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Tricuspid regurgitation (TR) secondary to cardiac implantable electronic devices (CIEDs) has been well documented and is associated with worse cardiovascular outcomes. A variety of mechanisms have been proposed including lead‐induced mechanical disruption of the tricuspid valvular or subvalvular apparatus and pacing‐induced electrical dyssynchrony. Patient characteristics such as age, sex, baseline atrial fibrillation, and pre‐existing TR have not been consistent predictors of CIED‐induced TR. While two‐ dimensional echocardiography is helpful in assessing the severity of TR, three‐dimensional echocardiography has significantly improved accuracy in identifying the etiology of TR and whether lead position contributes to TR. Three‐dimensional echocardiography may therefore play a future role in optimizing lead positioning during implant to reduce the risk of CIED‐induced TR. Optimal lead management strategies in addition to percutaneous interventions and surgery in alleviating TR are very important. [ABSTRACT FROM AUTHOR]

The incidence and prevalence of cardiovascular diseases (CVD) have risen over the last few decades worldwide, resulting in a cost burden to healthcare systems and increasingly complex procedures. Among many strategies for treating heart diseases, treating arrhythmias using cardiac implantable electronic devices (CIEDs) has been shown to improve quality of life and reduce the incidence of sudden cardiac death. The battery‐powered CIEDs have the inherent challenge of regular battery replacements depending upon energy usage for their programmed tasks. Nanogenerator‐based energy harvesters have been extensively studied, developed, and optimized continuously in recent years to overcome this challenge owing to their merits of self‐powering abilities and good biocompatibility. Although these nanogenerators and others currently used in energy harvesters, such as biofuel cells (BFCs) exhibit an infinite spectrum of uses for this novel technology, their demerits should not be dismissed. Despite the emergence of Qi wireless power transfer (WPT) has revolutionized the technological world, its application in CIEDs has yet to be studied well. This review outlines the working principles and applications of currently employed energy harvesters to provide a preliminary exploration of CIEDs based on Qi WPT, which may be a promising technology for the next generation of functionalized CIEDs. [ABSTRACT FROM AUTHOR]

This is a report of one of the most serious complications of the cardiac pacemaker implantation ‐ infection of the implanted system. We present the case, which was misdiagnosed at the beginning and after cardiological consultation it was decided to immediately remove the peacemaker and transfer the patient to the Cardiological Department. [ABSTRACT FROM AUTHOR]

Objectives: Atrial high‐rate episodes (AHRE) are asymptomatic atrial tachy‐arrhythmias detected through continuous monitoring with a cardiac implantable electronic device (CIED). AHRE's have been associated with increased risks of developing clinically manifested atrial fibrillation (AF), thromboembolism, cardiovascular events, and mortality. Several variables has been researched and identified to predict AHRE development. The aim of this study, which compared the six frequently‐used scoring systems for thromboembolic risk in AF (CHA2DS2‐VASc, mC2HEST, HAT2CH2, R2‐CHADS2, R2‐CHA2DS2‐VASc, and ATRIA) in terms of their prognostic power in predicting AHRE. Materials and methods: This retrospective study included 174 patients with CIED's. The study population was divided into two groups according to presence of AHRE: patients with AHRE (+) and patients without AHRE (‐). Thereafter, patients baseline characteristics and scoring systems were analyzed for prediction of AHRE. Results: The distribution of patients' baseline characteristics and scoring systems according to presence of AHRE was evaluated. Furthermore, ROC curve analyses of the stroke risk scoring systems have been investigated in terms of predicting the development of AHREs. ATRIA, which predicted AHRE with a specificity of 92% and sensitivity of 37.5% for ATRIA values of >6, performed better than other scoring systems in predicting AHRE (AUC: 0.700, 0.626‐0.767 95% confidence interval (CI), p =.004) Conclusion: AHRE is common in patients with a CIED. In this context, several risk scoring systems have been used to predict the development of AHRE in patients with a CIED. This study's findings revealed that The ATRIA stroke risk scoring system performed better than other commonly used risk scoring systems in predicting AHRE. [ABSTRACT FROM AUTHOR]

An editorial is presented which expresses the views on the feasibility and safety of exclusive remote follow-up for CIEDs, as evidenced by a study conducted during the COVID-19 pandemic. Topics include the benefits of alert-based remote monitoring in reducing in-clinic visits and clinic working time, the importance of patient and clinician satisfaction, and the challenges related to reimbursement structures and technology reliability that must be addressed for widespread adoption.

