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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EIn advanced heart failure, patient prognosis is being influenced by new technologies in cardiovascular implantable electronic devices, including a totally subcutaneous implantable cardioverter defibrillator with an impressive complication-free rate, leadless cardiac pacing, and multiple-sensor ICDs that are better able to monitor heart failure status.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiac resynchronization therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardioverter-defibrillator\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eheart failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eleadless pacing\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Enontransvenous implantable cardioverter-defibrillator\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epercutaneous\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ES3 audible frequency\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ES3 subaudible frequency\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EICD sensors\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EThe prognosis of patients with chronic heart failure (CHF) can be influenced greatly by new technology in cardiovascular implantable electronic devices, including nontransvenous implantable cardioverter defibrillators (ICDs), leadless pacing, and cardiac resynchronization therapy (CRT).\u003C\/p\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\u003Ch2 class=\u0022\u0022\u003ENew Sensors in Cardiovascular Implantable Electronic Devices\u003C\/h2\u003E\u003Cp id=\u0022p-3\u0022\u003EAn ICD can be used to collect high-quality physiologic data in patients with CHF, alerting physicians to CHF decompensation, said John P. Boehmer, MD, Penn State College of Medicine, Hershey, Pennsylvania, USA. Implantable device technology in ICDs and CRT-defibrillators with associated remote monitoring systems may better identify worsening status than systems with single sensors. Data show that S3 subaudible frequency, tidal volume, and rapid shallow breathing can predict a heart failure event.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe MultiSENSE clinical trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01128166\u0026amp;atom=%2Fspmdc%2F15%2F12%2F24.atom\u0022\u003ENCT01128166\u003C\/a\u003E], with 900 enrolled patients, collected data simultaneously from multiple sensors in CRT-defibrillators to develop algorithms for early detection of worsening HF. In preliminary data, differences in combined S3 audible and subaudible frequencies (6-70 Hz) between the CHF group and non-CHF group were statistically significant (\u003Cem\u003EP\u2005\u003C\/em\u003E=\u2005.03), demonstrating that this parameter appears superior to the audible-alone component in distinguishing patients with CHF from those without CHF. Rapid shallow breathing worsened prior to heart failure events; relative tidal volume and minute ventilation did not change significantly. Index of rapid shallow breathing (respiratory rate\/tidal volume) showed even greater change than respiratory rate. In addition, a high variability in respiratory rate carried a 4.9-fold increased risk of heart failure events within 30 days, said Dr Boehmer.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn another trial, PRE-SENSE [Klodas E et al. \u003Cem\u003EJ Card Fail\u003C\/em\u003E. 2013], S3 amplitude significantly correlated with several key echocardiographic parameters. Significant separation was seen between the low and high S3 groups, measuring left ventricular (LV) ejection fraction, LV volume, left atrial volume, and diastolic filling (E and A waves).\u003C\/p\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\u003Ch2 class=\u0022\u0022\u003ENontransvenous ICD\u003C\/h2\u003E\u003Cp id=\u0022p-6\u0022\u003ELong-term results of nontransvenous ICDs show a very high shock efficacy, reliable detection and discrimination, complication-free rate\/low mortality beyond the first year, and no endovascular infection or electrode failure, said Andrew Grace, PhD, University of Cambridge\u2013Papworth Hospital, Cambridge, United Kingdom. These results were observed in a broad patient range and improved with operator experience.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAccording to Prof Grace, leads are the \u201cweakest link\u201d of defibrillators, causing venous obstruction, thrombosis, infection, and inappropriate shocks in \u0026gt;\u200520% of patients. Simpler systems with subcutaneous electrodes can avoid lead issues.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EA totally subcutaneous ICD had a complication-free rate of 99% and an acute ventricular fibrillation conversion rate \u0026gt;\u200590% at 180 days [Weiss R et al. \u003Cem\u003ECirculation\u003C\/em\u003E. 2013]. Pooled 2-year results of the IDE study and EFFORTLESS registry showed that spontaneous shock efficacy of the subcutaneous ICD was 90.1% for first shock and 98.2% within 5 available shocks for an episode [Burke MC et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E. 2015]. The most recently implanted quartile of patients had a lower rate of inappropriate shocks at 6 months (Q1: 6.9%, Q4: 4.5%), although this did not reach statistical significance. The incidence of inappropriate shocks with dual-zone programming was lower than single zone (\u003Cem\u003EP\u2005\u003C\/em\u003E=\u2005.001). The complication-free rate was 90.6% through follow-up, with neither systemic blood infections nor electrode failures, noted Prof Grace.\u003C\/p\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\u003Ch2 class=\u0022\u0022\u003ELeadless Pacing\u003C\/h2\u003E\u003Cp id=\u0022p-9\u0022\u003ELeadless right ventricular cardiac pacing is safe and feasible with proof of principle for subacute retrieval, said Petr Neuzil, MD, PhD, Na Homolce Hospital, Prague, Czech Republic. Benefits of a transcatheter leadless approach include reduced invasiveness and improved efficiency and outcomes. In the LEADLESS study [Knops RE et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E. 2015], a feasibility study of leadless cardiac pacing, procedure times included a mean introducer time of 28 minutes (range, 11 to 74 minutes), a catheter in\/out time of 16 minutes (range, 3 to 57 minutes), and a mean of 0.5 catheter repositionings (range, 0 to 3). Mean time from procedure to hospital discharge was 1 day (range, 1 to 4 days).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EEarly performance of the Micra leadless transcatheter pacing system was evaluated in 140 patients with class I or II indication for ventricular inhibited pacing [Ritter P et al. HRS 2015 (abstr AB06-06)]. Freedom from major complications at 6 months was \u0026gt;\u200583%, and \u0026gt;\u200580% of patients demonstrated low and stable pacing thresholds, said Prof Neuzil.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EEliminating the coronary sinus lead improves therapy for all CHF patients, said Prof Neuzil, and is compatible with all manufacturers\u2019 devices. Leadless pacing complements the subcutaneous ICD platform, allowing for delivery of anti-tachycardia pacing, pacing medications, bradycardia pacing support, and enhanced intracardiac sensing.\u003C\/p\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\u003Ch2 class=\u0022\u0022\u003ECRT Advances for Nonresponders\u003C\/h2\u003E\u003Cp id=\u0022p-12\u0022\u003EPhilippe Ritter, MD, H\u00f4pital du Haut-L\u00e9v\u00eaque, Bordeaux-Pessac, France, discussed improving outcomes in nonresponders to CRT. Electrocardiographic mapping can improve CRT efficacy through evaluation of electrical synchrony. Nonspecific intraventricular conduction delay reveals intermediary results between narrow and left bundle branch block. When no LV electrical dysynchrony is observed, however, CRT is not useful.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EAdvances in echocardiographic imaging provide pre-implant assessment of ventricular dysynchrony and an accurate estimate of the amount and location of scar zones, allowing for intra-implant guidance of LV and right ventricular lead position. Comorbidity with kidney disease is associated with higher mortality even when short-term response is good. Follow-up of complicated patients at a multidisciplinary CRT clinic vs conventional follow-up resulted in greater event-free survival (\u003Cem\u003EP\u2005\u003C\/em\u003E=\u2005.0015) [Altman RK et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E. 2012].\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003ESome actions to improve outcomes include avoidance of apical sites, a preference for the latest activated segments, avoidance of scar zones, and use of cardiac magnetic resonance imaging to optimize lead position.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/12\/24.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzljm1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}