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Robinson A, Billakanty S, Fu E, Amin A. Successful extravascular implantable cardioverter-defibrillator implantation in a patient with recurrent transvenous implantable cardioverter-defibrillator erosion. Heart Rhythm O2 2024; 5:243-245. [PMID: 38690143 PMCID: PMC11056457 DOI: 10.1016/j.hroo.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Affiliation(s)
- Andrea Robinson
- OhioHealth Heart and Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - Sreedhar Billakanty
- OhioHealth Heart and Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - Eugene Fu
- OhioHealth Heart and Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - Anish Amin
- OhioHealth Heart and Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
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2
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Wiedmann F, De Simone R, Rose P, Karck M, Gorenflo M, Frey N, Schmidt C. Case report of an S-ICD implantation for secondary prevention in a patient with complex congenital heart disease, dextrocardia, and situs solitus. Eur Heart J Case Rep 2022; 6:ytac253. [PMID: 35821967 PMCID: PMC9269672 DOI: 10.1093/ehjcr/ytac253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/17/2022] [Accepted: 06/22/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Dextrocardia is a congenital anomaly in which the apex of the heart is abnormally located on the right side of the chest. Situs solitus describes viscera that are in the normal position, with the stomach on the left side. In these patients, implantation of transvenous implantable cardioverter-defibrillator (ICD) can be limited by anatomical abnormalities commonly associated with this condition.
Case summary
We present the case of a young female patient with absent right atrioventricular connection, morphologically left systemic ventricle, muscular restrictive ventricular septal defect, and dextrocardia with situs solitus who was indicated for secondary prophylactic ICD implantation after resuscitation for polymorphic ventricular tachycardia. Due to a bilateral bidirectional Glenn anastomosis, transvenous access via the vena cava superior to the right ventricle could not be achieved. For this reason, we successfully implanted a subcutaneous ICD (S-ICD) with an individually optimized right parasternal electrode position. Potential complications of epimyocardial implantation via re-thoracotomy could thus be circumvented.
Discussion
In patients with complex congenital heart disease, the S-ICD is an effective method of preventing sudden cardiac death. Our case report demonstrates the feasibility of left S-ICD implantation even in the presence of dextrocardia with situs solitus.
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Affiliation(s)
- Felix Wiedmann
- Department of Cardiology, University Hospital Heidelberg , Heidelberg , Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg , Heidelberg , Germany
- HCR, Heidelberg Centre for Heart Rhythm Disorders, University Hospital Heidelberg , Heidelberg , Germany
| | - Raffaele De Simone
- Department of Cardiac Surgery, University Hospital Heidelberg , Heidelberg , Germany
| | - Peter Rose
- Department of Cardiac Surgery, University Hospital Heidelberg , Heidelberg , Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University Hospital Heidelberg , Heidelberg , Germany
| | - Matthias Gorenflo
- Department of Pediatric Cardiology and Congenital Heart Diseases, University Hospital Heidelberg , Heidelberg , Germany
| | - Norbert Frey
- Department of Cardiology, University Hospital Heidelberg , Heidelberg , Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg , Heidelberg , Germany
- HCR, Heidelberg Centre for Heart Rhythm Disorders, University Hospital Heidelberg , Heidelberg , Germany
| | - Constanze Schmidt
- Department of Cardiology, University Hospital Heidelberg , Heidelberg , Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg , Heidelberg , Germany
- HCR, Heidelberg Centre for Heart Rhythm Disorders, University Hospital Heidelberg , Heidelberg , Germany
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3
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Wang H, Shi J, Shi S, Bo R, Zhang X, Hu Y. Bibliometric analysis on the progress of chronic heart failure. Curr Probl Cardiol 2022; 47:101213. [PMID: 35525461 DOI: 10.1016/j.cpcardiol.2022.101213] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic heart failure (CHF) is the terminal stage of a variety of heart diseases with higher morbidity and mortality. Although CHF has been studied for decades, the comprehensive analysis by bibliometrics has not been done. So, we analyzed the scientific outputs of global chronic heart failureresearches, explored the current research status and hotpots from 2009 to 2019. METHODS Web of Science Core Collection (WOSCC) was the data source, and the data was retrieved on June 25, 2020, according to the set search strategy. Bibliometrics tools- CiteSpace V (Drexel university, Chaomei Chen) and VOS viewer (Leiden University, van Eck NJ)-were used for analyzing published literature and exploring research hotspots and frontier directions. RESULTS A total of 21,484 articles were included, and the rate of published articles increased from 2009 to 2019 annually. United States of America (USA) was the leading country, Duke University was the leading institution, and Stefan D Anker was the most productive researcher in this field. The analysis of keywords showed that mortality, risk, outcomes, association, and dysfunction were the main hotpots and frontier directions of CHF. CONCLUSION Bibliometric analysis of the outputs on CHF shows an overall view about the current status of the research on CHF. Clinical treatment and the associations among organs in the patients with CHF are the major research frontiers. However, further research and collaboration are still required worldwide. Our findings can help researchers grasp the research status of CHF and determine new directions for future researches as soon as possible.
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Affiliation(s)
- Huan Wang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jingjing Shi
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shuqing Shi
- Graduate School, Beijing University of Chinese Medicine
| | - Rongqiang Bo
- Graduate School, Beijing University of Chinese Medicine
| | - Xuesong Zhang
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanhui Hu
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Rosero EB, Rajan N, Joshi GP. Pro-Con Debate: Are Patients With a Cardiovascular Implantable Electronic Device Suitable to Receive Care in a Free-Standing Ambulatory Surgery Center? Anesth Analg 2022; 134:919-925. [PMID: 35427265 DOI: 10.1213/ane.0000000000005776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Migration of surgical and other procedures that require anesthesia care from a hospital to a free-standing ambulatory surgery center (ASC) continues to grow. Patients with cardiac implantable electronic devices (CIED) might benefit from receiving their care in a free-standing ASC setting. However, these patients have cardiovascular comorbidities that can elevate the risk of major adverse cardiovascular events. CIEDs are also complex devices and perioperative management varies between devices marketed by various manufacturers and require consultation and ancillary services, which may not be available in a free-standing ASC. Thus, perioperative care of these patients can be challenging. Therefore, the suitability of this patient population in a free-standing ASC remains highly controversial. Although applicable advisories exist, considerable discussion continues with surgeons and other proceduralists about the concerns of anesthesiologists. In this Pro-Con commentary article, we discuss the arguments for and against scheduling a patient with a CIED in a free-standing ASC.
