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Ghanta SN, Alotaibi B, Paydak H, Mounsey JP, Vallurupalli S, Devabhaktuni S. Inappropriate Subcutaneous Implantable Cardioverter-defibrillator Shocks-A Rare Case of Triple Counting. J Innov Card Rhythm Manag 2023; 14:5670-5674. [PMID: 38155720 PMCID: PMC10752427 DOI: 10.19102/icrm.2023.14121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/20/2023] [Indexed: 12/30/2023] Open
Abstract
Sudden cardiac death (SCD) caused by ventricular tachyarrhythmias is a significant contributor to cardiovascular deaths worldwide. Implantable cardioverter-defibrillators (ICDs) have shown efficacy in preventing and reducing mortality from SCD, but traditional transvenous ICDs have inherent challenges and drawbacks, such as lead fractures, lead-associated endocarditis, and lead failure. To address these issues, subcutaneous ICDs (S-ICDs) have been developed. S-ICDs lack pacing capacity but are a valid alternative for patients at high risk for infection or with difficult venous access. Pre-implantation screening can help prevent inappropriate device shocks. We present a case in which a patient received inappropriate S-ICD therapy, which was attributed to the triple counting of P-, R-, and T-waves in a patient with sinus rhythm. This is an unusual occurrence, and, to the best of our knowledge, there are only a limited number of case reports documenting inappropriate shocks due to the oversensing of P-waves and T-waves.
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Affiliation(s)
- Sai Nikhila Ghanta
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bader Alotaibi
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hakan Paydak
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J. Paul Mounsey
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Srikanth Vallurupalli
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Subodh Devabhaktuni
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Savelieva I, Fumagalli S, Kenny RA, Anker S, Benetos A, Boriani G, Bunch J, Dagres N, Dubner S, Fauchier L, Ferrucci L, Israel C, Kamel H, Lane DA, Lip GYH, Marchionni N, Obel I, Okumura K, Olshansky B, Potpara T, Stiles MK, Tamargo J, Ungar A. EHRA expert consensus document on the management of arrhythmias in frailty syndrome, endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA). Europace 2023; 25:1249-1276. [PMID: 37061780 PMCID: PMC10105859 DOI: 10.1093/europace/euac123] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 04/17/2023] Open
Abstract
There is an increasing proportion of the general population surviving to old age with significant chronic disease, multi-morbidity, and disability. The prevalence of pre-frail state and frailty syndrome increases exponentially with advancing age and is associated with greater morbidity, disability, hospitalization, institutionalization, mortality, and health care resource use. Frailty represents a global problem, making early identification, evaluation, and treatment to prevent the cascade of events leading from functional decline to disability and death, one of the challenges of geriatric and general medicine. Cardiac arrhythmias are common in advancing age, chronic illness, and frailty and include a broad spectrum of rhythm and conduction abnormalities. However, no systematic studies or recommendations on the management of arrhythmias are available specifically for the elderly and frail population, and the uptake of many effective antiarrhythmic therapies in these patients remains the slowest. This European Heart Rhythm Association (EHRA) consensus document focuses on the biology of frailty, common comorbidities, and methods of assessing frailty, in respect to a specific issue of arrhythmias and conduction disease, provide evidence base advice on the management of arrhythmias in patients with frailty syndrome, and identifies knowledge gaps and directions for future research.
