2
|
Magnusson P, Kastberg R. Balloon venoplasty opens the road for an implantable defibrillator patient with complex stenosis. Clin Case Rep 2017; 5:1067-1071. [PMID: 28680596 PMCID: PMC5494389 DOI: 10.1002/ccr3.1002] [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: 12/14/2016] [Revised: 03/20/2017] [Accepted: 04/20/2017] [Indexed: 11/07/2022] Open
Abstract
There is an increasing need for physicians to handle venous obstructions in pacemaker/implantable cardioverter-defibrillator implants. Venoplasty performed by an experienced operator is a simple, safe, and fast way to manage this situation and proceed to implant. Compared to other approaches, this strategy may offer particular advantages.
Collapse
Affiliation(s)
- Peter Magnusson
- Cardiology Research UnitDepartment of MedicineKarolinska InstitutetStockholmSE‐171 76Sweden
- Centre for Research and DevelopmentUppsala University/Region GävleborgGävleSE‐ 801 87Sweden
| | - Robert Kastberg
- Centre for Research and DevelopmentUppsala University/Region GävleborgGävleSE‐ 801 87Sweden
| |
Collapse
|
3
|
Bennett M, Parkash R, Nery P, Sénéchal M, Mondesert B, Birnie D, Sterns LD, Rinne C, Exner D, Philippon F, Campbell D, Cox J, Dorian P, Essebag V, Krahn A, Manlucu J, Molin F, Slawnych M, Talajic M. Canadian Cardiovascular Society/Canadian Heart Rhythm Society 2016 Implantable Cardioverter-Defibrillator Guidelines. Can J Cardiol 2016; 33:174-188. [PMID: 28034580 DOI: 10.1016/j.cjca.2016.09.009] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 09/25/2016] [Accepted: 09/26/2016] [Indexed: 11/26/2022] Open
Abstract
Sudden cardiac death is a major public health issue in Canada. However, despite the overwhelming evidence to support the use of implantable cardioverter defibrillators (ICDs) in the prevention of cardiac death there remains significant variability in implantation rates across Canada. Since the most recent Canadian Cardiovascular Society position statement on ICD use in Canada in 2005, there has been a plethora of new scientific information to assist physicians in their discussions with patients considered for ICD implantation to prevent sudden cardiac death due to ventricular arrhythmias. We have reviewed, critically appraised, and synthesized the pertinent evidence to develop recommendations regarding: (1) ICD implantation in the primary and secondary prevention of sudden cardiac death in patients with and without ischemic heart disease; (2) when it is reasonable to withhold ICD implantation on the basis of comorbidities; (3) ICD implantation in patients listed for heart transplantation; (4) implantation of a single- vs dual-chamber ICD; (5) implantation of single- vs dual-coil ICD leads; (6) the role of subcutaneous ICDs; and (7) ICD implantation infection prevention strategies. We expect that this document, in combination with the companion article that addresses the implementation of these guidelines, will assist all medical professionals with the care of patients who have had or at risk of sudden cardiac death.
Collapse
Affiliation(s)
- Matthew Bennett
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Ratika Parkash
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pablo Nery
- Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Mario Sénéchal
- Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Blandine Mondesert
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - David Birnie
- Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Laurence D Sterns
- Island Medical Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claus Rinne
- St Mary's General Hospital, Kitchener, Ontario, Canada
| | - Derek Exner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada.
| | | | - Jafna Cox
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Dorian
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vidal Essebag
- McGill University Health Centre, Montréal, Quebec, Canada
| | - Andrew Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaimie Manlucu
- London Cardiac Institute, University of Western Ontario, London, Ontario, Canada
| | - Franck Molin
- Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Michael Slawnych
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Mario Talajic
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| |
Collapse
|
4
|
Defibrillation Threshold Testing: Who Doesn't Get It? Card Electrophysiol Clin 2016; 4:135-41. [PMID: 26939810 DOI: 10.1016/j.ccep.2012.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Defibrillation testing has been routinely performed as part of the implantable cardioverter-defibrillator (ICD) implantation procedure, and is currently supported by practice guidelines; however, more recently, this practice has been called into question. Such testing is safe, and serious complications are rare. With modern ICD systems, physicians will rarely encounter a patient in whom defibrillation will fail. This article reviews the literature regarding the utility, necessity, complications, and cost of routine operative and follow-up defibrillation testing, and, it is hoped, clarifies the issue of "Who doesn't get it?"