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Affiliation(s)
- Eric B Rosero
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Niraja Rajan
- Department of Anesthesiology and Perioperative Medicine, Penn State Health, Hershey, Pennsylvania
| | - Girish P Joshi
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
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5
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Mitacchione G, Schiavone M, Gasperetti A, Viecca M, Curnis A, Forleo GB. Neglected lead tip erosion: An unusual case of S‐ICD inappropriate shock. J Cardiovasc Electrophysiol 2020; 31:3322-3325. [DOI: 10.1111/jce.14746] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | - Marco Schiavone
- Department of Cardiology Luigi Sacco University Hospital Milan Italy
| | | | - Maurizio Viecca
- Department of Cardiology Luigi Sacco University Hospital Milan Italy
| | - Antonio Curnis
- Department of Cardiology Spedali Civili Hospital University of Brescia Brescia Italy
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6
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A case of pseudo-appropriate shock. HeartRhythm Case Rep 2020; 6:344-347. [PMID: 32577392 PMCID: PMC7300332 DOI: 10.1016/j.hrcr.2020.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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7
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Kaya E, Siebermair J, Vonderlin N, Hadjamu N, Azizy O, Rassaf T, Wakili R. Impact of diabetes as a risk factor in patients undergoing subcutaneous implantable cardioverter defibrillator implantation: A single-centre study. Diab Vasc Dis Res 2020; 17:1479164120911560. [PMID: 32292066 PMCID: PMC7510351 DOI: 10.1177/1479164120911560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Patients with diabetes mellitus are known to carry an increased risk for surgical site infections and perioperative complications. The subcutaneous implantable cardioverter defibrillator is an established treatment option in patients at risk for sudden cardiac death especially with an increased risk for infection over time. METHODS AND RESULTS Forty-eight patients (mean age = 55.0 ± 21.3 years, 31.3% patients with diabetes mellitus, 75% male) who underwent consecutive subcutaneous implantable cardioverter defibrillator surgery between February 2016 and May 2019 were retrospectively analysed. Overall adverse events including relevant bleeding complications, any surgical wound problems and infections requiring reoperation or device malfunction were evaluated as primary combined safety endpoint. Patients with diabetes mellitus tended to be older with a higher body mass index compared to non-diabetes mellitus. Procedure duration and postsurgery hospital days were not different in diabetes mellitus versus non-diabetes mellitus patients. Analysis of the primary combined endpoint showed no significant difference but a trend towards higher event rates in the diabetes mellitus group (diabetes mellitus vs non-diabetes mellitus: 20% vs 12.1%, p = 0.119). CONCLUSION Diabetes mellitus is a frequent and relevant variable in patients undergoing subcutaneous implantable cardioverter defibrillator implantation represented by 31.3% in this consecutive cohort. Our results suggest that diabetes mellitus is not associated with a prolonged hospital stay or increased rate of periprocedural adverse events.
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Affiliation(s)
| | | | | | | | | | | | - Reza Wakili
- Reza Wakili, Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University of Duisburg–Essen, Essen, Hufelandstrasse 55, 45147 Essen, Germany.
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8
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Abstract
Background: The comparative outcomes of subcutaneous implantable cardioverter-defibrillator (S-ICD) and transvenous ICD (T-ICD) have not been well studied. The aim of this study was to evaluate the safety and efficacy of currently available S-ICD and T-ICD. Methods: The study included 86 patients who received an S-ICD and 1:1 matched to those who received single-chamber T-ICD by gender, age, diagnosis, left ventricular ejection fraction (LVEF), and implant year. The clinical outcomes and implant complications were compared between the two groups. Results: The mean age of the 172 patients was 45 years, and 129 (75%) were male. The most common cardiac condition was hypertrophic cardiomyopathy (HCM, 37.8%). The mean LVEF was 50%. At a mean follow-up of 23 months, the appropriate and inappropriate ICD therapy rate were 1.2% vs. 4.7% (χ2 = 1.854, P = 0.368) and 9.3% vs. 3.5% (χ2 = 2.428, P = 0.211) in S-ICD and T-ICD groups respectively. There were no significant differences in device-related major and minor complications between the two groups (7.0% vs. 3.5%, χ2 = 1.055, P = 0.496). The S-ICD group had higher T-wave oversensing than T-ICD group (9.3% vs. 0%, χ2 = 8.390, P = 0.007). Sixty-five patients had HCM (32 in S-ICD and 33 in T-ICD). The incidence of major complications was not significantly different between the two groups. Conclusions: The efficacy of an S-ICD is comparable to that of T-ICD, especially in a dominantly HCM patient population. The S-ICD is associated with fewer major complications demanding reoperation.
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9
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Hasegawa K, Miyazaki S, Kaseno K, Tada H. Iatrogenic Palpitations during Exercise in a Patient with a Dual Chamber Implantable Cardioverter-Defibrillator and Lead Dysfunction. Int Heart J 2019; 60:462-465. [PMID: 30626767 DOI: 10.1536/ihj.18-248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Implantable cardioverter-defibrillators (ICDs) are an effective treatment to prevent sudden cardiac death; however, lead dysfunction is an important complication during the long-term follow-up period in ICD recipients. Careful device programming is required in accordance with the individual situation in patients with lead dysfunction. We herein present a patient in whom programming to AAI triggered palpitations during exercise.
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Affiliation(s)
- Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Kenichi Kaseno
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
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10
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Halawa A, Gautam S. T wave oversensing in subcutaneous implantable cardioverter defibrillator secondary to hematoma formation: A potential cause of early postimplantation inappropriate shocks. J Arrhythm 2019; 35:130-132. [PMID: 30805053 PMCID: PMC6373653 DOI: 10.1002/joa3.12132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 12/03/2022] Open
Abstract
T wave oversensing (TWOS) is the most common cause of inappropriate shocks in subcutaneous cardioverter-defibrillators (S-ICD). We are presenting a patient with severe ischemic cardiomyopathy who received a S-ICD while on antiplatelets therapy. Pressure dressing was applied due to significant bleeding. On the first postoperative day, the device delivered 26 inappropriate shocks after removal of the pressure dressing. Interrogation revealed new TWOS, likely related to changes in the sensing vectors after hematoma formation.
