Efficacy of CRT upgrade in pacemaker-induced cardiomyopathy in an outpatient clinic - Results of a prospective registry.

Purpose: The aim of this prospective, monocentric registry study was to investigate whether upgrading to cardiac resynchronization therapy (CRT) in pacemaker-induced cardiomyopathy (PICM) can improve left ventricular function in typical outpatient clinical patients.

Methods: We screened for PICM in a pacemaker outpatient clinic between 2017 and 2021. The follow-up period was 6 months.

Incidence of lead erosion in a real-world cohort and a case of successful treatment with an antimicrobial mesh.

Cardiac implantable electronic device (CIED)-related infections are a major complication of CIED therapy and associated with high morbidity and mortality. The aim of the present study was to evaluate the incidence of lead erosion as one cause of the CIED-related infections and to provide detailed information about the therapy of two cases of lead erosion. We retrospectively screened the database of a large clinic specialized on patients with CIED (HIZ BERLIN Herzschrittmacher- und ICD-Zentrum, Berlin, Germany) for cases of lead erosion between 2015 and 2020.

Prevalence of left ventricular systolic dysfunction in a typical outpatient pacemaker cohort.

Background: Right ventricular (RV) pacing is the standard treatment for symptomatic bradycardia. RV pacing is known to cause dyssyncrony. New treatment options like His bundle pacing enhance the focus on left ventricular dysfunction in patients with pacemakers.

Plasma Kynurenine Predicts Severity and Complications of Heart Failure and Associates with Established Biochemical and Clinical Markers of Disease.

Background: Kynurenine, a metabolite of the L-tryptophan pathway, plays a pivotal role in neuro-inflammation, cancer immunology, and cardiovascular inflammation, and has been shown to predict cardiovascular events.

Objectives: It was our objective to increase the body of data regarding the value of kynurenine as a biomarker in chronic heart failure (CHF).

Methods: We investigated the predictive value of plasma kynurenine in a CHF cohort (CHF, n = 114); in a second cohort of defibrillator carriers with CHF (AICD, n = 156), we determined clinical and biochemical determinants of the marker which was measured by enzyme immunoassay.

Homoarginine Associates with Zonulin and Tryptophan - Findings in a High-Risk Cohort of Patients Carrying an AICD.

Background: Homoarginine (hArg) is known to have an impact on nitric oxide (NO) metabolism. It seems to increase NO generation and/or availability, thereby enhancing endothelial function. In addition, hArg is connected to energy metabolism since the key enzyme, L-arginine-glycine amidinotransferase (AGAT) for hArg synthesis in the kidneys, is also involved in the synthesis of energy metabolites like guanidinoacetate.

Plasma Zonulin and its Association with Kidney Function, Severity of Heart Failure, and Metabolic Inflammation.

Background: The tight junction regulator zonulin has attracted clinical attention as a biomarker of increased gastrointestinal permeability. Recent work also suggests zonulin to represent a general regulator of tissue barriers and a player in metabolic inflammation. Here, we investigated the associations of zonulin with chronic heart failure (CHF), kidney function, and metabolic inflammation.

Surgery for prosthetic valve endocarditis: associations between morbidity, mortality and costs.

Objectives: Surgery for prosthetic valve endocarditis (PVE) is associated with significant morbidity and mortality as well as with increased resource utilization and costs. For risk and cost reduction, an understanding of contributing factors and interrelations is essential.

Methods: Out of 1080 heart valve procedures performed between January 2010 and December 2012, 41 patients underwent surgery for PVE.

Efficacy of optimal medical therapy and cardiac resynchronization therapy upgrade in patients with pacemaker-induced cardiomyopathy.

Purpose: The aim of our study was to assess the prevalence of pacemaker-induced cardiomyopathy (PMiCMP) and its response to biventricular stimulation and optimal medical therapy.

Methods: To identify patients with PMiCMP, we screened all patients that presented for pacemaker interrogation in our outpatient clinic in 2012 and 2013 (n = 615). Left ventricular (LV) function was assessed by transthoracic echocardiography.

Prevalence of E/A wave fusion and A wave truncation in DDD pacemaker patients with complete AV block under nominal AV intervals.

Aims: Optimization of the AV-interval (AVI) in DDD pacemakers improves cardiac hemodynamics and reduces pacemaker syndromes. Manual optimization is typically not performed in clinical routine. In the present study we analyze the prevalence of E/A wave fusion and A wave truncation under resting conditions in 160 patients with complete AV block (AVB) under the pre-programmed AVI.

Outcome after surgery for prosthetic valve endocarditis and the impact of preoperative treatment.

Objectives: This study examined the outcomes of surgery for active prosthetic valve endocarditis in a recent decade, with special interest in preoperative treatment and predictors for early and late events.

Methods: From 2000 to 2010, a cohort of 149 consecutive patients (mean age, 64±13.9 years; 72% were male) underwent redo-surgery for prosthetic valve endocarditis and were reviewed regarding early (≤60 days) and late (>60 days) events (death, reinfection, reoperation).