Key Clinical Message: Nonspecific symptoms such as pleuritic or pericardial chest pain in cardiovascular implantable electronic devices patients, even with unremarkable ECG or device parameters, should always raise suspicion of electrode perforation, regardless of how long ago the implantation was performed. We report the successful percutaneous management of a 77‐year‐old woman who had a dual‐chamber pacemaker implanted more than 1 year ago and presented with pericarditis pain and compensated pericardial hemorrhagic tamponade. The symptoms were due to very late acute perforation of the atrial lead. This report is intended to raise awareness of procedure‐related complications in the large group of cardiovascular implantable electronic device patients. Pleuritic or pericardial pain in these patients should raise suspicion of electrode perforation, as the risk of perforation is not restricted to the period immediately after implantation and a lifelong risk cannot apparently be excluded. [ABSTRACT FROM AUTHOR]

Remote monitoring is beneficial for the management of patients with cardiovascular implantable electronic devices by impacting morbidity and mortality. With increasing numbers of patients using remote monitoring, keeping up with higher volume of remote monitoring transmissions creates challenges for device clinic staff. This international multidisciplinary document is intended to guide cardiac electrophysiologists, allied professionals, and hospital administrators in managing remote monitoring clinics. This includes guidance for remote monitoring clinic staffing, appropriate clinic workflows, patient education, and alert management. This expert consensus statement also addresses other topics such as communication of transmission results, use of third‐party resources, manufacturer responsibilities, and programming concerns. The goal is to provide evidence‐based recommendations impacting all aspects of remote monitoring services. Gaps in current knowledge and guidance for future research directions are also identified. [ABSTRACT FROM AUTHOR]

Introduction: Capsulectomy is recommended in patients with cardiac implantable electronic device (CIED) infection after transvenous lead extraction (TLE) but is time‐consuming and requires extensive tissue debridement. In this study, we describe the outcomes of chlorhexidine gluconate (CHG) lavage in lieu of capsulectomy for the treatment of CIED infections. Methods: This retrospective study included patients who underwent TLE for CIED‐related infections in two institutions in Colombia. In the capsulectomy group, complete capsulectomy was performed after hardware removal. In the CHG group, exhaustive lavage of the generator pocket with 20 cc of CHG at 2% followed by irrigation with approximately 500 cc of normal saline (0.9% sodium chloride) was performed. The primary outcomes included reinfection and hematoma formation in the generator pocket. Secondary outcomes included the occurrence of any adverse reaction to chlorhexidine, the need for reintervention, infection‐related mortality, and total procedural time. Results: A total of 102 patients (mean age 67.2 ± 13 years, 32.4% female) underwent CIED extraction with either total capsulectomy (n = 54) or CHG (n = 48) lavage. Hematoma formation was significantly higher in the capsulectomy group versus the CHG group (13% vs. 0%, p =.014), with no significant differences in the reinfection rate. Capsulectomy was associated with longer procedural time (133.7 ± 78.5 vs. 89.9 ± 51.8 min, p =.002). No adverse reactions to CHG were found. Four patients (4.3%) died from worsening sepsis: three in the capsulectomy group and one in the CHG group (p =.346). Conclusions: In patients with CIED infections, the use of CHG without capsulectomy resulted in a lower risk of hematoma formation and shorter procedural times without an increased risk of reinfection or adverse events associated with CHG use. [ABSTRACT FROM AUTHOR]

