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OBJECTIVE: To describe complications and outcomes in dogs undergoing epicardial pacemaker (EP) implantation, identify factors associated with survival, and investigate improvement in clinical signs and health-related quality of life (HRQoL) following surgery.
METHODS: 52 client-owned dogs that underwent EP placement.
METHODS: Medical records of 4 UK-based referral hospitals were searched and data reviewed retrospectively between July 2010 and December 2022. Factors contributing to outcomes after EP placement were assessed.
RESULTS: The primary reasons for referral included collapsing/syncopal episodes (n = 36), exercise intolerance (15), and significant bradycardia (46). Third-degree atrioventricular block (39/52 [75%]) was the predominant indication for pacemaker placement, and common reasons for EP placement included previous transvenous pacemaker dislodgment/loss of capture (n = 12) and small body size (10). Intra- and postoperative complications were documented in 11% and 23% of dogs, respectively. Overall, 96% of dogs survived to discharge, and median follow-up time was 462 days (range, 31 to 3,139 days). Presence of coexistent myocardial or valvular disease at the time of EP implantation was associated with a reduced survival. Owners reported decreased clinical signs, increased activity levels, and improved HRQoL.
CONCLUSIONS: Epicardial pacemaker implantation is a valuable option for dogs requiring artificial cardiac pacing. Complications were common but did not impact the overall outcome. Dogs with a coexisting cardiac pathology had a shorter life expectancy after EP placement, but their HRQoL appeared to be good, with an improvement in clinical signs and increased activity levels.

To date, studies assessing the safety profile of 3D printing materials for application in cardiac ablation are sparse. Our aim is to evaluate the safety and feasibility of two biocompatible 3D printing materials, investigating their potential use for intra-procedural guides to navigate surgical cardiac arrhythmia ablation. Herein, we 3D printed various prototypes in varying thicknesses (0.8 mm-3 mm) using a resin (MED625FLX) and a thermoplastic polyurethane elastomer (TPU95A). Geometrical testing was performed to assess the material properties pre- and post-sterilization. Furthermore, we investigated the thermal propagation behavior beneath the 3D printing materials during cryo-energy and radiofrequency ablation using an in vitro wet-lab setup. Moreover, electron microscopy and Raman spectroscopy were performed on biological tissue that had been exposed to the 3D printing materials to assess microparticle release. Post-sterilization assessments revealed that MED625FLX at thicknesses of 1 mm, 2.5 mm, and 3 mm, along with TPU95A at 1 mm and 2.5 mm, maintained geometrical integrity. Thermal analysis revealed that material type, energy source, and their factorial combination with distance from the energy source significantly influenced the temperatures beneath the 3D-printed material. Electron microscopy revealed traces of nitrogen and sulfur underneath the MED625FLX prints (1 mm, 2.5 mm) after cryo-ablation exposure. The other samples were uncontaminated. While Raman spectroscopy did not detect material release, further research is warranted to better understand these findings for application in clinical settings.

Recent developments in cardiac macrophage biology have broadened our understanding of the critical functions of macrophages in the heart. As a result, there is further interest in understanding the independent contributions of distinct subsets of macrophage to cardiac development and function. Here, we demonstrate that genetic loss of interferon regulatory factor 8 (Irf8)-positive embryonic-derived macrophages significantly disrupts cardiac conduction, chamber function, and innervation in adult zebrafish. At 4 months post-fertilization (mpf), homozygous irf8st96/st96 mutants have significantly shortened atrial action potential duration and significant differential expression of genes involved in cardiac contraction. Functional in vivo assessments via electro- and echocardiograms at 12 mpf reveal that irf8 mutants are arrhythmogenic and exhibit diastolic dysfunction and ventricular stiffening. To identify the molecular drivers of the functional disturbances in irf8 null zebrafish, we perform single cell RNA sequencing and immunohistochemistry, which reveal increased leukocyte infiltration, epicardial activation, mesenchymal gene expression, and fibrosis. Irf8 null hearts are also hyperinnervated and have aberrant axonal patterning, a phenotype not previously assessed in the context of cardiac macrophage loss. Gene ontology analysis supports a novel role for activated epicardial-derived cells (EPDCs) in promoting neurogenesis and neuronal remodeling in vivo. Together, these data uncover significant cardiac abnormalities following embryonic macrophage loss and expand our knowledge of critical macrophage functions in heart physiology and governing homeostatic heart health.

UNASSIGNED: Coronary artery, aortic valve, and descending aorta calcification (CAC, AVC, DAC) are manifestations of atherosclerosis, and cardiac epicardial adipose tissue (EAT) indicates heart adiposity. This study explored the association between cardiac adipose tissue and cardiovascular calcification in participants with long-standing T1D.
UNASSIGNED: EAT and intra-thoracic adipose tissue (IAT) were measured in 100 T1D subjects with cardiac computed tomography (CT) scans in the EDIC study. Volume analysis software was used to measure fat volumes. Spearman correlations were calculated between CAC, AVC, DAC with EAT, and IAT. Associations were evaluated using multiple linear and logistic regression models.
UNASSIGNED: Participants ranged in age from 32 to 57. Mean EAT, and IAT were 38.5 and 50.8 mm3, respectively, and the prevalence of CAC, AVC, and DAC was 43.6 %, 4.7 %, and 26.8 %, respectively. CAC was positively correlated with age (p-value = 0.0001) and EAT (p-value = 0.0149) but not with AVC and DAC; IAT was not associated with calcified lesions. In models adjusted for age and sex, higher levels of EAT and IAT were associated with higher CAC (p-value < 0.0001 for both) and higher AVC (p-values of 0.0111 and 0.0053, respectively), but not with DAC. The associations with CAC remained significant (p-value < 0.0001) after further adjustment for smoking, systolic blood pressure, BMI, and LDL, while the associations with AVC did not remain significant.
UNASSIGNED: In participants with T1D, higher EAT and IAT levels are correlated with higher CAC scores. EAT and IAT were not independently correlated with DAC or AVC.

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Temporary pacing wires are often used following cardiac surgery to optimise the heart rhythm. Although setting and checking temporary pacemakers is typically undertaken by anaesthetists, intensivists, and nursing staff who care for post-cardiac surgical patients, almost all patients with temporary pacing wires are transferred to the ward with the pacing wires left in situ, where surgical, often junior, staff become responsible for temporary pacing wire management. Thus, knowledge is required not only of temporary pacing wire indications, types, and positioning at surgery, but also of practical skills in performing a pacing check, setting the pacemaker, and troubleshooting common problems. The available literature targets clinicians well-versed in temporary pacing wire management. However, this paper provides a practical \'how to\' for surgical staff managing temporary pacing wires in a non-critical care environment.

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Epicardial pulsed field ablation (PFA) of ganglionated plexi (GPs) is being explored as a potential treatment for atrial fibrillation. Initial work using open-chest access with a monopolar ablation device has been completed. This study describes the early development work for a device that can be used with subxiphoid access and deliver bipolar ablation pulses. Electric field computational models have been used for the initial guidance on pulse parameters. An in vivo assessment of these ablation parameters has been performed in an open-chest canine study, while subxiphoid access and navigation of the device has been demonstrated in a porcine model. Results from this acute study have demonstrated the promising potential of this approach.