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Mavragani A, Zhang Z, Gong C, Fang Y. The Effect of Prophylactic Intravenous Amiodarone Administration on Reperfusion Ventricular Fibrillation in Patients With Left Ventricular Hypertrophy Undergoing Cardiopulmonary Bypass Surgery: Protocol for a Randomized Double-Blind Clinical Trial. JMIR Res Protoc 2023; 12:e40115. [PMID: 36705966 PMCID: PMC9919463 DOI: 10.2196/40115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Ventricular fibrillation (VF) is a common arrhythmia that occurs after the release of aortic cross-clamp (ACC) in patients undergoing cardiopulmonary bypass (CPB) surgery. Repeated defibrillation and long duration of VF could increase myocardial injuries. In patients with left ventricular hypertrophy (LVH), VF is easier to occur and more difficult to be terminated. Amiodarone, known as class III antiarrhythmic agent, has the prominent properties of converting VF and restoring the sinus rhythm. Before ACC release, administration of amiodarone has been confirmed useful to reduce occurrence of VF. However, few studies are focused on the effect of amiodarone before ACC release on reducing VF in patients with LVH. OBJECTIVE This study aimed at determining the efficacy of prophylactic intravenous amiodarone administration on reperfusion VF after release of ACC in patients with LVH undergoing CPB surgery. METHODS This will be a prospective, randomized, double-blind, placebo-controlled trial. The trial will enroll 54 patients with LVH aged 18-75 years who will undergo CPB surgery. All eligible participants will be randomly allocated to either the amiodarone or placebo group by using the block randomization in a 1:1 ratio. The primary end point will be the incidence rate of VF 30 minutes after ACC release and be assessed using the Fisher exact test. All data will be analyzed in accordance with the intention-to-treat principle. RESULTS The study began in August 2022, and the data collection will take place for the next 2 academic years. As of this writing, 21 participants have already been recruited for the study. CONCLUSIONS With this trial, we are hoping to demonstrate that prophylactic infusion of amiodarone before ACC release could reduce the occurrence of reperfusion VF in patients with LVH. TRIAL REGISTRATION ClinicalTrials.gov ChiCTR2000035057; https://www.chictr.org.cn/showprojen.aspx?proj=57145. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40115.
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Affiliation(s)
| | - Zhenfeng Zhang
- Department of Anesthesia and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chanjuan Gong
- Department of Anesthesia and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yin Fang
- Department of Anesthesia and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Kavsur R, Becher MU, Nassan W, Sedaghat A, Aksoy A, Schrickel JW, Nickenig G, Tiyerili V. CHA 2DS 2-VASC score predicts coronary artery disease progression and mortality after ventricular arrhythmia in patients with implantable cardioverter-defibrillator. IJC HEART & VASCULATURE 2021; 34:100802. [PMID: 34095451 PMCID: PMC8165543 DOI: 10.1016/j.ijcha.2021.100802] [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: 04/06/2021] [Revised: 05/06/2021] [Accepted: 05/15/2021] [Indexed: 11/14/2022]
Abstract
AIM The CHA2DS2-VASC score has expanded its use beyond the initial purpose of predicting the risk of stroke in patients with atrial fibrillation. We aimed to investigate the value of the CHA2DS2-VASC score as a risk assessment tool to predict relevant coronary artery disease (CAD) leading to percutaneous coronary intervention (PCI), and all-cause mortality after detected ventricular arrhythmia (VA) in patients with an Implantable Cardioverter-Defibrillator (ICD). METHODS A total of 183 ICD-patients who underwent coronary angiography after VA were included and classified according to their CHA2DS2-VASC score in a low(1-3), intermediate(4-5) and high(6-8) score group. We evaluated the predictive value of CHA2DS2-VASC score for the presence of relevant CAD leading to percutaneous coronary intervention (PCI), as well as late all-cause mortality. RESULTS A total of 60 patients (32.8%) had significant CAD and underwent successful PCI. After adjustment for relevant parameters such as ischemic cardiomyopathy, angina pectoris, left ventricular ejection fraction, CHA2DS2-VASC score remained the only independent predictor of CAD leading to PCI [HR 1.73 (1.07-2.80)]. The Area under curve was 0.64 (0.56-72, p = 0.002). Kaplan-Meier analysis and log-rank showed an increased three-year mortality of ICD-patients with an intermediate or high score after VA (p = 0.003). Multivariate cox-regression analysis revealed that CHA2DS2-VASC score was also independently associated with all-cause mortality following adjustment for clinically relevant variables (HR 2.20, 1.17-4.14). CONCLUSIONS CHA2DS2-VASC score can be a predictor of CAD leading to PCI in ICD-patients after VA. ICD-Patients with a high score have an increased risk for reduced three-year all-cause mortality after VA.
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Key Words
- AF, Atrial fibrillation
- CABG, Coronary artery bypass graft
- CAD, Coronary artery disease
- CK-MB, Creatine Kinase MB Isoenzyme
- Coronary angiography
- Coronary artery disease
- ICD, Implantable Cardioverter-Defibrillator
- Implantable Cardioverter Defibrillator
- LDL, Low-Density Lipoprotein
- LVEF, Left Ventricular Ejection Fraction
- PCI, Percutaneous Coronary Intervention
- VA, Ventricular Arrhythmia
- VF, Ventricular Fibrillation
- VT, Ventricular Tachycardia
- Ventricular fibrillation
- Ventricular tachycardia
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Affiliation(s)
- Refik Kavsur
- Corresponding author at: Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | | | - Welat Nassan
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Sedaghat
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Adem Aksoy
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jan Wilko Schrickel
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Vedat Tiyerili
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Aktaş MK, Younis A, Zareba W, Kutyifa V, Klein H, Daubert JP, Estes M, McNitt S, Polonsky B, Goldenberg I. Survival After Implantable Cardioverter-Defibrillator Shocks. J Am Coll Cardiol 2021; 77:2453-2462. [PMID: 34016257 DOI: 10.1016/j.jacc.2021.03.329] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There are conflicting data on the impact of implantable cardioverter-defibrillator (ICD) shocks on subsequent mortality. OBJECTIVES The aim of this study was to determine whether the arrhythmic substrate leading to ICD therapy or the therapy itself increases mortality. METHODS The study cohort included 5,516 ICD recipients who were enrolled in 5 landmark ICD trials (MADIT-II, MADIT-RISK, MADIT-CRT, MADIT-RIT, RAID). The authors evaluated the association of device therapy with subsequent mortality in 4 separate time-dependent models: model I, type of ICD therapy; model II, type of arrhythmia for which ICD therapy was delivered; model III, combined assessment of all arrhythmia and therapy types during follow-up; and model IV, incremental risk associated with repeated ICD shocks. RESULTS When analyzed by the type of ICD therapy (model I), a first appropriate ICD shock was associated with increased risk of subsequent mortality with or without concomitant occurrence of inappropriate shock during follow-up (hazard ratio [HR]: 2.78 and 2.31; p < 0.001 and p = 0.12), whereas inappropriate shock alone was not associated with mortality risk (HR: 1.23; p = 0.42). Similarly, ICD therapy for ventricular tachycardia (VT) ≥200 beats/min or ventricular fibrillation (VF) (model II) was associated with increased risk of death with or without concomitant therapy for VT <200 beats/min (HRs: 2.25 and 2.62; both p < 0.001), whereas appropriate therapy for VT <200 beats/min or inappropriate therapy (regardless of etiology) did not reach statistical significance (all p > 0.10). Combined assessment of all therapy and arrhythmia types during follow-up (model III) showed that appropriate ICD shocks for VF, shocks for fast VT (≥200 beats/min) without prior antitachycardia pacing (ATP), as well as shocks for fast VT delivered after failed ATP, were associated with the highest risk of subsequent death (HR: all >2.8; p < 0.001). Finally, 2 or more ICD appropriate shocks were not associated with incremental risk to the first appropriate ICD shock (model IV). CONCLUSION The combined data from 5 landmark ICD trials suggest that the underlying arrhythmic substrate rather than the ICD therapy is the more important determinant of mortality in ICD recipients.
