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Singireddy S, Edusa S. Peri-Operative Outcomes Associated With the Placement of Implantable Cardioverter-Defibrillators in Patients With Sarcoidosis: A Nationwide Database Analysis. Cureus 2024; 16:e55589. [PMID: 38576645 PMCID: PMC10994648 DOI: 10.7759/cureus.55589] [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: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
Rationale Sarcoidosis with cardiac involvement can be associated with serious life-threatening arrhythmias and an increased risk of sudden cardiac death. Implantable cardiac defibrillators (ICDs) have been used for primary and secondary prevention of sudden death in patients with cardiac sarcoidosis (CS). Post-ICD placement complications have been shown to be higher in patients with CS. However, data comparing postoperative ICD complications among sarcoidosis patients with the general population is limited. Here, we evaluated the association of postoperative complications with implantable cardioverter-defibrillators in sarcoidosis. Methods Using the NIS database, we identified cases of adults aged ≥ 18 years undergoing surgical placement of implantable cardioverter-defibrillators between 2010 and 2019. Using ICD-9 and ICD-10 codes, we identified patients with sarcoidosis. In all statistical analyses, we applied weights provided by HCUP to produce results representative of national estimates. We compared categorical and continuous covariates in the baseline characteristics using the chi-square test and analysis of variance, respectively. We employed multivariable logistic and linear regression to compare binomial and continuous outcomes to assess differences in mortality rates. Results We analyzed 114073 patients during the study period. Of these, 1012 (0.9%) had sarcoidosis and were found to be significantly younger and female compared to patients without sarcoidosis (56.4 ±11.5 years vs. 65.6 ± 13.9 years, p <0.001) and (39.4% vs. 28.3%, p<0.001) respectively. Further, patients with sarcoidosis were more likely to be African American (45% vs. 16.3%), have private insurance (45.4% vs. 23.8%), and less likely to have Medicare (34.9% vs. 60.9%). Overall, post-ICD placement complications such as lead complications (4.2% vs. 6.9%, p = 0.03), post-procedure hemorrhage (4.1% vs. 5.5%, p=0.048), and requirement for transfusion (2.3% vs. 4.4%) were less likely in patients with sarcoidosis. Regarding post-ICD placement inpatient mortality, sarcoidosis was not associated with any difference (OR: 0.71, 95% CI 0.18-2.88 p=0.634). Conclusions Placement of implantable cardioverter-defibrillators in patients with sarcoidosis is a safe procedure and is associated with significantly lower rates of lead complications, post-procedure hemorrhage, and requirement for transfusion. This is of great importance as it is known that patients with underlying sarcoidosis are predisposed to developing more cardiac complications.
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Affiliation(s)
| | - Samuel Edusa
- Internal Medicine, Piedmont Athens Regional, Athens, USA
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2
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Yao J, Gao J, Yan JF, Fang S. Cardiac contractility modulation and subcutaneous defibrillator (S-ICD): First experience with simultaneous implantation. Pacing Clin Electrophysiol 2023; 46:1595-1598. [PMID: 36938703 DOI: 10.1111/pace.14695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/08/2023] [Accepted: 03/07/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUNDS Two technologies, cardiac contractility modulation (CCM) and subcutaneous implantable cardioverter-defibrillator (S-ICD), can be successfully combined and applied to patients with advanced heart failure (HF) with reduced left ventricular ejection fraction (LVEF). CASE REPORT We reported a case of a 51-year-old man with reduced ejection fraction (LVEF = 33%) and a narrow QRS complex who first underwent simultaneous implantation of CCM and S-ICD. CONCLUSION Our case report aimed to reveal that the simultaneous implantation of CCM and S-ICD could be successfully used in patients with advanced HF, which could significantly improve the clinical symptoms of such patients during one surgery.
