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Sears SF, Force Z, Khan S, Nekkanti R. Patient acceptance: Metrics, meaning, and the "missing piece" in evaluating novel devices. J Cardiovasc Electrophysiol 2021; 33:90-92. [PMID: 34796998 DOI: 10.1111/jce.15292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA.,Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Zachary Force
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Saleen Khan
- Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Rajasekhar Nekkanti
- Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
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Vicentini A, Bisignani G, De Vivo S, Viani S, Savarese G, Francia P, Celentano E, Checchi L, Carreras G, Santini L, Lamberti F, Ottaviano L, Scalone A, Giorgi D, Lovecchio M, Valsecchi S, Rordorf R. Patient acceptance of subcutaneous versus transvenous defibrillator systems: A multi-center experience. J Cardiovasc Electrophysiol 2021; 33:81-89. [PMID: 34797012 DOI: 10.1111/jce.15297] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective alternative to the transvenous ICD. No study has yet compared S-ICD and transvenous ICD by assessing patient acceptance as a patient-centered outcome. OBJECTIVE To evaluate the patient acceptance of the S-ICD and to investigate its association with clinical and implantation variables. In patients with symptomatic heart failure and reduced ejection fraction (HFrEF), the acceptance of the S-ICD was compared with a control group of patients who received a transvenous ICD. METHODS Patient acceptance was calculated with the Florida Patient Acceptance Survey (FPAS) which measures four factors: return to function (RTF), device-related distress (DRD), positive appraisal (PA), and body image concerns (BIC). The survey was administered 12 months after implantation. RESULTS 176 patients underwent S-ICD implantation. The total FPAS and the single factors did not differ according to gender, body habitus, or generator positioning. Patients with HFrEF had lower FPAS and RTF. Younger patients showed better RTF (75 [56-94] vs. 56 [50-81], p = .029). Patients who experienced device complications or device therapies showed higher DRD (40 [35-60] vs. 25 [10-50], p = .019). Patients with HFrEF receiving the S-ICD had comparable FPAS, RTF, DRD, and BIC to HFrEF patients implanted with the transvenous ICD while exhibited significantly better PA (88 [75-100] vs. 81 [63-94], p = .02). CONCLUSIONS Our analysis revealed positive patient acceptance of the S-ICD, even in groups at risk of more distress such as women or patients with thinner body habitus, and regardless of the generator positioning. Among patients receiving ICDs for HFrEF, S-ICD was associated with better PA versus transvenous ICD.
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Affiliation(s)
- Alessandro Vicentini
- Department of Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico 'S. Matteo', Pavia, Italy
| | | | - Stefano De Vivo
- Unità Operativa di Elettrofisiologia, 'Studio e Terapia delle Aritmie', Monaldi Hospital, Naples, Italy
| | - Stefano Viani
- Division of Second Cardiology, Department of Cardio-Thoracic and Vascular, University Hospital of Pisa, Pisa, Italy
| | - Gianluca Savarese
- Department of Cardiology, 'San Giovanni Battista' Hospital, Foligno, Italy
| | - Pietro Francia
- Cardiology, Department of Clinical and Molecular Medicine, 'St. Andrea' Hospital, Sapienza University, Rome, Italy
| | - Eduardo Celentano
- Department of Cardiology, 'Santa Maria della Pietà' Hospital, Casoria, Napoli, Italy
| | | | | | - Luca Santini
- Division of Cardiology, Divisiono of Hospital Cardiology, 'Giovan Battista Grassi' Hospital, Rome, Italy
| | - Filippo Lamberti
- Department of Medicine, Cardiovascular Section, 'San Eugenio' Hospital, Rome, Italy
| | - Luca Ottaviano
- Department of Cardiology, Istituto Clinico 'Sant'Ambrogio', Milan, Italy
| | | | - Davide Giorgi
- Division of Cardiology, 'San Luca' Hospital, Lucca, Italy
| | | | | | - Roberto Rordorf
- Department of Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico 'S. Matteo', Pavia, Italy
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van Dijk VF, Boersma LVA. Non-transvenous ICD therapy: current status and beyond. Herz 2021; 46:520-525. [PMID: 34751802 DOI: 10.1007/s00059-021-05077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Abstract
Subcutaneous implantable cardioverter/defibrillators (S-ICDs) have been developed to offer ICD treatment to patients without venous access to the heart and to overcome complications associated with transvenous leads, particularly lead fracture/insulation defects and endocarditis. Several studies and registries have demonstrated the feasibility and safety of S‑ICD in different groups of patients. Further developments in S‑ICD technology involve the combination with devices that can provide anti-bradycardia and anti-tachycardia pacing if needed. The extravascular ICD (EV-ICD) is a new system that similarly offers ICD therapy without a transvenous lead but uses a substernal instead of a subcutaneous lead to facilitate detection of ventricular fibrillation and to provide anti-tachycardia and also temporary anti-bradycardia pacing. The first animal but also clinical data on EV-ICDs have been published. This review discusses the current state, potential advantages and limitations, and future research of both S‑ICD and EV-ICD.