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Affiliation(s)
- Mehmet K Aktaş
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA.
| | - Arwa Younis
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA. https://twitter.com/arwayounis2
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Helmut Klein
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - James P Daubert
- Division of Cardiology, Duke University, Durham, North Carolina, USA
| | - Mark Estes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Scott McNitt
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Bronislava Polonsky
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
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Bodin A, Labas V, Bisson A, Teixeira-Gomes AP, Blasco H, Tomas D, Combes-Soia L, Marcelo P, Miquelestorena-Standley E, Baron C, Angoulvant D, Babuty D, Clementy N. Acute pathophysiological myocardial changes following intra-cardiac electrical shocks using a proteomic approach in a sheep model. Sci Rep 2020; 10:20252. [PMID: 33219330 PMCID: PMC7679418 DOI: 10.1038/s41598-020-77346-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/04/2020] [Indexed: 12/18/2022] Open
Abstract
Implantable cardioverter-defibrillators (ICD) are meant to fight life-threatening ventricular arrhythmias and reduce overall mortality. Ironically, life-saving shocks themselves have been shown to be independently associated with an increased mortality. We sought to identify myocardial changes at the protein level immediately after ICD electrical shocks using a proteomic approach. ICD were surgically implanted in 10 individuals of a healthy male sheep model: a control group (N = 5) without any shock delivery and a shock group (N = 5) with the delivery of 5 consecutive shocks at 41 J. Myocardial tissue samples were collected at the right-ventricle apex near to the lead coil and at the right ventricle basal free wall region. Global quantitative proteomics experiments on myocardial tissue samples were performed using mass spectrometry techniques. Proteome was significantly modified after electrical shock and several mechanisms were associated: protein, DNA and membrane damages due to extreme physical conditions induced by ICD-shock but also due to regulated cell death; metabolic remodeling; oxidative stress; calcium dysregulation; inflammation and fibrosis. These proteome modifications were seen in myocardium both "near" and "far" from electrical shock region. N-term acetylated troponin C was an interesting tissular biomarker, significantly decreased after electrical shock in the "far" region (AUC: 0.93). Our data support an acute shock-induced myocardial tissue injury which might be involved in acute paradoxical deleterious effects such as heart failure and ventricular arrhythmias.
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Affiliation(s)
- Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France.
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France.
| | - Valérie Labas
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France
- INRAE, CHU de Tours, Plate-Forme de Chirurgie Et D'Imagerie Pour La Recherche Et L'Enseignement, Université de Tours, 37380, Nouzilly, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France
| | | | - Hélène Blasco
- Imagerie Et Cerveau - UMR 1253, Université de Tours, Tours, France
| | - Daniel Tomas
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France
- INRAE, CHU de Tours, Plate-Forme de Chirurgie Et D'Imagerie Pour La Recherche Et L'Enseignement, Université de Tours, 37380, Nouzilly, France
| | - Lucie Combes-Soia
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France
- INRAE, CHU de Tours, Plate-Forme de Chirurgie Et D'Imagerie Pour La Recherche Et L'Enseignement, Université de Tours, 37380, Nouzilly, France
| | - Paulo Marcelo
- Plate-Forme ICAP, Centre Universitaire de Recherche en Santé, Université de Picardie Jules Verne, 80054, Amiens, France
| | | | - Christophe Baron
- Transplantation, Immunologie et Inflammation T2i - EA 4245, Université de Tours, Tours, France
| | - Denis Angoulvant
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France
- Transplantation, Immunologie et Inflammation T2i - EA 4245, Université de Tours, Tours, France
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France
| | - Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France
- Transplantation, Immunologie et Inflammation T2i - EA 4245, Université de Tours, Tours, France
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Weigand S, O'Connor M, Blažek P, Kantenwein V, Friedrich L, Grebmer C, Schaarschmidt C, von Olshausen G, Reents T, Deisenhofer I, Lennerz C, Kolb C. Release of high-sensitive TROPonin T by implantation of an entirely subcutaneous Implantable Cardioverter-defibrillator compared to a conventional transvenous approach: the TROPIC registry. J Interv Card Electrophysiol 2020; 62:75-81. [PMID: 32959177 DOI: 10.1007/s10840-020-00874-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/10/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD) has become an alternative option when a conventional transvenous approach is not suitable. The myocardial damage caused by S-ICD implantation appears to be minimal despite mandatory defibrillation threshold (DFT) testing. However, there has not been a direct comparison with the traditional transvenous placement of a single-chamber ICD (VVI-ICD). The aim of this study was to determine the extent of myocardial damage by analysing the changes in serum levels of cardiac enzymes after S-ICD implantation in comparison with VVI-ICD. METHODS In 43 patients who received an S-ICD system, differences in serum levels of high-sensitive troponin T (ΔhsTnT) and creatine kinase total (ΔCK) and muscle brain fraction (ΔCK-MB) were acquired by blood sampling before and the day after implantation. The control group consisted of 43 patients from the TropShock study who had received a transvenous VVI-ICD without DFT. RESULTS After S-ICD implantation and testing procedure, ΔhsTnT (0.000 ng/ml, IQR - 0.003-0.002 ng/ml) was significantly lower than after conventional VVI-ICD implantation (0.018 ng/ml, IQR 0.004-0.032 ng/ml; p < 0.001). There was no significant difference in CK (ΔCKS-ICD 85.0 U/I, IQR 30.5-225.8 U/I vs ΔCKVVI-ICD 69.5 U/I, IQR 22.9-172.3 U/I; p = 0.357), but there was a significant difference in CK-MB (ΔCK-MBS-ICD of - 0.60, IQR - 2.60-1.0 vs ΔCK-MBVVI-ICD 1.0, IQR - 1.08-3.18; p = 0.030). CONCLUSION S-ICD implantation causes less myocardial damage than VVI-ICD implantation evidenced by ΔhsTnT and ΔCK-MB.
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Affiliation(s)
- Severin Weigand
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
| | - Matthew O'Connor
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - Patrick Blažek
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Verena Kantenwein
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Lena Friedrich
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Christian Grebmer
- Abteilung für Elektrophysiologie, Kantonsspital Luzern, Herzzentrum, Lucerne, Switzerland
| | - Claudia Schaarschmidt
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Gesa von Olshausen
- Medizinische Klinik I, Klinikum rechts der Isar, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Tilko Reents
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Isabel Deisenhofer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Carsten Lennerz
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christof Kolb
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
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D'Onofrio A, Russo V, Bianchi V, Cavallaro C, Leonardi S, De Vivo S, Vecchione F, Rago A, Ammendola E, Tavoletta V, Atripaldi L, Mocavero PE, Nigro G. Effects of defibrillation shock in patients implanted with a subcutaneous defibrillator: a biomarker study. Europace 2019; 20:f233-f239. [PMID: 29095967 PMCID: PMC6140430 DOI: 10.1093/europace/eux330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/27/2017] [Indexed: 11/13/2022] Open
Abstract
Aims Implantable cardioverter defibrillator (ICD) shocks are associated with a subsequent increased risk of death, and an elevation of cardiac enzymes has been measured after defibrillation testing (DFT). In an experimental swine study, subcutaneous ICD (S-ICD) shocks caused less myocardial damage than traditional ICD shocks. The aim of our study was to investigate the association between S-ICD shock and acute cardiac damage in humans, as evaluated by means of sensitive and highly specific circulating biomarkers. Methods and results We calculated the variation in the serum levels of high-sensitivity cardiac troponin I (hs-CTnI) and creatine kinase-MB mass concentration (CK-MB mass), measured before and after an S-ICD shock delivered during intraoperative DFT. We also measured the degree of haemodynamic stress, as the variation in the serum levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and copeptin (CP), after the S-ICD shock. We analysed 30 consecutive patients who received an S-ICD and who underwent DFT by means of a single 65 J shock. The levels of biomarkers did not change from baseline to 1 h post-shock, i.e. hs-CTnI (from 0.029 ± 0.005 ng/mL to 0.030 ± 0.005 ng/mL, P = 0.079) and CK-MB mass (from 1.37 ± 0.17 ng/mL to 1.41 ± 0.18, P = 0.080) and remained stable 6 and 24 h after DFT. The plasma NT-proBNP did not change, whereas CP levels were significantly higher at 1 h post-shock evaluation. However, 6 h after DFT, the levels had returned to the baseline and remained stable at 24 h. Conclusion The S-ICD shock did not seem to cause myocardial injuries. Although CP levels temporarily rose after DFT, they returned to basal levels within 6 h, which suggests that DFT does not have long-term prognostic implications. ICD shocks are associated with a subsequent increased risk of death, and an elevation of cardiac enzymes has been measured after DFT. We showed that serum levels of biomarkers of myocardial damage did not increase after high-energy DFT in patients who had undergone S-ICD device implantation. This suggests that S-ICD shock does not have long-term prognostic implications.