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Affiliation(s)
- Ahmad Halawa
- Division of Cardiovascular MedicineUniversity of Missouri‐ColumbiaColumbiaMissouri
| | - Sandeep Gautam
- Division of Cardiovascular MedicineUniversity of Missouri‐ColumbiaColumbiaMissouri
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11
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González-Cordero A, López-Puebla J, Franqui-Rivera H. Implantation of a completely right sided subcutaneous cardioverter-defibrillator in a patient with situs inversus dextrocardia. Indian Pacing Electrophysiol J 2018; 19:72-74. [PMID: 30468861 PMCID: PMC6450821 DOI: 10.1016/j.ipej.2018.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/18/2018] [Accepted: 11/20/2018] [Indexed: 12/27/2022] Open
Abstract
Dextrocardia is a congenital anomaly where the heart is abnormally located in the right hemithorax. In these patients, the implementation of transvenous implantable cardioverter-defibrillator (TV-ICD) can be technically challenging and pose a higher risk of complications than the general population. We present the case of a male patient that was successfully submitted to right-sided implantation of subcutaneous ICD (S-ICD) as an alternative to transvenous ICD (TV-ICD) for primary prevention of sudden cardiac death. This option is not only feasible but may potentially be ideal for these patients, as it circumvents challenges and potential complications of TV-ICD insertion.
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Affiliation(s)
- Ariel González-Cordero
- University of Puerto Rico School of Medicine, Department of Medicine, Cardiology Division, USA.
| | - Javier López-Puebla
- University of Puerto Rico School of Medicine, Department of Medicine, Cardiology Division, USA
| | - Hilton Franqui-Rivera
- University of Puerto Rico School of Medicine, Department of Medicine, Cardiology Division, USA.
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Abstract
Infections associated with cardiac implantable electronic devices are increasing and are associated with significant morbidity and mortality. This article reviews the epidemiology, microbiology, and risk factors for acquisition of these infections. The complex diagnostic and management strategies associated with these serious infections are reviewed with an emphasis on recent updates and advances, as well as existing controversies. Additionally, the latest in preventative strategies are reviewed.
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Affiliation(s)
- Christopher J Arnold
- Division of Infectious Diseases and International Health, University of Virginia Health System, PO Box 800545, Charlottesville, VA 22908-0545, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University Hospital, Duke Box 102359, Durham, NC 27710, USA.
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13
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Tate J, Stinstra J, Pilcher T, Poursaid A, Jolley MA, Saarel E, Triedman J, MacLeod RS. Measuring defibrillator surface potentials: The validation of a predictive defibrillation computer model. Comput Biol Med 2018; 102:402-410. [PMID: 30195579 DOI: 10.1016/j.compbiomed.2018.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/24/2018] [Accepted: 08/24/2018] [Indexed: 01/26/2023]
Abstract
Implantable cardioverter defibrillators (ICDs) are commonly used to reduce the risk in patients with life-threatening arrhythmias, however, clinicians have little systematic guidance to place the device, especially in cases of unusual anatomy. We have previously developed a computational model that evaluates the efficacy of a delivered shock as a clinical and research aid to guide ICD placement on a patient specific basis. We report here on progress to validate this model with measured ICD surface potential maps from patients undergoing ICD implantation and testing for defibrillation threshold (DFT). We obtained body surface potential maps of the defibrillation pulses by adapting a limited lead selection and potential estimation algorithm to deal with the limited space for recording electrodes. Comparison of the simulated and measured potential maps of the defibrillation shock yielded similar patterns, a typical correlation greater than 0.9, and a relative error less than 15%. Comparison of defibrillation thresholds also showed accurate prediction of the simulations. The high agreement of the potential maps and DFTs suggests that the predictive simulation generates realistic potential values and can accurately predict DFTs in patients. These validation results pave the way for use of this model in optimization studies prior to device implantation.
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Affiliation(s)
- Jess Tate
- Department of Bioengineering, University of Utah, Salt Lake City, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, USA.
| | - Jeroen Stinstra
- Department of Bioengineering, University of Utah, Salt Lake City, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, USA
| | - Thomas Pilcher
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, USA
| | - Ahrash Poursaid
- Department of Bioengineering, University of Utah, Salt Lake City, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, USA
| | - Matthew A Jolley
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Elizabeth Saarel
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, USA
| | - John Triedman
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Rob S MacLeod
- Department of Bioengineering, University of Utah, Salt Lake City, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, USA
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Berkowitz EJ, Pleimann BE, Rosenfeld LE. Subcutaneous implantable cardioverter defibrillator oversensing and shock delivery due to chest compressions during CPR. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1687-1690. [DOI: 10.1111/pace.13468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/15/2018] [Accepted: 07/31/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Eric J. Berkowitz
- Section of Cardiovascular Medicine; Yale University School of Medicine; New Haven Connecticut
| | | | - Lynda E. Rosenfeld
- Section of Cardiovascular Medicine; Yale University School of Medicine; New Haven Connecticut
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Essandoh MK, Mark GE, Aasbo JD, Joyner CA, Sharma S, Decena BF, Bolin ED, Weiss R, Burke MC, McClernon TR, Daoud EG, Gold MR. Anesthesia for subcutaneous implantable cardioverter‐defibrillator implantation: Perspectives from the clinical experience of a U.S. panel of physicians. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:807-816. [DOI: 10.1111/pace.13364] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/25/2018] [Accepted: 03/18/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Michael K. Essandoh
- Department of AnesthesiologyThe Ohio State University Wexner Medical Center Columbus OH USA
| | - George E. Mark
- Department of CardiologyCooper University Hospital Camden NJ USA
| | - Johan D. Aasbo
- The Heart Institute of ProMedica Toledo Hospital Toledo OH USA
| | - Charles A Joyner
- Department of CardiologyLevinson Heart Hospital at Chippenham and Johnston Willis Medical Center Richmond VA USA
| | - Saumya Sharma
- Department of ElectrophysiologyMcGovern Medical School ‐ University of Texas Health Science Center Houston TX USA
| | - Beningo F Decena
- Department of CardiologyTucson Medical Center and Northwest Medical Center Tucson AZ USA
| | - Eric D Bolin
- Department of Anesthesia and Perioperative MedicineMedical University of South Carolina Charleston SC USA
| | - Raul Weiss
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical Center Columbus OH USA
| | | | | | - Emile G. Daoud
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical Center Columbus OH USA
| | - Michael R. Gold
- Division of CardiologyMedical University of South Carolina Charleston SC USA
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Forman J, Baumbusch J, Jackson H, Lindenberg J, Shook A, Bashir J. Exploring the patients’ experiences of living with a subcutaneous implantable cardioverter defibrillator. Eur J Cardiovasc Nurs 2018; 17:698-706. [DOI: 10.1177/1474515118777419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The implantable cardioverter defibrillator provides effective treatment for the prevention of sudden cardiac arrest but significant risks associated with transvenous implantation persist. The subcutaneous implantable cardioverter defibrillator has proven to be an alternative and innovative treatment option for select patients to mitigate these risks. Obtaining the patients’ perspectives can provide clinicians with essential information to guide implant selection, procedural decision-making, and support patient management. Conventional implantable cardioverter defibrillator patients have reported shock-related anxiety, fear, insufficient education, and challenges adapting to physical and psychological changes. Little evidence exists to determine whether differences between the subcutaneous implantable cardioverter defibrillator and conventional implantable cardioverter defibrillator allow for the transferability of our current knowledge to the care and management of this population. Aims: The purpose of this study was to explore patients’ experiences of living with a subcutaneous implantable cardioverter defibrillator including the decision-making process, implant, and follow-up care processes. Methods: Using an exploratory qualitative approach, semi-structured interviews were conducted by telephone with 15 participants who underwent subcutaneous implantable cardioverter defibrillator implant. Results: Analysis revealed five main themes: (a) influences on decision-making; (b) unmet education needs; (c) physical impact; (d) psychological impact; and (e) recommendations. Conclusion: As a new technology, little knowledge of the subcutaneous implantable cardioverter defibrillator exists outside of the tertiary implanting sites, therefore developing new strategies to increase learning and dissemination is essential. Although similarities exist in our findings to those of conventional implantable cardioverter defibrillators, there are significant differences in the decision-making process and physical impact which require individualized care planning and development of strategies to provide a patient-centered approach to care.