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Affiliation(s)
- Vincent F van Dijk
- Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435, CM Nieuwegein, The Netherlands
| | - Lucas V A Boersma
- Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435, CM Nieuwegein, The Netherlands. .,Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
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104
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Registro Español de Desfibrilador Automático Implantable. XVII Informe Oficial de la Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología (2020). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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105
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Fernández Lozano I, Osca Asensi J, Alzueta Rodríguez J. Spanish Implantable Cardioverter-defibrillator Registry. 17th Official Report of the Heart Rhythm Association of the Spanish Society of Cardiology (2020). REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:971-982. [PMID: 34583912 DOI: 10.1016/j.rec.2021.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/13/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES We present the data corresponding to implantable cardioverter-defibrillator (ICD) implants in Spain in 2020. METHODS The data in this registry were drawn from implantation centers, which voluntarily completed a data collection sheet. RESULTS In 2020, 7056 implant sheets were received compared with 7106 reported by Eucomed (European Confederation of Medical Suppliers Associations), indicating that data were collected from 99% of the devices implanted in Spain. Completion of the implant sheet ranged from 99.8% for the field "name of the implanting hospital" to 2.6% for the variable "referral hospital". A total of 173 hospitals performed ICD implants and participated in the registry, which is a similar figure to that in 2019 (n=172). The total rate of registered implants was 149/million inhabitants (150 according to Eucomed), revealing a slight reduction in implants in Spain in 2020 as a result of the impact of the COVID-19 pandemic. This reduction was uneven among the autonomous communities. CONCLUSIONS The Spanish Implantable Cardioverter Defibrillator Registry for 2020 shows an improvement in the rate of implants reported and a reduction in the number of ICD implants, which likely reflects the decrease in hospital activity not related to the treatment of COVID-19 infection. Similar to previous years, the total number of implants in Spain is still much lower than the average for the European Union, with an increase in the differences between Spanish autonomous communities.
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106
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Matteucci A, Bonanni M, Versaci F, Frati G, Peruzzi M, Sangiorgi G, Biondi-Zoccai G, Massaro G. Cardiovascular medicine: a year in review. Minerva Cardiol Angiol 2021; 70:40-55. [PMID: 34713681 DOI: 10.23736/s2724-5683.21.05816-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cardiovascular medicine is facing several challenges in the current era, dominated by the rapid spread of a previously unknown virus around the world. Indeed, the 2020 COVID-19 pandemic set the course of cardiovascular science and education in an extraordinary way, hogging the attention of the medical community. Notably, while COVID-19 impacted research progress, there has been considerable effort in exploring topics of great interest, from the management of acute coronary syndromes to new horizons in the treatment of heart failure, from novelties in the surgical treatment of cardiovascular disease to new data on implantable cardiac devices, and from new diagnostic applications of multimodal imaging techniques to relevant basic science findings. Minerva Cardiology and Angiology, formerly Minerva Cardioangiologica, has strived to inform its readers on these topics and novelties, aiming for a succinct yet poignant melding of timeliness and accuracy. Accordingly, the purpose of this narrative review is to highlight and summarize the major research and review articles published during 2020. In particular, we provide a broad overview of the novelties identifying six major areas of interest in the field of cardiovascular sciences in which new evidences have contributed to improving prevention, diagnosis and treatment of heart and vessels diseases.