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Affiliation(s)
- Juan Yao
- Cardiology Department, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Jie Gao
- Cardiology Department, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Jian-Feng Yan
- Cardiology Department, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Shu Fang
- Cardiology Department, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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3
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Cardelli LS, Delbaere Q, Massin F, Granier M, Casella G, Barbato G, Dupasquier V, Macia JC, Leclercq F, Pasquie JL, Roubille F. Wearable Cardioverter Defibrillator Shortens the Lengths of Stay in Patients with Left Ventricular Dysfunction after Myocardial Infarction: A Single-Centre Real-World Experience. J Clin Med 2023; 12:4884. [PMID: 37568286 PMCID: PMC10419391 DOI: 10.3390/jcm12154884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/22/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
The wearable cardioverter defibrillator (WCD) has been proven to be effective in preventing sudden cardiac death (SCD) in patients soon after acute myocardial infarction (AMI) and left ventricular ejection fraction (LVEF) ≤35%. The aim of this study was to assess whether a WCD may shorten the length of an initial hospital stay (total length, days in the intensive care unit (ICU) and in the acute cardiac care unit (ACCU)) among these patients. This was a single-centre, retrospective observational study of patients referred for the management of SCD risk post-AMI and LVEF ≤35%, in a tertiary care hospital. The clinical characteristics and length of index hospitalization of the group of patients discharged, with or without WCD, were compared. A propensity score analysis was performed, then weighted regression models were conducted. A total of 101 patients in the WCD group and 29 in the control group were enrolled in the analysis. In the weighted regression models, WCD significantly reduced the days spent in ACCU (p < 0.001). WCD patients had significantly fewer days spent in ACCU (5.5 ± 2.6 vs. 8.4 ± 12.8 days, p < 0.001) and shorter hospitalizations (10.2 ± 5.7 vs. 13.4 ± 17.6 days, p = 0.005), compared with the control group. It was concluded that the WCD appears to reduce the total length of hospitalization and lengths of stay in ACCU for patients post-AMI and with left ventricular dysfunction.
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Affiliation(s)
| | - Quentin Delbaere
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - François Massin
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - Mathieu Granier
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - Gianni Casella
- Cardiology Department, Ospedale Maggiore, 40100 Bologna, Italy
| | - Gaetano Barbato
- Cardiology Department, Ospedale Maggiore, 40100 Bologna, Italy
| | - Valentin Dupasquier
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - Jean-Christophe Macia
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - Florence Leclercq
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - Jean-Luc Pasquie
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - François Roubille
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
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4
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Bakogiannis C, Mouselimis D, Tsarouchas A, Papadopoulos CE, Theofillogiannakos EK, Lechat E, Antoniadis AP, Pagourelias ED, Kelemanis I, Tzikas S, Fragakis N, Efthimiadis GK, Karamitsos TD, Doumas M, Vassilikos VP. Iron therapy and severe arrhythmias in HFrEF: rationale, study design, and baseline results of the RESAFE-HF trial. ESC Heart Fail 2023; 10:1184-1192. [PMID: 36647691 PMCID: PMC10053179 DOI: 10.1002/ehf2.14276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/11/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS The Iron Intravenous Therapy in Reducing the burden of Severe Arrhythmias in HFrEF (RESAFE-HF) registry study aims to provide real-word evidence on the impact of intravenous ferric carboxymaltose (FCM) on the arrhythmic burden of patients with heart failure with reduced ejection fraction (HFrEF), iron deficiency (ID), and implanted cardiac implantable electronic devices (CIEDs). METHODS AND RESULTS The RESAFE-HF (NCT04974021) study was designed as a prospective, single-centre, and open-label registry study with baseline, 3, 6, and 12 month visits. Adult patients with HFrEF and CIEDs scheduled to receive IV FCM as treatment for ID as part of clinical practice were eligible to participate. The primary endpoint is the composite iron-related endpoint of haemoglobin ≥ 12 g/dL, ferritin ≥ 50 ng/L, and transferrin saturation > 20%. Secondary endpoints include unplanned HF-related hospitalizations, ventricular tachyarrhythmias detected by CIEDs and Holter monitors, echocardiographic markers, functional status (VO2 max and 6 min walk test), blood biomarkers, and quality of life. In total, 106 patients with a median age of 72 years (14.4) were included. The majority were male (84.9%), whereas 92.5% of patients were categorized to New York Heart Association II/III. Patients' arrhythmic burden prior to FCM administration was significant-19 patients (17.9%) received appropriate CIED therapy for termination of ventricular tachyarrhythmia in the preceding 12 months, and 75.5% of patients have frequent, repetitive multiform premature ventricular contractions. CONCLUSIONS The RESAFE-HF trial is expected to provide evidence on the effect of treating ID with FCM in HFrEF based on real-world data. Special focus will be given on the arrhythmic burden post-FCM administration.