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Chang SC, Patton KK, Robinson MR, Poole JE, Prutkin JM. Subcutaneous ICD screening with the Boston Scientific ZOOM programmer versus a 12-lead ECG machine. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:511-516. [PMID: 29476654 DOI: 10.1111/pace.13314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/24/2018] [Accepted: 02/17/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) requires preimplant screening to ensure appropriate sensing and reduce risk of inappropriate shocks. Screening can be performed using either an ICD programmer or a 12-lead electrocardiogram (ECG) machine. It is unclear whether differences in signal filtering and digital sampling change the screening success rate. METHODS Subjects were recruited if they had a transvenous single-lead ICD without pacing requirements or were candidates for a new ICD. Screening was performed using both a Boston Scientific ZOOM programmer (Marlborough, MA, USA) and General Electric MAC 5000 ECG machine (Fairfield, CT, USA). A pass was defined as having at least one lead that fit within the screening template in both supine and sitting positions. RESULTS A total of 69 subjects were included and 27 sets of ECG leads had differing screening results between the two machines (7%). Of these sets, 22 (81%) passed using the ECG machine but failed using the programmer and five (19%) passed using the ECG machine but failed using the programmer (P < 0.001). Four subjects (6%) passed screening using the ECG machine but failed using the programmer. No subject passed screening with the programmer but failed with the ECG machine. CONCLUSION There can be occasional disagreement in S-ICD patient screening between an ICD programmer and ECG machine, all of whom passed with the ECG machine but failed using the programmer. On a per lead basis, the ECG machine passes more subjects. It is unknown what the inappropriate shock rate would be if an S-ICD was implanted. Clinical judgment should be used in borderline cases.
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Affiliation(s)
- Shu C Chang
- Division of Cardiology, University of Colorado, Aurora, Colorado, USA
| | - Kristen K Patton
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Melissa R Robinson
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jeanne E Poole
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jordan M Prutkin
- Division of Cardiology, University of Washington, Seattle, Washington, USA
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Hernández-Madrid A, Paul T, Abrams D, Aziz PF, Blom NA, Chen J, Chessa M, Combes N, Dagres N, Diller G, Ernst S, Giamberti A, Hebe J, Janousek J, Kriebel T, Moltedo J, Moreno J, Peinado R, Pison L, Rosenthal E, Skinner JR, Zeppenfeld K, Sticherling C, Kautzner J, Wissner E, Sommer P, Gupta D, Szili-Torok T, Tateno S, Alfaro A, Budts W, Gallego P, Schwerzmann M, Milanesi O, Sarquella-Brugada G, Kornyei L, Sreeram N, Drago F, Dubin A. Arrhythmias in congenital heart disease: a position paper of the European Heart Rhythm Association (EHRA), Association for European Paediatric and Congenital Cardiology (AEPC), and the European Society of Cardiology (ESC) Working Group on Grown-up Congenital heart disease, endorsed by HRS, PACES, APHRS, and SOLAECE. Europace 2018; 20:1719-1753. [DOI: 10.1093/europace/eux380] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Antonio Hernández-Madrid
- Department of Cardiology, Arrhythmia Unit, Ramón y Cajal Hospital, Alcalá University, Carretera Colmenar Viejo, km 9, 100, Madrid, Spain
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Robert-Koch-Str. 40, Göttingen, Germany
| | - Dominic Abrams
- PACES (Pediatric and Congenital Electrophysiology Society) Representative, Department of Cardiology, Boston Childreńs Hospital, Boston, MA, USA
| | - Peter F Aziz
- HRS Representative, Pediatric Electrophysiology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Academical Medical Center, Amsterdam, The Netherlands
| | - Jian Chen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Massimo Chessa
- Pediatric and Adult Congenital Heart Centre-University Hospital, IRCCS Policlinico San Donato, Milan, Italy
| | - Nicolas Combes
- Arrhythmia Unit, Department of Pediatric and Adult Congenital Heart Disease, Clinique Pasteur, Toulouse, France
| | - Nikolaos Dagres
- Department of Electrophysiology, University Leipzig Heart Center, Leipzig, Germany
| | | | - Sabine Ernst
- Royal Brompton and Harefield Hospital, London, UK
| | - Alessandro Giamberti
- Congenital Cardiac Surgery Unit, Policlinico San Donato, University and Research Hospital, Milan, Italy
| | - Joachim Hebe
- Center for Electrophysiology at Heart Center Bremen, Bremen, Germany
| | - Jan Janousek
- 2nd Faculty of Medicine, Children's Heart Centre, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Thomas Kriebel
- Westpfalz-Klinikum Kaiserslautern, Children’s Hospital, Kaiserslautern, Germany
| | - Jose Moltedo
- SOLAECE Representative, Head Pediatric Electrophysiology, Section of Pediatric Cardiology Clinica y Maternidad Suizo Argentina, Buenos Aires, Argentina
| | - Javier Moreno
- Department of Cardiology, Arrhythmia Unit, Ramón y Cajal Hospital, Alcalá University, Carretera Colmenar Viejo, km 9, 100, Madrid, Spain
| | - Rafael Peinado
- Department of Cardiology, Arrhythmia Unit, Hospital la Paz, Madrid, Spain
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Eric Rosenthal
- Consultant Paediatric and Adult Congenital Cardiologist, Evelina London Children's Hospital, Guy's and St Thomas' Hospital Trust, London, UK
| | - Jonathan R Skinner
- APHRS Representative, Paediatric and Congenital Cardiac Services Starship Childreńs Hospital, Grafton, Auckland, New Zealand
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Joseph Kautzner