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Affiliation(s)
- Antonio D'Onofrio
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Vincenzo Russo
- Chair of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Valter Bianchi
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Ciro Cavallaro
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Silvia Leonardi
- Hematology and Cellular Immunology (Clinical Biochemistry), Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Stefano De Vivo
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Filippo Vecchione
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Anna Rago
- Chair of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Ernesto Ammendola
- Chair of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Vincenzo Tavoletta
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Luigi Atripaldi
- Hematology and Cellular Immunology (Clinical Biochemistry), Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Paola Elvira Mocavero
- Post Operative Intensive Care Unit, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Gerardo Nigro
- Chair of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
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Naka KK, Bazoukis G, Bechlioulis A, Korantzopoulos P, Michalis LK, Ntzani EE. Association between atrial fibrillation and patient-important outcomes in heart failure patients with implantable cardioverter-defibrillators: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:96-104. [PMID: 30462233 DOI: 10.1093/ehjqcco/qcy054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 01/05/2023]
Abstract
AIMS To assess the association between atrial fibrillation (AF) and all-cause mortality and implantable cardioverter-defibrillators (ICDs) therapies in heart failure (HF) patients with reduced ejection fraction and an ICD implanted. METHODS AND RESULTS A systematic MEDLINE search performed from inception through November 2016, supplemented by hand searching of reference lists, identified 62 eligible studies (227 998 patients) reporting on the association between AF and outcomes in HF patients; 36 studies included data on all-cause mortality, 30 on appropriate, and 17 on inappropriate ICD interventions. Hazard ratio, risk ratio, or odds ratio estimates were used based on data availability. Effect estimates were synthesized under a random-effects model. Implantable cardioverter-defibrillator-implanted HF patients with a history of AF had a 42% {combined effect estimate (cEE) 1.42 [95% confidence interval (CI) 1.28-1.57]} higher risk of all-cause mortality compared with patients with no AF history. Furthermore, AF patients had a higher risk of appropriate [cEE 1.44 (95% CI 1.27-1.64)] and inappropriate ICD interventions [cEE 2.05 (95% CI 1.75-2.44)]. CONCLUSION Atrial fibrillation history is statistically significantly associated with adverse major clinical outcomes in ICD-implanted HF patients. Patients with AF have a higher risk of all-cause mortality, appropriate, and inappropriate ICD interventions compared with patients with no AF history. Whether AF may have an independent deleterious effect on HF prognosis or may simply be a marker of HF severity should be further investigated.
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Affiliation(s)
- Katerina K Naka
- 2nd Department of Cardiology, University of Ioannina Medical School, University Campus, Ioannina, Greece
| | - George Bazoukis
- Department of Cardiology, Catheterization Laboratory, Evangelismos General Hospital of Athens, Ipsilantou 45-47, Athens, Greece
| | - Aris Bechlioulis
- 2nd Department of Cardiology, University of Ioannina Medical School, University Campus, Ioannina, Greece
| | - Panagiotis Korantzopoulos
- 1st Department of Cardiology, University of Ioannina Medical School, University Campus, Ioannina, Greece
| | - Lampros K Michalis
- 2nd Department of Cardiology, University of Ioannina Medical School, University Campus, Ioannina, Greece
| | - Evangelia E Ntzani
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, University Campus, Ioannina, Greece
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8
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Impact of Implantable Cardioverter-Defibrillator Interventions on All-Cause Mortality in Heart Failure Patients. Cardiol Rev 2019; 27:160-166. [PMID: 30052536 DOI: 10.1097/crd.0000000000000226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Biton Y, Daimee UA, Baman JR, Kutyifa V, McNitt S, Polonsky B, Zareba W, Goldenberg I. Prognostic Importance of Defibrillator-Appropriate Shocks and Antitachycardia Pacing in Patients With Mild Heart Failure. J Am Heart Assoc 2019; 8:e010346. [PMID: 30857452 PMCID: PMC6475071 DOI: 10.1161/jaha.118.010346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients with heart failure and an implantable cardioverter-defibrillator ( ICD ) for primary prevention are at increased mortality risk after receiving shock therapy. We sought to determine the prognostic significance of ICD therapies, both shock and antitachycardia pacing, delivered for different ventricular arrhythmia ( VA ) rates. Methods and Results We evaluated mortality risk among 1790 ICD -implanted patients from MADIT -CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). For the first analysis, patients were divided into mutually exclusive groups by the rate of treated VA only: slow VA (<200 beats per minute) and fast VA (≥200 beats per minute or ventricular fibrillation). In a secondary analysis, both the type of ICD therapy and VA rate were used. The reference group was always patients who had no ICD therapy. ICD therapy for fast VA was associated with increased mortality risk (hazard ratio [ HR] , 2.27; 95% CI , 1.48-3.48; P<0.001). However, mortality risk after ICD therapy for slow VA was similar to the risk related to no ICD therapy ( HR , 1.45; 95% CI , 0.86-2.44; P=0.162). Consistently, shocks ( HR , 2.96; 95% CI , 1.91-4.60; P<0.001) and antitachycardia pacing ( HR , 2.22; 95% CI , 0.96-5.14; P=0.063) for fast VA were both associated with increased mortality risk. Shocks and antitachycardia pacing for slow VA were not significantly associated with increased mortality risk ( HR , 1.43 [95% CI , 0.52-3.92; P=0.489]; and HR , 1.43 [95% CI, 0.80-2.56; P=0.232], respectively). Conclusions In patients with mild heart failure receiving ICD for primary prevention, mortality is associated with the rate of underlying VA rather than the type of therapy. These findings suggest that fast VA is a marker for increased mortality rather than shock therapy directly contributing to increased risk. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 00180271.
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Affiliation(s)
- Yitschak Biton
- 1 Heart Research Follow-Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY.,2 Massachusetts General Hospital Harvard Medical School Boston MA.,3 Department of Cardiology Hadassah Medical Center Hadassah School of Medicine Hebrew University Jerusalem Israel
| | - Usama A Daimee
- 1 Heart Research Follow-Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY
| | - Jayson R Baman
- 1 Heart Research Follow-Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY.,4 Department of Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Valentina Kutyifa
- 1 Heart Research Follow-Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY
| | - Scott McNitt
- 1 Heart Research Follow-Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY
| | - Bronislava Polonsky
- 1 Heart Research Follow-Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY
| | - Wojciech Zareba
- 1 Heart Research Follow-Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY
| | - Ilan Goldenberg
- 1 Heart Research Follow-Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY
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Sanders P, Connolly AT, Nabutovsky Y, Fischer A, Saeed M. Increased Hospitalizations and Overall Healthcare Utilization in Patients Receiving Implantable Cardioverter-Defibrillator Shocks Compared With Antitachycardia Pacing. JACC Clin Electrophysiol 2018; 4:243-253. [DOI: 10.1016/j.jacep.2017.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 11/16/2022]
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11
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Zheng Y, Gu Q, Chen HW, Peng HM, Jia DY, Zhou Y, Xiang MX. Efficacy of amiodarone and lidocaine for preventing ventricular fibrillation after aortic cross-clamp release in open heart surgery: a meta-analysis of randomized controlled trials. J Zhejiang Univ Sci B 2017; 18:1113-1122. [PMID: 29204991 PMCID: PMC5742294 DOI: 10.1631/jzus.b1700229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/16/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The relative preventative efficacy of amiodarone and lidocaine for ventricular fibrillation (VF) after release of an aortic cross-clamp (ACC) during open heart surgery has not been determined. This meta-analysis was designed to systematically evaluate the influence of amiodarone, lidocaine, or placebo on the incidence of VF after ACC. METHODS Prospective randomized controlled trials (RCTs) that compared the VF-preventative effects of amiodarone with lidocaine, or amiodarone or lidocaine with placebo were included. PubMed, EMBASE, and the Cochrane Library were searched for relevant RCTs. Fixed or randomized effect models were applied according to the heterogeneity of the data from the selected studies. RESULTS We included eight RCTs in the analysis. Pooled results suggested that the preventative effects of amiodarone and lidocaine were comparable (relative risk (RR)=1.12, 95% confidence interval (CI): 0.70 to 1.80, P=0.63), but both were superior to the placebo (amiodarone, RR=0.71, 95% CI: 0.51 to 1.00, P=0.05; lidocaine, RR=0.63, 95% CI: 0.46 to 0.88, P=0.006). The percentage of patients requiring electric defibrillation counter shocks (DCSs) did not differ significantly among patients administered amiodarone (RR=0.21, 95% CI: 0.04 to 1.19, P=0.08), lidocaine (RR=2.44, 95% CI: 0.13 to 44.02, P=0.55), or the placebo (RR=0.56, 95% CI: 0.25 to 1.25, P=0.16). CONCLUSIONS Amiodarone and lidocaine are comparably effective in preventing VF after ACC, but the percentage of patients who subsequently require DCSs does not differ among those administered amiodarone, lidocaine, or placebo.