Background: Patients with cardiac implantable electronic devices (CIEDs) living in rural areas have difficulty obtaining follow‐up visits for device interrogation and programming in specialized healthcare facilities. Objective: To describe the use of an assisted reality device designed to provide front‐line workers with real‐time online support from a remotely located specialist (Realwear HTM‐1; Realwear) during CIED assistance in distant rural areas. Methods: This is a prospective study of patients requiring CIED interrogation using the Realwear HMT‐1 in a remote rural population in Colombia between April 2021 and June 2022. CIED interrogation and device programming were performed by a general practitioner and guided by a cardiac electrophysiologist. Non‐CIED‐related medical interventions were allowed and analyzed. The primary objective was to determine the incidence of clinically significant CIED alerts. Secondary objectives were the changes medical interventions used to treat the events found in the device interrogations regarding non‐CIED related conditions. Results: A total of 205 CIED interrogations were performed on 139 patients (age 69 ± 14 years; 54% female). Clinically significant CIED alerts were reported in 42% of CIED interrogations, consisting of the detection of significant arrhythmias (35%), lead malfunction (3%), and device in elective replacement interval (3.9%). Oral anticoagulation was initiated in 8% of patients and general medical/cardiac interventions unrelated to the CIED were performed in 52% of CIED encounters. Conclusion: Remote assistance using a commercially available assisted reality device has the potential to provide specialized healthcare to patients in difficult‐to‐reach areas, overcoming current difficulties associated with RM, including the inability to change device programming. Additionally, these interactions provided care beyond CIED‐related interventions, thus delivering significant social and clinical impact to remote rural populations. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation and flutter are often treated with external electrical cardioversion (ECV) in patients with potentially electrically sensitive cardiovascular implantable electronic devices (CIED). Long‐term follow‐up data on contemporary CIED undergoing ECV is sparse. The aim is to investigate shock‐related complications and impact on CIEDs. Methods: All ECV procedures from 2010 to 2020 in patients with CIED performed at a tertiary university hospital were identified in the Danish National Patient Registry. Changes in device measurements after ECV were retrospectively studied and procedure‐related complications were identified by review of medical records. Results: We analyzed 763 ECV procedures in 372 patients, median device implant time 1.9 years. The mean age of patients was 69.9 ± 9.9 years of which 73.4% were men. We identified two cases of device programming changes and four cases of premature battery depletion (≤3 years after device implant). Minor changes in device measurements were found for impedances, sensing, and pacing thresholds. No patients died due to ECV‐related device dysfunctions within the first 12 months after cardioversions. Conclusion: External cardioversion in patients with contemporary pacemakers and implantable cardioverter‐defibrillators seems safe in the majority of patients. Clinically important changes in device function following cardioversion were rarely observed but may be critical for device function. In an observational study, causality between cardioversion and device dysfunction cannot be established. For patient safety, we suggest that routine device interrogation after cardioversion still should be part of standard care. [ABSTRACT FROM AUTHOR]

The article explores the impact of cardiac implantable electronic devices (CIEDs) on tricuspid regurgitation (TR) and discusses the challenges in management. Topics discussed include the pathophysiologic mechanisms of CIED-associated TR, imaging methods for assessing TR with a focus on three-dimensional transesophageal echocardiography (3DTEE), and the role of different pacing strategies in mitigating TR severity.

Background: There is insufficient evidence regarding postoperative systemic antibiotic prophylaxis use for more than 24 h following cardiovascular implantable electronic devices (CIED) implantation and its impact on infection prevention. However, this strategy remains a common practice in many institutions. Methods: We conducted a systematic review and meta‐analysis including studies that compared the outcomes of patients: (1) who received preoperative plus 24 h or more of postoperative antibiotic prophylaxis (intervention group); and (2) who received either preoperative only or preoperative plus less than 24 h of antibiotic prophylaxis (control group). Risk of bias was assessed with ROBINS‐I and ROB‐2 tools. Risk ratio (RR) was pooled using random‐effect meta‐analyses with inverse variance method. Results: Eight studies that included two randomized controlled trials (RCTs) and six cohort studies with a total of 26,187 patients were included in the analysis. Overall, there were no differences in outcomes between the two groups, which included rates of CIED infection (RR 0.77, 95% CI 0.42, 1.42), mortality (RR 1.19, 95% CI 0.69, 2.06), pocket hematoma (RR 1.15, 95% CI 0.44, 3.00) or reintervention (RR 0.87, 95% CI 0.22, 3.46). Of note, the results were primarily impacted by the larger RCT. Conclusions: There was no benefit of postoperative antibiotic prophylaxis for more than 24 h following CIED implantation in the current systematic review and meta‐analysis. This supports the practice advocated by current guidelines which foster antibiotic stewardship and may result in reductions of adverse drug events, selection for antibiotic resistance, and financial costs of prolonged postoperative antibiotic prophylaxis. [ABSTRACT FROM AUTHOR]