- Institute For Clinical and Experimental Medicine, Prague, Czech Republic
| | - Erik Wissner
- University of Illinois at Chicago, 840 S. Wood St., 905 S (MC715), Chicago, IL, USA
| | - Philipp Sommer
- Heart Center Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Dhiraj Gupta
- Consultant Electrophysiologist Liverpool Heart and Chest Hospital, Honorary Senior Lecturer Imperial College London and University of Liverpool, Liverpool, UK
| | | | - Shigeru Tateno
- Chiba Cerebral and Cardiovascular Center, Tsurumai, Ichihara, Chiba, Japan
| | | | - Werner Budts
- UZ Leuven, Campus Gasthuisberg, Herestraat 49, Leuven, Belgium
| | | | - Markus Schwerzmann
- INSELSPITAL, Universitätsspital Bern, Universitätsklinik für Kardiologie, Zentrum für angeborene Herzfehler ZAH, Bern, Switzerland
| | - Ornella Milanesi
- Department of Woman and Child's Health, University of Padua, Padua Italy
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Electrophysiology and Sudden Death Unit, Department of Cardiology, Hospital Sant Joan de Déu, Barcelona - Universitat de Barcelona, Passeig Sant Joan de Déu, 2, Esplugues, Barcelona, Catalunya, Spain
| | - Laszlo Kornyei
- Gottsegen Gyorgy Orszagos Kardiologiai, Pediatric, Haller U. 29, Budapest, Hungary
| | - Narayanswami Sreeram
- Department of Pediatric Cardiology, University Hospital Of Cologne, Kerpenerstrasse 62, Cologne, Germany
| | - Fabrizio Drago
- IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Roma
| | - Anne Dubin
- Division of Pediatric Cardiology, 750 Welch Rd, Suite 321, Palo Alto, CA, USA
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Gierula J, Kearney MT, Witte KK. Devices in heart failure; diagnosis, detection and disease modification. Br Med Bull 2018; 125:91-102. [PMID: 29342243 PMCID: PMC6410397 DOI: 10.1093/bmb/ldx051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION/BACKGROUND Implantable cardiac devices are widely used in chronic heart failure (CHF) therapy. This review covers current CHF treatment with electronic cardiac devices, areas of discussion and emerging technologies. SOURCES OF DATA A comprehensive search of available literature resources including Pubmed, MEDLINE and EMBASE was performed. National and international guidelines were accessed. AREAS OF AGREEMENT Excessive right ventricular pacing is detrimental to cardiac function. Cardiac resynchronization therapy is beneficial in specific individuals with CHF. AREAS OF CONTROVERSY Implantable cardioverter defibrillators might not benefit all. Optimizing CRT delivery. Remote monitoring seems not to be of benefit in CHF. GROWING POINTS Device-based optimization. AREAS TIMELY FOR DEVELOPING RESEARCH Personalization of device therapy. Focussing implantable cardioverter defibrillator therapy. What to do at implantable cardioverter defibrillator box change?
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Affiliation(s)
- John Gierula
- Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS29JT, UK
| | - Mark T Kearney
- Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS29JT, UK
| | - Klaus K Witte
- Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS29JT, UK
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20
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Boey E, Kojodjojo P. Optimal Strategies for Mitigating Sudden Cardiac Death Risk in At-risk Patients with Structural Heart Disease. J Innov Card Rhythm Manag 2018; 9:3025-3032. [PMID: 32494485 PMCID: PMC7252838 DOI: 10.19102/icrm.2018.090204] [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: 07/09/2017] [Accepted: 08/29/2017] [Indexed: 12/03/2022] Open
Abstract
This article reviews the strategies used to mitigate sudden death risks in at-risk patients with structural heart disease. The roles of implantable and non-implantable technologies to prevent arrhythmic death are discussed.
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Affiliation(s)
- Elaine Boey
- Division of Cardiology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Pipin Kojodjojo
- Division of Cardiology, Ng Teng Fong General Hospital, National University Health System, Singapore,Address correspondence to: Pipin Kojodjojo, PhD, National University Heart Centre, 1E Kent Ridge Road, National University Health System Tower Block, Level 9, Singapore 119228.
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21
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Fukata M, Arita T, Kadota H, Odashiro K, Maruyama T, Akashi K. Successful management of wound dehiscence after implantation of a subcutaneous implantable cardioverter-defibrillator without device removal. HeartRhythm Case Rep 2017; 3:415-417. [PMID: 28948145 PMCID: PMC5601323 DOI: 10.1016/j.hrcr.2017.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mitsuhiro Fukata
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Takeshi Arita
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Hideki Kadota
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Keita Odashiro
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Toru Maruyama
- Faculty of Art and Science, Kyushu University, Fukuoka, Japan
| | - Koichi Akashi
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
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22
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Kaushal M, Leff J, Gross J, Jakobleff WA, Forest S, Leyvi G. Reporting the First Subcutaneous ICD Placed in the Immediate Postorthotopic Heart Transplant Period for Acute Cellular Rejection-Associated Cardiac Arrest and Investigating the Role of Secondary Prevention ICDs in This Population. J Cardiothorac Vasc Anesth 2017; 31:1784-1788. [PMID: 28764990 DOI: 10.1053/j.jvca.2017.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Mudit Kaushal
- Department of Anesthesiology, Montefiore Medical Center, Bronx, NY.