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Affiliation(s)
- Irina Savelieva
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Stefano Fumagalli
- Department of Experimental and Clinical Medicine, Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, University of Florence and AOU Careggi, Florence, Italy
| | - Rose Anne Kenny
- Mercer’s Institute for Successful Ageing, Department of Medical Gerontology, St James’s Hospital, Dublin, Ireland
| | - Stefan Anker
- Department of Cardiology (CVK), Germany
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Germany
- German Centre for Cardiovascular Research (DZHK) partner site Berlin, Germany
- Charité Universitätsmedizin Berlin, Germany
| | - Athanase Benetos
- Department of Geriatric Medicine CHRU de Nancy and INSERM U1116, Université de Lorraine, Nancy, France
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Jared Bunch
- (HRS representative): Intermountain Medical Center, Cardiology Department, Salt Lake City,Utah, USA
- Stanford University, Department of Internal Medicine, Palo Alto, CA, USA
| | - Nikolaos Dagres
- Heart Center Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - Sergio Dubner
- (LAHRS representative): Clinica Suizo Argentina, Cardiology Department, Buenos Aires Capital Federal, Argentina
| | - Laurent Fauchier
- Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | | | - Carsten Israel
- Evangelisches Krankenhaus Bielefeld GmbH, Bielefeld, Germany
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, General Cardiology Division, University of Florence and AOU Careggi, Florence, Italy
| | - Israel Obel
- (CASSA representative): Milpark Hospital, Cardiology Unit, Johannesburg, South Africa
| | - Ken Okumura
- (APHRS representative): Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Brian Olshansky
- University of Iowa Hospitals and Clinics, Iowa CityIowa, USA
- Covenant Hospital, Waterloo, Iowa, USA
- Mercy Hospital Mason City, Iowa, USA
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Serbia
- Cardiology Clinic, Clinical Center of Serbia, Serbia
| | - Martin K Stiles
- (APHRS representative): Waikato Clinical School, University of Auckland and Waikato Hospital, Hamilton, New Zealand
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, CIBERCV, Universidad Complutense, Madrid, Spain
| | - Andrea Ungar
- Department of Experimental and Clinical Medicine, Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, University of Florence and AOU Careggi, Florence, Italy
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3
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Römers H, van Dijk V, Boersma L. Evolution of extravascular implantable cardioverter-defibrillator therapy for ventricular arrhythmias. Heart Rhythm O2 2022; 4:59-64. [PMID: 36713037 PMCID: PMC9877388 DOI: 10.1016/j.hroo.2022.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Implantable cardioverter-defibrillators have become an established therapy for the prevention of sudden cardiac death due to life-threatening ventricular arrhythmias in the last decades. In all those years, the use of transvenous leads has proven to be the most vulnerable part of the system. The development of the completely subcutaneous implantable cardioverter-defibrillator opened a new era of device therapy outside of the vascular system. The next step, enabling extravascular devices with the option of antitachycardia pacing, is just around the corner. This may become an important option for all patients without a bradycardia pacing indication that are in need for antitachycardia pacing because of monomorphic ventricular tachycardia.
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Affiliation(s)
- Hans Römers
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Address reprint requests and correspondence: Dr Hans Römers, Cardiology, St Antonius Hospital, University of Amsterdam, Koekoekslaan 1, Nieuwe-gein, Utrecht 3435CM, the Netherlands.
| | - Vincent van Dijk
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Lucas Boersma
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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Wieniawski P, Buczyński M, Grabowski M, Winter J, Werner B. Subcutaneous Implantable Cardioverter Defibrillators for the Prevention of Sudden Cardiac Death: Pediatric Single-Center Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11661. [PMID: 36141934 PMCID: PMC9517274 DOI: 10.3390/ijerph191811661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter defibrillator (S-ICD) was developed as an alternative to the transvenous ICD, to prevent lead-related complications associated with the latter. The absence of intravascular or intracardiac components offers potential advantages to pediatric patients. AIMS The aim of the study is to present an overview of our experience with S-ICDs in the pediatric center that, currently, has performed the largest number of implantations in children in Poland. METHODS Retrospective analysis of data from medical history, qualification, implantation procedure, and S-ICD post-implantation observations in 11 pediatric patients were performed. RESULTS S-ICDs were implanted in 11 patients, 8 boys and 3 girls, aged 12-17 years. The S-ICD was implanted for primary prevention in seven patients: four with hypertrophic cardiomyopathy (HCM), two with dilated cardiomyopathy (DCM), and one with arrhythmogenic right ventricular cardiomyopathy (ARVC). It was implanted for secondary prevention in four patients: two with sudden cardiac arrest (SCA) in the course of idiopathic ventricular fibrillation (IVF), one with long QT syndrome (LQTS) after probable SCA, and one with Brugada syndrome after SCA. In all patients, the device was implanted intramuscularly. One patient did not have a defibrillation test performed due to the presence of an intracardiac thrombus. In one patient, during screening, it was decided to implant an electrode on the right side of the sternum. There were no early or late complications with any of the procedures. So far, no inadequate discharges have been observed. CONCLUSIONS Our results prove the efficacy of the S-ICD treatment option along with technically simple surgery, which supports its further and more widespread application in children.