Background: Transvenous lead extraction (TLE) is standard of care for the management of patients with cardiac implantable electronic device infection or lead‐related complications. Currently, objective data on TLE in Latin America is lacking. Objective: To describe the current practice standards in Latin American centers performing TLE. Methods: An online survey was sent through the mailing list of the Latin American Heart Rhythm Society. Online reminders were sent through the mailing list; duplicate answers were discarded. The survey was available for 1 month, after which no more answers were accepted. Results: A total of 48 answers were received, from 44 different institutions (39.6% from Colombia, 27.1% from Brazil), with most respondents (82%) being electrophysiologists. Twenty‐nine institutions (66%) performed <10 lead extractions/year, with 7 (16%) institutions not performing lead extraction. Although most institutions in which lead extraction is performed reported using several tools, mechanical rotating sheaths were cited as the main tool (66%) and only 13% reported the use of laser sheaths. Management of infected leads was performed according to current guidelines. Conclusion: This survey is the first attempt to provide information on TLE procedures in Latin America and could provide useful information for future prospective registries. According to our results, the number of centers performing high volume lead extraction in Latin America is smaller than that reported in other continents, with most interventions performed using mechanical tools. Future prospective registries assessing acute and long‐term success are needed. [ABSTRACT FROM AUTHOR]

Background: Cardiac implantable electronic device (CIED) therapy contributes to an improvement in morbidity and mortality across all patient demographics. Patient age is a recognized risk factor for unfavorable outcomes in invasive procedures. This is the largest series of non‐laser transvenous lead extraction (TLE) evaluating the association between patient age and procedure outcomes. Methods: Data of 2205 (3849 leads) patients was collected retrospectively from six European TLE centers between January 2005–December 2018 in the PROMET study. Of these, 153 patients with 319 leads were excluded for incomplete data. A comparison of outcomes was performed between the age groups young [< 50 years], young intermediate [50–69 years], older intermediate [70–79 years], and octogenarian [≥80 years]. Results: Infection was most common indication for TLE in the octogenarian cohort, less common in the younger population (60.1% vs. 33.2%, respectively, p <.01). High‐voltage leads were extracted most frequently from young patients, less frequently from octogenarians (31.6% vs. 10%, p <.001), while the opposite was evident for pacemaker leads (p <.001). Rotational sheath use was equally prevalent across all patient groups (p =.79). Minor and major complications across all the age groups were statistically similar, as was procedural success; the 30‐day mortality was most significant in the octogenarian and least in the young patients (4.9% vs. 0.4%, p =.005). Propensity matching multivariate analysis found systemic infection, lead dwell time, and patient age (p =.013, OR 1.064 [1.013–1.116]) increased risk of 30‐day mortality. Conclusion: TLE is safe and effective across all age groups. 30‐day mortality risk is significantly higher in the older patients. [ABSTRACT FROM AUTHOR]

Background: Implantable cardioverter defibrillator (ICD) and permanent pacemaker (PPM) lead placement may worsen or result in tricuspid regurgitation (TR). While the association between lead placement and the incidence of TR has been established, current understanding of this problem remains incomplete. This systematic review and meta‐analysis sought to pool the existing evidence to better understand the occurrence and severity of TR associated with cardiac implantable electrical device (CIED) insertion. Methods: An electronic search was performed to identify all relevant studies published from 2000 to 2018. Overall, 15 studies were selected for the analysis comprising 4019 patients with data reported on TR development following ICD or PPM lead placement. Demographic information, perioperative clinical variables, and clinical outcome measures, including pre and postoperative echocardiographic TR grade changes, were extracted and pooled for systematic review. Results: Mean patient age was 69 years [95% CI: 64.62‐73.59], and 63% [95% CI: 57‐68] were male. Devices implanted included ICD in 57% [95%CI: 43‐70] and PPM in 41% [95%CI: 31‐52]. The most common indications for pacemaker implantation were sick sinus syndrome in 22% [95% CI: 22‐37] and AV block in 21% [95%CI:12‐34. The commonest indications for ICD implantation were primary and secondary prevention of sudden cardiac death. Atrial fibrillation was present in 37% [95%CI: 28‐46] and congestive heart failure in 15% [95%CI: 2‐57]. Baseline distribution of TR grades were as follows: grade 0/1 TR in 89% [95%CI: 82‐93], grade 2 TR in 8% [95%CI: 5‐13], grade 3 TR in 2% [95%CI: 0‐7] and grade 4 TR in 2% [95%CI: 1‐4]. Post‐procedure, grade 0/ 1 TR decreased to 68% [95% CI: 51‐81] (p < 0.01), grade 2 TR increased to 21% [15‐28] (p < 0.01), grade 3 TR increased to 13% [95%CI: 5‐32] (p = 0.02), and grade 4 TR increased to 7% [95%CI: 5‐9] (p < 0.01). Conclusion: ICD and PPM lead placement is associated with increased TR post‐procedure. Further studies are warranted to evaluate changes in TR grade in the long term. [ABSTRACT FROM AUTHOR]