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Affiliation(s)
- Yong Zheng
- Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
- Cardiovascular Key Lab of Zhejiang Province, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Qiang Gu
- Department of Anesthesiology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Hong-wu Chen
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Huai-ming Peng
- Department of Respiratory, Tinhu People's Hospital, Yancheng 224001, China
| | - Dong-yu Jia
- Department of Biology, Georgia Southern University, Statesboro 30460, USA
| | - Yu Zhou
- Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
- Cardiovascular Key Lab of Zhejiang Province, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Mei-xiang Xiang
- Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
- Cardiovascular Key Lab of Zhejiang Province, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
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Mina GS, Acharya M, Shepherd T, Gobrial G, Tekeste M, Watti H, Bhandari R, Saini A, Reddy P, Dominic P. Digoxin Is Associated With Increased Shock Events and Electrical Storms in Patients With Implantable Cardioverter Defibrillators. J Cardiovasc Pharmacol Ther 2017; 23:142-148. [DOI: 10.1177/1074248417732416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- George S. Mina
- Department of Cardiology, LSU Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Madan Acharya
- Department of Cardiology, LSU Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Taylor Shepherd
- Department of Cardiology, LSU Health Sciences Center Shreveport, Shreveport, LA, USA
| | - George Gobrial
- Department of Medicine, LSU Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Michael Tekeste
- Department of Medicine, LSU Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Hussam Watti
- Department of Cardiology, LSU Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Ruchi Bhandari
- Department of Cardiology, LSU Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Aditya Saini
- Department of Cardiology, LSU Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Pratap Reddy
- Department of Cardiology, LSU Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Paari Dominic
- Department of Cardiology, LSU Health Sciences Center Shreveport, Shreveport, LA, USA
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STRICKBERGER SADAM, CANBY ROBERT, COOPER JOSHUA, COPPESS MARK, DOSHI RAHUL, JOHN ROY, CONNOLLY ALLISONT, ROBERTS GREGORY, KARST EDWARD, DAOUD EMILEG. Association of Antitachycardia Pacing or Shocks With Survival in 69,000 Patients With an Implantable Defibrillator. J Cardiovasc Electrophysiol 2017; 28:416-422. [DOI: 10.1111/jce.13170] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/11/2017] [Accepted: 01/18/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - ROBERT CANBY
- Texas Cardiac Arrhythmia Institute; Austin Texas USA
| | - JOSHUA COOPER
- Temple University Health System; Philadelphia Pennsylvania USA
| | - MARK COPPESS
- Stern Cardiovascular Foundation; Memphis Tennessee USA
| | - RAHUL DOSHI
- University of Southern California; Los Angeles California USA
| | - ROY JOHN
- Brigham and Women's Hospital; Boston Massachusetts USA
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Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, Aguinaga L, Berger RD, Cuesta A, Daubert JP, Dubner S, Ellenbogen KA, Estes NAM, Fenelon G, Garcia FC, Gasparini M, Haines DE, Healey JS, Hurtwitz JL, Keegan R, Kolb C, Kuck KH, Marinskis G, Martinelli M, McGuire M, Molina LG, Okumura K, Proclemer A, Russo AM, Singh JP, Swerdlow CD, Teo WS, Uribe W, Viskin S, Wang CC, Zhang S. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. J Arrhythm 2016; 32:1-28. [PMID: 26949427 PMCID: PMC4759125 DOI: 10.1016/j.joa.2015.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Key Words
- AF, atrial fibrillation
- ATP, antitachycardia pacing
- Bradycardia mode and rate
- CI, confidence interval
- CL, cycle length
- CRT, cardiac resynchronization therapy
- CRT-D, cardiac resynchronization therapy–defibrillator
- DT, defibrillation testing
- Defibrillation testing
- EEG, electroencephalography
- EGM, electrogram
- HF, heart failure
- HR, hazard ratio
- ICD, implantable cardioverter-defibrillator
- Implantable cardioverter-defibrillator
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- MI, myocardial infarction
- MVP, managed ventricular pacing
- NCDR, National Cardiovascular Data Registry
- NYHA, New York Heart Association
- OR, odds ratio
- PEA, peak endocardial acceleration
- PVC, premature ventricular contraction
- Programming
- RCT, randomized clinical trial
- RV, right ventricle
- S-ICD, subcutaneous implantable cardioverter-defibrillator
- SCD, sudden cardiac death
- SVT, supraventricular tachycardia
- TIA, transient ischemic attack
- Tachycardia detection
- Tachycardia therapy
- VF, ventricular fibrillation
- VT, ventricular tachycardia (Heart Rhythm 2015;0:1–37)
- aCRT, adaptive cardiac resynchronization therapy
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Affiliation(s)
| | | | | | - Carlos A Morillo
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | - Jesœs Almendral
- Grupo HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | | | | | - Alejandro Cuesta
- Servicio de Arritmias, Instituto de Cardiologia Infantil, Montevideo, Uruguay
| | | | - Sergio Dubner
- Clinica y Maternidad Suizo Argentina; De Los Arcos Sanatorio, Buenos Aires, Argentina
| | | | | | | | - Fermin C Garcia
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - David E Haines
- William Beaumont Hospital Division of Cardiology, Royal Oak, Michigan
| | - Jeff S Healey
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | | | | | | | | | | | | | - Luis G Molina
- Mexico's National University, Mexico's General Hospital, Mexico City, Mexico
| | - Ken Okumura
- Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Alessandro Proclemer
- Azienda Ospedaliero Universitaria S. Maria della Misericordia- Udine, Udine, Italy
| | | | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Wee Siong Teo
- National Heart Centre Singapore, Singapore, Singapore
| | - William Uribe
- CES Cardiología and Centros Especializados San Vicente Fundación, Medellín y Rionegro, Colombia
| | - Sami Viskin
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Shu Zhang
- National Center for Cardiovascular Disease and Beijing Fu Wai Hospital, Peking Union Medical College and China Academy of Medical Sciences, Beijing, China
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Factors underlying elevated troponin I levels following pacemaker primo-implantation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160:248-56. [PMID: 26769435 DOI: 10.5507/bp.2015.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/11/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cardiac troponins are routinely used as markers of myocardial damage. Originally, they were only intended for use in diagnosing acute coronary syndromes; however, we now know that raised serum troponin levels are not always caused by ischemia. There are many other clinical conditions that cause damage to cardiomyocytes, leading to raised levels of troponin. However, the specificity of cardiac troponins towards the myocardium is absolute. Our work focuses on mechanical damage to the myocardium and on monitoring the factors that raise the levels of cardiospecific markers after primo-implantation of a pacemaker with an actively fixed electrode. AIMS (i) To determine whether the use of a primo-implanted pacemaker with an electrode system with active fixation will raise troponin levels over baseline. (ii) To assess whether troponin I elevation is dependent on procedure complexity. METHODS We enrolled 219 consecutive patients indicated for pacemaker primo-implantation; cardiospecific marker values (troponin I, CKMB, myoglobin) were determined before the implantation procedure and again at 6- and 18-h intervals after the procedure. We monitored duration of cardiac skiascopy, number of attempts to place the electrode (active penetration into the tissue) and intervention range (single-chamber versus dual-chamber pacing), and we assessed the clinical data. RESULTS The average age of the enrolled patients was 78.2 ± 8.0 years (median age, 80 years); women constituted 45% of the group. We implanted 128 dual-chamber and 91 single-chamber devices with an average skiascopic time of 38.6 ± 22.0 s (median, 33.5 s). Troponin I serum levels increased from an initial 0.03 ± 0.07 μg/L (median, 0.01) to 0.18 ± 0.17 μg/L (median, 0.13) and 0.09 ± 0.18 μg/L (median, 0.04) at 6 and 18 h, respectively. The differences were statistically significant (P < 0.001 or P < 0.001). We confirmed a correlation between troponin increase and duration of skiascopy (P < 0.001). We also demonstrated a correlation between increased troponin I and number of attempts to place a pacemaker electrode (penetration into the tissue) at 6 h (P < 0.001) post-implantation. CONCLUSION We detected slightly elevated troponin I levels in patients with primo-implanted pacemakers using electrodes with active fixation. We demonstrated a direct correlation between myocardial damage (number of electrode penetrations into the myocardium) and troponin I elevation, as well as between complexity (severity) of the implantation procedure (indicated by prolonged skiascopy) and raised troponin I. The described phenomenon demonstrates the loss of the diagnostic role of troponin I early after pacemaker primo-implantation in patients with concomitant chest pain.
