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Cardiac implantable electronic devices (CIED) are medical devices that play a significant role in the management of heart disease by regulating cardiac rate and rhythm. CIEDs encompass pacemakers, implantable cardioverter defibrillators, cardiac resynchronisation devices (CRT), and implantable cardiac monitors. While robust evidence supports the use of these devices, there are several areas where technical developments have outpaced robust clinical trials, including: the role of primary prevention implantable cardioverter-defibrillators in the era of contemporary heart failure (HF) therapy, risk stratification in hypertrophic and dilated cardiomyopathies, the use of conduction system pacing, the impact of tricuspid regurgitation in the presence of a CIED, the role of CIEDs in structural valve interventions (such as percutaneous tricuspid valve interventions and transcatheter aortic valve implantation), and role of leadless CIED systems. Here, we critically appraise the literature associated with these evidence gaps, provide expert review and assessment based on the current evidence, and attempt to foster dialogue among key stakeholders, including clinicians, researchers, industry leaders, and policymakers, in order to generate the evidence needed to refine clinical decision-making and improve patient outcomes.
There is no gold standard for assessment of medication adherence. This study aimed to systematically review the literature to identify validated medication adherence measurement tools and methods used in clinical practice and research settings in the context of patients with chronic kidney disease (CKD) and to synthesize key features of the identified medication adherence tools. We systematically reviewed MEDLINE via Ovid, Embase via Ovid, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL (via EBSCO) from inception to September 25, 2025. All abstracts were screened by pairs of reviewers independently, followed by a full-text review identifying the tool/method used for measuring medication adherence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this systematic review. General study and medication adherence method/tool-specific characteristics were summarized. The quality criteria for measurement properties were applied across the included studies to synthesize and assess the strength of the evidence. The 43 included articles originated from 25 countries. The most common measures used for evaluating medication adherence were the Eight-Item Morisky Medication Adherence Scale (MMAS-8) (n = 11 [25.6
BACKGROUND:Patients undergoing orthotopic transcatheter tricuspid valve replacement (TTVR) frequently present with a cardiac implantable electronic device (CIED) lead traversing the tricuspid valve. OBJECTIVES:This study sought to investigate the clinical, procedural, and lead-related outcomes of orthotopic TTVR in patients with transvalvular CIED leads. METHODS:All consecutive patients enrolled in the multicenter TRIPLACE (Global Multicenter Registry on Transcatheter Tricuspid Valve Replacement) registry were included for analysis. Patients were stratified based on the presence of a CIED lead traversing the tricuspid valve. Changes in lead function parameters were assessed after TTVR in a subset of these patients who had pacemaker lead parameter data recorded. Lead failure was defined as structural or electrical malfunction requiring new lead or CIED insertion. RESULTS:Among 395 patients, 104 (26.3%) had transvalvular CIED leads. Procedural success, symptomatic improvement, and 30-day mortality were comparable between those with and without CIED. Patients with CIED leads had lower rates of mild or less residual tricuspid regurgitation (82.6% vs 91.4%; P < 0.041) and higher rates of moderate or greater paravalvular leak (17.1% vs 7.1%; P < 0.017). Lead failure occurred in 5.8% over a median follow-up time of 183 days, with modest changes in pacing thresholds. No significant increase in adverse events or mortality was observed at 30 days. CONCLUSIONS:Orthotopic TTVR in patients with transvalvular CIED leads can be safely and effectively performed with low rates of lead failure. Significant paravalvular leak and residual tricuspid regurgitation is more common with a jailed lead. These patients require close CIED follow-up with alternative pacing strategies in place, particularly when pacing dependent. (Global Multicenter Registry on Transcatheter TRIcuspid Valve RePLACEment [TRIPLACE]; NCT06033274).