| | - Jonathan Leff
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Montefiore Medical Center, Bronx, NY
| | - Jay Gross
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - William Alex Jakobleff
- Division of Cardiothoracic Surgery, Department of Surgery, Montefiore Medical Center, Bronx, NY
| | - Stephen Forest
- Division of Cardiothoracic Surgery, Department of Surgery, Montefiore Medical Center, Bronx, NY
| | - Galina Leyvi
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Montefiore Medical Center, Bronx, NY
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23
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Thomas VC, Peterson M, McDaniel M, Restrepo H, Rothman A, Jain A. Analysis of Screening Electrocardiogram for the Subcutaneous Defibrillator in Adults with Congenital Heart Disease. Pediatr Cardiol 2017; 38:1162-1168. [PMID: 28534239 DOI: 10.1007/s00246-017-1635-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/13/2017] [Indexed: 01/04/2023]
Abstract
Candidates for the subcutaneous implantable cardioverter-defibrillator (S-ICD) are screened using an electrocardiogram (S-ECG) tool to measure appropriate detection. We sought to define the S-ICD candidacy of congenital heart disease patients using the S-ECG tool. We also analyzed the reliability of the (S-ECG) tool between measurers in this population. Patients above the age of 12 and with a diagnosis associated with either a higher incidence of cardiac arrest or vascular access challenges were asked to undergo screening. S-ECGs were then analyzed by a pediatric electrophysiologist, an S-ICD device engineer, and an S-ICD clinical representative for candidacy. Results were compared for interobserver variability and S-ECGs were analyzed by t test to determine variables that differ among passing and failing leads. Thirty-one patients underwent screening. Two of the 31 (6.5%) patients failed S-ICD screening. Analysis of the screening leads demonstrated the highest passing rates using lead III at a 5 mm/mV amplitude setting with 71 and 62% pass rate in the supine and standing positions, respectively. Interobserver analysis correlated well among the three measurers. There was a higher amplitude difference between QRS and T waves among passing versus failing S-ECG. Congenital heart disease patients have acceptable passage rates utilizing the S-ECG algorithm. Interobserver measurements were well correlated and these data suggest that the proximal coil to device (lead III) vector would be best utilized in this patient population. A larger difference between QRS and T wave amplitudes was associated with a higher S-ECG passing rate.
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Affiliation(s)
- Vincent C Thomas
- University of Nebraska Medical Center, Children's Hospital and Medical Center, 8200 Dodge Street, Omaha, NE, 68164, USA.
| | | | | | | | - Abraham Rothman
- Children's Heart Center Nevada, Las Vegas, NV, USA
- University of Nevada School of Medicine, Reno, NV, USA
| | - Amit Jain
- University of Nevada School of Medicine, Reno, NV, USA
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24
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Saini A, Ellenbogen KA. Oversensing and inappropriate shock in a patient with subcutaneous implantable cardioverter defibrillator: What is the mechanism? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:897-899. [PMID: 28598578 DOI: 10.1111/pace.13105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/22/2017] [Accepted: 04/24/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Aditya Saini
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, VA
| | - Kenneth A Ellenbogen
- Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, VA
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25
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Batul SA, Yang F, Wats K, Shrestha S, Greenberg YJ. Inappropriate subcutaneous implantable cardioverter-defibrillator therapy due to R-wave amplitude variation: Another challenge in device management. HeartRhythm Case Rep 2017; 3:78-82. [PMID: 28491773 PMCID: PMC5420026 DOI: 10.1016/j.hrcr.2016.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Syeda A. Batul
- Cardiology Division, Maimonides Medical Center, Brooklyn, New York
- Department of Cardiac Electrophysiology, Montefiore Medical Center, Bronx, New York
| | - Felix Yang
- Department of Cardiac Electrophysiology, Cardiology Division
| | - Karan Wats
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Suvash Shrestha
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York
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26
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Lazaros G, Oikonomou E, Tousoulis D. Established and novel treatment options in acute myocarditis, with or without heart failure. Expert Rev Cardiovasc Ther 2016; 15:25-34. [PMID: 27858465 DOI: 10.1080/14779072.2017.1262764] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Acute myocarditis is a disorder characterized by an unpredictable clinical course which ranges from asymptomatic, incidentally discovered forms, to cases with fulminant course and adverse outcome. The most challenging issues in the context of acute myocarditis are the appearance of difficult to treat heart failure in the acute phase and the potential progression in the long-term to dilated cardiomyopathy. Areas covered: With respect to available treatment options in acute myocarditis, in the absence of specific guidelines, management is supportive and overall empirical, especially for the oligo- or asymptomatic patients with preserved ejection fraction. Haemodynamically instable patients should be treated in referral centers with capability of advanced cardiopulmonary support. Patients with heart failure but without haemodynamic impairment should be treated according to the heart failure guidelines. Endomyocardial biopsy may be performed in an individualized basis both for diagnostic purposes and to guide treatment, based on the detection or not of viral genome. Expert commentary: Apart from the already established treatments, novel therapies against several targets are currently investigated and are expected to contribute to a more efficacious management options in the future. Increased awareness among medical professionals is essential for the early diagnosis and best care of acute myocarditis patients.
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Affiliation(s)
- George Lazaros
- a First Department of Cardiology, 'Hippokration' Hospital , University of Athens Medical School , Athens , Greece
| | - Evangelos Oikonomou
- a First Department of Cardiology, 'Hippokration' Hospital , University of Athens Medical School , Athens , Greece
| | - Dimitris Tousoulis
- a First Department of Cardiology, 'Hippokration' Hospital , University of Athens Medical School , Athens , Greece
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27
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Droghetti A, Locatelli A, Casiraghi B, Malacrida M, Arupi M, Ragusa M. Totally submuscular implantation of subcutaneous implantable cardioverter defibrillator: a safe and effective solution for obese or oversized patients. Clin Case Rep 2016; 4:1009-1011. [PMID: 27761257 PMCID: PMC5054481 DOI: 10.1002/ccr3.652] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/17/2016] [Accepted: 07/14/2016] [Indexed: 11/29/2022] Open
Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a safe alternative to transvenous ICD. We describe a submuscular S-ICD placement technique in a severely obese with an oversized chest. Submuscular configuration allows optimal system positioning and impendence values warranting a safe and effective shock transmission. This technique is safe and improves patients comfort.