We report a case in which real‐time remote interrogation and reprogramming of the parameters of a dual‐chamber pacemaker was performed during the COVID‐19 pandemic. The described case demonstrated the safety and effectiveness of CIED remote programming based on the 5G cloud technology support platform (5G‐CTP), and showed that the application of real‐time remote programming would help in reducing the risk of cross‐infection between doctors and patients. [ABSTRACT FROM AUTHOR]

Introduction: While wideband segmented, breath‐hold late gadolinium‐enhancement (LGE) cardiovascular magnetic resonance (CMR) has been shown to suppress image artifacts associated with cardiac‐implanted electronic devices (CIEDs), it may produce image artifacts in patients with arrhythmia and/or dyspnea. Single‐shot LGE is capable of suppressing said artifacts. We sought to compare the performance of wideband single‐shot free‐breathing LGE against the standard and wideband‐segmented LGEs in CIED patients. Methods and Results: We retrospectively identified all 54 consecutive patients (mean age: 61 ± 15 years; 31% females) with CIED who had undergone CMR with standard segmented, wideband segmented, and/or wideband single‐shot LGE sequences as part of quality assurance for determining best clinical practice at 1.5 T. Two raters independently graded the conspicuity of myocardial scar or normal myocardium and the presence of device artifact level on a 5‐point Likert scale (1: worst; 3: acceptable; 5: best). Summed visual score (SVS) was calculated as the sum of conspicuity and artifact scores (SVS ≥ 6 defined as diagnostically interpretable). Median conspicuity and artifact scores were significantly better for wideband single‐shot LGE (F = 24.2, p <.001) and wideband‐segmented LGE (F = 20.6, p <.001) compared to standard‐segmented LGE. Among evaluated myocardial segments, 72% were deemed diagnostically interpretable—defined as SVS ≥ 6—for standard‐segmented LGE, 89% were deemed diagnostically interpretable for wideband‐segmented LGE, and 94% segments were deemed diagnostically interpretable for wideband single‐shot LGE. Conclusions: Wideband single‐shot LGE and wideband‐segmented LGE produced similarly improved image quality compared to standard LGE. [ABSTRACT FROM AUTHOR]

