The use of cardiac implantable electronic devices (CIEDs) has substantially increased in the last
decades. They have a significant impact on reducing morbidity and mortality of patients suffering
from cardiac arrhythmias and heart failure. Several developments of technical issues have appeared
over recent years to improve safety and efficacy. However, their role in daily clinical practice is still
unclear.
For instance, different leadless technologies, such as leadless pacemakers, subcutaneous
defibrillators or wearables are only partly or not included in the current guideline
recommendations. There are also several attempts to improve clinical response to cardiac
resynchronization therapy with multipoint or fusion optimized technologies, it is however not clear
which patients really benefit from these.
The same is true for novel conduction system pacing modalities: His-bundle pacing seems to be the
most physiological but manually challenging compared to left bundle branch area pacing, which
latter restores only the physiologic activation of the left ventricle but may be easier to perform. The
classical indications for primary prophylactic ICD are also questioned based on some new study
results, highlighting the need for an improved, more detailed and individual risk stratification for
better patient selection.
We have important but somehow controversial study results regarding preventive antibiotic therapy
(incremental perioperative antibiotics vs antibiotic-eluting envelope) during CIED implantation. Lead
extraction tools are also expanding but randomized controlled trials regarding the best approach are
completely missing in this field. The importance of remote monitoring is also constantly growing,
especially in the current pandemic times, the best way of patient selection needs however more
research.
The aim of this article collection is to help clinicians to better understand the most relevant
problems and achievements of cardiac device therapy, supporting better implementation in the daily
clinical practice.
Suggested paper themes include:
1) Leadless pacemakers.
2) S-ICD.
3) Improved cardiac resynchronization therapy (quadripolar leads, multipoint pacing, fusion
optimized technologies, AV/VV-optimization methods).
4) Better selection of patients for primary prophylactic ICD implantation.
5) Prevention of CIED implantation related complications, especially infections.
6) Wearables (including WCD).
7) His–Purkinje conduction system pacing, including His bundle pacing (HBP) and left bundle
branch area pacing (LBBP).
8) Transvenous lead extraction techniques.
9) Remote monitoring.
The use of cardiac implantable electronic devices (CIEDs) has substantially increased in the last
decades. They have a significant impact on reducing morbidity and mortality of patients suffering
from cardiac arrhythmias and heart failure. Several developments of technical issues have appeared
over recent years to improve safety and efficacy. However, their role in daily clinical practice is still
unclear.
For instance, different leadless technologies, such as leadless pacemakers, subcutaneous
defibrillators or wearables are only partly or not included in the current guideline
recommendations. There are also several attempts to improve clinical response to cardiac
resynchronization therapy with multipoint or fusion optimized technologies, it is however not clear
which patients really benefit from these.
The same is true for novel conduction system pacing modalities: His-bundle pacing seems to be the
most physiological but manually challenging compared to left bundle branch area pacing, which
latter restores only the physiologic activation of the left ventricle but may be easier to perform. The
classical indications for primary prophylactic ICD are also questioned based on some new study
results, highlighting the need for an improved, more detailed and individual risk stratification for
better patient selection.
We have important but somehow controversial study results regarding preventive antibiotic therapy
(incremental perioperative antibiotics vs antibiotic-eluting envelope) during CIED implantation. Lead
extraction tools are also expanding but randomized controlled trials regarding the best approach are
completely missing in this field. The importance of remote monitoring is also constantly growing,
especially in the current pandemic times, the best way of patient selection needs however more
research.
The aim of this article collection is to help clinicians to better understand the most relevant
problems and achievements of cardiac device therapy, supporting better implementation in the daily
clinical practice.
Suggested paper themes include:
1) Leadless pacemakers.
2) S-ICD.
3) Improved cardiac resynchronization therapy (quadripolar leads, multipoint pacing, fusion
optimized technologies, AV/VV-optimization methods).
4) Better selection of patients for primary prophylactic ICD implantation.
5) Prevention of CIED implantation related complications, especially infections.
6) Wearables (including WCD).
7) His–Purkinje conduction system pacing, including His bundle pacing (HBP) and left bundle
branch area pacing (LBBP).
8) Transvenous lead extraction techniques.
9) Remote monitoring.