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2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Heart Rhythm 2015; 13:e50-86. [PMID: 26607062 DOI: 10.1016/j.hrthm.2015.11.018] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Indexed: 12/12/2022]
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18
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Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, Aguinaga L, Berger RD, Cuesta A, Daubert JP, Dubner S, Ellenbogen KA, Estes NAM, Fenelon G, Garcia FC, Gasparini M, Haines DE, Healey JS, Hurtwitz JL, Keegan R, Kolb C, Kuck KH, Marinskis G, Martinelli M, Mcguire M, Molina LG, Okumura K, Proclemer A, Russo AM, Singh JP, Swerdlow CD, Teo WS, Uribe W, Viskin S, Wang CC, Zhang S. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Europace 2015; 18:159-83. [PMID: 26585598 DOI: 10.1093/europace/euv411] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Semmler V, Biermann J, Haller B, Jilek C, Sarafoff N, Lennerz C, Vrazic H, Zrenner B, Asbach S, Kolb C. ICD Shock, Not Ventricular Fibrillation, Causes Elevation of High Sensitive Troponin T after Defibrillation Threshold Testing--The Prospective, Randomized, Multicentre TropShock-Trial. PLoS One 2015. [PMID: 26208329 PMCID: PMC4514854 DOI: 10.1371/journal.pone.0131570] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The placement of an implantable cardioverter defibrillator (ICD) has become routine practice to protect high risk patients from sudden cardiac death. However, implantation-related myocardial micro-damage and its relation to different implantation strategies are poorly characterized. METHODS A total of 194 ICD recipients (64±12 years, 83% male, 95% primary prevention of sudden cardiac death, 35% cardiac resynchronization therapy) were randomly assigned to one of three implantation strategies: (1) ICD implantation without any defibrillation threshold (DFT) testing, (2) estimation of the DFT without arrhythmia induction (modified "upper limit of vulnerability (ULV) testing") or (3) traditional safety margin testing including ventricular arrhythmia induction. High-sensitive Troponin T (hsTnT) levels were determined prior to the implantation and 6 hours after. RESULTS All three groups showed a postoperative increase of hsTnT. The mean delta was 0.031±0.032 ng/ml for patients without DFT testing, 0.080±0.067 ng/ml for the modified ULV-testing and 0.064±0.056 ng/ml for patients with traditional safety margin testing. Delta hsTnT was significantly larger in both of the groups with intraoperative ICD testing compared to the non-testing strategy (p≤0.001 each). There was no statistical difference in delta hsTnT between the two groups with intraoperative ICD testing (p = 0.179). CONCLUSION High-sensitive Troponin T release during ICD implantation is significantly higher in patients with intraoperative ICD testing using shock applications compared to those without testing. Shock applications, with or without arrhythmia induction, did not result in a significantly different delta hsTnT. Hence, the ICD shock itself and not ventricular fibrillation seems to cause myocardial micro-damage. TRIAL REGISTRATION ClinicalTrials.gov NCT01230086.
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Affiliation(s)
- Verena Semmler
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
- * E-mail:
| | - Jürgen Biermann
- Cardiology and Angiology I, Heart Center, Freiburg University, Freiburg, Germany
| | - Bernhard Haller
- Klinikum rechts der Isar, Institut für Medizinische Statistik und Epidemiologie, Technische Universität, Munich, Germany
| | - Clemens Jilek
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
- Schön Klinik Starnberger See, Kardiologie, Starnberg, Germany
| | - Nikolaus Sarafoff
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
- Medizinische Klinik I und Poliklinik, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Carsten Lennerz
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Hrvoje Vrazic
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
- University Hospital Dubrava, Division of Cardiology, Department of Internal Medicine, Zagreb, Croatia
| | - Bernhard Zrenner
- Krankenhaus Landshut-Achdorf, Medizinische Klinik I, Kardiologie, Landshut, Germany
| | - Stefan Asbach
- Cardiology and Angiology I, Heart Center, Freiburg University, Freiburg, Germany
| | - Christof Kolb
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
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Phan K, Kabunga P, Kilborn MJ, Sy RW. Defibrillator Threshold Testing at Generator Replacement: Is it Time to Abandon the Practice? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:777-81. [PMID: 25790073 DOI: 10.1111/pace.12630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 02/09/2015] [Accepted: 03/12/2015] [Indexed: 01/29/2023]
Affiliation(s)
- Kevin Phan
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Peter Kabunga
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael J Kilborn
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Raymond W Sy
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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A prospective study of anxiety in ICD patients with a pilot randomized controlled trial of cognitive behavioral therapy for patients with moderate to severe anxiety. J Interv Card Electrophysiol 2015; 43:65-75. [DOI: 10.1007/s10840-015-9990-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/18/2015] [Indexed: 11/24/2022]
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Furniss G, Shi B, Jimenez A, Harding SA, Larsen PD. Cardiac troponin levels following implantable cardioverter defibrillation implantation and testing. Europace 2014; 17:262-6. [PMID: 25414480 DOI: 10.1093/europace/euu306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Previous studies have reported the defibrillation testing during implantable cardioverter defibrillator (ICD) implantation is associated with elevated cardiac biomarkers and ST-segment electrocardiogram (ECG) changes suggesting that shocks during testing may cause harm. However, the effects of testing have not been isolated from the implant procedure itself, where lead deployment may cause myocardial damage. This prospective study examined high sensitivity troponin T (hs-TnT) levels and ECG changes during ICD implanting alone, ICD implantation with testing and device testing as a stand-alone procedure. METHODS AND RESULTS We examined hs-TnT at baseline, and 6-8 h post procedure and 12 lead ECG at baseline, and 30 s, 5 min, and 10 min post right ventricle lead deployment and post defibrillation. There was no significant change in hs-TnT levels in a group of patients (n = 11) undergoing defibrillation testing alone, while hs-TnT was significantly elevated in patients undergoing implantation alone (n = 13, median increase 96%, P = 0.005) and in patients undergoing implantation and testing (n = 13, median increase 161%, P = 0.005). There was a significant correlation between the number of lead deployments and the percentage change in hs-TnT (r = -0.51, P = 0.01), but no correlation between either the number of shocks (r = 0.26, P = 0.25) or the total delivered energy (r = 0.24, P = 0.30) and percentage change in hs-TnT. CONCLUSION Implantation of ICD leads was associated with release of troponin, but we did not observe any evidence that ICD shocks alone cause myocardial injury.