Introduction: Remote monitoring (RM) has significantly transformed the standard of care for patients with cardiac electronic implantable devices. It provides easy access to valuable information, such as arrhythmic events, acute decompensation manifestations and device‐related issues, without the need of in‐person visits. Methods: Starting March 1st, 332 patients were introduced to an RM program during the Italian lockdown to limit the risk of in‐hospital exposure to severe acute respiratory syndrome‐coronavirus‐2. Patients were categorized into two groups based on the modality of RM delivery (home [n = 229] vs. office [n = 103] delivered). The study aimed at assessing the efficacy of the new follow‐up protocol, assessed as mean RM activation time (AT), and the need for technical support. In addition, patients' acceptance and anxiety status were quantified via the Home Monitoring Acceptance and Satisfaction Questionnaire and the Generalized Anxiety Disorder 7‐item scale. Results: AT time was less than 48 h in 93% of patients and 7% of them required further technical support. Despite a higher number of trans‐telephonic technical support in the home‐delivered RM group, mean AT was similar between groups (1.33 ± 0.83 days in home‐delivered vs 1.28 ± 0.81 days in office‐delivered patients; p =.60). A total of 28 (2.5%) urgent/emergent in‐person examinations were required. A high degree of patient satisfaction was reached in both groups whereas anxiety status was higher in the office‐delivered group. Conclusions: The adoption of RM resulted in high patient satisfaction, regardless of the modality of modem delivery; nonetheless, in‐office modem delivery was associated with a higher prevalence of anxiety symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Venous stenosis is a late complication of the atrial switch (Mustard/Senning) procedure seen in patients with transposition of the great arteries (d‐TGA). Many atrial switch patients require cardiac implantable electronic devices (CIEDs) which further increases the incidence of venous stenosis. Stenosis of the superior limb of the systemic venous pathway (SLSVP) in the presence of CIED leads presents a management challenge. We propose a method for navigating SLSVP stenosis in atrial switch patients with CIEDs. Methods: The pulse generator and leads were removed using standard extraction techniques. Axillary access was retained via existing leads or new access was obtained. The interventional cardiology team, via groin access, performed stent‐angioplasty of the stenotic SLSVP. After stent deployment, the axillary access wire was snared from below, guided through the stent, and pulled into a long groin sheath. A sheath was then advanced over the axillary wire and into the groin sheath creating a path for passage of leads through the stent. New leads were advanced through the axillary sheath into the heart. Leads were secured using standard techniques. Results: All patients had a history of d‐TGA and prior atrial switch procedures. In each case, there was stenosis of the SLSVP in the setting of a CIED lead. There were no immediate complications and there was no restenosis on follow‐up. Conclusion: Post‐atrial switch patients with CIEDs can develop stenosis of the SLSVP. A collaboration between electrophysiology and interventional cardiology can allow for device extraction, stent‐angioplasty, and lead reimplantation to avoid "jailing" the leads. [ABSTRACT FROM AUTHOR]

Background: There have been a few cases of echogenic cardiac implantable electric device (CIED) lead‐associated oscillating intracardiac masses (ICMs) in leads imaged by echocardiography. The histological properties of ICMs could help clarify the etiological diagnosis. Although there is extensive literature on mass size, the histological properties of such masses have not been characterized. The aim of this research was to clarify the histological features of oscillating ICMs in CIED patients. Methods: Preoperative echocardiography was performed in all candidates for CIED removal. In the patients with ICMs, specimens were obtained by 3 methods: direct tissue collection during open‐heart surgery; tissue collection together with the CIED lead during transvenous extraction; and tissue collection by catheter vacuum during transvenous CIED removal. A standard histopathological examination of ICM tissue was performed. Results: A total of 106 patients underwent lead removal in our institute (April 2009‐March 2018); 14 patients had an ICM (13.2%), and 7 specimens were obtained in patients with CIED lead‐related ICM. Following histological examination, 2 types of ICM were identified: one mainly composed of thickened endocardium (EN type; 3 patients), and the other mainly an aggregate of inflammatory cells as a neutrophil cell (NC type; 4 patients). Conclusions: Two histological types of intracardiac masses, including a thickened endocardium type and a neutrophil cell type, were identified. These classifications might help make an accurate histological diagnosis of lead‐associated intracardiac masses. [ABSTRACT FROM AUTHOR]