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Affiliation(s)
- Andrea Matteucci
- Department of Experimental Medicine, Tor Vergata University of Rome, Rome, Italy -
| | - Michela Bonanni
- Department of Experimental Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Francesco Versaci
- UOC UTIC Emodinamica e Cardiologia, S. Maria Goretti Hospital, Latina, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.,IRCCS NEUROMED, Pozzilli, Isernia, Italy
| | - Mariangela Peruzzi
- Mediterranea Cardiocentro, Napoli, Italy.,Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- IRCCS NEUROMED, Pozzilli, Isernia, Italy.,Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Gianluca Massaro
- Division of Cardiology, Tor Vergata University of Rome, Rome, Italy
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107
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Tonko JB, Rinaldi CA. Non-traditional implantable cardioverter-defibrillator configurations and insertion techniques: a review of contemporary options. Europace 2021; 24:181-192. [PMID: 34453529 PMCID: PMC8824518 DOI: 10.1093/europace/euab178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/01/2021] [Indexed: 11/14/2022] Open
Abstract
Implantable cardioverter-defibrillators (ICDs) have revolutionized the treatment of acquired or inherited cardiac diseases associated with a high risk of sudden cardiac death due to ventricular tachyarrhythmias. Contemporary ICD devices offer reliable arrhythmia detection and discrimination algorithms and deliver highly efficient tachytherapies. Percutaneously inserted transvenous defibrillator coils with pectoral generator placement are the first-line approach in the majority of adults due to their extensively documented clinical benefit and efficiency with comparably low periprocedural implantation risks as well as the option of providing pain-free tachycardia treatment via anti-tachycardia pacing (ATP), concomitant bradycardiaprotection, and incorporation in a cardiac resynchronization therapy if indicated. Yet, expanding ICD indications particularly among younger and more complex patient groups as well as the increasingly evident long-term consequences and complications associated with intravascular lead placements promoted the development of alternative ICD configurations. Most established in daily clinical practice is the subcutaneous ICD but other innovative extravascular approaches like epicardial, pericardial, extra-pleural, and most recently substernal defibrillator coil placements have been introduced as well to overcome shortcomings associated with traditional devices and allow for individualized treatment strategies tailored to the patients characteristics and needs. The review aims to provide practical solutions for common complications encountered with transvenous ICD systems including restricted venous access, high defibrillation/fibrillation thresholds (DFTs), and recurrent device infections. We summarize the contemporary options for non-traditional extravascular ICD configurations outlining indications, advantages, and disadvantages.
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Affiliation(s)
- Johanna B Tonko
- Department of Cardiology, St. Thomas' Hospital, Westminster Bridge Rd, London SE1 7EH, UK.,Department of Cardiovascular Imaging, Arrhythmia Research Group, King's College London, School of Biomedical Engineering & Imaging Sciences, London, UK
| | - Christopher A Rinaldi
- Department of Cardiology, St. Thomas' Hospital, Westminster Bridge Rd, London SE1 7EH, UK.,Department of Cardiovascular Imaging, Arrhythmia Research Group, King's College London, School of Biomedical Engineering & Imaging Sciences, London, UK
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108
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Karimianpour A, John L, Gold MR. The Subcutaneous ICD: A Review of the UNTOUCHED and PRAETORIAN Trials. Arrhythm Electrophysiol Rev 2021; 10:108-112. [PMID: 34401183 PMCID: PMC8353550 DOI: 10.15420/aer.2020.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/17/2021] [Indexed: 11/05/2022] Open
Abstract
The ICD is an important part of the treatment and prevention of sudden cardiac death in many high-risk populations. Traditional transvenous ICDs (TV-ICDs) are associated with certain short- and long- term risks. The subcutaneous ICD (S-ICD) was developed in order to avoid these risks and complications. However, this system is associated with its own set of limitations and complications. First, patient selection is important, as S-ICDs do not provide pacing therapy currently. Second, pre-procedural screening is important to minimise T wave and myopotential oversensing. Finally, until recently, the S-ICD was primarily used in younger patients with fewer co-morbidities and less structural heart disease, limiting the general applicability of the device. S-ICDs achieve excellent rates of arrhythmia conversion and have demonstrated noninferiority to TV-ICDs in terms of complication rates in real-world studies. The objective of this review is to discuss the latest literature, including the UNTOUCHED and PRAETORIAN trials, and to address the risk of inappropriate shocks.
