1
|
Haeberlin A, Kueffer T, Reichlin T, Noti F. Repeated inappropriate S-ICD discharges in a river caused by interferences with the railway system. Clin Res Cardiol 2024; 113:1505-1507. [PMID: 37498364 DOI: 10.1007/s00392-023-02273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3005, Bern, Switzerland.
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
| | - Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3005, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3005, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3005, Bern, Switzerland
| |
Collapse
|
2
|
Doldi F, Frommeyer G, Löher A, Ellermann C, Wolfes J, Güner F, Zerbst M, Engelke H, Korthals D, Reinke F, Eckardt L, Willy K. Validation of the PRAETORIAN score in a large subcutaneous implantable cardioverter-defibrillator collective: Usefulness in clinical routine. Heart Rhythm 2024; 21:1057-1063. [PMID: 38382685 DOI: 10.1016/j.hrthm.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/20/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND To assess the risk of unsuccessful conversion of ventricular fibrillation during defibrillation testing (DFT) with the subcutaneous implantable cardioverter-defibrillator (S-ICD), the PRAETORIAN score has been proposed. OBJECTIVE The purpose of this study was to validate the PRAETORIAN score in a large S-ICD collective. METHODS A retrospective single-center analysis of S-ICD patients receiving intraoperative DFT was performed. DFT was performed using a stepwise protocol with 65-J standard polarity, change of polarity, increase to 80 J, and repositioning if necessary. If all DFTs failed, we switched to a transvenous ICD. RESULTS Overall, 398 patients were analyzed (268 male [67.3%]; mean age 42.4 ± 15.9 years; mean body mass index [BMI] 25.9 ± 4.8 kg/m2). Successful DFT with the first ICD shock was observed in 264 patients (66.3%). One hundred fourteen patients were defibrillated with the second (n = 104) or third (n = 10) DFT after changing shock polarity and/or shock energy. Overall, 20 patients needed at least 3 DFT (ie, 80 J and/or re-positioning). The majority (n = 88 [65.7%]) of DFT failures occurred before 2015 with the first-generation S-ICD. PRAETORIAN score was an independent predictor of DFT failure (odds ratio [OR] 1.007; 95% confidence interval [CI] 1.003-1.011 P ≤.001), while whereas BMI alone was not (P = .31). Presence of hypertrophic cardiomyopathy (HCM) (OR 2.6; 95% CI 1.3-4.4; P = .004) was predictive for at least 1 unsuccessful DFT in our multivariate regression analysis. CONCLUSION PRAETORIAN score proved to be a useful and valid predictive tool for successful DFT, whereas BMI only had a limited role. Patients with HCM were at increased risk for DFT failure or needed higher DFT energy.
Collapse
Affiliation(s)
- Florian Doldi
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany.
| | - Gerrit Frommeyer
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Andreas Löher
- Department for Cardio-Thoracic Surgery, University Hospital Münster, Münster, Germany
| | - Christian Ellermann
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Julian Wolfes
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Fatih Güner
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Mathis Zerbst
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Hauke Engelke
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Dennis Korthals
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Florian Reinke
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Kevin Willy
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| |
Collapse
|
3
|
Monkhouse C, Wharmby A, Carter Z, Hunter R, Dhinoja M, Chow A, Creta A, Honarbakhsh S, Ahsan S, Orini M, Lambiase PD. Exploiting SMART pass filter deactivation detection to minimize inappropriate subcutaneous implantable cardioverter defibrillator therapies: a real-world single-centre experience and management guide. Europace 2023; 25:euad040. [PMID: 37001913 PMCID: PMC10227655 DOI: 10.1093/europace/euad040] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/23/2023] [Indexed: 08/24/2023] Open
Abstract
AIMS The SMART Pass™ (SP) algorithm is a high-pass filter that aims to reduce inappropriate therapy (IT) in subcutaneous internal cardiac defibrillator (S-ICD), but SP can deactivate due to low amplitude sensed R waves or asystole. The association between IT and SP deactivation and management strategies were evaluated, hypothesizing SP deactivation increases the risk of IT and device re-programming, or lead/generator re-positioning could reduce this risk. METHODS AND RESULTS Retrospective single-centre audit of Emblem™ S-ICD devices implanted 2016 to 2020 utilizing health records and remote monitoring data. Cox regression models evaluated associations between SP deactivation and IT. A total of 348 patients (27 ± 16.6 months follow-up) were studied: 73% primary prevention. Thirty-eight patients (11.8%) received 83 shocks with 27 patients (7.8%) receiving a total of 44 IT. Causes of IT were oversensing (98%) and aberrantly conducted atrial fibrillation (2%). SP deactivation occurred in 32 of 348 patients (9%) and was significantly associated with increased risk of IT (hazard ratio 5.36, 95% CI 2.37-12.13). SP deactivation was due to low amplitude R waves (94%), associated with a higher defibrillation threshold at implant and presence of arrhythmogenic right ventricular cardiomyopathy. No further IT occurred 16 ± 15.5 months after corrective interventions, with changing the sensing vector being successful in 59% of cases. CONCLUSION To reduce the risk of IT, the cause of the SP deactivation should be investigated, and appropriate reprogramming, device, or lead modifications made. Utilizing the alert for SP deactivation and electrograms could pro-actively prevent IT.
