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TauroPace™ in rhythm surgery

Conditions and treatments

Cardiac implantable electronic devices (CIEDs) – i.e. types of pacemakers or defibrillators – are often necessary to treat arrhythmic conditions in patients. Without sufficient protection however, they can lead to dangerous infections and put a patient’s life at risk. TauroPace™ is an antimicrobial solution used during surgical procedures to prevent CIED infections. [10]

When do you need a pacemaker or an implantable defibrillator?

Irregular heartbeats that require the implantation of a CIED can occur in many different forms. All of these forms may become clinically symptomatic when the heart fails to supply the body’s organs with blood. The most common diagnoses include: 

Condition

For an average healthy adult, the heart rate ranges between 60 to 100 per minute at rest. In case of bradycardia, the rate remains below 60 per minute (which might be normal for highly trained individuals, e.g. professional athletes).

 

Symptoms

  • shortness of breath
  • fatigue
  • dizziness
  • fainting 
  • (all either during everyday activities or while resting)

 

Causes / risk factors

  • heart tissue damage (e.g. coronary artery disease, heart failure, valve impairment, cardiomyopathy)
  • prescription of special medication
  • age above 64 years
  • recent cardiac surgery

 

Treatment

A permanent pacemaker is the most common therapy for symptomatic bradycardia.

Condition

Patients suffering from tachycardia (also known as tachyarrhythmia) have an average heartbeat that exceeds 100 – or in some cases even 200 – per minute at rest. 

 

Symptoms

  • shortness of breath
  • fatigue
  • dizziness
  • fainting 
  • stenocardia (chest pain or discomfort)

 

Causes / risk factors

  • high blood pressure (arterial hypertension)
  • heart tissue conditions (e.g. coronary artery disease, cardiomyopathy, valvular impairment, heart failure, myocarditis)
  • vessel disease (e.g. atherosclerosis, pulmonary arterial hypertension)
  • thyroid gland impairment
  • chronic pulmonary disease
  • renal impairment
  • psycho-emotional stress
  • substance abuse (alcohol/drugs)
  • excessive caffeine intake
  • smoking 

 

Treatment

In some cases, an implantable cardioverter defibrillator (ICD) can be an option to treat tachycardia.

Condition

Inability of the heart to pump blood in a sufficient amount. 

 

Symptoms

  • shortness of breath
  • fatigue
  • fainting 
  • coughing with produce
  • swollen legs and feet (as a result of venous pooling of the blood which cannot be sufficiently forwarded)
  • nocturia (waking up frequently at night to urinate) 

Please note: Acute onset of heart failure (with symptoms such as shortness of breath, dizziness, and fainting) is oftentimes detected rather quickly. In cases of chronic heart failure though, symptoms can become noticeable gradually over time, which might delay the process of diagnosis and subsequent treatment.  

 

Causes / risk factors

Heart failure is a result of structural damage and usually develops somewhat slowly. Acute heart failure can also be triggered by a heart attack. Circumstances that may put patients at greater risk include: 

  • high blood pressure (arterial hypertension)
  • coronary artery disease and heart attack (myocardial infarction)
  • innate or acquired valve impairment
  • congenital heart defect
  • heart tissue defect (cardiomyopathy)
  • infection of the heart (endocarditis)
  • inflammation of the heart tissue (myocarditis)
  • family history of cardiac diseases
  • diabetes
  • any type of irregular heartbeat (cardiac arrhythmia) 

Treatment

Depending on the level of impairment, heart failure might be treated with the implantation of a special pacemaker device.

Condition

Due to a momentary lack of perfusion in the cortex, patients will lose consciousness (and often injure themselves in the process). It can happen either once or recurrently and might thus severely impair a patient’s quality of life.

 

Symptoms

  • dizziness
  • fainting
  • nausea
  • lack of orientation
  • sweating
  • blurred vision

 

Causes / risk factors

 

1. Reflex syncope

A neuronal reflex leads to a sudden decrease of the median arterial pressure, followed by a slowed-down heartbeat. This can be triggered by:

  • strong sense of fear or pain
  • visual stimulus or bad odor
  • prolonged upright position (standing for a long time)
  • psycho-emotional stress 

 

2. Orthostatic syncope

A rapid movement switching from lying down to sitting or standing upright leads to venous pooling and lack of oxygen in the cortex. This can be triggered by lack of hydration.

 

3. Cardiac syncope

In some cases, an arrhythmic condition (i.e. irregular heartbeat) may also result in a loss of consciousness or even sudden cardiac arrest.  

 

Treatment

If cardiac arrhythmia is the underlying disease and other therapies prove obsolete, syncope might require the implantation of a pacemaker or even defibrillator.

Heart-Surgery-Lead-Canva

References

  1. Rennert-May et al. Epidemiology of cardiac implantable electronic device infections in the United States: A population-based cohort study. Heart Rhythm 2020. DOI: 10.1016/j.hrthm.2020.02.012 
  2. Sohail et al. Increased long-term mortality in patients with cardiovascular implantable electronic device infections. Pacing Clin Electrophysiol 2015. DOI: 10.1111/pace.12518
  3. Ludwig et al. Incidence and costs of cardiac device infections: retrospective analysis using German health claims data. J Comp Eff Res 2018. DOI: 10.2217/cer-2017-0080
  4. Blomström-Lundqvist et al. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections […]. EP Europace 2020. DOI: 10.1093/europace/euz246
  5. Tarakji et al. Antibacterial Envelope to Prevent Cardiac Implantable Device Infection. N Engl J Med 2019. DOI: 10.1056/NEJMoa1901111
  6. Mittal et al. Cardiac implantable electronic device infections: incidence, risk factors, and the effect of the AigisRx antibacterial envelope. Heart Rhythm 2014. DOI: 10.1016/j.hrthm.2013.12.013
  7. Eby et al. Predictors of cardiac implantable electronic device infection from a large United States healthcare organisation. EP Europace 2018. DOI: 10.1093/europace/euy015.306
  8. Unpublished WIDO data on file at CAU Medical Faculty (Kiel, Germany). 
  9. Henke et al. Taurolidine containing antimicrobial wash to prevent cardiac implantable electronic device infection. Abstract presented at Heart Rhythm Congress 2022. Eur J Arrhythm Electrophysiol 2022. (Abstract 129)
  10. Borov et al. Use of a taurolidine containing antimicrobial wash to reduce cardiac implantable electronic device infection. EP Europace 2023. DOI: 10.1093/europace/euad306
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