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Affiliation(s)
- Ahmadreza Karimianpour
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, US
| | - Leah John
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, US
| | - Michael R Gold
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, US
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109
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Yamasaki H, Ando K, Ikeda T, Mitsuhashi T, Murohara T, Nishii N, Nogami A, Sakata Y, Shimizu W, Simon T, Beaudoint C, Kayser T, Kutyifa V, Aonuma K. Rationale and design of the HINODE study: Heart failure indication and sudden cardiac death prevention trial Japan. J Arrhythm 2021; 37:1031-1037. [PMID: 34386129 PMCID: PMC8339090 DOI: 10.1002/joa3.12577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/12/2021] [Accepted: 05/24/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Randomized trials in Western countries have provided evidence that prophylactic implantable cardioverter-defibrillator (ICD) therapy reduces mortality in heart failure (HF) patients with reduced left ventricular ejection fraction. However, the risk of life-threatening ventricular arrhythmias in Japanese HF patients sharing similar risk factors is still unknown. METHODS The Heart Failure Indication and Sudden Cardiac Death Prevention Trial Japan trial (NCT03185832) is a prospective, multicenter registry designed to collect data on ventricular arrhythmia, HF events, and mortality in Japanese HF patients. Japanese patients with HF and 2-5 predefined risk factors who were indicated for cardiac device implantation based on European Society of Cardiology guidelines were enrolled in four treatment arms: implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy defibrillator (CRT-D), HF pacing (PA; Pacemaker and cardiac resynchronization pacemaker), and nondevice (ND) cohorts and followed for a minimum of 12 months. Since it is anticipated that some baseline patient characteristics and risk factors will differ significantly from those reported in predominantly Western populations, event rates will be compared to a propensity-matched population from the MADIT RIT trial. Primary endpoints are composite rates of first appropriately treated ventricular arrhythmias (VA) or/and life-threatening VA symptoms for the ICD and CRT-D cohorts. For nondevice and PA cohorts, the primary outcome is all-cause mortality. CONCLUSIONS The Heart Failure Indication and Sudden Cardiac Death Prevention Trial Japan is a large prospective multicenter registry with defined device treatment cohorts and will provide data for risk stratification for cardiovascular events in Japanese HF patients.
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Affiliation(s)
- Hiro Yamasaki
- Department of CardiologyFaculty of MedicineUniversity of TsukubaIbarakiJapan
| | - Kenji Ando
- Department of CardiologyKokura Memorial HospitalFukuokaJapan
| | - Takanori Ikeda
- Department of Cardiovascular MedicineFaculty of MedicineToho UniversityTokyoJapan
| | | | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of MedicineAichiJapan
| | - Nobuhiro Nishii
- Department of Cardiovascular TherapeuticsOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaIbarakiJapan
| | - Yasushi Sakata
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Wataru Shimizu
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
| | - Torri Simon
- Department of BiostatisticsBoston ScientificSt PaulMNUSA
| | | | - Torsten Kayser
- Department Clinical ResearchBoston ScientificDiegemBelgium
| | | | - Kazutaka Aonuma
- Department of CardiologyFaculty of MedicineUniversity of TsukubaIbarakiJapan
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110
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Crozier I, O'Donnell D, Boersma L, Murgatroyd F, Manlucu J, Knight BP, Birgersdotter-Green UM, Leclercq C, Thompson A, Sawchuk R, Willey S, Wiggenhorn C, Friedman P. The extravascular implantable cardioverter-defibrillator: The pivotal study plan. J Cardiovasc Electrophysiol 2021; 32:2371-2378. [PMID: 34322918 PMCID: PMC9290824 DOI: 10.1111/jce.15190] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/23/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022]
Abstract
Background Transvenous implantable cardioverter defibrillators (TV ICD) provide life‐saving therapy for millions of patients worldwide. However, they are susceptible to several potential short‐ and long‐ term complications including cardiac perforation and pneumothorax, lead dislodgement, venous obstruction, and infection. The extravascular ICD system's novel design and substernal implant approach avoids the risks associated with TV ICDs while still providing pacing features and similar generator size to TV ICDs. Study Design The EV ICD pivotal study is a prospective, multicenter, single‐arm, nonrandomized, premarket clinical study designed to examine the safety and acute efficacy of the system. This study will enroll up to 400 patients with a Class I or IIa indication for implantation of an ICD. Implanted subjects will be followed up to approximately 3.5 years, depending on when the patient is enrolled. Objective The clinical trial is designed to demonstrate safety and effectiveness of the EV ICD system in human use. The safety endpoint is freedom from major complications, while the efficacy endpoint is defibrillation success. Both endpoints will be assessed against prespecified criteria. Additionally, this study will evaluate antitachycardia pacing performance, electrical performance, extracardiac pacing sensation, asystole pacing, appropriate and inappropriate shocks, as well as a summary of adverse events. Conclusion The EV ICD pivotal study is designed to provide clear evidence addressing the safety and efficacy performance of the EV ICD System.
