Abstract
The heart is served by intrinsic, efficient and coordinated electrical activation provided by its specialised conduction system. The conduction system can be damaged, requiring the provision of pacing to maintain an adequate cardiac output. Causes of cardiac conduction disease are most commonly idiopathic or degenerative relating to calcium deposition. Pacing is not uncommonly indicated after cardiac surgery, particularly following procedures on the aortic valve especially in the presence of underlying conduction disease. The disturbance and damage caused to the conduction system may be short lived and resolve whilst back-up pacing support is provided by a temporary pacing system or more permanent damage may result requiring a permanent pacing solution. Managing a temporary pacing system and determining if and when to convert to a permanent pacing approach can at times be difficult. This chapter provides an overview of standard indications for pacemakers and implantable defibrillators as well as clarifies basic principles of pacing including commonly used terms such as threshold and sensitivity. It explores new developments in the sphere of cardiac pacing such as pacemakers in an MRI field as well as emerging technologies namely leadless and His bundle pacing. It includes a practical section on troubleshooting of temporary epicardial systems and provides insight into cases where cardiac surgeons may be called upon to assist cardiology colleagues, namely, surgical lead implantation or lead extraction.
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References
Parkes J, Bryant J, Milne R. Implantable cardioverter defibrillators: arrhythmias. A rapid and systematic review. Health Technol Assess. 2000;4:1–69.
Connolly SJ, Hallstrom AP, Cappato R, et al. Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. AVID, CASH and CIDS studies. Antiarrhythmics vs implantable defibrillator study. Cardiac arrest study hamburg. Canadian implantable defibrillator study. Eur Heart J. 2000;21:2071–8.
Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European heart rhythm association (EHRA). Eur Heart J. 2013;34(29):2281–329.
Cleland JGF, Daubert J-C, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352:1539–49.
Moss AJ, Hall WJ, Cannom DS, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009;361:1329–38.
Rajappan K. Permanent pacemaker implantation technique: part I. Heart. 2009;95:259–64.
Rajappan K. Permanent pacemaker implantation technique: part II. Heart. 2009;95:334–42.
van Rees JB, de Bie MK, Thijssen J, Borleffs CJW, Schalij MJ, van Erven L. Implantation-related complications of implantable cardioverter-defibrillators and cardiac resynchronization therapy devices: a systematic review of randomized clinical trials. J Am Coll Cardiol. 2011;58:995–1000.
Sharma PS, Dandamudi G, Naperkowski A, et al. Permanent His-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice. Heart Rhythm. 2015;12:305–12.
Sharma PS, Dandamudi G, Herweg B, et al. Permanent His-bundle pacing as an alternative to biventricular pacing for cardiac resynchronization therapy: A multicenter experience. Heart Rhythm. 2018;15:413–20.
Roberts PR, Clementy N, Al Samadi F, et al. A leadless pacemaker in the real-world setting: the micra transcatheter pacing system post-approval registry. Heart Rhythm. 2017;14:1375–9.
Lambiase PD, Barr C, Theuns DAMJ, et al. Worldwide experience with a totally subcutaneous implantable defibrillator: early results from the EFFORTLESS S-ICD Registry. Eur Heart J. 2014;35:1657–65.
Reddy VY, Miller MA, Neuzil P, et al. Cardiac resynchronization therapy with wireless left ventricular endocardial pacing: the SELECT-LV study. J Am Coll Cardiol. 2017;69:2119–29.
Last A. Radiotherapy in patients with cardiac pacemakers. Br J Radiol. 1998;71:4–10.
Bagur R, Chamula M, Brouillard É, et al. Radiotherapy-induced cardiac implantable electronic device dysfunction in patients with cancer. Am J Cardiol. 2017;119:284–9.
Zaremba T, Jakobsen AR, Søgaard M, Thøgersen AM, Riahi S. Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators: a literature review. Europace. 2016;18:479–91.
Salukhe TV, Dob D, Sutton R. Pacemakers and defibrillators: anaesthetic implications. Br J Anaesth. 2004;93:95–104.
American Society of Anesthesiologists. Practice advisory for the perioperative management of patients with cardiac implantable electronic devices: pacemakers and implantable cardioverter-defibrillators: an updated report by the american society of anesthesiologists task force on perioperative management of patients with cardiac implantable electronic devices. Anesthesiology. 2011;114:247–61.
Beinart R, Nazarian S. Effects of external electrical and magnetic fields on pacemakers and defibrillators: from engineering principles to clinical practice. Circulation. 2013;128:2799–809.
Nazarian S, Hansford R, Rahsepar AA, et al. Safety of magnetic resonance imaging in patients with cardiac devices. N Engl J Med. 2017;377:2555–64.
Reade MC. Temporary epicardial pacing after cardiac surgery: a practical review: part 1: general considerations in the management of epicardial pacing. Anaesthesia. 2007;62:264–71.
Reade MC. Temporary epicardial pacing after cardiac surgery: a practical review. Part 2: Selection of epicardial pacing modes and troubleshooting. Anaesthesia. 2007;62:364–73.
Steyers CM, Khera R, Bhave P. Pacemaker dependency after cardiac surgery: a systematic review of current evidence. PLoS One. 2015;10:e0140340.
Onalan O, Crystal A, Lashevsky I, et al. Determinants of pacemaker dependency after coronary and/or mitral or aortic valve surgery with long-term follow-up. Am J Cardiol. 2008;101:203–8.
Fukuda T, Hawley RL, Edwards JE. Lesions of conduction tissue complicating aortic valvular replacement. Chest. 1976;69:605–14.
Mazine A, Teoh K, Bouhout I, et al. Sutureless aortic valve replacement: a Canadian multicentre study. Can J Cardiol. 2015;31:63–8.
Lever N, Ferguson JD, Bashir Y, Channon KM. Prolonged temporary cardiac pacing using subcutaneous tunnelled active-fixation permanent pacing leads. Heart. 2003;89:209–10.
Raza SS, Li J-M, John R, et al. Long-term mortality and pacing outcomes of patients with permanent pacemaker implantation after cardiac surgery. Pacing Clin Electrophysiol. 2011;34:331–8.
Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American college of cardiology/American heart association task force on practice guidelines (writing committee to revise the ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices) developed in collaboration with the American association for thoracic surgery and society of thoracic surgeons. J Am Coll Cardiol. 2008;51:e1–62.
Post MC, Budts W, Van de Bruaene A, et al. Failure of epicardial pacing leads in congenital heart disease: not uncommon and difficult to predict. Neth Heart J. 2011;19:331–5.
Ector B, Willems R, Heidbüchel H, et al. Epicardial pacing: a single-centre study on 321 leads in 138 patients. Acta Cardiol. 2006;61:343–51.
Byrd CL, Wilkoff BL, Love CJ, Sellers TD, Reiser C. Clinical study of the laser sheath for lead extraction: the total experience in the United States. Pacing Clin Electrophysiol. 2002;25:804–8.
Kusumoto FM, Schoenfeld MH, Wilkoff BL, et al. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017;14:e503–51.
Pecha S, Vogler J, Reichenspurner H, Hakmi S. The Bridge Occlusion Balloon as a safety net in a high-risk transvenous lead extraction procedure. Interact Cardiovasc Thorac Surg. 2018;26:360–1.
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Keene, D., Sohaib, S.M.A., Wong, T. (2020). Cardiac Pacing in Adults. In: Raja, S. (eds) Cardiac Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-24174-2_8
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DOI: https://doi.org/10.1007/978-3-030-24174-2_8
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