. Our case shows that electrophysiological study and the succeeding implantation of an implantable cardiac defibrillator is highly important in identifying and terminating ventricular arrhythmias in high-risk DM patients. Orv Hetil. 2021; 162(46): 1856–1858.

Cardiovascular disease

This chapter describes the anaesthetic management of the patient with cardiovascular disease. The topics include ischaemic heart disease (including perioperative myocardial infarction and percutaneous coronary intervention), valvular heart disease (incuding prosthetic valves), congenital heart disease, cardiomyopathy, pericardial disease, the patient with a transplanted heart, narrow complex arrhythmias, broad complex arrhythmias and heart block. For each topic, pre-operative investigation and optimisation, treatment, and anaesthetic management are described including peri-operative management of pre-existing arrhythmias (such as atrial fibrillation), and the patient with an implanted pacemaker or defibrillator.

Previous pacemaker therapy was not associated with the risk of clinical events in patients with atrial fibrillation: the Fushimi AF Registry

Background Patients with atrial fibrillation (AF) occasionally require pacemaker implantation. Meanwhile, patients with implanted pacemaker are occasionally found to have subclinical AF and develop clinical AF. However, little is known about the clinical outcomes of AF patients with implanted pacemaker. Purpose We aimed to investigate the clinical outcomes in AF patients undergoing previous pacemaker therapy. Methods The Fushimi AF Registry is a community-based prospective survey of the AF patients in a city of Japan. Follow-up data including prescription status were available for 4,447 patients. After exclusion of patients with implantable cardioverter defibrillator and cardiac resynchronization therapy, we investigated 293 AF patients with pacemaker implantation at baseline. We performed propensity score-matching analysis to assess the impact of pacemaker therapy in AF patients. Results Of a total cohort, patients with pacemaker were more often female (51.2% vs. 39.7%; p<0.01) and older (78.0 vs. 73.3 years of age; p<0.01). Patients with pacemaker were more likely to have pre-existing heart failure (33.1% vs. 26.6%; p<0.01), valvular heart disease (22.9% vs. 16.8%; p<0.01), chronic kidney disease (48.8% vs. 34.7%; p<0.01), and history of performing direct current cardioversion (7.2% vs. 3.1%; p<0.01), compared with patients without pacemaker. Mean CHA2DS2-VASc score was higher in patients with pacemaker (3.80 vs. 3.34; p<0.01). Patients with pacemaker were more often prescribed oral anticoagulants (62.1% vs. 55.2%; p=0.02), verapamil (13.3% vs. 9.4%; p=0.03), and loop diuretics (30.7% vs. 21.8%; p<0.01). Using propensity score-matching, 291 patients with pacemaker and 291 without pacemaker were matched and baseline characteristics were comparable. The median follow-up period was 1,819 days. All-cause death occurred in 91 patients with pacemaker (6.0 /100 person-years) and 79 patients without pacemaker (5.9 /100 person-years), with a hazard ratio (HR) for patients with pacemaker of 1.01 (95% confidence interval [CI], 0.75 to 1.37; p=0.93). Furthermore, HR of cardiac death for patients with pacemaker was 1.00 (95% CI, 0.23 to 4.32; p=0.99), that of stroke or systemic embolism was 0.69 (95% CI, 0.44 to 1.07; p=0.10) and that of hospitalization for heart failure was 0.94 (95% CI, 0.65 to 1.37; p=0.76). Conclusion We identified that patients undergoing previous pacemaker therapy were not associated with the incidence of various adverse clinical events in Japanese AF patients. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Boehringer Ingelheim, Bayer Healthcare, Pfizer, Bristol-Myers Squibb, Astellas Pharma, AstraZeneca, Daiichi Sankyo, Novartis Pharma, MSD, Sanofi-Aventis, Takeda Pharmaceutical, and the Practical Research Project for Life-Style related Diseases including Cardiovascular Diseases and Diabetes Mellitus from Japan Agency for Medical Research and Development.

Anxiety and depression intensity and the quality of life of patients with an implanted pacemaker

Introduction. The consequences of anxiety and depression in various forms affect the course of cardiovascular diseases - including patients with an implanted pacemaker. To improve the quality of care for such patients, it is important to understand the scale of the problem, as well as to determine the impact of the above-mentioned symptoms on the patients' quality of life.Aim of research. The aim of the study was to assess the relationship between the quality of life and the anxiety and depression intensity on patients with implanted pacemakers.Material and methods. The study involved 100 patients hospitalized at the SPSK 4 cardiology clinic in Lublin with an implanted pacemaker. The method of diagnostic survey and research tools were used - the WHOQOL - Bref questionnaire to assess the quality of life and the Hospital Anxiety and Depression Scale (HADS-M). The results of the research are summarized in the statistical analysis.Results. The average score obtained by the respondents on the depression scale was 6.05 points with a standard deviation of 4.47. On the anxiety scale, this result was 7.99 points with a standard deviation of 4.54. The results indicating disorders in both scales concern values higher than or equal to 11 points. On the depression scale they were obtained by 16% of the respondents, while on the anxiety scale 26%. The conducted analyses showed a statistically significant relationship between the level of anxiety and depression and the quality of life of the respondents in all domains. The overall declared quality of life of the respondents and the self-esteem of the health condition were the lower, the higher the anxiety and depression severity coefficient in the study group.Conclusions.1. Most of the studied patients with pacemakers do not have high levels of anxiety and depression. 2. The occurrence of anxiety and depression affects the quality of life of respondents after pacemaker implantation in all domains. 3. Patients with high levels of anxiety and depression have a lower assessment of their quality of life and health.

Cardiac Pacemaker in Pregnancy: How to Manage?

Despite the increasing use of permanent cardiac pacemakers in a younger patient population, there are little data related to pregnancy. Normal physiologic alterations of pregnancy need to be taken into account in the management of the pregnant woman with a pacemaker in place. Similarly, gestational events including the potential for surgical intervention require a basic knowledge of pacemaker technology and monitoring. We present a case of a patient with junctional escape rhythm and was implanted pacemaker during pregnancy. A 24 years old women referred from obstetric outpatient clinic with asymptomatic bradycardia and cryptogenic stroke 2 years earlier. ECG shows sinus arrest with junctional escape rhythm. After multi-disciplinary discussion, team decided to implant double chamber pacemaker implantation. The pacemaker setting is adjusted to prepare caesarean section at 39 weeks gestation with delivery of an aterm infant. The postoperative course was uneventful. Pre-pregnancy pacemaker settings were re-established after the postpartum period. The current literature on managing pregnant patients with pacemakers is quite limited. Such patients require a multidisciplinary approach to care. Electromagnetic Interference (EMI) should be noticed.

Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part 2: ventricular arrhythmias, channelopathies, and implantable defibrillators

This paper belongs to a series of recommendation documents for participation in leisure-time physical activity and competitive sports by the European Association of Preventive Cardiology (EAPC). Together with an accompanying paper on supraventricular arrhythmias, this second text deals specifically with those participants in whom some form of ventricular rhythm disorder is documented, who are diagnosed with an inherited arrhythmogenic condition, and/or who have an implanted pacemaker or cardioverter defibrillator. A companion text on recommendations in athletes with supraventricular arrhythmias is published in the European Journal of Preventive Cardiology. Since both texts focus on arrhythmias, they are the result of a collaboration between EAPC and the European Heart Rhythm Association (EHRA). The documents provide a framework for evaluating eligibility to perform sports, based on three elements, i.e. the prognostic risk of the arrhythmias when performing sports, the symptomatic impact of arrhythmias while performing sports, and the potential progression of underlying structural problems as the result of sports.