Collapse
|
5
|
Tsurugi T, Matsui S, Nakajima H, Nishii N, Honda T, Kaneko Y. Various mechanisms and clinical phenotypes in electrical short circuits of high-voltage devices: report of four cases and review of the literature. Europace 2015; 17:909-14. [DOI: 10.1093/europace/euv022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/27/2015] [Indexed: 11/13/2022] Open
|
6
|
Keyser A, Hilker MK, Ucer E, Wittmann S, Schmid C, Diez C. Significance of intraoperative testing in right-sided implantable cardioverter-defibrillators. J Cardiothorac Surg 2013; 8:77. [PMID: 23577747 PMCID: PMC3639089 DOI: 10.1186/1749-8090-8-77] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 04/08/2013] [Indexed: 11/12/2022] Open
Abstract
Background Implantation of implantable cardioverter-defibrillators (ICD) from the left pectoral region is the standard therapeutical method. Increasing numbers of system revisions due to lead dysfunction and infections will consecutively increase the numbers of right-sided implantations. The reliability of devices implanted on the right pectoral side remains controversially discussed, and the question of testing these devices remains unanswered. Methods In a prospectively designed study all 870 patients (60.0±14 years, 689 male) who were treated with a first ICD from July 2005 until May 2012 and tested intraoperatively according to the testing protocol were analyzed. The indication for implantation was primary prophylactic in 71.5%. Underlying diseases included ischemic cardiomyopathy (50%), dilative cardiomyopathy (37%), and others (13%). Mean ejection faction was 27±12%. Implantation site was right in 4.5% and left in 95.5%. Results Five patients supplied with right-sided ICD (13%, p = 0.02 as compared to left-sided) failed initial intraoperative testing with 21 J. 3 patients were male. The age of the patients failing intraoperative testing with right-sided devices appeared higher than of patients with left-sided devices (p = 0.07). The ejection fraction was 28±8%. All patients reached a sufficient DFT ≤ 21 J after corrective procedures. Conclusion Implantation of ICDs on the right side results in significantly higher failure rate of successful termination of intraoperatively induced ventricular fibrillation. The data of our study suggest the necessity of intraoperative ICD testing in right-sided implanted ICDs.
Collapse
Affiliation(s)
- Andreas Keyser
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany.
| | | | | | | | | | | |
Collapse
|
7
|
Saito A, Kaneko Y, Nakajima T, Irie T, Ota M, Kato T, Iijima T, Akiyama M, Ito T, Manita M, Kurabayashi M. Left-sided ICD implantation via right-sided venous access in a patient with left hemodialysis fistula. Intern Med 2010; 49:221-2. [PMID: 20118598 DOI: 10.2169/internalmedicine.49.2787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A sufficient patency of the central vein ipsilateral to atriovenous fistula is the lifeline for hemodialysis patients. We describe a case with left dialysis fistula who underwent left-sided pectoral implantation of an implantable cardioverter defibrillator via right subclavicular venous access in order to avoid the possibility of development of left subclavian stenosis or occlusion and to achieve lower defibrillation thresholds. This approach may serve as an alternative choice in patients unsuitable for left-sided venous access and with higher defibrillation thresholds on right-positioned implantable cardioverter defibrillator.
