Publications by authors named "Breitenstein Alexander"
Lead Integrity and Failure Evaluation in Left Bundle Branch Area Pacing (LIFE-LBBAP) Study.
JACC Clin Electrophysiol
November 2024
Background: Left bundle branch area pacing (LBBAP) has gained increased adoption globally with the use of both lumenless leads (LLLs) and stylet-driven leads (SDLs). As these leads have been developed for conventional endocardial pacing sites, concerns remain regarding the lead integrity with LBBAP.
Objectives: This study evaluates lead integrity of pacing leads used for LBBAP in a large, real-world cohort of patients with LBBAP.
Article Synopsis
- - A 52-year-old man was diagnosed with malignant mitral valve prolapse syndrome and initially had surgery to repair his mitral valve.
- - Four years later, he needed an implantable cardioverter-defibrillator (ICD) to manage his condition.
- - He opted for a substernal ICD, which was successfully implanted with no complications, showing good electrical performance.
Background: Cardiac resynchronization therapy (CRT) is a cornerstone in the treatment of selected heart failure patients. However, a relevant proportion of patients do not show beneficial response. Identification of simple, additive, and outcome-relevant selection criteria may improve selection of patients.
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- The study aims to evaluate the performance and safety of subcutaneous-implantable cardioverter defibrillator (S-ICD) technology in athletes compared to nonathletes, focusing on device-related complications and shock occurrences.
- Athletes made up 10.2% of the 1493 patients studied and showed higher incidences of certain heart conditions, with a tendency to experience appropriate shocks more frequently during exercise, although this was not statistically significant after adjusting for other factors.
- Overall, S-ICDs appear to be a safe option for athletes, as there was no significant difference in overall complications or inappropriate shocks between the two groups, though athletes had a higher risk of myopotential oversensing and lead infections shortly after implant.
Article Synopsis
- * It included 863 patients, revealing that while higher comorbidity increased in-hospital and overall mortality, peri-procedural complications did not differ significantly between low and high-comorbidity groups.
- * Findings suggest that LPM implantation is safe for elderly patients, and those with low comorbidity (CCI ≤ 3) have a mortality rate similar to the general population, despite a higher three-year mortality rate in high comorbidity patients.
Article Synopsis
- The study aimed to assess the safety and effectiveness of implanting a leadless pacemaker via the jugular vein as an alternative to the traditional femoral vein method, particularly for patients where femoral access isn't viable.
- Researchers analyzed data from 100 patients implanted with the Micra™ leadless pacemaker through the jugular vein, finding that this method resulted in shorter procedure and fluoroscopy times compared to the femoral approach, with similar electrical performance of the devices.
- Complications were notably fewer with the jugular approach (only 2 reported) compared to 16 complications in the femoral method, suggesting that the jugular route is a safer option for leadless pacemaker implantation.*
Article Synopsis
- - The study analyzed outcomes of leadless pacemakers (LPMs) in patients with varying stages of chronic kidney disease (CKD) collected from the international i-LEAPER registry, focusing on major complications and electrical performance post-implantation.
- - Results indicated that while patients with CKD experienced similar rates of major complications during and after LPM implantation compared to those with normal kidney function, all-cause mortality was notably higher in severe CKD stages (G4/G5).
- - Additionally, patients with CKD displayed a slightly increased pacing threshold during the initial follow-up month, but overall, LPM electrical performance remained comparable across all groups. The research suggests that patients with advanced CKD are less frequently represented in LPM procedures despite
Article Synopsis
- Pulsed field ablation (PFA) is a new method for treating atrial fibrillation (AF) that focuses on ablating heart tissue while minimizing harm to nearby structures.
- In the MANIFEST-17K study, data from 106 centers involved 17,642 patients and showed no serious complications like esophageal damage, with only a 1% major complication rate.
- The results suggest that PFA has a strong safety profile and may change how AF is treated, compared to traditional thermal ablation methods.
Aims: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) have become established in preventing sudden cardiac death, with some advantages over transvenous defibrillator systems, including a lower incidence of lead failures. Despite technological advancements, S-ICD carriers may suffer from significant complications, such as premature battery depletion (PBD), that led to an advisory for nearly 40 000 patients. This multicentre study evaluated the incidence of PBD in a large set of S-ICD patients.
View Article and Find Full Text PDFBackground: Advances in leadless pacemaker technology have enabled accelerometer-based atrioventricular (AV) synchronous pacing by sensing atrial mechanical contraction.
Objective: The purpose of this study was to report the performance of the Micra AV leadless pacemaker from the worldwide Micra AV post-approval registry (PAR) through 12 months.
Methods: The Micra AV PAR is a prospective, single-arm, observational registry designed to assess the safety and effectiveness of Micra AV in a real-world setting.
Aims: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) offer potentially distinct advantages over transvenous defibrillator systems. Recent randomized trials showed significantly lower lead failure rates than transvenous ICD. Still, S-ICDs remain associated with the risk of inappropriate shocks (IAS).
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- Leadless pacemaker (LP) implantation is becoming a viable alternative for patients with prior conventional pacing systems (CPS), with a study analyzing its safety and effectiveness in 257 patients from two Swiss centers.