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Affiliation(s)
- Ian Crozier
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - David O'Donnell
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Lucas Boersma
- Department of Cardiology, St. Antonius Hospital Nieuwegein and Amsterdam UMC, Amsterdam, Netherlands
| | | | - Jaimie Manlucu
- Division of Cardiology, London Health Sciences Centre, London, Ontario, Canada
| | - Bradley P Knight
- Division of Cardiology, Northwestern University, Chicago, Illinois, USA
| | | | - Christophe Leclercq
- Department of Cardiology, CHU de Rennes-Hôpital Pontchaillou France, Rennes, France
| | - Amy Thompson
- Department of Cardiac Rhythm, Medtronic plc, Mounds View, Minnesota, USA
| | - Robert Sawchuk
- Department of Cardiac Rhythm, Medtronic plc, Mounds View, Minnesota, USA
| | - Sarah Willey
- Department of Cardiac Rhythm, Medtronic plc, Mounds View, Minnesota, USA
| | | | - Paul Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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111
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Crijns HJGM, Prinzen F, Lambiase PD, Sanders P, Brugada J. The year in cardiovascular medicine 2020: arrhythmias. Eur Heart J 2021; 42:499-507. [PMID: 33388752 DOI: 10.1093/eurheartj/ehaa1091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/08/2020] [Accepted: 12/19/2020] [Indexed: 12/12/2022] Open
Abstract
of the progress in arrhythmias in 2020. RACE4 and ALL-IN indicated that integrated nurse-led care improves outcomes in AF patients.3,4 The same was reported for early rhythm control therapy15 and cryoablation as initial AF treatment.25,26 Subcutaneous ICD was non-inferior to classical transvenous ICD therapy in PRAETORIAN.54 One mechanistic study showed that autoantibodies against misexpressed actin, keratin, and connexin-43 proteins create a blood-borne biomarker profile enhancing diagnosis of Brugada syndrome.50 Another mechanistic study indicated that transseptal LV pacing yields similar improvement in contractility as His bundle pacing whilst being more easy to execute.44 In PRE-DETERMINE a simple-to-use ECG risk score improved risk prediction in patients with ischemic heart disease possibly enhancing appropriate ICD therapy in high risk patients.58.
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Affiliation(s)
- Harry J G M Crijns
- Department of Cardiology and Cardiovascular Research Centre Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frits Prinzen
- Department of Physiology and Cardiovascular Research Centre Maastricht (CARIM), University of Maastricht, Maastricht, The Netherlands
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clinic, Pediatric Arrhythmia Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
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112
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Francia P, Adduci C, Angeletti A, Ottaviano L, Perrotta L, De Vivo S, Bongiorni MG, Migliore F, Russo AD, De Filippo P, Caravati F, Nigro G, Palmisano P, Viani S, D'Onofrio A, Lovecchio M, Valsecchi S, Ziacchi M. Acute shock efficacy of the subcutaneous implantable cardioverter-defibrillator according to the implantation technique. J Cardiovasc Electrophysiol 2021; 32:1695-1703. [PMID: 33969578 DOI: 10.1111/jce.15081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/19/2021] [Accepted: 05/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The traditional technique for subcutaneous implantable cardioverter defibrillator (S-ICD) implantation involves three incisions and a subcutaneous (SC) pocket. An intermuscular (IM) 2-incision technique has been recently adopted. AIMS We assessed acute defibrillation efficacy (DE) of S-ICD (DE ≤65 J) according to the implantation technique. METHODS We analyzed consecutive patients who underwent S-ICD implantation and DE testing at 53 Italian centers. Regression analysis was used to determine the association between DFT and implantation technique. RESULTS A total of 805 patients were enrolled. Four groups were assessed: IM + 2 incisions (n = 546), SC + 2 incisions (n = 133), SC + 3 incisions (n = 111), and IM + 3 incisions (n = 15). DE was ≤65 J in 782 (97.1%) patients. Patients with DE ≤65 J showed a trend towards lower body mass index (25.1 vs. 26.5; p = .12), were less frequently on antiarrhythmic drugs (13% vs. 26%; p = .06) and more commonly underwent implantation with the 2-incision technique (85% vs. 70%; p = .04). The IM + 2-incision technique showed the lowest defibrillation failure rate (2.2%) and shock impedance (66 Ohm, interquartile range: 57-77). On multivariate analysis, the 2-incision technique was associated with a lower incidence of shock failure (hazard ratio: 0.305; 95% confidence interval: 0.102-0.907; p = .033). Shock impedance was lower with the IM than with the SC approach (66 vs. 70 Ohm p = .002) and with the 2-incision than the 3-incision technique (67 vs. 72 Ohm; p = .006). CONCLUSIONS In a large population of S-ICD patients, we observed a high defibrillation success rate. The IM + 2-incision technique provides lower shock impedance and a higher likelihood of successful defibrillation.