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Affiliation(s)
- Constantinos Bakogiannis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Dimitrios Mouselimis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Anastasios Tsarouchas
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Christodoulos E. Papadopoulos
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Efstratios K. Theofillogiannakos
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | | | - Antonios P. Antoniadis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Efstathios D. Pagourelias
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Ioannis Kelemanis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Stergios Tzikas
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Nikolaos Fragakis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Georgios K. Efthimiadis
- First Cardiology Department, School of MedicineAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Theodoros D. Karamitsos
- First Cardiology Department, School of MedicineAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Michael Doumas
- Second Propaedeutics Department of Internal MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
- Georgetown University and VAMC and George Washington UniversityWashingtonDCUSA
| | - Vassilios P. Vassilikos
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
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5
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Rosamilia MB, Lu IM, Landstrom AP. Pathogenicity Assignment of Variants in Genes Associated With Cardiac Channelopathies Evolve Toward Diagnostic Uncertainty. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2022; 15:e003491. [PMID: 35543671 DOI: 10.1161/circgen.121.003491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accurately determining variant pathogenicity is critical in the diagnosis of cardiac channelopathies; however, it remains unknown how variant pathogenicity status changes over time. Our aim is to use a comprehensive analysis of ClinVar to understand the mutability of variant evaluation in channelopathy-associated genes to inform clinical decision-making around variant calling. METHODS We identified 10 genes (RYR2, CASQ2, KCNQ1, KCNH2, SCN5A, CACNA1C, CALM1, CALM2, CALM3, TRDN) strongly associated with cardiac channelopathies, as well as 3 comparison gene sets (disputed long QT syndrome, sudden unexpected death in epilepsy, and all ClinVar). We comprehensively analyzed variant pathogenicity calls over time using the ClinVar database with Rstudio. Analyses focused on the frequency and directionality of clinically meaningful changes in disease association, defined as a change from one of the following three categories to another: likely benign/benign, conflicting evidence of pathogenicity/variant of uncertain significance, and likely pathogenic/pathogenic. RESULTS In total, among channelopathy-associated genes, there were 9975 variants in ClinVar and 8.4% had a clinically meaningful change in disease association at least once over the past 10 years, as opposed to 4.9% of all ClinVar variants. The 3 channelopathy-associated genes with the most variants undergoing a clinically significant change were KCNQ1 (20.9%), SCN5A (11.2%), and KCNH2 (10.1%). Ten of the 12 included genes had variant evaluations that trended toward diagnostic uncertainty over time. Specifically, channelopathy-associated gene variants with either pathogenic/likely pathogenic or benign/likely benign assignments were 5.6× and 2×, respectively, as likely to be reevaluated to conflicting/variant of uncertain significance compared to the converse. CONCLUSIONS Over the past 10 years, 8.4% of variants in channelopathy-associated genes have changed pathogenicity status with a decline in overall diagnostic certainty. Ongoing clinical and genetic variant follow-up is needed to account for presence of clinically meaningful change in variant pathogenicity assignment over time.