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Affiliation(s)
- Piotr Wieniawski
- Department of Paediatric Cardiology and General Paediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Michał Buczyński
- Department of Cardiac and General Paediatric Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Joachim Winter
- Division of Cardiac Surgery, University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Bożena Werner
- Department of Paediatric Cardiology and General Paediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland
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5
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Perel N, Tovia-Brodie O, Rav Acha M, Accinelli S, Levy EE, Glikson M, Michowitz Y. Lack of magnet use during chest compressions leads to multiple inappropriate shocks by a subcutaneous implantable cardioverter-defibrillator. HeartRhythm Case Rep 2022; 8:815-819. [PMID: 36620368 PMCID: PMC9811013 DOI: 10.1016/j.hrcr.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Nimrod Perel
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | | | | | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel,Address reprint requests and correspondence: Dr Yoav Michowitz, Department of Cardiology, Shaare Zedek Hospital, 12 Shmuel Beit St, Jerusalem 9103102, Israel.
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6
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Yáñez C, DeMas-Giménez G, Royo S. Overview of Biofluids and Flow Sensing Techniques Applied in Clinical Practice. SENSORS (BASEL, SWITZERLAND) 2022; 22:6836. [PMID: 36146183 PMCID: PMC9503462 DOI: 10.3390/s22186836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
This review summarizes the current knowledge on biofluids and the main flow sensing techniques applied in healthcare today. Since the very beginning of the history of medicine, one of the most important assets for evaluating various human diseases has been the analysis of the conditions of the biofluids within the human body. Hence, extensive research on sensors intended to evaluate the flow of many of these fluids in different tissues and organs has been published and, indeed, continues to be published very frequently. The purpose of this review is to provide researchers interested in venturing into biofluid flow sensing with a concise description of the physiological characteristics of the most important body fluids that are likely to be altered by diverse medical conditions. Similarly, a reported compilation of well-established sensors and techniques currently applied in healthcare regarding flow sensing is aimed at serving as a starting point for understanding the theoretical principles involved in the existing methodologies, allowing researchers to determine the most suitable approach to adopt according to their own objectives in this broad field.
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Boersma LV, El-Chami M, Steinwender C, Lambiase P, Murgatroyd F, Mela T, Theuns DAMJ, Khelae SK, Kalil C, Zabala F, Stuehlinger M, Lenarczyk R, Clementy N, Tamirisa KP, Rinaldi CA, Knops R, Lau CP, Crozier I, Boveda S, Defaye P, Deharo JC, Botto GL, Vassilikos V, Oliveira MM, Tse HF, Figueroa J, Stambler BS, Guerra JM, Stiles M, Marques M. Practical considerations, indications, and future perspectives for leadless and extravascular cardiac implantable electronic devices: a position paper by EHRA/HRS/LAHRS/APHRS. Europace 2022; 24:1691-1708. [PMID: 35912932 DOI: 10.1093/europace/euac066] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lucas V Boersma
- Cardiology Department, St Antonius Hospital, Nieuwegein, The Netherlands.,Cardiology Department, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Mikhael El-Chami
- Medicine/Cardiology Department, Emory University, Atlanta, GA, USA
| | - Clemens Steinwender
- Department of Cardiology and Internal Intensive Care, Kepler University Hospital Linz, Krankenhausstraße 9, Linz, Austria
| | - Pier Lambiase
- Department of Cardiology, UCL & Barts Heart Centre, Institute of Cardiovascular Science, UCL, Barts Heart Centre, London, UK
| | | | - Theofania Mela
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Dominic A M J Theuns
- Erasmus MC, Cardiology, Clinical Electrophysiology, CA Rotterdam, The Netherlands
| | | | - Carlos Kalil
- Cardiology Department, Hospital São Francisco da Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - Federico Zabala
- Electrophysiology Unit, Hospital San Martin de La Plata, Buenos Aires, Argentina
| | - Markus Stuehlinger
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Disease, Curie-Sklodowska Str 9, 41-800 Zabrze, Poland
| | - Nicolas Clementy
- Cardiology Department, Centre Hospitalier Régional Universitaire de Tours, France
| | - Kamala P Tamirisa
- Cardiac Electrophysiology, Cardiac MRI, Texas Cardiac Arrhythmia Institute, 11970 N, Central Expressway, Dallas, TX, USA
| | | | - Reinoud Knops
- Cardiology Department, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Chu-Pak Lau
- Department of Medicine, Queen Mary Hospital, Suite 1303, Central Building, 1 Pedder Street, Central, Hong Kong
| | - Ian Crozier