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Affiliation(s)
- Pietro Francia
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Carmen Adduci
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Andrea Angeletti
- Department of Experimental, Diagnostic, and Specialty Medicine, Institute of Cardiology, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Luca Ottaviano
- Unit of Arrhythmia and Electrophysiology, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Laura Perrotta
- Arrhythmic Disease Unit, University of Florence, Florence, Italy
| | - Stefano De Vivo
- Monaldi Hospital, "Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie", Naples, Italy
| | - Maria Grazia Bongiorni
- Division of Second Cardiology, Department of Cardio-Thoracic and Vascular, University Hospital of Pisa, Pisa, Italy
| | - Federico Migliore
- Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Paolo De Filippo
- Department of Cardiac and Vascular Sciences, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fabrizio Caravati
- Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Gerardo Nigro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy, Naples, Italy
| | - Pietro Palmisano
- Department of Cardiology, "Card. G. Panico" Hospital, Tricase, Lecce, Italy
| | - Stefano Viani
- Division of Second Cardiology, Department of Cardio-Thoracic and Vascular, University Hospital of Pisa, Pisa, Italy
| | - Antonio D'Onofrio
- Monaldi Hospital, "Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie", Naples, Italy
| | | | | | - Matteo Ziacchi
- Department of Experimental, Diagnostic, and Specialty Medicine, Institute of Cardiology, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
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Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients-An Experience-Based Narrative Review. J Clin Med 2021; 10:jcm10081745. [PMID: 33920553 PMCID: PMC8073061 DOI: 10.3390/jcm10081745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular implantable electronic devices (CIEDs) are a standard therapy utilized for different cardiac conditions. They are implanted in a growing number of patients, including those with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Cardiovascular diseases, including heart failure and malignant arrhythmia, remain the leading cause of mortality among CKD patients, especially in ESKD. CIED implantation procedures are considered minor surgery, typically with transvenous leads inserted via upper central veins, followed by an impulse generator introduced subcutaneously. A decision regarding optimal hemodialysis (HD) modality and the choice of permanent vascular access (VA) could be particularly challenging in CIED recipients. The potential consequences of arteriovenous access on the CIED side are related to (1) venous hypertension from lead-related central vein stenosis and (2) the risk of systemic infection. Therefore, when creating permanent vascular access, the clinical scenario may be complicated by the CIED presence on one side and the lack of suitable vessels for arteriovenous fistula on the contralateral arm. These factors suggest the need for an individualized approach according to different clinical situations: (1) CIED in a CKD patient; (2) CIED in a patient on hemodialysis CIED; and (3) VA in a patient with CIED. This complex clinical conundrum creates the necessity for close cooperation between cardiologists and nephrologists.