Collapse
Affiliation(s)
- Akihiro Saito
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Gold MR, Shih HT, Herre J, Breiter D, Zhang Y, Schwartz M. Comparison of defibrillation efficacy and survival associated with right versus left pectoral placement for implantable defibrillators. Am J Cardiol 2007; 100:243-6. [PMID: 17631078 DOI: 10.1016/j.amjcard.2007.02.087] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 02/22/2007] [Accepted: 02/22/2007] [Indexed: 11/29/2022]
Abstract
The preferred location for an implantable cardioverter-defibrillator (ICD) generator is the left pectoral region as a result of the shock vector formed by the active can and the lead system. However, a right pectoral site is necessary when left-sided implantation is contraindicated. The Low Energy Safety Study was a prospective, randomized trial conducted to assess chronic defibrillation efficacy in 627 patients, including 37 (5.9%) who received right pectoral implants and 590 (94.1%) who received left pectoral implants. Patients were followed for a mean of 24 +/- 13 months. There were no significant differences observed between patients who received left versus right pectoral implants in age, gender, indications, New York Heart Association classification, or ejection fraction. Patients who received a right pectoral implant had higher defibrillation thresholds at implantation (10.6 +/- 3.8 J) than those who received a left pectoral implant (8.9 +/- 4.2 J, p = 0.01) despite similar shock impedances. The conversion efficacy for spontaneous arrhythmia episodes among patients who received right and left pectoral implants were not significantly different (33 of 33 [100%] vs 255 of 263 [97%], respectively; p = 0.31). In addition, the conversion efficacy for induced ventricular fibrillation episodes were also similar (187 of 188 [99%] on the right vs 2429 of 2475 [98%] on the left, p = 0.18). However, the all-cause mortality rate was higher for patients who received right-sided implants (hazard ratio 1.93, p <0.004). In conclusion, defibrillation thresholds are higher with right pectoral implants compared with left-sided implants, but with a proper energy safety margin, there are no significant differences in spontaneous or induced shock conversion efficacy. However, the near doubling of the mortality rate among patients with right-sided implants needs to be considered when recommending such device therapy.
Collapse
Affiliation(s)
- Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA.
| | | | | | | | | | | |
Collapse
|
9
|
Rashba EJ, Farasat M, Kirk MM, Shorofsky SR, Peters RW, Gold MR. Effect of an active abdominal pulse generator on defibrillation thresholds with a dual-coil, transvenous ICD lead system. J Cardiovasc Electrophysiol 2006; 17:617-20. [PMID: 16836709 DOI: 10.1111/j.1540-8167.2006.00374.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Many patients with implantable cardioverter defibrillators (ICDs) have older lead systems, which are usually not replaced at the time of pulse generator replacement unless a malfunction is noted. Therefore, optimization of defibrillation with these lead systems is clinically important. The objective of this prospective study was to determine if an active abdominal pulse generator (Can) affects chronic defibrillation thresholds (DFTs) with a dual-coil, transvenous ICD lead system. METHODS AND RESULTS The study population consisted of 39 patients who presented for routine abdominal pulse generator replacement. Each patient underwent two assessments of DFT using a step-down protocol, with the order of testing randomized. The distal right ventricular (RV) coil was the anode for the first phase of the biphasic shocks. The proximal superior vena cava (SVC) coil was the cathode for the Lead Alone configuration (RV --> SVC). For the Active Can configuration, the SVC coil and Can were connected electrically as the cathode (RV --> SVC + Can). The Active Can configuration was associated with a significant decrease in shock impedance (39.5 +/- 5.8 Omega vs. 50.0 +/- 7.6 Omega, P < 0.01) and a significant increase in peak current (8.3 +/- 2.6 A vs. 7.2 +/- 2.4 A, P < 0.01). There was no significant difference in DFT energy (9.0 +/- 4.6 J vs. 9.8 +/- 5.2 J) or leading edge voltage (319 +/- 86 V vs. 315 +/- 83 V). An adequate safety margin for defibrillation (> or =10 J) was present in all patients with both shocking configurations. CONCLUSION DFTs are similar with the Active Can and Lead Alone configurations when a dual-coil, transvenous lead is used with a left abdominal pulse generator. Since most commercially available ICDs are only available with an active can, our data support the use of an active can device with this lead system for patients who present for routine pulse generator replacement.
Collapse
Affiliation(s)
- Eric J Rashba
- Division of Cardiology, University of Maryland School of Medicine, Baltimore, Maryland 21201-1595, USA.
| | | | | | | | | | | |
Collapse
|