- Out of the patients studied, 24 had previous CPS, and a significant number (83%) required lead extraction due to various issues, while LP implantation showed low complication rates overall.
- Results indicated that LP implantation was effective and safe even in patients with prior CPS, as no infections or complications occurred after the procedures, contributing to positive outcomes in this population.
Article Synopsis
- The study investigates sex differences in outcomes among recipients of subcutaneous implantable cardioverter-defibrillators (S-ICDs), noting that historically, women have been underrepresented in such trials.
- Using a multicenter international registry, researchers compared 399 females to a matched cohort of males, focusing on the rate of appropriate shocks and device complications over time.
- Results showed that women had a lower rate of appropriate shocks compared to men (1.7% vs. 3.4% per year), but no significant difference in device-related complications, indicating that while women are less likely to receive effective ICD therapy, they face no increased risk of adverse effects from the devices.
: In the COMPASS trial, the combination of acetylsalicylic acid (ASA) plus 2.5 mg rivaroxaban twice daily (dual-pathway inhibition, DPI) has been shown to be superior to ASA monotherapy for the reduction in ischemic major adverse cardiovascular events (MACEs, i.e.
View Article and Find Full Text PDFCardiac resynchronization therapy (CRT) has evolved into an established therapy for patients with chronic heart failure and a wide QRS complex. Data on long-term outcomes over time are scarce and the criteria for implantation remain a subject of investigation. An international, multicenter, retrospective registry includes 2275 patients who received CRT between 30 November 2000 and 31 December 2019, with a mean follow-up of 3.
View Article and Find Full Text PDFBackground: Impairment of the conduction system is a common complication of transcatheter aortic valve replacement (TAVR), which is typically performed in elderly patients. A leadless pacemaker (LP) may be a suitable option in this frail population, but the available scientific data concerning the efficacy and safety of leadless pacing after TAVR are sparse. The purpose of this analysis was to evaluate the efficacy and safety of LP implantation in patients with relevant bradycardias after TAVR, compared to other indications.
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- Researchers wanted to see if a special heart treatment called catheter ablation (CA) helps patients who have a specific type of heart problem called ventricular tachycardia (VT), especially those with a certain type of defibrillator.
- They looked at data from patients who had either received a shock from their device or were in the hospital for VT, dividing them into two groups: those who had the treatment and those who didn't.
- The results showed that patients who had the treatment had fewer heart issues and lower chances of dying from heart problems over time compared to those who didn’t have the treatment.
Article Synopsis
- The Micra AV is a new type of transcatheter pacing system that achieves synchronous pacing by sensing mechanical contractions of the atrium, using advanced programming features like A3 and A4 windows.
- It’s essential for electrophysiologists to have in-depth knowledge of these programming parameters to enhance AV synchrony and address variability in patient outcomes.
- An expert panel of European electrophysiologists recommends specific programming approaches based on patient profiles, including evaluating atrial activity via echocardiography before implantation and customizing settings for optimal performance in different types of AV blocks.
Article Synopsis
- Leadless pacemakers (LPs) for VDD pacing rely on mechanical sensing of atrial contraction, which is less reliable than electrical sensing.
- This study analyzed P-wave amplitudes from preoperative ECGs to predict mechanical sensing in patients undergoing LP implantation.
- Findings showed that specific P-wave amplitudes correlate with mechanical contraction signals, indicating a potential method to enhance atrial-synchronous pacing success.
Challenges and pitfalls during CRT implantation in patients with persistent left superior vena cava.
J Interv Card Electrophysiol
October 2024
Background: Persistent left superior vena cava (PLSVC) is a rare venous anomaly, affecting 0.3-0.5% of the general population.
View Article and Find Full Text PDFBackground: Outcome comparisons among subcutaneous implantable cardioverter-defibrillator (S-ICD) recipients with nonischemic cardiomyopathies are scarce.
Objective: The aim of this study was to evaluate differences in device-related outcomes among S-ICD recipients with different structural substrates.
Methods: Patients enrolled in the i-SUSI (International SUbcutaneouS Implantable cardioverter defibrillator registry) project were grouped according to the underlying substrate (ischemic vs nonischemic) and subgrouped into dilated cardiomyopathy, hypertrophic cardiomyopathy, Brugada syndrome (BrS), arrhythmogenic right ventricular cardiomyopathy (ARVC).
Aim: Cardiac resynchronization therapy (CRT) is a cornerstone in the management of chronic heart failure in patients with a broad or paced QRS. However, data on long-term outcome after upgrade to CRT are scarce.
Methods And Results: This international, multicentre retrospective registry included 2275 patients who underwent a de novo or upgrade CRT implantation with a mean follow-up of 3.
Background: Device patients may require upgrade interventions from simpler to more complex cardiac implantable electronic devices. Prior to upgrading interventions, clinicians need to balance the risks and benefits of transvenous lead extraction (TLE), additional lead implantation or lead abandonment. However, evidence on procedural outcomes of TLE at the time of device upgrade is scarce.
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