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France.,Universitair Ziekenhuis Brussel-VUB, Heart Rhythm Management Centre, Brussels, Belgium, and INSERM U970, 75908 Paris Cedex 15 France
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Jean Claude Deharo
- Aix-Marseille Université, Faculté de Médecine, F-13385 Marseille, France.,Cardiology Department, Hospital de Santa Cruz, Lisbon, Portugal
| | | | - Vassilios Vassilikos
- Medical School, Aristotle University of Thessaloniki, Greece & Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
| | - Hung Fat Tse
- The Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Hong Kong-Guangdong Stem Cell and Regenerative Medicine Research Centre, The University of Hong Kong and Guangzhou Institutes of Biomedicine and Health, Hong Kong SAR, China
| | - Jorge Figueroa
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Bruce S Stambler
- Unidad de Arritmias y Marcapasos, Sanatorio Allende, Obispo Oro 42, CP 5000, Córdoba, Argentina
| | - Jose M Guerra
- Piedmont Heart Institute, 275 Collier Road Northwest, Suite 500, Atlanta, GA 30309, USA
| | - Martin Stiles
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Manlio Marques
- Waikato Clinical School, University of Auckland, Auckland, New Zealand.,National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
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van Dijk VF, Boersma LVA. Non-transvenous ICD therapy: current status and beyond. Herz 2021; 46:520-525. [PMID: 34751802 DOI: 10.1007/s00059-021-05077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Abstract
Subcutaneous implantable cardioverter/defibrillators (S-ICDs) have been developed to offer ICD treatment to patients without venous access to the heart and to overcome complications associated with transvenous leads, particularly lead fracture/insulation defects and endocarditis. Several studies and registries have demonstrated the feasibility and safety of S‑ICD in different groups of patients. Further developments in S‑ICD technology involve the combination with devices that can provide anti-bradycardia and anti-tachycardia pacing if needed. The extravascular ICD (EV-ICD) is a new system that similarly offers ICD therapy without a transvenous lead but uses a substernal instead of a subcutaneous lead to facilitate detection of ventricular fibrillation and to provide anti-tachycardia and also temporary anti-bradycardia pacing. The first animal but also clinical data on EV-ICDs have been published. This review discusses the current state, potential advantages and limitations, and future research of both S‑ICD and EV-ICD.
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Affiliation(s)
- Vincent F van Dijk
- Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435, CM Nieuwegein, The Netherlands
| | - Lucas V A Boersma
- Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435, CM Nieuwegein, The Netherlands. .,Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
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Subcutaneous implantable cardioverter defibrillator in children and adolescents: results from the S-ICD "Monaldi care" registry. J Interv Card Electrophysiol 2021; 63:283-293. [PMID: 33709295 DOI: 10.1007/s10840-021-00966-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 02/15/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICD) are widely accepted therapy in children and adolescents who are survivors of cardiac arrest or for high-risk patients with inheritable channelopathies, cardiomyopathies, or congenital heart disease. Initial experience with subcutaneous ICD (S-ICD) systems has shown a high efficacy in adults. However, the use of S-ICD in children and adolescents implies some specific considerations, as the safety for these patients is unknown and recommendations among physicians may vary widely. METHODS We reviewed the data and studied the indications for S-ICD in children and adolescents and discuss the preliminary clinical experience. RESULTS From a cohort of 297 patients enrolled in the S-ICD "Monaldi care" registry that encompass all the patients implanted in the Monaldi Hospital of Naples, we considered 21 consecutive children and adolescents (mean age 13.9 years, range 8-18 years, mean body weight 59.3 kg, range 38-100 kg) who underwent S-ICD implant from April 2014 to June 2020. Mean follow-up was 41.9±21.9 months. Only one patient presented, 6 weeks after implantation, skin erosion at the inferior parasternal incision that resolved after antibiotic therapy, without the necessity of any system revision. Two patients experienced appropriate shocks and four inappropriate shocks, due to T wave oversensing or atrial arrhythmia. Only one patient, with arrhythmogenic right ventricular dysplasia, required a system revision after 36 months of the first implantation and then a reintervention with a replacement of the S-ICD by a conventional ICD system. CONCLUSIONS Our experience suggests that the S-ICD device can be used in some children over the age of 8 as well as adults, with a similar rate of unwanted side effects, and early evidence of apparent efficacy.