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van Barreveld M, Verstraelen TE, van Dessel PFHM, Boersma LVA, Delnoy PPHM, Tuinenburg AE, Theuns DAMJ, van der Voort PH, Kimman GJ, Buskens E, Zwinderman AH, Wilde AAM, Dijkgraaf MGW. Dutch Outcome in Implantable Cardioverter-Defibrillator Therapy: Implantable Cardioverter-Defibrillator-Related Complications in a Contemporary Primary Prevention Cohort. J Am Heart Assoc 2021; 10:e018063. [PMID: 33787324 PMCID: PMC8174382 DOI: 10.1161/jaha.120.018063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background One third of primary prevention implantable cardioverter‐defibrillator patients receive appropriate therapy, but all remain at risk of defibrillator complications. Information on these complications in contemporary cohorts is limited. This study assessed complications and their risk factors after defibrillator implantation in a Dutch nationwide prospective registry cohort and forecasts the potential reduction in complications under distinct scenarios of updated indication criteria. Methods and Results Complications in a prospective multicenter registry cohort of 1442 primary implantable cardioverter‐defibrillator implant patients were classified as major or minor. The potential for reducing complications was derived from a newly developed prediction model of appropriate therapy to identify patients with a low probability of benefitting from the implantable cardioverter‐defibrillator. During a follow‐up of 2.2 years (interquartile range, 2.0–2.6 years), 228 complications occurred in 195 patients (13.6%), with 113 patients (7.8%) experiencing at least one major complication. Most common ones were lead related (n=93) and infection (n=18). Minor complications occurred in 6.8% of patients, with lead‐related (n=47) and pocket‐related (n=40) complications as the most prevailing ones. A surgical reintervention or additional hospitalization was required in 53% or 61% of complications, respectively. Complications were strongly associated with device type. Application of stricter implant indication results in a comparable proportional reduction of (major) complications. Conclusions One in 13 patients experiences at least one major implantable cardioverter‐defibrillator–related complication, and many patients undergo a surgical reintervention. Complications are related to defibrillator implantations, and these should be discussed with the patient. Stricter implant indication criteria and careful selection of device type implanted may have significant clinical and financial benefits.
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Affiliation(s)
- Marit van Barreveld
- Department of Cardiology, Heart Center Amsterdam UMC, University of Amsterdam the Netherlands.,Department of Epidemiology and Data Science Amsterdam UMC, University of Amsterdam the Netherlands
| | - Tom E Verstraelen
- Department of Cardiology, Heart Center Amsterdam UMC, University of Amsterdam the Netherlands
| | - Pascal F H M van Dessel
- Department of Cardiology, Thorax Center Twente Medisch Spectrum Twente Enschede the Netherlands
| | - Lucas V A Boersma
- Department of Cardiology, Heart Center Amsterdam UMC, University of Amsterdam the Netherlands.,Cardiology Department St. Antonius Ziekenhuis Nieuwegein Nieuwegein the Netherlands
| | | | - Anton E Tuinenburg
- Division of Heart and Lungs Department of Cardiology University Medical Centre Utrecht the Netherlands
| | | | | | - Geert-Jan Kimman
- Department of Cardiology Noordwest Ziekenhuisgroep Alkmaar the Netherlands
| | - Erik Buskens
- Department of Epidemiology University Medical Centre Groningen Groningen the Netherlands
| | - Aeilko H Zwinderman
- Department of Epidemiology and Data Science Amsterdam UMC, University of Amsterdam the Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Heart Center Amsterdam UMC, University of Amsterdam the Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science Amsterdam UMC, University of Amsterdam the Netherlands
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Abstract
Cardiac implantable electronic devices (CIEDs) are essential for the management of a variety of cardiac conditions, including tachyarrhythmias, bradyarrhythmias, and medically refractory heart failure (HF). Recent advancements in CIED technology have led to innovative solutions that overcome shortcomings associated with traditional devices or address unmet needs. Leadless pacemakers, subcutaneous implantable cardioverter defibrillators (ICDs), and extravascular ICDs eliminate lead-related complications common with conventional pacemakers or ICDs. Conduction system pacing (His bundle pacing and left bundle branch pacing) is a more physiologic method of pacing and avoids the deleterious consequences associated with long-term right ventricular pacing. For HF-related devices, cardiac contractility modulation is an emerging therapy that bridges a gap for many patients ineligible for cardiac resynchronization therapy and has been shown to improve HF symptoms and decrease hospitalizations and mortality in select patients. Implantable pulmonary artery pressure monitors help guide HF management and reduce hospitalizations. Lastly, new phrenic nerve stimulating devices are being utilized to treat central sleep apnea, a common comorbidity associated with HF. While further long-term studies are still underway for many of these new technologies, it is anticipated that these devices will become indispensable therapeutics in the expanding cardiovascular armamentarium.
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Affiliation(s)
- Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (S.M.A.-K.)
| | - Fred M Kusumoto
- Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, FL (F.M.K.)
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