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Implantable Devices

Observational Study: Association of antiarrhythmic drug use with increased risk of pacemaker implantation and syncope in new-onset atrial fibrillation patients

23 Mar, 2024 | 20:08h | UTC

Study Design and Population

This observational study utilized data from the Korean National Health Insurance Service to evaluate the impact of antiarrhythmic drugs (AADs) on the risk of pacemaker implantation or syncope in patients diagnosed with new-onset atrial fibrillation (AF) between 2013 and 2019. A total of 770,977 new-onset AF cases were identified, with 142,141 patients prescribed AADs within one year of diagnosis. The study compared the risk of these outcomes between AAD users and nonusers.

Main Findings

The study found that the use of AADs was associated with a significantly increased risk of pacemaker implantation or syncope, with adjusted risks being 3.5 times higher for either outcome, 2.0 times higher for syncope alone, and 5.0 times higher for pacemaker implantation. These associations were consistent across various patient subgroups, and propensity score-matched analysis supported these findings. Notably, women were found to be more susceptible to the adverse effects of AADs than men.

Implications for Practice

The findings suggest a need for careful evaluation of the risks associated with AAD use in patients with new-onset AF, particularly regarding the potential for pacemaker implantation or syncope. These results highlight the importance of individualized patient assessment before prescribing AADs to mitigate these risks effectively. Further research is needed to explore the mechanisms behind these associations and to develop strategies to minimize adverse outcomes in this patient population.

Reference

Yun Gi Kim et al. (2024). Association of Antiarrhythmic Drug Therapy With Syncope and Pacemaker Implantation in Patients With Atrial Fibrillation. Journal of the American College of Cardiology, 83(11), 1027-1038. DOI: 10.1016/j.jacc.2024.01.013.

Registry Analysis | Incidence and impact of pacemaker implantation after TAVR with self-expanding valves

8 Aug, 2023 | 13:29h | UTC

Incidence, Predictors, and Prognostic Impact of New Permanent Pacemaker Implantation After TAVR With Self-Expanding Valves – JACC: Cardiovascular Interventions (link to abstract – $ for full-text)

Commentaries:

Permanent pacemakers after TAVR: Tracking the impact of modern self-expanding valves – Cardiovascular Business

Pacemaker Implantation Still Risky, Not Rare With Self-Expanding TAVI Devices – TCTMD

 

Perspective | Cardiac device infection: removing barriers to timely and adequate treatment

4 Aug, 2023 | 11:54h | UTC

Cardiac device infection: removing barriers to timely and adequate treatment – European Heart Journal

 

Review | Early lead extraction for infected implanted cardiac electronic devices

22 Jun, 2023 | 15:03h | UTC

Early Lead Extraction for Infected Implanted Cardiac Electronic Devices: JACC Review Topic of the Week – Journal of the American College of Cardiology

 

Single-arm study | Dual-chamber leadless pacemaker system – a 90-day safety and performance evaluation

30 May, 2023 | 11:32h | UTC

A Dual-Chamber Leadless Pacemaker – New England Journal of Medicine (link to abstract – $ for full-text)

 

Commentary on Twitter

 

Preliminary study show wireless pacemakers may be safe and effective for children with bradycardia

24 Apr, 2023 | 13:27h | UTC

Transcatheter Leadless Pacing in Children: A PACES Collaborative Study in the Real-World Setting – Circulation: Arrhythmia and Electrophysiology

News Release: Wireless pacemakers may be safe, effective for children with irregular heart rhythms – American Heart Association

Commentary: Leadless Pacemakers Could Prove Useful for Pediatric Patients with Arrhythmias – HCP Live

 

EHRA clinical consensus statement on conduction system pacing implantation

18 Apr, 2023 | 12:59h | UTC

EHRA clinical consensus statement on conduction system pacing implantation: endorsed by the Asia Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS), and Latin American Heart Rhythm Society (LAHRS) – EP Europace

News Release: Detailed guidance on natural pacemaker method published today – European Society of Cardiologyv

 

Crossover RCT | Atrial pacing to increase exercise HR did not improve performance in HFpEF patients with chronotropic incompetence

9 Mar, 2023 | 14:22h | UTC

Summary: The RAPID-HF randomized clinical trial investigated whether implanting and programming a pacemaker for rate-adaptive atrial pacing would improve exercise performance in patients with heart failure with preserved ejection fraction (HFpEF) and chronotropic incompetence.