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10
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van Dijk VF, Boersma LVA. The subcutaneous implantable cardioverter defibrillator in 2019 and beyond. Trends Cardiovasc Med 2020; 30:378-384. [DOI: 10.1016/j.tcm.2019.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 11/16/2022]
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11
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Madjarov JM, Madzharov S, Abedinov F, Chappuis S, Fedor JM. Revision of subcutaneous implantable cardioverter defibrillator to intermuscular pocket to prevent inappropriate shocks. Clin Case Rep 2020; 8:1081-1085. [PMID: 32577270 PMCID: PMC7303875 DOI: 10.1002/ccr3.2819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/14/2020] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
Sensing and defibrillation threshold for a S-ICD are impacted by positioning at implant or revision. The intermuscular pocket prevents device migration and provides appropriate, stable sensing vectors.
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Affiliation(s)
- Jeko M. Madjarov
- Department of Cardiovascular SurgerySanger Heart &Vascular InstituteAtrium HealthCharlotteNorth Carolina
| | - Svetozar Madzharov
- Department of Cardiovascular SurgerySanger Heart &Vascular InstituteAtrium HealthCharlotteNorth Carolina
- Faculty of MedicineSofia Bulgaria Medical UniversitySofiaBulgaria
| | | | | | - John M. Fedor
- Department of ElectrophysiologySanger Heart & Vascular InstituteAtrium HealthCharlotteNorth Carolina
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12
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Kaczmarek K, Kempa M, Grabowski M, Tajstra M, Sokal A, Cygankiewicz I, Zwoliński R, Michalak M, Kowara M, Budrejko S, Kurek A, Wranicz JK, Raczak G, Opolski G, Gąsior M, Kowalski O, Ptaszyński P. Multicentre early experience with totally subcutaneous cardioverter-defibrillators in Poland. Arch Med Sci 2020; 16:764-771. [PMID: 32542076 PMCID: PMC7286329 DOI: 10.5114/aoms.2019.83817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/19/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Implantable cardioverter-defibrillators (ICD) have a strong position in the prevention of sudden death. Nowadays, the most commonly used high-energy cardiac devices are transvenous ICDs. A new technology of totally subcutaneous ICDs (S-ICD) was invented and recently introduced into clinical practice in order to reduce lead-related complications of conventional ICDs. The aim of this paper is to present early experience with this new technology implemented in a few centres in Poland. MATERIAL AND METHODS Medical records of patients who had S-ICD-related interventions in Poland were retrospectively analysed. RESULTS During the first year of S-ICD introduction into the Polish health system 18 patients underwent surgery connected with S-ICDs. Majority of them (17 patients) were implanted de novo. In one patient surgical revision of a device implanted abroad was performed. Most of patients (78%) had S-ICDs implanted for secondary prevention. Inability of transvenous system implantation due to venous access obstruction or high risk of infection related with transvenous leads accounted for 83% of indications for S-ICD. Only in three patients were S-ICDs implanted due to young age and active mode of life. The implantations of S-ICDs were performed without important early or late complications. During follow-up one patient had episodes of ventricular arrhythmia successfully terminated with high-energy shocks. One patient died due to progression of heart failure. CONCLUSIONS S-ICD implantation procedure has been successfully and safely introduced in Polish clinical routine. Nevertheless, despite clear indications in recent ESC guidelines, this therapy is not directly reimbursed in Poland and needs individual application for refund.
