Achieving Cardiac resynchronization therapy (CRT) with Biventricular pacing(BiVP) pacing for pati... more Achieving Cardiac resynchronization therapy (CRT) with Biventricular pacing(BiVP) pacing for patients with moderate-tosevere heart failure (HF), left ventricular (LV) systolic dysfunction and ventricular dyssynchrony is well established and is currently the standard of care. Multiple studies have demonstrated significant improvement in quality of life, functional status, and exercise capacity in patients with New York Heart Association (NYHA) class III and IV heart failure who underwent resynchronization therapy1,2. In addition, resynchronization therapy is associated with survival benefit3. However, one third of patients do not respond to BIVP. New modalities for resynchronization have emerged namely His bundle pacing (HBP) and left ventricular septal pacing (LVSP). In this paper, we will review the benefits and limitations of BiVP and also the role of new pacing modalities such as HBP and LVSP in patients with HF with reduced left ventricular ejection fraction (LVEF) and electrical dysynchrony.
Journal of the American College of Cardiology, 2019
Internal insulation breaches (IBR) in implantable cardioverter-defibrillator (ICD) leads may caus... more Internal insulation breaches (IBR) in implantable cardioverter-defibrillator (ICD) leads may cause high-voltage short-circuiting (SHORT) and low-voltage noise/oversensing (NOS). SHORTs may compromise therapy delivery and NOS may case inappropriate antitachycardia pacing or shocks (IARx). Concerns
BACKGROUND Internal insulation breaches (IBR) may result in implantable cardioverter-defibrillato... more BACKGROUND Internal insulation breaches (IBR) may result in implantable cardioverter-defibrillator lead failure and adverse clinical events. Concerns exist that the Durata lead may be prone to IBR. OBJECTIVE The goals of this study were to assess Durata failures in the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database and compare them to failures in MAUDE for Endotak Reliance and Sprint Quattro Secure (QS) leads. METHODS We searched the MAUDE database from 2008 to 2018 for IBR and other failure modes. Included were explanted leads whose manufacturers found an insulation or conductor defect not caused by extrinsic factors. RESULTS The MAUDE search found 1011 qualifying leads. The cause of failure differed among leads (P < .001). The primary cause of Durata failure was IBR (293 of 316 leads [93%]), with IBR accounting for 47% (137 of 293); few QS (9 of 523 [1.7%]) and no Endotak Reliance leads failed because of IBR (P < .001). Durata IBR were responsible for 11 failures to treat ventricular tachycardia/ventricular fibrillation, and all were caused by high-voltage (HV) shorts between the proximal superior vena cava coil and a distal right ventricular coil cable (n = 10) or sensing conductor (n = 1); low values of HV impedance were found in these leads during defibrillation threshold testing (n = 3), after a shock or aborted shock (n = 7), and by an alert (n = 1). Inappropriate therapy was caused by 51 Durata IBR, but no QS IBR. CONCLUSION Durata implantable cardioverter-defibrillator leads are susceptible to IBR that may result in failure to treat ventricular tachycardia/ventricular fibrillation or inappropriate therapy; such failures may occur without forewarning. HV testing of Durata leads may be indicated during pulse generator replacement or when an insulation defect is suspected.
Although several risk factors are associated with spontaneous coronary artery dissection, strenuo... more Although several risk factors are associated with spontaneous coronary artery dissection, strenuous activity is an uncommon risk factor for women. We report a case of a patient who developed spontaneous coronary artery dissection shortly after starting F45, a highly strenuous fitness program. As high-intensity exercise regimens become more mainstream, clinicians should more readily consider spontaneous coronary artery dissection in young patients with history of recent strenuous activity when presenting with symptoms concerning for acute coronary syndrome.
Achieving Cardiac resynchronization therapy (CRT) with Biventricular pacing(BiVP) pacing for pati... more Achieving Cardiac resynchronization therapy (CRT) with Biventricular pacing(BiVP) pacing for patients with moderate-tosevere heart failure (HF), left ventricular (LV) systolic dysfunction and ventricular dyssynchrony is well established and is currently the standard of care. Multiple studies have demonstrated significant improvement in quality of life, functional status, and exercise capacity in patients with New York Heart Association (NYHA) class III and IV heart failure who underwent resynchronization therapy1,2. In addition, resynchronization therapy is associated with survival benefit3. However, one third of patients do not respond to BIVP. New modalities for resynchronization have emerged namely His bundle pacing (HBP) and left ventricular septal pacing (LVSP). In this paper, we will review the benefits and limitations of BiVP and also the role of new pacing modalities such as HBP and LVSP in patients with HF with reduced left ventricular ejection fraction (LVEF) and electrical dysynchrony.
Journal of the American College of Cardiology, 2019
Internal insulation breaches (IBR) in implantable cardioverter-defibrillator (ICD) leads may caus... more Internal insulation breaches (IBR) in implantable cardioverter-defibrillator (ICD) leads may cause high-voltage short-circuiting (SHORT) and low-voltage noise/oversensing (NOS). SHORTs may compromise therapy delivery and NOS may case inappropriate antitachycardia pacing or shocks (IARx). Concerns
BACKGROUND Internal insulation breaches (IBR) may result in implantable cardioverter-defibrillato... more BACKGROUND Internal insulation breaches (IBR) may result in implantable cardioverter-defibrillator lead failure and adverse clinical events. Concerns exist that the Durata lead may be prone to IBR. OBJECTIVE The goals of this study were to assess Durata failures in the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database and compare them to failures in MAUDE for Endotak Reliance and Sprint Quattro Secure (QS) leads. METHODS We searched the MAUDE database from 2008 to 2018 for IBR and other failure modes. Included were explanted leads whose manufacturers found an insulation or conductor defect not caused by extrinsic factors. RESULTS The MAUDE search found 1011 qualifying leads. The cause of failure differed among leads (P < .001). The primary cause of Durata failure was IBR (293 of 316 leads [93%]), with IBR accounting for 47% (137 of 293); few QS (9 of 523 [1.7%]) and no Endotak Reliance leads failed because of IBR (P < .001). Durata IBR were responsible for 11 failures to treat ventricular tachycardia/ventricular fibrillation, and all were caused by high-voltage (HV) shorts between the proximal superior vena cava coil and a distal right ventricular coil cable (n = 10) or sensing conductor (n = 1); low values of HV impedance were found in these leads during defibrillation threshold testing (n = 3), after a shock or aborted shock (n = 7), and by an alert (n = 1). Inappropriate therapy was caused by 51 Durata IBR, but no QS IBR. CONCLUSION Durata implantable cardioverter-defibrillator leads are susceptible to IBR that may result in failure to treat ventricular tachycardia/ventricular fibrillation or inappropriate therapy; such failures may occur without forewarning. HV testing of Durata leads may be indicated during pulse generator replacement or when an insulation defect is suspected.
Although several risk factors are associated with spontaneous coronary artery dissection, strenuo... more Although several risk factors are associated with spontaneous coronary artery dissection, strenuous activity is an uncommon risk factor for women. We report a case of a patient who developed spontaneous coronary artery dissection shortly after starting F45, a highly strenuous fitness program. As high-intensity exercise regimens become more mainstream, clinicians should more readily consider spontaneous coronary artery dissection in young patients with history of recent strenuous activity when presenting with symptoms concerning for acute coronary syndrome.
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Papers by Moses Wananu