Abstract: Background: Atrial tachyarrhythmias are common in patients with cardiac implantable electronic devices (CIEDs). Restoration of sinus rhythm by external electrical cardioversion (eECV) is frequently used to alleviate symptoms and to ensure optimal device function. Objectives: To evaluate the safety of eECV in patients with contemporary CIEDs and to assess the need for immediate device interrogation after eECV. Methods: We conducted a retrospective observational study of 229 patients (27.9% female, age 69 ± 10 years) with a CIED (104 pacemakers, 69 implantable cardioverter defibrillators, and 56 biventricular devices) who underwent eECV between 2008 and 2016 in two centers. Data from device interrogation before eECV, immediately afterwards, and at first follow‐up (FU) after eECV were collected. CIED‐related complications and adverse events during and after eECV were recorded. Results: No significant differences between right atrial (RA) and right ventricular (RV) sensing or threshold values before eECV, immediately afterwards, or at FU were observed. A small yet significant decrease was observed in RA and RV impedance immediately after eECV (484 Ω vs 462 Ω, P < 0.001 and 536 Ω vs 514 Ω, P < 0.001, respectively). The RV impedance did not recover to the baseline value (538 Ω vs 527 Ω, P  =  0.02). The impedance changes were without clinical consequences. No changes in left ventricular lead threshold or impedance values were measured. No CIED‐related complications or adverse events were documented following eECV. Conclusion: eECV in patients with contemporary CIEDs is safe. There seems to be no need for immediate device interrogation after eECV. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Readmissions are a burden on health care resources and have negative impact on patients. Cardiovascular implantable electronic devices (CIEDs) are frequently used in the management of rhythm disorders and advanced heart failure. We assessed 30‐day readmissions in patients admitted for CIED implantation in a sample of United States patients. Methods: Data were extracted from Nationwide Readmissions Database for calendar year 2013. Patients admitted for CIED implantation were identified using ICD‐9 codes. Patients <18 years of age, with missing data, who died during hospitalization or discharged in December were excluded. Primary endpoint was all‐cause 30‐day readmission rate. Factors associated with 30‐day readmissions were identified and examined using multivariate logistic regression. Results: We identified 320,783 admissions for CIED implantations. After applying exclusion criteria, 290,420 patients were included in final analysis, out of whom 45,467 (15.7%) patients were readmitted within 30 days. Readmitted patients were younger and had more comorbidities. Septicemia (5.1%), pneumonia (3.4%), CHF (2.35%), and paroxysmal ventricular tachycardia (2.3%) were common primary causes of 30‐day readmission. Young age, female gender, key comorbidities, weekend admissions, and admission to medium and large size hospital were independent predictors of 30‐day readmissions. Conclusion: In our study, 15.7% patients were readmitted within 30 days of an index admission for CIED implantation. Most readmissions were due to infectious or cardiovascular causes. There is a need to identify patients at risk for readmission to improve outcomes and curb the cost of care. [ABSTRACT FROM AUTHOR]

Background The feasibility, safety, and potential demand of emergent magnetic resonance imaging (MRI) of patients with a cardiac implantable electronic device (CIED) in emergency situations are unknown. Methods We retrospectively compared emergent and scheduled MRI orders for patients with CIEDs at Kameda General Hospital, a tertiary hospital in Japan, from October 2012 to September 2016. Results We identified 11 emergent MRI orders via the emergency room and 38 scheduled MRI orders. Although the baseline characteristics were similar between the two groups, brain scanning was predominant in emergent scanning ( p =0.002). The reasons for MRI and physicians who ordered it were also significantly different between the two groups ( p <0.001, p =0.03, respectively). Among the emergent orders via the emergency room, 10 out of 11 were brain scans. Nine out of 10 patients underwent successful emergent brain MRI. The time from arrival at the emergency room to MRI was 144±29 min, and the time from the MRI order made by the cardiologist to its actual performance was 60±10 min. Four out of 9 patients had a diagnosis of acute stroke confirmed by emergent MRI, and two had emergent thrombolysis with a complete neurological recovery. All emergent scanning was conducted safely with no complications. Conclusions Our study found the potential demand of brain MRI of patients with CIEDs in emergency situations compared with scheduled scanning, which was shown to be feasible and safe for the diagnosis and treatment of an acute stroke. [ABSTRACT FROM AUTHOR]

Prolonged longevity of cardiac implantable electronic devices (CIEDs) is needed not only as a passive response to match the prolonging life expectancy of patient recipients, but will also actively prolong their life expectancy by avoiding/deferring the risks (and costs) associated with device replacement. CIEDs are still exclusively powered by nonrechargeable primary batteries, and energy exhaustion is the dominant and an inevitable cause of device replacement. The longevity of a CIED is thus determined by the attrition rate of its finite energy reserve. The energy available from a battery depends on its capacity (total amount of electric charge), chemistry (anode, cathode, and electrolyte), and internal architecture (stacked plate, folded plate, and spiral wound). The energy uses of a CIED vary and include a background current for running electronic circuitry, periodic radiofrequency telemetry, high-voltage capacitor reformation, constant ventricular pacing, and sporadic shocks for the cardiac resynchronization therapy defibrillators. The energy use by a CIED is primarily determined by the patient recipient's clinical needs, but the energy stored in the device battery is entirely under the manufacturer's control. A larger battery capacity generally results in a longer-lasting device, but improved battery chemistry and architecture may allow more space-efficient designs. Armed with the necessary technical knowledge, healthcare professionals and purchasers will be empowered to make judicious selection on device models and maximize the utilization of all their energy-saving features, to prolong device longevity for the benefits of their patients and healthcare systems. [ABSTRACT FROM AUTHOR]