Clinical, anatomical, and technical risk factors for postoperative pacemaker or defibrillator lead perforation with particular focus on myocardial thickness.

Background: Postoperative lead perforation is a life-threatening complication of cardiac pacing. Identification of precipitating factors for this serious complication may help to anticipate a specific risk profile and to minimize the incidence.

Methods: We conducted a retrospective tertiary referral center analysis to clarify clinical, anatomical, and technical characteristics related to pacemaker (PM) and cardioverter/defibrillator lead perforation.

Not left ventricular lead position, but the extent of immediate asynchrony reduction predicts long-term response to cardiac resynchronization therapy.

Cardiac resynchronization therapy (CRT) is an effective treatment for a large subgroup of chronic heart failure patients. Various attempts to improve the high non-responder rate of 30 % by preoperative asynchrony assessment have failed. We hypothesized that superior response to CRT is correlated with greater acute reduction of asynchrony and that a concordant left ventricular (LV) lead is beneficial compared to a discordant lead.

Complete atrioventricular block after TAVI: when is pacemaker implantation safe?

Introduction: Atrioventricular (AV) block is a frequent complication of transcatheter aortic valve implantation (TAVI). TAVI is routinely performed under anticoagulation using heparin, which potentially may lead to an increased bleeding rate in patients who undergo permanent pacemaker (PPM) implantation immediately after TAVI. As the number of TAVI procedures continues to rise, data on the optimal management of TAVI-related AV block are needed.

Left ventricular asynchrony in patients with right bundle branch block and normal ejection fraction.

Aims: The role of right bundle branch block (RBBB) for the induction of left ventricular (LV) asynchrony is discussed controversially. The objective of this study was to assess presence and degree of LV asynchrony in patients with RBBB, left bundle branch block (LBBB), or left anterior hemiblock (LAH) and normal LV function.

Methods: We included 15 patients with RBBB, 13 patients with RBBB and concomitant LAH, 10 patients with pure LBBB, and 100 healthy controls into this study.

Therapy of cardiac device pocket infections with vacuum-assisted wound closure-long-term follow-up.

Background: Cardiac device infections are serious complications that require aggressive treatment strategies, including interventional or surgical lead extraction.

Methods: Here we describe the long-time follow-up of vacuum-assisted closure (V.A.

Dyssynchrony parameter-guided interventricular delay programming.

Aims: Interventricular (VV) delay optimization for cardiac resynchronization therapy (CRT) is recommended by current guidelines and several algorithms have been proposed. So far, however, no gold standard has been established in the clinical routine. We hypothesized that dyssynchrony parameter assessment might guide VV delay optimization and investigated whether dyssynchrony parameter changes induced by sequential biventricular pacing follow a predictable pattern.

Pacing-induced cardiomyopathy in patients with right ventricular stimulation for >15 years.

Aims: The prevalence of pacing-induced cardiomyopathy (PiCMP) has been reported to be 9% 1 year after implantation. As long-term data are sparse, the aim of our study was to evaluate the prevalence of PiCMP in a cohort of patients with at least 15 years of right ventricular (RV) pacing.

Methods And Results: Inclusion criteria were RV stimulation for at least 15 years due to atrioventricular block III° and absence of structural heart disease at the time of initial implantation.

Successful reduction of intraventricular asynchrony is associated with superior response to cardiac resynchronization therapy.

Background: Cardiac resynchronization therapy (CRT) is generally associated with a low to moderate increase of the left ventricular ejection fraction (LVEF). In some patients, however, LVEF improves remarkably and reaches near-normal values. The aim of the present study was to further characterize these so called 'super-responders' with a special focus on the extent of intra- and interventricular asynchrony before and after device implantation compared to average responders.

Is antiarrhythmia device implantation safe under dual antiplatelet therapy?

Background: Device implantations in patients on dual antiplatelet-therapy (DA-therapy) continue to rise. The aim of our study was to compile and analyze data on complications of antiarrhythmia device implantation under DA-therapy.

Methods: We prospectively collected data on all device implantations in our department from January 2008 until February 2009.

A modified echocardiographic protocol with intrinsic plausibility control to determine intraventricular asynchrony based on TDI and TSI.

Background: Established methods to determine asynchrony suffer from high intra- and interobserver variability and failed to improve patient selection for cardiac resynchronization therapy (CRT). Thus, there is a need for easy and robust approaches to reliably assess cardiac asynchrony.

Methods And Results: We performed echocardiography in 100 healthy subjects and 33 patients with left bundle branch block (LBBB).

Implementation of seven echocardiographic parameters of myocardial asynchrony to improve the long-term response rate of cardiac resynchronization therapy (CRT).

Background: Cardiac resynchronization Therapy (CRT) is an effective therapy for chronic heart failure with beneficial hemodynamic effects leading to a reduction of morbidity and mortality. The responder rates, however, are low. There are various and contentious echocardiographic parameters of myocardial asynchrony.