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Affiliation(s)
- Guy Furniss
- Cardiology Department, Wellington Hospital, Wellington, New Zealand Wellington Cardiovascular Research Group, Wellington, New Zealand
| | - Bijia Shi
- Wellington Cardiovascular Research Group, Wellington, New Zealand University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - Alejandro Jimenez
- Cardiology Department, Wellington Hospital, Wellington, New Zealand Wellington Cardiovascular Research Group, Wellington, New Zealand
| | - Scott A Harding
- Cardiology Department, Wellington Hospital, Wellington, New Zealand Wellington Cardiovascular Research Group, Wellington, New Zealand
| | - Peter D Larsen
- Wellington Cardiovascular Research Group, Wellington, New Zealand University of Otago Wellington, PO Box 7343, Wellington, New Zealand
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Prognostic evaluation of the troponin I elevation after multiple spontaneous shocks of the implantable cardioverter/defibrillator. Am J Emerg Med 2014; 32:1085-8. [DOI: 10.1016/j.ajem.2014.04.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/21/2014] [Accepted: 04/23/2014] [Indexed: 01/21/2023] Open
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Clementy N, Pierre B, Simeon E, Lallemand B, Fauchier L, Babuty D. Programming implantable cardioverter-defibrillators in primary prevention: Higher or later. Arch Cardiovasc Dis 2014; 107:308-18. [DOI: 10.1016/j.acvd.2014.03.006] [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] [Received: 02/27/2014] [Accepted: 03/28/2014] [Indexed: 11/16/2022]
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Sood N, Ruwald ACH, Solomon S, Daubert JP, McNitt S, Polonsky B, Jons C, Clyne CA, Zareba W, Moss AJ. Association between myocardial substrate, implantable cardioverter defibrillator shocks and mortality in MADIT-CRT. Eur Heart J 2013; 35:106-15. [DOI: 10.1093/eurheartj/eht451] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Powell BD, Saxon LA, Boehmer JP, Day JD, Gilliam FR, Heidenreich PA, Jones PW, Rousseau MJ, Hayes DL. Survival after shock therapy in implantable cardioverter-defibrillator and cardiac resynchronization therapy-defibrillator recipients according to rhythm shocked. The ALTITUDE survival by rhythm study. J Am Coll Cardiol 2013; 62:1674-1679. [PMID: 23810882 DOI: 10.1016/j.jacc.2013.04.083] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 03/20/2013] [Accepted: 04/23/2013] [Indexed: 01/11/2023]
Abstract
OBJECTIVES This study sought to determine if the risk of mortality associated with inappropriate implantable cardioverter-defibrillator (ICD) shocks is due to the underlying arrhythmia or the shock itself. BACKGROUND Shocks delivered from ICDs are associated with an increased risk of mortality. It is unknown if all patients who experience inappropriate ICD shocks have an increased risk of death. METHODS We evaluated survival outcomes in patients with an ICD and a cardiac resynchronization therapy defibrillator enrolled in the LATITUDE remote monitoring system (Boston Scientific Corp., Natick, Massachusetts) through January 1, 2010. First shock episode rhythms from 3,809 patients who acutely survived the initial shock were adjudicated by 7 electrophysiologists. Patients with a shock were matched to patients without a shock (n = 3,630) by age at implant, implant year, sex, and device type. RESULTS The mean age of the study group was 64 ± 13 years, and 78% were male. Compared with no shock, there was an increased rate of mortality in those who received their first shock for monomorphic ventricular tachycardia (hazard ratio [HR]: 1.65, p < 0.0001), ventricular fibrillation/polymorphic ventricular tachycardia (HR: 2.10, p < 0.0001), and atrial fibrillation/flutter (HR: 1.61, p = 0.003). In contrast, mortality after first shocks due to sinus tachycardia and supraventricular tachycardia (HR: 0.97, p = 0.86) and noise/artifact/oversensing (HR: 0.91, p = 0.76) was comparable to that in patients without a shock. CONCLUSIONS Compared with no shock, those who received their first shock for ventricular rhythms and atrial fibrillation had an increased risk of death. There was no significant difference in survival after inappropriate shocks for sinus tachycardia or noise/artifact/oversensing. In this study, the adverse prognosis after first shock appears to be more related to the underlying arrhythmia than to an adverse effect from the shock itself.
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Affiliation(s)
- Brian D Powell
- Division of Cardiovascular Disease, Sanger Heart & Vascular Institute, Charlotte, North Carolina.
| | - Leslie A Saxon
- Division of Cardiovascular Disease, University of Southern California, Los Angeles, California
| | - John P Boehmer
- Division of Cardiovascular Disease, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - John D Day
- Division of Cardiovascular Disease, Intermountain Medical Center, Salt Lake City, Utah
| | - F Roosevelt Gilliam
- Division of Cardiovascular Disease, Cardiology Associates of Northeast Arkansas, Jonesboro, Arkansas
| | - Paul A Heidenreich
- Division of Cardiovascular Disease, VA Palo Alto Health Care System, Palo Alto, California
| | - Paul W Jones
- Biostatistics, Boston Scientific, St. Paul, Minnesota
| | | | - David L Hayes
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
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Killingsworth CR, Melnick SB, Litovsky SH, Ideker RE, Walcott GP. Evaluation of acute cardiac and chest wall damage after shocks with a subcutaneous implantable cardioverter defibrillator in Swine. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1265-72. [PMID: 23713608 DOI: 10.1111/pace.12173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 03/21/2013] [Accepted: 04/02/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND A subcutaneous implantable cardioverter defibrillator (S-ICD) could ease placement and reduce complications of transvenous ICDs, but requires more energy than transvenous ICDs. Therefore we assessed cardiac and chest wall damage caused by the maximum energy shocks delivered by both types of clinical devices. METHODS During sinus rhythm, anesthetized pigs (38 ± 6 kg) received an S-ICD (n = 4) and five 80-Joule (J) shocks, or a transvenous ICD (control, n = 4) and five 35-J shocks. An inactive S-ICD electrode was implanted into the same control pigs to study implant trauma. All animals survived 24 hours. Troponin I and creatine kinase muscle isoenzyme (CK-MM) were measured as indicators of myocardial and skeletal muscle injury. Histopathological injury of heart, lungs, and chest wall was assessed using semiquantitative scoring. RESULTS Troponin I was significantly elevated at 4 hours and 24 hours (22.6 ± 16.3 ng/mL and 3.1 ± 1.3 ng/mL; baseline 0.07 ± 0.09 ng/mL) in control pigs but not in S-ICD pigs (0.12 ± 0.11 ng/mL and 0.13 ± 0.13 ng/mL; baseline 0.06 ± 0.03 ng/mL). CK-MM was significantly elevated in S-ICD pigs after shocks (6,544 ± 1,496 U/L and 9,705 ± 6,240 U/L; baseline 704 ± 398 U/L) but not in controls. Electrocardiogram changes occurred postshock in controls but not in S-ICD pigs. The myocardium and lungs were histologically normal in both groups. Subcutaneous injury was greater in S-ICD compared to controls. CONCLUSION Although CK-MM suggested more skeletal muscle injury in S-ICD pigs, significant cardiac, lung, and chest wall histopathological changes were not detected in either group. Troponin I data indicate significantly less cardiac injury from 80-J S-ICD shocks than 35-J transvenous shocks.
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Affiliation(s)
- Cheryl R Killingsworth
- Cardiac Rhythm Management Laboratory, Division of Cardiovascular Diseases, Department of Medicine
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ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation task force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2012; 60:2427-63. [PMID: 23154053 DOI: 10.1016/j.jacc.2012.08.969] [Citation(s) in RCA: 263] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Number of shocks during elective cardioversion predicts long term recurrence of atrial fibrillation. Int J Cardiol 2012; 158:451-3. [PMID: 22633432 DOI: 10.1016/j.ijcard.2012.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 05/04/2012] [Indexed: 11/20/2022]
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FREEDBERG NAHUMA, FELDMAN ALEXANDER. Prognostic Significance of Implantable Defibrillator Shock: Are All Shocks Created Equal? J Cardiovasc Electrophysiol 2012; 23:741-3. [DOI: 10.1111/j.1540-8167.2012.02299.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Francis CK, Kuo YH, Azzam I, Selim S, Patel N, Beri R, Goldman D, Girgis I, Daniels S. Brain natriuretic peptide and biomarkers of myocardial ischemia increase after defibrillation threshold testing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:314-9. [PMID: 22126159 DOI: 10.1111/j.1540-8159.2011.03275.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND During implantable cardioverter defibrillator insertion, induced ventricular fibrillation followed by test shocks (defibrillation threshold testing [DFT]) is utilized to confirm effective device function. The effect of DFT on ventricular function is uncertain. Brain natriuretic peptide (BNP) is a marker of ventricular dysfunction and hemodynamic stress. We hypothesized that DFT causes increased BNP levels. METHODS BNP, creatine kinase, creatine kinase-MB (CK-MB), and troponin I (cTnI) were measured in 31 patients (mean age 71.4 years; 12 women) at preinsertion (T1), at 2-4 hours (T2), and at 8-12 hours (T3) after DFT. Biomarker levels were compared in patients receiving one shock (Group A) or two shocks (Group B). RESULTS After DFT all biomarkers increased above baseline levels but did not reach levels diagnostic for myocardial infarction. From T1 to T2, elevations in CK-MB and cTnI occurred in the highest proportion of patients (CK-MB 90% and cTnI 84%). From T1 to T3, elevation in BNP and cTnI were most prevalent (BNP 83% and cTnI 90%). Significant increases were measured in BNP levels from T1 to T3 (P = 0.0003), CK-MB levels from T1 to T2 (P < 0.0001), and cTnI levels from T1 to T2 (P < 0.0001) and from T1 to T3 (P < 0.0001). CK-MB levels did not increase significantly from T1 to T3 (P = 0.51). CONCLUSIONS BNP levels rise progressively after DFT accompanied by early CK-MB increases and sustained increases in cTnI. These data suggest that DFT is associated with hemodynamic stress and left ventricular dysfunction, as evidenced by increases in BNP.
