Search

Background: Minimal evidence is available of the reduction in healthcare utilization of remote care in ICD patients over a longer period of follow-up., Objectives: This study compared healthcare utilization up to 3 year follow-up in implantable cardioverter-defibrillator (ICD) patients with remote care compared to conventional care., Methods: We conducted a retrospective cohort study of patients who received a single or dual-chamber ICD or cardiac resynchronization therapy-defibrillator (CRT-D) between 2016 and 2018. Patients with remote care and patients were compared with patients with received conventional care (control group). The primary endpoint was a composite of cardiac follow-up visits, ICD follow-up visits, telephone consultations, emergency department (ED) visits and hospital admissions and was defined as total healthcare utilization. The secondary endpoints were the individual care activities and one-year all-cause mortality., Results: A total of 497 patients were included in the study, of which 299 patients were allocated to the remote care and 198 patients to the control group. Mean follow-up was 815 ± 279 days. Remote care was associated with a significantly lower rate of adjusted total healthcare utilization in comparison to the control group that sustained for 3 subsequent follow-up years (IRR = 0.78, 95% CI [0.67 to 0.92], p < .01). One-year all-cause mortality was similar between the remote care and control group (respectively 3.0% vs. 5.5%, p = .29)., Conclusions: Compared to the standard follow-up of in-office care, a remote care program was associated with a sustained lower rate of planned and unplanned healthcare utilization up to 3 subsequent years after ICD/CRT-D implantation., (© 2021 Wiley Periodicals LLC.)

Background: After catheter ablation there is often a discrepancy between acute and chronic success rates. We aimed to evaluate major determinants for lesion quality and understand different manifestations of lesion structures., Methods: In a canine thigh muscle model radiofrequency (RF) current was delivered for 60 seconds at 30 W (n = 39) or 50 W (n = 18) with 15-g contact force. A second-generation 12-hole gold open irrigation catheter (SGIT) and a first-generation six-hole platinum-iridium catheter (FGIT; Biotronik, Berlin, Germany) were used. Electrode and tissue temperatures (at the surface and 3.5-mm and 7-mm depth) were recorded and lesion dimensions were measured. Lesions with steam pops were excluded. Histological examination was performed to evaluate homogeneity of the lesions. Inhomogeneity was defined as a visual multiband lesion pattern indicating different histological characteristics., Results: In total 57 lesions were created. Seventeen lesions were excluded (steam pops) and 40 lesions were analyzed. A total number of 11 homogeneous and 29 inhomogeneous lesions were identified. Using the SGIT catheter 16.7% of the lesions was homogeneous and 83.3% inhomogeneous; for FGIT it was 43.8% and 56.2% (P = 0.065), respectively. Homogeneous lesions had lower volumes as compared to inhomogeneous lesions (514.0 ± 198.8 vs 914.8 ± 399.1 mm, P = 0.003). Multiple logistic regression analysis indicated that the SGIT catheter is a significant predictor for inhomogeneous lesions (odds ratio 6.5, 95% confidence interval 1.1-38.8; P = 0.040) independent from power setting and flow rate., Conclusions: The development of inhomogeneous lesions after acute RF ablation is associated with higher lesion volumes and the use of the second-generation irrigation gold-tip catheter., (©2014 Wiley Periodicals, Inc.)

Background: Epicardial pacing lead implantation is the currently preferred surgical alternative for left ventricular (LV) lead placement. For endocardial LV pacing, we developed a fundamentally new surgical method. The trans-apical lead implantation is a minimally invasive technique that provides access to any LV segments. The aim of this prospective randomized study was to compare the outcome of patients undergoing either trans-apical endocardial or epicardial LV pacing., Methods: In group I, 11 end-stage heart failure (HF) patients (mean age 59.7 ± 7.9 years) underwent trans-apical LV lead implantation. Epicardial LV leads were implanted in 12 end-stage HF patients (group II; mean age 62.8 ± 7.3 years). Medical therapy was optimized in all patients. The following parameters were compared during an 18-month follow-up period: LV ejection fraction (LVEF), LV end-diastolic diameter (LVEDD), LV end-systolic diameter, and New York Heart Association (NYHA) functional class., Results: Nine out of 11 patients responded favorably to the treatment in group I (LVEF 39.7 ± 12.5 vs 26.0 ± 7.8%, P < 0.01; LVEDD 70.4 ± 13.6 mm vs 73.7 ± 10.5 mm, P = 0.002; NYHA class 2.2 ± 0.4 vs 3.5 ± 0.4, P < 0.01) and eight out of 12 in group II (LVEF 31.5 ± 11.5 vs 26.4 ± 8.9%, P = < 0.001; NYHA class 2.7 ± 0.4 vs 3.6 ± 0.4, P < 0.05). During the follow-up period, one patient died in group I and three in group II. There was one intraoperative LV lead dislocation in group I and one early postoperative dislocation in each group. None of the patients developed thromboembolic complications., Conclusions: Our data suggest that trans-apical endocardial LV lead implantation is an alternative to epicardial LV pacing., (©2011, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.)

Background: Radiofrequency (RF) catheter ablation is highly effective with a low complication rate. However, lesions created by RF energy are irreversible, inhomogeneous, and therefore potentially proarrhythmic., Objectives: The aim of this study was to examine the magnitude and importance of long-term proarrhythmic effects of RF energy., Methods and Results: Between 1991 and 1995, 120 patients underwent RF ablation for atrioventricular nodal reentrant tachycardia (AVNRT). Patient data were collected by contacting patients and/or filling out a questionnaire, and medical files were screened for recurrent, documented arrhythmias, pharmacological treatment, and repeated EP study. Referring cardiologists were asked about recurrences of tachyarrhythmias. Fourteen patients (11%) were lost to follow-up. During a mean follow-up of 10 years, six patients died. Recurrences of AVNRT were not any more observed after 3 years after ablation. A total of 29 patients (24%) suffered from new arrhythmias, 6 from type 1 atrial flutter, 6 from atrial tachycardia, 9 from atrial fibrillation, and finally 16 from symptomatic premature atrial contractions (PACs), needing medical treatment or a combination of these arrhythmias. Nine patients underwent pacemaker implantation, 4 after developing procedural atrioventricular (AV) conduction disturbances, 2 after His ablation for permanent atrial fibrillation, 1 patient for sick sinus syndrome, and another 2 patients after developing late AV block, respectively, 7 and 9 years after ablation., Conclusion: During long-term follow-up after RF ablation for AVNRT, no AVNRT recurrences were observed, but 29 patients (24%) suffered from new arrhythmias or late AV block. This potential proarrhythmic effect of RF energy promotes the application of alternative energy sources for ablative therapies for cardiac arrhythmias.