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Affiliation(s)
- Andrea Droghetti
- Department of Cardiac, Thoracic and Vascular SciencesThoracic Surgery UnitC. Poma HospitalMantovaItaly
| | | | | | | | | | - Mark Ragusa
- Thoracic Surgery UnitPerugia University Medical SchoolTerniItaly
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28
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Kempa M, Budrejko S, Raczak G. Subcutaneous implantable cardioverter-defibrillator (S-ICD) for secondary prevention of sudden cardiac death. Arch Med Sci 2016; 12:1179-1180. [PMID: 27695509 PMCID: PMC5016596 DOI: 10.5114/aoms.2016.61921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/22/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Szymon Budrejko
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
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30
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- #] [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: 02/10/2023] Open
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31
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- awyx] [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: 02/10/2023] Open
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32
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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- -] [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: 02/10/2023] Open
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33
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37:2129-2200. [PMID: 27206819 DOI: 10.1093/eurheartj/ehw128] [Citation(s) in RCA: 8957] [Impact Index Per Article: 1119.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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34
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 and 1880=1880] [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: 02/10/2023] Open
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35
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- #] [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: 02/10/2023] Open
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36
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- -] [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: 02/10/2023] Open
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37
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- gadu] [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: 02/10/2023] Open
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Long-time “real-life” performance of the subcutaneous ICD in patients with electrical heart disease or idiopathic ventricular fibrillation. J Interv Card Electrophysiol 2016; 47:185-188. [DOI: 10.1007/s10840-016-0143-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/16/2016] [Indexed: 12/31/2022]
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39
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 2016; 18:891-975. [DOI: 10.1002/ejhf.592] [Citation(s) in RCA: 4631] [Impact Index Per Article: 578.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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40
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Raman AS, Shabari FR, Kar B, Loyalka P, Hariharan R. No Electromagnetic Interference Occurred in a Patient with a HeartMate II Left Ventricular Assist System and a Subcutaneous Implantable Cardioverter-Defibrillator. Tex Heart Inst J 2016; 43:183-5. [PMID: 27127441 DOI: 10.14503/thij-14-4795] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The use of subcutaneous implantable cardioverter-defibrillators is a novel option for preventing arrhythmia-mediated cardiac death in patients who are at risk of endovascular-device infection or in whom venous access is difficult. However, the potential for electromagnetic interference between subcutaneous defibrillators and left ventricular assist devices is largely unknown. We report the case of a 24-year-old man in whom we observed no electromagnetic interference between a subcutaneous implanted cardioverter-defibrillator and a HeartMate II Left Ventricular Assist System, at 3 different pump speeds. To our knowledge, this is the first report of such findings in this circumstance.
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Frommeyer G, Zumhagen S, Dechering DG, Larbig R, Bettin M, Löher A, Köbe J, Reinke F, Eckardt L. Intraoperative Defibrillation Testing of Subcutaneous Implantable Cardioverter-Defibrillator Systems-A Simple Issue? J Am Heart Assoc 2016; 5:e003181. [PMID: 27068637 PMCID: PMC4943283 DOI: 10.1161/jaha.115.003181] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background The results of the recently published randomized SIMPLE trial question the role of routine intraoperative defibrillation testing. However, testing is still recommended during implantation of the entirely subcutaneous implantable cardioverter‐defibrillator (S‐ICD) system. To address the question of whether defibrillation testing in S‐ICD systems is still necessary, we analyzed the data of a large, standard‐of‐care prospective single‐center S‐ICD registry. Methods and Results In the present study, 102 consecutive patients received an S‐ICD for primary (n=50) or secondary prevention (n=52). Defibrillation testing was performed in all except 4 patients. In 74 (75%; 95% CI 0.66–0.83) of 98 patients, ventricular fibrillation was effectively terminated by the first programmed internal shock. In 24 (25%; 95% CI 0.22–0.44) of 98 patients, the first internal shock was ineffective and further internal or external shock deliveries were required. In these patients, programming to reversed shock polarity (n=14) or repositioning of the sensing lead (n=1) or the pulse generator (n=5) led to successful defibrillation. In 4 patients, a safety margin of <10 J was not attained. Nevertheless, in these 4 patients, ventricular arrhythmias were effectively terminated with an internal 80‐J shock. Conclusions Although it has been shown that defibrillation testing is not necessary in transvenous ICD systems, it seems particular important for S‐ICD systems, because in nearly 25% of the cases the primary intraoperative test was not successful. In most cases, a successful defibrillation could be achieved by changing shock polarity or by optimizing the shock vector caused by the pulse generator or lead repositioning.
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Affiliation(s)
- Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Germany
| | - Sven Zumhagen
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Germany
| | - Dirk G Dechering
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Germany
| | - Robert Larbig
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Germany
| | - Markus Bettin
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Germany
| | - Andreas Löher
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Münster, Germany
| | - Julia Köbe
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Germany
| | - Florian Reinke
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Germany
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Calvagna GM, Vasquez L, Patanè F, Sansone F, Ceresa F, Tassone L, Patanè S. The safety and effectiveness of closure access leading venous advanced gain new ability. Int J Cardiol 2016; 207:39-43. [PMID: 26788821 DOI: 10.1016/j.ijcard.2016.01.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/02/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo, Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039, Taormina, (Messina), Italy.