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Affiliation(s)
- Michael B Rosamilia
- Division of Pediatric Cardiology, Department of Pediatrics (M.B.R., I.M.L., A.P.L.), Duke University School of Medicine, Durham, NC
| | - Isa M Lu
- Division of Pediatric Cardiology, Department of Pediatrics (M.B.R., I.M.L., A.P.L.), Duke University School of Medicine, Durham, NC
| | - Andrew P Landstrom
- Division of Pediatric Cardiology, Department of Pediatrics (M.B.R., I.M.L., A.P.L.), Duke University School of Medicine, Durham, NC.,Department of Cell Biology (A.P.L.), Duke University School of Medicine, Durham, NC
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6
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Lewandowski M. A Review of the Commercially Available ECG Detection and Transmission Systems-The Fuzzy Logic Approach in the Prevention of Sudden Cardiac Arrest. MICROMACHINES 2021; 12:mi12121489. [PMID: 34945338 PMCID: PMC8705604 DOI: 10.3390/mi12121489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 12/24/2022]
Abstract
Sudden cardiac death (SCD) constitutes a major clinical and public health problem, whose death burden is comparable to the current worldwide pandemic. This comprehensive review encompasses the following topics: available rescue systems, wearable electrocardiograms (ECG), detection and transmission technology, and a newly developed fuzzy logic algorithm (FA) for heart rhythm classification which is state-of-the art in the field of SCD prevention. Project “PROTECTOR”, the Polish Rapid Transtelephonic ECG to Obtain Resuscitation for development of a rapid rescue system for patients at risk of sudden cardiac arrest (SCA), is presented. If a lethal arrhythmia is detected on the basis of FA, the system produces an alarm signal audible for bystanders and transmits the alarm message along with location to the emergency medical center. Phone guided resuscitation can be started immediately because an automated external defibrillator (AED) localization map is available. An automatic, very fast diagnosis is a unique feature of the PROTECTOR prototype. The rapid detection of SCA is based on a processor characterized by 100% sensitivity and 97.8% specificity (as measured in the pilot studies). An integrated circuit which implements FA has already been designed and a diagnosis is made within few seconds, which is extremely important in ischemic brain damage prophylaxis. This circuit could be implemented in smart implants (Sis).
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Affiliation(s)
- Michał Lewandowski
- 2nd Department of Arrhythmia, National Institute of Cardiology, 04-628 Warsaw, Poland
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7
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Hong W, Jiang C, Qin M, Song Z, Ji P, Wang L, Tu K, Lu L, Guo Z, Yang B, Wang X, Liu J. Self-adaptive cardiac optogenetics device based on negative stretching-resistive strain sensor. SCIENCE ADVANCES 2021; 7:eabj4273. [PMID: 34818034 PMCID: PMC8612680 DOI: 10.1126/sciadv.abj4273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Precision medicine calls for high demand of continuous, closed-loop physiological monitoring and accurate control, especially for cardiovascular diseases. Cardiac optogenetics is promising for its superiority of cell selectivity and high time-space accuracy, but the efficacy of optogenetics relative to the input of light stimulus is detected and controlled separately by discrete instruments in vitro, which suffers from time retardation, energy consumption, and poor portability. Thus, a highly integrated system based on implantable sensors combining closed-loop self-monitoring with simultaneous treatment is highly desired. Here, we report a self-adaptive cardiac optogenetics system based on an original negative stretching-resistive strain sensor array for closed-loop heart rate recording and self-adaptive light intensity control. The strain sensor exhibits a dual and synchronous capability of precise monitor and physiological-electrical-optical regulation. In an in vivo ventricular tachycardia model, our system demonstrates the potential of a negative stretching-resistive device in controlling-in-sensor electronics for wearable/implantable autodiagnosis and telehealth applications.
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Affiliation(s)
- Wen Hong
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, Shanghai Jiao Tong University, Shanghai 200240, China
- Department of Micro/Nano Electronics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Chunpeng Jiang
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, Shanghai Jiao Tong University, Shanghai 200240, China
- Department of Micro/Nano Electronics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Mu Qin
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China
| | - Ziliang Song
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China
| | - Pengfei Ji
- Department of Micro/Nano Electronics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Longchun Wang
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, Shanghai Jiao Tong University, Shanghai 200240, China
- Department of Micro/Nano Electronics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Kejun Tu
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, Shanghai Jiao Tong University, Shanghai 200240, China
- Department of Micro/Nano Electronics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Lijun Lu
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, Shanghai Jiao Tong University, Shanghai 200240, China
- Department of Micro/Nano Electronics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Zhejun Guo
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, Shanghai Jiao Tong University, Shanghai 200240, China
- Department of Micro/Nano Electronics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Bin Yang
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Xiaolin Wang
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Jingquan Liu
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, Shanghai Jiao Tong University, Shanghai 200240, China
- Corresponding author.
