Safety and performance of MR-conditional pacing systems with automated MRI mode at 1.5 and 3 Tesla.

OBJECTIVES: To evaluate at 1.5 and 3 T MRI the safety and performance of trademarked ENO®, TEO®, or OTO® pacing systems with automated MRI Mode and the image quality of non-enhanced MR examinations. METHODS: A total of 267 implanted patients underwent MRI examination (brain, cardiac, shoulder, cervical spine) at 1.5 (n = 126) or 3 T (n = 141). MRI-related device complications, lead electrical performances stability at 1-month post-MRI, proper functioning of the automated MRI mode and image quality were evaluated. RESULTS: Freedom from MRI-related complications at 1 month post-MRI was 100% in both 1.5 and 3 T arms (both p < 0.0001). The stability of pacing capture threshold was respectively at 1.5 and 3 T (atrial:: 98.9% (p = 0.001) and 100% (p < 0.0001); ventricular: both 100% (p < 0001)). The stability of sensing was respectively at 1.5 and 3 T (atrial: 100% (p = 0.0001) and 96.9% (p = 0.01); ventricular: 100% (p < 0.0001) and 99.1% (p = 0.0001)). All devices switched automatically to the programmed asynchronous mode in the MRI environment and to initially programmed mode after the MRI exam. While all MR examinations were assessed as interpretable, artifacts deteriorated a subset of examinations including mostly cardiac and shoulder ones. CONCLUSION: This study demonstrates the safety and electrical stability of ENO®, TEO®, or OTO® pacing systems at 1 month post-MRI at 1.5 and 3 T. Even if artifacts were noticed in a subset of examinations, overall interpretability was preserved. CLINICAL RELEVANCE STATEMENT: ENO®, TEO®, and OTO® pacing systems switch to MR-mode when detecting magnetic field and switch back on conventional mode after MRI. Their safety and electrical stability at 1 month post MRI were shown at 1.5 and 3 T. Overall interpretability was preserved. KEY POINTS: • Patients implanted with an MRI conditional cardiac pacemaker can be safely scanned under 1.5 or 3 Tesla MRI with preserved interpretability. • Electrical parameters of the MRI conditional pacing system remain stable after a 1.5 or 3 Tesla MRI scan. • The automated MRI mode enabled the automatic switch to asynchronous mode in the MRI environment and to initial settings after the MRI scan in all patients.

Gapless Electrocardiogram-Monitoring in stroke at high risk of atrial fibrillation.

BACKGROUND AND PURPOSE: Previous studies investigating prolonged electrocardiogram (ECG)-monitoring after ischemic stroke had significant gaps between the index event and the beginning of long-term monitoring. Atrial fibrillation (AF) detection might be higher if prolonged cardiac rhythm documentation is performed with a gapless approach without any interruption of monitoring time. METHODS: This investigator-initiated, prospective study included patients with acute ischemic stroke or transient ischemic attack at three study centers. Participants received gapless ECG-monitoring via telemetry during stroke-unit admission until implantation of an insertable cardiac monitor (ICM) within the first days after the index event. Patients acted as their own controls and also received standard 24-72-h Holter ECG. RESULTS: A total of 110 patients were included, of whom 86 (78.2%) had an embolic stroke of unknown source, 14 (12.7%) had small-vessel disease, and 10 (9.1%) had large-artery disease. AF was newly diagnosed in 17 (15.5%) patients via ICM monitoring, compared to one (0.9%) patient via Holter ECG during 6 months of follow-up (p < 0.001). The detection rate of AF within the first 30 days was 10.0%, which accounted for 64% of all new AF diagnoses. The median duration of the detected episodes was 1.7 (interquartile range = 0.2-4.7) h. All patients with new onset AF were treated with oral anticoagulation. CONCLUSIONS: Gapless ECG-monitoring is an effective strategy to significantly increase the detection rate of AF after ischemic stroke. This finding supports the use of long-term ECG-monitoring with a gapless approach without any interruption in monitoring time as the gold standard for clinical practice.

Acute coronary syndrome in immigrants and non-immigrants : Results of an Austrian prospective pilot study.

BACKGROUND: There are indications that immigrant patients with acute coronary syndrome (ACS) differ in demographic characteristics and clinical presentation from non-immigrant patients. The aim of this prospective pilot study was to gather clinical and sociodemographic data from patients with ACS and to compare immigrants with non-immigrants. METHODS: Included were consecutive patients who underwent acute coronary angiography in one cardiological department for ACS from September 2011 to September 2013. Information was gathered about age, sex, results of the coronary angiography, classical risk factors, socioeconomic characteristics as well as ethnicity. Patients who had their place of birth outside Austria were specified as immigrants. RESULTS: A total of 100 patients (29% female) with a mean age of 60 years (range 34-91 years) were included. Of the patients 35 (35%) were immigrants, 12 came from Serbia, 4 from Bosnia, 3 from South America, 2 from Germany, 2 from Turkey, 2 from the Czech Republic, 2 from Croatia, 2 from Macedonia, and 1 each from Bangladesh, Poland, Romania, Libya, Bulgaria and Pakistan. Immigrants tended to be younger on average (56 vs. 62 years, p = 0.04) and had a two or multivessel disease more often than the non-immigrants but this difference was not significant (51% vs. 38%, p = 0.29). There were no differences between non-immigrants and immigrants concerning the classical risk factors for ACS (hypercholesterinemia 60% vs. 69%, nicotine abuse 51% vs. 60%, hypertension 69% vs. 79%) except diabetes mellitus (15% vs. 37%, p = 0.02). Sociodemographic data showed differences in education and socioeconomic status (SES). Non-immigrants had jobs with high skill level more often than immigrants (30% vs. 4%, p = 0.02), although there was no difference between immigrants and non-immigrants in the level of high education (9% each); however, immigrants more often had low education (31% vs. 11%, p = 0.01) and a monthly income below 1000 € than non-immigrants (41% vs. 14%, p = 0.03). CONCLUSIONS: Immigrants with ACS suffered more often from coronary two or multivessel disease and diabetes mellitus and were slightly younger than non-immigrants, although they did not differ regarding classical risk factors. Results suggest that the lower SES of immigrants compared with non-immigrants might contribute to the severity of coronary heart disease.

Familial Himalayan p wave and left ventricular hypertrabeculation/noncompaction.

BACKGROUND: "Himalayan P waves," are reported in congenital heart disease and cardiomyopathies. METHODS: We report a family with hypertrophic cardiomyopathy, Himalayan P waves, extensive focal right atrial wall thickening and left ventricular hypertrabeculation/noncompaction (LVHT). RESULTS: The father received a pacemaker and underwent heart transplantation because of hypertrophic cardiomyopathy. His daughters showed Himalayan P waves and right atrial wall thickening. LVHT was diagnosed in sister A at age 23 years and developed in sister B between 42 and 46 years. In sister A the heart rate continuously declined. She refused implantation of a pacemaker and died with 49 years. Sister B, suffers from bradycardia. CONCLUSIONS: Himalayan P waves are due to focal right atrial wall thickening, may be familially and associated with LVHT.