| | - Ludovico Vasquez
- Cardiologia Ospedale San Vincenzo, Taormina (Me) and Cardiologia Presidio Ospedaliero "G. Fogliani", Milazzo (ME) Azienda Sanitaria Provinciale di Messina, Italy
| | - Francesco Patanè
- Cardiochirurgia Ospedale Papardo Messina, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, 98158 Messina, Italy
| | - Fabrizio Sansone
- Cardiochirurgia Ospedale Papardo Messina, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, 98158 Messina, Italy
| | - Fabrizio Ceresa
- Cardiochirurgia Ospedale Papardo Messina, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, 98158 Messina, Italy
| | - Laura Tassone
- Cardiochirurgia Ospedale Papardo Messina, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, 98158 Messina, Italy
| | - Salvatore Patanè
- Cardiologia Ospedale San Vincenzo, Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039, Taormina, (Messina), Italy
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El-Chami MF, Harbieh B, Levy M, Leon AR, Merchant FM. Clinical and electrocardiographic predictors of T wave oversensing in patients with subcutaneous ICD. J Arrhythm 2016; 32:181-5. [PMID: 27354862 PMCID: PMC4913160 DOI: 10.1016/j.joa.2016.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/18/2015] [Accepted: 01/07/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND T wave oversensing (TWOS) is a major drawback of the subcutaneous implantable cardioverter defibrillator (S-ICD). Data on predictors of TWOS in S-ICD recipients are limited. We sought to investigate predictors of TWOS in a cohort of patients receiving an S-ICD at our institution. METHODS S-ICD recipients at our center were identified retrospectively and stratified based on the presence or absence of TWOS. Clinical and electrocardiographic parameters were collected and compared between the 2 groups. RESULTS Ninety-two patients underwent an S-ICD implantation at our institution between April 2010 and January 2015. Six (6.5%) patients had TWOS. These patients were younger (38.1±13.7 vs. 52.3±16.1 years, p=0.04) and had higher left ventricle ejection fractions (48.5±14.9% vs. 28.4±12.2%, p<0.01) than patients without a history of TWOS. Baseline 12-lead electrocardiogram (ECG) parameters were not different between the 2 groups. Leads I, II, and avF (which mimic the sensing vectors of the S-ICD) were further inspected to identify ECG characteristics that could predict TWOS. The QRS amplitude in ECG lead I was significantly smaller in the TWOS group than in the non-TWOS group (3.7 vs. 7.4 mV, p=0.02). CONCLUSION In this study, younger age, higher ejection fraction, and lower QRS amplitude were associated with TWOS. These findings could help identify patients referred for S-ICD at high-risk of TWOS.
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Affiliation(s)
- Mikhael F El-Chami
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA 30308, USA
| | - Bernard Harbieh
- Department of Medicine, Division of Cardiology, American University of Beirut, AUBMC, Department of Internal Medicine, P.O. Box: 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Mathew Levy
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA 30308, USA
| | - Angel R Leon
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA 30308, USA
| | - Faisal M Merchant
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA 30308, USA
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Panna ME, Miles WM. The Subcutaneous Implantable Cardioverter-Defibrillator: A Practical Review and Real-World Use and Application. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016. [DOI: 10.15212/cvia.2015.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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45
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Calvagna GM, Patanè S, Ceresa F, Fontana A, Sicuso G, Vinci E, Muscio G, Vasquez L, Patanè F. Inadvertent implantation of a pacemaker lead in the left ventricle: A new challenge in cardiology. Int J Cardiol 2016; 202:914-7. [PMID: 26479958 DOI: 10.1016/j.ijcard.2015.10.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/04/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039, Taormina (Messina), Italy.
| | - Salvatore Patanè
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039, Taormina (Messina), Italy
| | - Fabrizio Ceresa
- Cardiochirurgia Ospedale Papardo Messina, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, 98158 Messina, Italy
| | - Alessandro Fontana
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039, Taormina (Messina), Italy
| | | | - Eugenio Vinci
- UOC Cardiologia Ospedale Umberto I° ASP Siracusa, Italy
| | | | - Ludovico Vasquez
- Cardiologia Ospedale San Vincenzo - Taormina (Me) and Cardiologia Presidio Ospedaliero "G. Fogliani" - Milazzo (ME) Azienda Sanitaria Provinciale di Messina, Italy
| | - Francesco Patanè
- Cardiochirurgia Ospedale Papardo Messina, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, 98158 Messina, Italy
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Verma N, Rhyner J, Knight BP. The subcutaneous implantable cardioverter and defibrillator: advantages, limitations and future directions. Expert Rev Cardiovasc Ther 2015; 13:989-99. [DOI: 10.1586/14779072.2015.1071189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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48
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Frommeyer G, Dechering DG, Zumhagen S, Löher A, Köbe J, Eckardt L, Reinke F. Long-term follow-up of subcutaneous ICD systems in patients with hypertrophic cardiomyopathy: a single-center experience. Clin Res Cardiol 2015; 105:89-93. [DOI: 10.1007/s00392-015-0901-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/30/2015] [Indexed: 01/14/2023]
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49
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Frommeyer G, Dechering DG, Zumhagen S, Köbe J, Eckardt L, Reinke F. Limitations in S-ICD therapy: reasons for system explantation. Clin Res Cardiol 2015; 104:902-7. [DOI: 10.1007/s00392-015-0880-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
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50
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EL-CHAMI MIKHAELF, LEVY MATHEW, KELLI HEVALM, CASEY MARY, HOSKINS MICHAELH, GOYAL ABHINAV, LANGBERG JONATHANJ, PATEL ANSHUL, DELURGIO DAVID, LLOYD MICHAELS, LEON ANGELR, MERCHANT FAISALM. Outcome of Subcutaneous Implantable Cardioverter Defibrillator Implantation in Patients with End-Stage Renal Disease on Dialysis. J Cardiovasc Electrophysiol 2015; 26:900-904. [DOI: 10.1111/jce.12705] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/24/2015] [Accepted: 04/29/2015] [Indexed: 11/28/2022]
Affiliation(s)
- MIKHAEL F. EL-CHAMI
- Division of Cardiology-Section of Electrophysiology, Department of Medicine; Emory University School of Medicine; Atlanta Georgia USA
| | | | - HEVAL M. KELLI
- Department of Medicine; Emory University School of Medicine; Atlanta Georgia USA
| | | | - MICHAEL H. HOSKINS
- Division of Cardiology-Section of Electrophysiology, Department of Medicine; Emory University School of Medicine; Atlanta Georgia USA
| | - ABHINAV GOYAL
- Division of Cardiology, Department of Medicine; Emory University School of Medicine; Atlanta Georgia USA
| | - JONATHAN J. LANGBERG
- Division of Cardiology-Section of Electrophysiology, Department of Medicine; Emory University School of Medicine; Atlanta Georgia USA
| | - ANSHUL PATEL
- Division of Cardiology-Section of Electrophysiology, Department of Medicine; Emory University School of Medicine; Atlanta Georgia USA
| | - DAVID DELURGIO
- Division of Cardiology-Section of Electrophysiology, Department of Medicine; Emory University School of Medicine; Atlanta Georgia USA
| | - MICHAEL S. LLOYD
- Division of Cardiology-Section of Electrophysiology, Department of Medicine; Emory University School of Medicine; Atlanta Georgia USA
| | - ANGEL R. LEON
- Division of Cardiology-Section of Electrophysiology, Department of Medicine; Emory University School of Medicine; Atlanta Georgia USA
| | - FAISAL M. MERCHANT
- Division of Cardiology-Section of Electrophysiology, Department of Medicine; Emory University School of Medicine; Atlanta Georgia USA
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