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8
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Faruk N, Abdulkarim A, Emmanuel I, Folawiyo YY, Adewole KS, Mojeed HA, Oloyede AA, Olawoyin LA, Sikiru IA, Nehemiah M, Ya'u Gital A, Chiroma H, Ogunmodede JA, Almutairi M, Katibi IA. A comprehensive survey on low-cost ECG acquisition systems: Advances on design specifications, challenges and future direction. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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9
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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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10
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Lee C, Maan A, Singh JP, Fradley MG. Arrhythmias and device therapies in patients with cancer therapy-induced cardiomyopathy. Heart Rhythm 2021; 18:1223-1229. [PMID: 33640446 DOI: 10.1016/j.hrthm.2021.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
Our knowledge of associated cardiotoxicities from novel therapeutics in oncology continues to expand. These include arrhythmias from cancer-therapy induced cardiomyopathy resulting from both direct and indirect effects on cardiomyocytes and other mechanisms that can adversely impact cardiovascular outcomes and overall mortality. In this review, we focus on both the arrhythmias of various classes of oncologic agents as well as the use of cardiac implantable electronic devices (cardioverter-defibrillators, permanent pacemakers, and cardiac resynchronization therapy) in cardio-oncology patients.
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Affiliation(s)
- Charlotte Lee
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Abhishek Maan
- Department of Cardiac Electrophysiology, The Mount Sinai Hospital, New York, New York
| | - Jagmeet P Singh
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael G Fradley
- Cardio-Oncology Center of Excellence, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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11
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Engstrom N, Dobson GP, Ng K, Letson HL. Primary Prevention Implantable Cardiac Defibrillators: A Townsville District Perspective. Front Cardiovasc Med 2020; 7:577248. [PMID: 33195463 PMCID: PMC7652736 DOI: 10.3389/fcvm.2020.577248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/14/2020] [Indexed: 12/07/2022] Open
Abstract
Background: Despite major advances in treating patients with severe heart failure, deciding who should receive an implantable cardiac defibrillator (ICD) remains challenging. Objective: To study the risk factors and mortality in patients after receiving an ICD (January 2008–December 2015) in a regional hospital in Australia. Methods: Eighty-two primary prevention patients received an ICD for ischemic cardiomyopathy (ICM, n = 41) and non-ischemic cardiomyopathy (NICM, n = 40) with 4.8-yrs follow-up. One patient had mixed ICM/NICM indications. Ventricular arrhythmias were assessed using intracardiac electrograms. Statistical analysis compared the total population and ICM and NICM groups using Kaplan-Meier for survival, Cox regression for mortality predictors, and binary logistic regression for predictors of ventricular arrhythmias (p < 0.05). Results: Major risk factors were hypercholesterolemia (70.7%), hypertension (47.6%), and obesity (41.5%). Severe obstructive sleep apnea (OSA) was found exclusively in NICM patients (23.7%, p = 0.001). Mortality was 30.5% after 4.8-yrs. The majority of patients (n=67) had no sustained ventricular arrhythmias yet 28% received therapy (n = 23), 18.51% were appropriate (n = 15), and 13.9% inappropriate (n = 11). Patients receiving ≥2 incidences of inappropriate shocks were 18-times more likely to die (p = 0.013). Three sudden cardiac deaths (SCD) (3.7%) were prevented by the ICD. Conclusion: Patients implanted with an ICD in Townsville had 30.5% all-cause mortality after 4.8-yrs. Only 28% of patients received ICD therapy and 13.9% were inappropriate. OSA may have contributed to the fourfold increase in inappropriate therapy in NICM patients. Our study raises important efficacy, ethical and healthcare cost questions about who should receive an ICD, and possible regional and urban center disparities.