Along with the increased frequency of implantation, the incidence of cardiac implantable electronic device (CIED) infection, which can have serious or fatal complications, has also increased. Although several successful conservative therapies for CIED infection have been reported, retained infected devices remain a source of relapse, which is closely related to a higher mortality rate. Presently, complete hardware removal is initially recommended for infected CIED patients, and indications for conservative therapy, including continuous administration of antibiotics, require careful consideration. On the other hand, complete removal is not required for superficial or incisional infection at the device pocket if an infection does not involve the device, but the patient should be closely followed for progression to deeper infection, which would require extraction. [ABSTRACT FROM AUTHOR]

Use of cardiovascular implantable electronic devices ( CIED), including permanent pacemakers ( PPM) and implantable cardioverter defibrillators ( ICD), has increased dramatically over the past two decades. Most CIED infections are caused by staphylococci. Fungal causes are rare and their prognosis is poor. To our knowledge, there has not been a previously reported case of multifocal Candida endocarditis involving both a native left-sided heart valve and a CIED lead. Here, we report the case of a 70-year-old patient who presented with nausea, vomiting, and generalised fatigue, and was found to have Candida glabrata endocarditis involving both a native aortic valve and right atrial ICD lead. We review the literature and summarise four additional cases of CIED-associated Candida endocarditis published from 2009 to 2014, updating a previously published review of cases prior to 2009. We additionally review treatment guidelines and discuss management of CIED-associated Candida endocarditis. [ABSTRACT FROM AUTHOR]

Background The number of patients with cardiovascular implantable electronic devices (CIEDs) is increasing. The purpose of this study was to compare three methods (sonication, swab cultures, and blood cultures) to detect bacteria in infections of CIEDs. Methods Patients with pocket infection of CIEDs and/or CIED-associated infective endocarditis were prospectively included. Generators and leads were sonicated together. Swab cultures of the generator pocket and blood cultures were performed. Results Between January 2009 and September 2012, 18 patients with a CIED infection were recorded, including two definite and four possible CIED-IEs. In 17 patients, blood cultures were performed and the device was analyzed by sonication. A swab culture from the device pocket was performed in 16 cases. Ten (59%) patients received antibiotic therapy before the device was removed. In 15 of 16 cases (94%), bacteria were detected by sonication, while bacteria were detected in only nine (56%) and seven (41%) cases by swab-and blood cultures, respectively. In four cases (24%), sonication was the only method that detected bacteria. The following bacteria were detected by sonication: methicillin-sensitive Staphylococcus aureus (MSSA; n = 6), coagulase-negative staphylococci (CNS; n = 3), Propionibacterium acnes (n = 2), Staphylococcus lugdunensis ( n = 1), MSSA/ Pseudomonas aeruginosa (n = 1), Bacillus cereus (n = 1), MSSA/ P. acnes (n = 1), and P. acnes/CNS (n = 1). All positive swab cultures and all positive blood cultures but one grew the same bacteria as sonication fluid cultures. Conclusion Sonication can be more sensitive than swab cultures or blood cultures in detecting bacteria in infections of CIEDs. [ABSTRACT FROM AUTHOR]

Abstract: Over the last two decades, there has been a surge in the number of Cardiac Implantable Electronic Device (CIED) implantation. These devices improve the quality of life and survival among certain cardiac patients. However, this benefit might be affected by device complications and one of the most important ones is CIED infection as it carries significant morbidity and mortality. CIED infection can present as a device pocket infection or endovascular infection and its diagnosis could be challenging. In general, management of CIED infection involves device removal and antibiotic therapy and requires collaboration between different clinical teams. Future efforts and research should focus on measures to prevent the occurrence of this outcome. [Copyright &y& Elsevier]