The study involved 29 patients with symptomatic HFpEF and chronotropic incompetence who underwent pacemaker implantation for the study and then were randomized to atrial rate responsive pacing or no pacing for four weeks, followed by a four-week washout period and then crossover for an additional four weeks.

The study found that atrial pacing increased early and peak exercise heart rate, but there was no improvement in exercise performance or quality of life. Despite a higher exercise heart rate, there was no increase in exercise cardiac output due to a decrease in stroke volume. Moreover, pacemaker implantation was associated with adverse events.

Article: Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection Fraction: The RAPID-HF Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Rate-Adaptive Pacing for Heart Failure With Preserved Ejection Fraction – JAMA (free for a limited period)

Commentaries:

RAPID-HF: Rate-Adaptive Pacing Doesn’t Help in HFpEF – TCTMD

Atrial Pacing for HFpEF Shows Lack of Benefit on Exercise Capacity – HCP Live

 

Commentary on Twitter

 

Post hoc analysis | Prevalence and significance of bradyarrhythmias in patients screened for atrial fibrillation

17 Feb, 2023 | 13:13h | UTC

Summary: This study looked at the prevalence and significance of bradyarrhythmias in people screened for atrial fibrillation using an implantable loop recorder compared to those who did not receive screening. The study found that screening was associated with the incidental diagnosis of bradyarrhythmias in 1 in 5 people and an increase in pacemaker implantations, but it did not reduce the risk of syncope or sudden death. While bradyarrhythmias are common in older people and can be risk markers, actively detecting and treating them in asymptomatic individuals may not improve clinical outcomes.*

Article: Prevalence and Prognostic Significance of Bradyarrhythmias in Patients Screened for Atrial Fibrillation vs Usual Care: Post Hoc Analysis of the LOOP Randomized Clinical Trial – JAMA Cardiology

Author Interview: Prevalence and Prognostic Significance of Bradyarrhythmias in Patients Screened for Atrial Fibrillation vs Usual Care – JAMA

 

Commentary on Twitter

 

*Note: This summary was created through the collaboration of a medical editor and ChatGPT.

 

RCT | Personalized accelerated pacing may improve QOL in patients with heart failure with preserved EF

6 Feb, 2023 | 13:35h | UTC

Effect of Personalized Accelerated Pacing on Quality of Life, Physical Activity, and Atrial Fibrillation in Patients With Preclinical and Overt Heart Failure With Preserved Ejection Fraction: The myPACE Randomized Clinical Trial – JAMA Cardiology (free for a limited period)

News Release: Speeding up heart rate helps heart failure patients with stiff hearts – University of Minnesota Medical School

 

Commentary on Twitter

 

M-A | Cardiac resynchronization may improve outcomes in patients with intraventricular conduction delay but not in those with RBBB

6 Feb, 2023 | 13:13h | UTC

Cardiac Resynchronization Therapy Improves Outcomes in Patients With Intraventricular Conduction Delay But Not Right Bundle Branch Block: A Patient-Level Meta-Analysis of Randomized Controlled Trials – Circulation (free for a limited period)

Commentary: CRT Likely Benefits Broader Group of Patients: Meta-analysis – TCTMD

 

Commentary on Twitter

 

Study suggests delivering high concentrations of antibiotics into the implantation site is feasible for infections in implanted CV electronic devices

13 Jan, 2023 | 13:26h | UTC

Regional Antibiotic Delivery for Implanted Cardiovascular Electronic Device Infections – Journal of the American College of Cardiology (link to abstract – $ for full-text)

Commentaries: 

Direct Delivery of Antibiotics to CV Device Pocket Infections Appears Promising – TCTMD

Regional Antibiotics for Implanted Cardiovascular Electronic Device Infections – American College of Cardiology

 

Consensus recommendations for magnetic resonance imaging for patients with cardiac implantable electronic devices.