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High-energy defibrillation increases the dispersion of regional ventricular repolarization. J Interv Card Electrophysiol 2011; 32:81-6. [PMID: 21671072 DOI: 10.1007/s10840-011-9589-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 05/12/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE This study evaluated the effects of shock energy on the dispersion of regional ventricular repolarization (DRVR), post-shock rhythm and sinus recovery time (SRT), and the relationship between DRVR and post-shock ventricular arrhythmias. MATERIALS AND METHODS Ten open-chest dogs were anesthetized. Ventricular fibrillation (VF) was electrically induced and recorded from a 6 × 6 unipolar electrode plaque (4 mm spacing) sutured on the left ventricular epicardium. Defibrillation threshold (DFT) was determined after 20 s of VF. DRVR was measured before VF, during the earliest post-shock sinus rhythm, and during sinus rhythm 30 s following shocks. Post-shock rhythm and SRT were evaluated after energies of 100% DFT, 125% DFT, 175% DFT, and 250% DFT. RESULTS In the100% DFT group, the DRVR of the earliest sinus rhythm and 30 s after successful defibrillation was not significantly different than that before VF. But the DRVRs were significantly increased in 125% DFT, 175% DFT, and 250% DFT group. DRVR after defibrillation in the 250% DFT group was higher than those in the 100% DFT and 125% DFT groups. SRT in the 250% DFT group was significantly longer than that in the other groups .The incidence of post-shock ventricular tachycardia was increased when a high-shock energy was applied (P = 0.041). CONCLUSION DRVR was increased by application of high-energy defibrillation associated with SRT prolongation. The increased DRVR may play an important role in the onset of post-shock ventricular tachycardia.
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Elayi CS, Whitbeck MG, Charnigo R, Shah J, Macaulay TE, Morales G, Gurley JC, Kakavand B, Thal S, Ching CK, Khaykin Y, Verma A, Barrett C, Bai R, Di Biase L, Patwardhan A, Moliterno DJ, Natale A. Is there an association between external cardioversions and long-term mortality and morbidity? Insights from the Atrial Fibrillation Follow-up Investigation of Rhythm Management study. Circ Arrhythm Electrophysiol 2011; 4:465-9. [PMID: 21511994 DOI: 10.1161/circep.110.960591] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cardiac electric therapies effectively terminate tachyarrhythmias. Recent data suggest a possible increase in long-term mortality associated with implantable cardioverter-defibrillator shocks. Little is known about the association between external cardioversion episodes (ECVe) and long-term mortality. We sought to assess the safety of repeated ECVe with regard to cardiovascular mortality and morbidity. METHODS AND RESULTS We analyzed the data of the 4060 patients from the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial. In particular, associations of ECVe with all-cause mortality, cardiovascular mortality, and hospitalizations after ECVe were studied. Over an average follow-up of 3.5 years, 660 (16.3%) patients died, 331 (8.2%) from cardiovascular causes. A total of 207 (5.1%) and 1697 (41.8%) patients had low ejection fraction and nonparoxysmal atrial fibrillation, respectively; 2460 patients received no ECVe, whereas 1600 experienced ≥ 1 ECVe. Death occurred in 412 (16.7%), 196 (16.5%), 39 (13.5%), and 13 (10.4%) of patients with 0, 1, 2, and ≥ 3 ECVe, respectively. There was no significant association between ECVe and mortality within any of the 4 subgroups defined by ejection fraction and atrial fibrillation type, although myocardial infarction, coronary artery bypass graft, and digoxin were significantly associated with death (estimated hazard ratios, 1.65, 1.59, and 1.62, respectively; P < 0.0001). ECVe were associated with increased cardiac hospitalization reported at the next follow-up visit (39.3% versus 5.8%; estimated odds ratio, 1.39; P < 0.0001). CONCLUSIONS In the AFFIRM study, there was no significant association between ECVe and long-term mortality, even though ECVe were associated with increased hospitalizations from cardiac causes. Digoxin, myocardial infarction, and coronary artery bypass graft were significantly associated with mortality.
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van Rees JB, Borleffs CJW, de Bie MK, Stijnen T, van Erven L, Bax JJ, Schalij MJ. Inappropriate Implantable Cardioverter-Defibrillator Shocks. J Am Coll Cardiol 2011; 57:556-62. [DOI: 10.1016/j.jacc.2010.06.059] [Citation(s) in RCA: 267] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 06/11/2010] [Accepted: 06/14/2010] [Indexed: 10/18/2022]
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LAWO THOMAS, SCHRADER JÜRGEN, BUDDENSIEK MICHAEL, SCHWEIKA OLIVER, MÜGGE ANDREAS, BÖSCHE LEIFI. Termination of Ventricular Tachycardia by Far-Field Stimulation in Humans: A Feasibility Study. Pacing Clin Electrophysiol 2010; 33:1540-7. [DOI: 10.1111/j.1540-8159.2010.02891.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prophylactic amiodarone versus lidocaine for prevention of reperfusion ventricular fibrillation after release of aortic cross-clamp. Eur J Anaesthesiol 2009; 26:1056-60. [DOI: 10.1097/eja.0b013e32832f0dfb] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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ALAITI MOHAMADA, MAROO ANJLI, EDEL THOMASB. Troponin Levels after Cardiac Electrophysiology Procedures: Review of the Literature. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:800-10. [DOI: 10.1111/j.1540-8159.2009.02370.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Implantable cardioverter-defibrillator shocks: a double-edged sword? J Am Coll Cardiol 2008; 51:1366-8. [PMID: 18387437 DOI: 10.1016/j.jacc.2007.12.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Revised: 12/03/2007] [Accepted: 12/10/2007] [Indexed: 11/22/2022]
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Kostis WJ, Tedford RJ, Miller DL, Schulman SP, Tomaselli GF. Troponin-I elevation in a young man with arrhythmogenic right ventricular dysplasia/cardiomyopathy. J Interv Card Electrophysiol 2008; 22:49-53. [DOI: 10.1007/s10840-008-9250-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Accepted: 02/25/2008] [Indexed: 10/22/2022]
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SBAROUNI EFTIHIA, GEORGIADOU PANAGIOTA, PANAGIOTAKOS DEMOSTHENES, LIVANIS EFTHIMIOS, THEODORAKIS GEORGEN, KREMASTINOS DIMITRIOSTH. The Ischemia-Modified Albumin in Relation to Pacemaker and Defibrillator Implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 31:83-7. [DOI: 10.1111/j.1540-8159.2007.00929.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mollerus M, Naslund L. Myocardial stunning following defibrillation threshold testing. J Interv Card Electrophysiol 2007; 19:213-6. [PMID: 17846876 DOI: 10.1007/s10840-007-9150-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2007] [Accepted: 07/10/2007] [Indexed: 10/22/2022]
Abstract
Implantable cardioverter-defibrillators (ICDs) have a proven mortality benefit in appropriately selected people. Several retrospective studies, though, have postulated that appropriate ICD therapy may lead to fatal, pulseless electrical alternans (PEA). This case report describes an episode of transient PEA from myocardial stunning and standstill following defibrillation threshold testing. The risk of post-shock myocardial stunning and standstill should be kept in mind as a potential complication of testing. With rapid recognition and prompt intervention, this complication is potentially reversible.
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Sonel AF, Shalaby A, McConnell JP, Czarnecki T, Hogen S, Zahid M, Amidi M. Detectable troponin levels predict poor prognosis in patients with left ventricular dysfunction undergoing internal defibrillator implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:839-44. [PMID: 17584264 DOI: 10.1111/j.1540-8159.2007.00770.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Troponin levels have been demonstrated to predict mortality in patients with cardiomyopathy. Implantable cardiac defibrillator (ICD) devices have been demonstrated to improve survival. It is not clear if ICDs would mitigate the negative outcome predicted by elevated troponin levels. METHODS We collected baseline blood samples for troponin T (TnT) and creatinine kinase-MB fraction in consecutive patients immediately before successful pectoral transvenous ICD implant. Patients were followed for total mortality. For analysis, patients were grouped by TnT detectability (>or=0.01 ng/mL). RESULTS Fifty-two men, aged 68 +/- 10 years, were studied. Mean ejection fraction was 29 +/- 12% and 65% had ischemic cardiomyopathy. Follow-up duration was 17 +/- 8 months. None of the patients had abnormal creatinine kinase-MB fraction levels (1.7 +/- 1.1 ng/mL). There were 37 patients with no detectable TnT (Group I) and 15 with detectable TnT (Group II). There was no difference between the two groups in terms of age (68 vs 69, P = NS), ejection fraction (30 vs 29%, P = NS), or proportion of patients with ischemic cardiomyopathy (68 vs 60%, P = NS). During follow-up 16 (31%) patients died. Patients in group I had mortality of 16% (6/37) compared to 67% mortality (10/15, P < 0.001) in group II. On multivariate analysis, detectable TnT remained an independent predictor of mortality (HR 4.5, CI 1.4-14.25, P = 0.01). CONCLUSION In a cohort of patients with cardiomyopathy undergoing ICD implantation for standard clinical indications, presence of detectable TnT was associated with high mortality despite ICD implantation. TnT obtained before ICD implantation may be useful for risk stratification.