Collapse
Affiliation(s)
| | - Amy Wharmby
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Zoe Carter
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Ross Hunter
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Mehul Dhinoja
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Anthony Chow
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Antonio Creta
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | | | - Syed Ahsan
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Michele Orini
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
- Institute of Cardiovascular Science, University College London (UCL), 62 Huntley Street, London EC1A 7BE, UK
| | - Pier D Lambiase
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
- Institute of Cardiovascular Science, University College London (UCL), 62 Huntley Street, London EC1A 7BE, UK
| |
Collapse
|
4
|
Hakamata T, Otsuki S, Izumi D, Sakaguchi Y, Suzuki N, Ikami Y, Hasegawa Y, Yagihara N, Iijima K, Chinushi M, Koichi F, Inomata T. Clinical impact of ECG change on oversensing of subcutaneous implantable cardioverter-defibrillators. Heart Rhythm 2022; 19:1704-1711. [PMID: 35688344 DOI: 10.1016/j.hrthm.2022.05.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 05/01/2022] [Accepted: 05/13/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Inappropriate shocks delivered from subcutaneous implantable cardioverter-defibrillators (S-ICD) are most frequently caused by cardiac oversensing. However, the predictors for oversensing of S-ICD remain unclear. OBJECTIVE We aimed to investigate the predictors for oversensing of S-ICD, especially clinical impact of ECG change. METHODS We retrospectively enrolled 99 consecutive patients who underwent S-ICD implantation between 2013 and 2021. Oversensing events were defined as inappropriate charge of the capacitors induced by cardiac or noncardiac signals other than tachycardia. RESULTS During a median 34 month (IQR 20-50 months) of the follow-up period, 11 of the 99 patients experienced 34 oversensing events and 4 patients received inappropriate shocks during their events. Six patients exhibited ECG changes (bundle branch block, 3; ventricular pacing, 1; inverted T wave, 1; poor R progression, 1) during follow-up period. Oversensing events were observed in four of the six patients with ECG changes (67%), and three patients underwent S-ICD removal because of inevitable shock. Contrastingly, among the remaining patients without ECG change, all 7 patients who experienced oversensing events could continue using S-ICD with reprogramming sensing vector and/or restriction of excessive exercise. Logistic regression analysis showed lower voltage of Sokolow-Lyon ECG (V1S+V5R) was the predictor of oversensing event among the patients without ECG change. When the cut off value was 2.1mV, the sensitivity, specificity, positive predictive value, and negative predictive value were 85.7%, 62.7%, 15.7%, and 98.1%, respectively. CONCLUSION Unavoidable oversensing resulting in S-ICD removal is caused by ECG changes. Oversensing in patients without ECG change can be managed.
Collapse
Affiliation(s)
- Takahiro Hakamata
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sou Otsuki
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Daisuke Izumi
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuta Sakaguchi
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Naomasa Suzuki
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yasuhiro Ikami
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuki Hasegawa
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Nobue Yagihara
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kenichi Iijima
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masaomi Chinushi
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | - Takayuki Inomata
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| |
Collapse
|
5
|
Stöllberger C, Gatterer E, Hasun M, Arnold Z, Finsterer J. Subcutaneous implanted cardioverter-defibrillator in ventricular noncompaction, coronary artery disease and stroke. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1797-1801. [PMID: 34254678 DOI: 10.1111/pace.14317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/16/2021] [Accepted: 07/11/2021] [Indexed: 02/04/2023]
Abstract
Left ventricular hypertrabeculation/noncompaction (LVHT) is associated with arrhythmias. Guidelines for prevention of sudden cardiac death by implanted cardioverter-defibrillator (ICD) also apply to LVHT-patients. Right ventricular perforation by the ICD-lead is a matter of concern. Subcutaneous ICD (S-ICD) may overcome disadvantages of transvenous ICD in patients without a need for pacing therapy. We report a LVHT-patient with arterial hypertension, hyperlipidemia, coronary artery disease with an anterior-wall myocardial infarction 2004 and stroke without neurological deficits in 2018. Since ejection fraction of 33% remained unchanged despite bisoprolol, sacubitril/valsartan and spironolactone, he was treated with S-ICD for primary prevention of sudden cardiac death.
Collapse
|
6
|
Chakafana G, Mutithu D, Hoevelmann J, Ntusi N, Sliwa K. Interplay of COVID-19 and cardiovascular diseases in Africa: an observational snapshot. Clin Res Cardiol 2020; 109:1460-1468. [PMID: 32809116 PMCID: PMC7433683 DOI: 10.1007/s00392-020-01720-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/23/2020] [Indexed: 12/19/2022]
Abstract
The COVID-19 pandemic, which started around December 2019 has, at present, resulted in over 450,000 deaths globally, and approximately 1% of these deaths have been reported in Africa. Despite the high prevalence of COVID-19 risk factors, namely: hypertension, diabetes, chronic pulmonary disease, cardiovascular diseases (CVDs) such as rheumatic heart disease, compromised immunity and obesity, low case fatality rates have been recorded in many parts of Africa so far. COVID-19 severity has previously been shown to be worse in patients with CVD and hypertension. We observed the severity of COVID-19 and mortality rates in Africa, and compared outcomes with prevalence of established risk factors (hypertension and CVD). We stratified data as per the United Nations’ 5 African subregions. North African countries show a positive association between the risk factors and the mortality rates from COVID-19. However, we observed discordant patterns in the relationship between COVID-19, and either CVD or hypertension, in sub-Saharan African countries. In this paper, we also review the pathogenesis of SARS-CoV-2 infection and how it worsens CVD and postulate that the differences in modulation of the renin–angiotensin–aldosterone system (RAAS) axis which controls angiotensin-converting enzyme (ACE)/ACE2 balance may be an important determinant of COVID-19 outcomes in Africa.
Collapse
Affiliation(s)
- Graham Chakafana
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA.,Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA
| | - Daniel Mutithu
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA.,Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA
| | - Julian Hoevelmann
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA.,Klinik für Innere Medizin III - Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Homburg (Saar), Deutschland
| | - Ntobeko Ntusi
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA.,Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA.,Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA. .,Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, RSA.
| |
Collapse
|