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Affiliation(s)
- Nathan Engstrom
- College of Medicine & Dentistry, Heart, Trauma and Sepsis Research Laboratory, James Cook University, Townsville, QLD, Australia.,Cardiac Investigations, The Townsville University Hospital, Douglas, QLD, Australia
| | - Geoffrey P Dobson
- College of Medicine & Dentistry, Heart, Trauma and Sepsis Research Laboratory, James Cook University, Townsville, QLD, Australia
| | - Kevin Ng
- Cardiology Clinic, Cairns Hospital, Cairns, QLD, Australia
| | - Hayley L Letson
- College of Medicine & Dentistry, Heart, Trauma and Sepsis Research Laboratory, James Cook University, Townsville, QLD, Australia
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12
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Device Therapy for Sudden Cardiac Death Prophylaxis After Acute Coronary Syndrome: When and Why? Curr Cardiol Rep 2020; 22:4. [DOI: 10.1007/s11886-020-1255-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Wongvibulsin S, Wu KC, Zeger SL. Clinical risk prediction with random forests for survival, longitudinal, and multivariate (RF-SLAM) data analysis. BMC Med Res Methodol 2019; 20:1. [PMID: 31888507 PMCID: PMC6937754 DOI: 10.1186/s12874-019-0863-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 11/08/2019] [Indexed: 12/23/2022] Open
Abstract
Background Clinical research and medical practice can be advanced through the prediction of an individual’s health state, trajectory, and responses to treatments. However, the majority of current clinical risk prediction models are based on regression approaches or machine learning algorithms that are static, rather than dynamic. To benefit from the increasing emergence of large, heterogeneous data sets, such as electronic health records (EHRs), novel tools to support improved clinical decision making through methods for individual-level risk prediction that can handle multiple variables, their interactions, and time-varying values are necessary. Methods We introduce a novel dynamic approach to clinical risk prediction for survival, longitudinal, and multivariate (SLAM) outcomes, called random forest for SLAM data analysis (RF-SLAM). RF-SLAM is a continuous-time, random forest method for survival analysis that combines the strengths of existing statistical and machine learning methods to produce individualized Bayes estimates of piecewise-constant hazard rates. We also present a method-agnostic approach for time-varying evaluation of model performance. Results We derive and illustrate the method by predicting sudden cardiac arrest (SCA) in the Left Ventricular Structural (LV) Predictors of Sudden Cardiac Death (SCD) Registry. We demonstrate superior performance relative to standard random forest methods for survival data. We illustrate the importance of the number of preceding heart failure hospitalizations as a time-dependent predictor in SCA risk assessment. Conclusions RF-SLAM is a novel statistical and machine learning method that improves risk prediction by incorporating time-varying information and accommodating a large number of predictors, their interactions, and missing values. RF-SLAM is designed to easily extend to simultaneous predictions of multiple, possibly competing, events and/or repeated measurements of discrete or continuous variables over time.Trial registration: LV Structural Predictors of SCD Registry (clinicaltrials.gov, NCT01076660), retrospectively registered 25 February 2010
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Affiliation(s)
- Shannon Wongvibulsin
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, USA.
| | - Katherine C Wu
- Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, USA
| | - Scott L Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Kirolos I, Jones D, Hesterberg K, Yarn C, Khouzam RN, Levine YC. Recent Updates in the Role of Wearable Cardioverter Defibrillator for Prevention of Sudden Cardiac Death. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:49. [DOI: 10.1007/s11936-019-0746-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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The Contemporary Era of Sudden Cardiac Death and Ventricular Arrhythmias: Basic Concepts, Recent Developments and Future Directions. Heart Lung Circ 2019; 28:1-5. [PMID: 30545580 DOI: 10.1016/s1443-9506(18)31972-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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