7 Dec, 2022 | 14:23h | UTC

Joint British Society consensus recommendations for magnetic resonance imaging for patients with cardiac implantable electronic devices – Heart

 

Commentary on Twitter

 

RCT | Subcutaneous vs. transvenous implantable cardioverter defibrillator implantations.

22 Nov, 2022 | 13:19h | UTC

Perioperative Safety and Early Patient and Device Outcomes Among Subcutaneous Versus Transvenous Implantable Cardioverter Defibrillator Implantations: A Randomized, Multicenter Trial – Annals of Internal Medicine (link to abstract – $ for full-text) 

News Release: S-ICD Associated with 92 Percent Reduction in Lead-Related Complications Typical in Patients with ICDs – American College of Physicians 

Commentaries: 

Subcutaneous ICD Reduces Lead-Related Complications – HealthDay 

Subcutaneous implantable cardioverter defibrillators reduce the risk of perioperative complications – Physician’s Weekly 

Related: 

Device-related complications in subcutaneous versus transvenous ICD: a secondary analysis of the PRAETORIAN trial – European Heart Journal 

Subcutaneous or Transvenous Defibrillator Therapy – New England Journal of Medicine 

 

Commentary on Twitter 

 

 

2ry analysis of a RCT | Device-related complications in subcutaneous versus transvenous ICD.

22 Nov, 2022 | 13:16h | UTC

Device-related complications in subcutaneous versus transvenous ICD: a secondary analysis of the PRAETORIAN trial – European Heart Journal 

Original Study: Subcutaneous or Transvenous Defibrillator Therapy – New England Journal of Medicine 

Related: Perioperative Safety and Early Patient and Device Outcomes Among Subcutaneous Versus Transvenous Implantable Cardioverter Defibrillator Implantations: A Randomized, Multicenter Trial – Annals of Internal Medicine (link to abstract – $ for full-text) 

 

RCT | Left bundle branch vs. biventricular pacing for cardiac resynchronization therapy.

27 Sep, 2022 | 13:11h | UTC

Randomized Trial of Left Bundle Branch vs Biventricular Pacing for Cardiac Resynchronization Therapy – Journal of the American College of Cardiology (link to abstract – $ for full-text)

Commentary: Trial of Left Bundle Branch vs. Biventricular Pacing for CRT – American College of Cardiology

 

Commentary on Twitter

 

#ESCCongress – Single-arm study | Efficacy and safety of an extravascular implantable cardioverter–defibrillator.

29 Aug, 2022 | 12:09h | UTC

Efficacy and Safety of an Extravascular Implantable Cardioverter–Defibrillator – New England Journal of Medicine (link to abstract – $ for full-text)

 

Commentary on Twitter

 

Position Paper | Practical considerations, indications, and future perspectives for leadless and extravascular cardiac implantable electronic devices.

2 Aug, 2022 | 12:15h | UTC

Practical considerations, indications, and future perspectives for leadless and extravascular cardiac implantable electronic devices: a position paper by EHRA/HRS/LAHRS/APHRS – EP Europace

 

Guidelines | Peri-operative management of people with cardiac implantable electronic devices.

1 Aug, 2022 | 12:39h | UTC

Guidelines for the peri-operative management of people with cardiac implantable electronic devices – Anaesthesia

 

M-A | Mid- to long-term clinical and echocardiographic effects of post-procedural permanent pacemaker implantation after transcatheter aortic valve replacement.

18 Jul, 2022 | 11:10h | UTC

Mid- to Long-Term Clinical and Echocardiographic Effects of Post-procedural Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis – Frontiers in Cardiovascular Medicine

 

RCT | Non-fasting vs. fasting for cardiac implantable electronic device procedures.

11 Jul, 2022 | 12:03h | UTC

A randomized trial of non-fasting vs. fasting for cardiac implantable electronic device procedures (Fast-CIED Study) – EP Europace (link to abstract – $ for full-text)

Commentary: Non-fasting yields better well-being, safety in patients getting implantable device – Healio (free registration required)

 

Commentary from one of the authors on Twitter

 

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