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Affiliation(s)
- Ali F Sonel
- Department of Cardiology, VA Pittsburgh Healthcare System and the University of Pittsburgh, Pittsburgh, Pennsylvania 15240, USA
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Swerdlow CD, Russo AM, Degroot PJ. The dilemma of ICD implant testing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:675-700. [PMID: 17461879 DOI: 10.1111/j.1540-8159.2007.00730.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ventricular fibrillation (VF) has been induced at implantable cardioverter defibrillator (ICD) implant to ensure reliable sensing, detection, and defibrillation. Despite its risks, the value was self-evident for early ICDs: failure of defibrillation was common, recipients had a high risk of ventricular tachycardia (VT) or VF, and the only therapy for rapid VT or VF was a shock. Today, failure of defibrillation is rare, the risk of VT/VF is lower in some recipients, antitachycardia pacing is applied for fast VT, and vulnerability testing permits assessment of defibrillation efficacy without inducing VF in most patients. This review reappraises ICD implant testing. At implant, defibrillation success is influenced by both predictable and unpredictable factors, including those related to the patient, ICD system, drugs, and complications. For left pectoral implants of high-output ICDs, the probability of passing a 10 J safety margin is approximately 95%, the probability that a maximum output shock will defibrillate is approximately 99%, and the incidence of system revision based on testing is < or = 5%. Bayes' Theorem predicts that implant testing identifies < or = 50% of patients at high risk for unsuccessful defibrillation. Most patients who fail implant criteria have false negative tests and may undergo unnecessary revision of their ICD systems. The first-shock success rate for spontaneous VT/VF ranges from 83% to 93%, lower than that for induced VF. Thus, shocks for spontaneous VT/VF fail for reasons that are not evaluated at implant. Whether system revision based on implant testing improves this success rate is unknown. The risks of implant testing include those related to VF and those related to shocks alone. The former may be due to circulatory arrest alone or the combination of circulatory arrest and shocks. Vulnerability testing reduces risks related to VF, but not those related to shocks. Mortality from implant testing probably is 0.1-0.2%. Overall, VF should be induced to assess sensing in approximately 5% of ICD recipients. Defibrillation or vulnerability testing is indicated in 20-40% of recipients who can be identified as having a higher-than-usual probability of an inadequate defibrillation safety margin based on patient-specific factors. However, implant testing is too risky in approximately 5% of recipients and may not be worth the risks in 10-30%. In 25-50% of ICD recipients, testing cannot be identified as either critical or contraindicated.
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Affiliation(s)
- Charles D Swerdlow
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, and the David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
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Saxon L. Delayed Defibrillation Testing After CRT-D Implant-Weighing Competing Risks. J Cardiovasc Electrophysiol 2005; 16:1284-5. [PMID: 16403057 DOI: 10.1111/j.1540-8167.2005.00275.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND Troponin I is used to diagnose myocardial infarction (MI). Its use and pattern of elevation is not well defined in coronary artery bypass graft (CABG) surgery. This study assessed the timing of troponin I elevation in patients undergoing urgent CABG. METHOD Patients undergoing urgent isolated-CABG with cardiopulmonary bypass were studied prospectively. Blood samples were taken to measure CK, CK-MB, and troponin I: preoperatively, 7 hours postoperatively, 14 to 18 hours postoperatively, 30 to 48 hours postoperatively, and on postoperative day 4. Electrocardiograms and in-hospital course were recorded. Perioperative MI (PMI) was defined by either (i) ECG criteria of new Q-waves in the presence of CK-MB elevation >50 microg/L or (ii) CK-MB > 100 microg/L. RESULTS Of the 50 patients studied, 6 met the criteria for PMI (12%); 2 by criteria (i) and 4 by criteria (ii). In patients not meeting the criteria for MI the troponin I level peaked at 7 hour post-op with a mean of 20.97 microg/L (95% CI, 17.11 to 24.83). At this time, patients who met the criteria for MI had a mean troponin I level of 46.85 microg/L (95% CI, 36.40 to 57.30). Of variables investigated for the 44 patients who did not meet MI criteria, only preoperative troponin I level impacted peak postoperative troponin I. CONCLUSIONS CABG elevates troponin I far beyond current diagnostic benchmarks without the clinical occurrence of a MI and appears to peak during the second postoperative day. An elevated preoperative troponin I may predict an elevated peak postoperative troponin I in patients who do not have a PMI.
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Abstract
CONTEXT Electronic medical devices (EMDs) with downloadable memories, such as implantable cardiac pacemakers, defibrillators, drug pumps, insulin pumps, and glucose monitors, are now an integral part of routine medical practice in the United States, and functional organ replacements, such as the artificial heart, pancreas, and retina, will most likely become commonplace in the near future. Often, EMDs end up in the hands of the pathologist as a surgical specimen or at autopsy. No established guidelines for systematic examination and reporting or comprehensive reviews of EMDs currently exist for the pathologist. OBJECTIVE To provide pathologists with a general overview of EMDs, including a brief history; epidemiology; essential technical aspects, indications, contraindications, and complications of selected devices; potential applications in pathology; relevant government regulations; and suggested examination and reporting guidelines. DATA SOURCES Articles indexed on PubMed of the National Library of Medicine, various medical and history of medicine textbooks, US Food and Drug Administration publications and product information, and specifications provided by device manufacturers. STUDY SELECTION Studies were selected on the basis of relevance to the study objectives. DATA EXTRACTION Descriptive data were selected by the author. DATA SYNTHESIS Suggested examination and reporting guidelines for EMDs received as surgical specimens and retrieved at autopsy. CONCLUSIONS Electronic medical devices received as surgical specimens and retrieved at autopsy are increasing in number and level of sophistication. They should be systematically examined and reported, should have electronic memories downloaded when indicated, will help pathologists answer more questions with greater certainty, and should become an integral part of the formal knowledge base, research focus, training, and practice of pathology.
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Affiliation(s)
- James B Weitzman
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
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Gormaz CL, de Juan IT, Broseta Viana L. Utilidad clínica de las troponinas cardíacas. Med Clin (Barc) 2003. [DOI: 10.1016/s0025-7753(03)73712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sparano JA, Brown DL, Wolff AC. Predicting cancer therapy-induced cardiotoxicity: the role of troponins and other markers. Drug Saf 2002; 25:301-11. [PMID: 12020170 DOI: 10.2165/00002018-200225050-00001] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Several anticancer drugs have been associated with cardiac toxicity, especially the anthracyclines and trastuzumab. The pathogenesis of anthracycline-associated toxicity has been well described, whereas the mechanism of trastuzumab-associated toxicity is unknown. Although routine cardiac imaging studies (e.g. echocardiogram or multiple gated acquisition scans) may identify subclinical evidence of myocardial dysfunction, available data do not support their routine use for monitoring asymptomatic patients undergoing cancer therapy. Other modalities such as nuclear medicine scintigraphy with indium-111-antimyosin antibody and endomyocardial biopsy have been shown to be useful in identifying early cardiac damage, but their routine use is limited by practical considerations such as feasibility and cost. Consequently, there is significant interest in developing simple and reproducible methods for identifying patients at risk for treatment-induced myocardial damage. Available data suggest that circulating markers such as troponins and natriuretic peptides could potentially be useful for this purpose. Measurement of plasma troponin levels are commonly used in clinical practice in order to provide diagnostic and prognostic information in patients with myocardial ischaemia. Elevated levels may likewise correlate with anthracycline-induced cardiac damage, although plasma levels are only minimally elevated (well below that associated with ischaemia), and elevations may persist for weeks or months after anthracycline exposure. Clinical trials are currently evaluating the role of these markers in predicting both early and late, clinical and subclinical damage associated with anthracyclines and trastuzumab.
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Affiliation(s)
- Joseph A Sparano
- Department of Oncology, Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, New York 10461, USA.
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