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Affiliation(s)
- Krzysztof Kaczmarek
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
- Corresponding author: Krzysztof Kaczmarek MD, PhD, Department of Electrocardiology, Medical University of Lodz, 1/3 Sterlinga St, 91-425 Lodz, Poland, E-mail:
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Grabowski
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Mateusz Tajstra
- 3 Chair and Department of Cardiology, Silesian Medical University, Katowice, Poland
| | - Adam Sokal
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, SIlesian Medical University, Katowice, Poland
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
| | | | - Marcin Michalak
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Michal Kowara
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Szymon Budrejko
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Anna Kurek
- 3 Chair and Department of Cardiology, Silesian Medical University, Katowice, Poland
| | - Jerzy K. Wranicz
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Opolski
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Gąsior
- 3 Chair and Department of Cardiology, Silesian Medical University, Katowice, Poland
| | - Oskar Kowalski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, SIlesian Medical University, Katowice, Poland
| | - Paweł Ptaszyński
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
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13
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Kaczmarek K, Kałowski M, Krzysztof Wranicz J, Ptaszyńsk P, Cygankiewicz I. Conventional and alternative preimplantation ECG screening for subcutaneous ICD in high risk hypertrophic cardiomyopathy patients. J Electrocardiol 2019; 58:68-73. [PMID: 31770668 DOI: 10.1016/j.jelectrocard.2019.11.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 11/04/2019] [Accepted: 11/18/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Patients with hypertrophic cardiomyopathy (HCM) relatively often fail preimplantation ECG screening for subcutaneous implantable cardioverter-defibrillator (S-ICD). We aimed to evaluate impact of conventional and alternative ECG electrodes placement on eligibility for S-ICD implantation in HCM patients at high risk of sudden cardiac death (SCD). We hypothesized that modified electrodes placement will influence QRS-T morphology and thus it will increase S-ICD eligibility in the screening process. MATERIAL AND METHODS This study enrolled 17 HCM patients at high risk of SCD (5-year SCD risk above 5%) referred for an ICD implantation. ECG screening for S-ICD eligibility in horizontal and vertical position was performed in each patient, in two different screening electrodes configuration: conventional (recommended by manufacturer) and alternative (precordial electrodes shifted rightwards and lateral electrodes dorsally). We evaluated QRS and T waves amplitude as well as T wave index. Primary, secondary and alternate sensing vectors were assessed. RESULTS Preimplantation ECG screening with alternative electrodes placement resulted in more sensing vectors that were screened successfully (77 vs. 88, p = 0.05). Modified screening combined with a standard one allowed more patients to qualify for S-ICD implantation (17/17 vs. 12/17, p = 0.04). Electrocardiographically, the alternative positioning of ECG electrodes resulted in significant decrease in absolute values of QRS complex and T waves amplitudes in almost all sensing vectors, which was responsible for successful screening. CONCLUSIONS The use of alternative placement of screening electrodes may be a valuable method to increase eligibility for S-ICD implantation in HCM patients at high risk of SCD.
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Affiliation(s)
- Krzysztof Kaczmarek
- Department of Electrocardiology, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland.
| | - Michał Kałowski
- Department of Electrocardiology, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland
| | - Jerzy Krzysztof Wranicz
- Department of Electrocardiology, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland.
| | - Pawel Ptaszyńsk
- Department of Electrocardiology, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland.
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland.
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14
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Camm CF, Rajappan K, Curson M, Tilling L. Twiddler’s syndrome with a subcutaneous implantable cardioverter-defibrillator presenting with an inappropriate shock: a case report. Eur Heart J Case Rep 2019; 3:1-5. [PMID: 32123805 PMCID: PMC7042151 DOI: 10.1093/ehjcr/ytz200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/06/2019] [Accepted: 10/09/2019] [Indexed: 12/01/2022]
Abstract
Background Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are increasingly used in patients at risk of fatal cardiac arrhythmias. Twiddler’s syndrome is a condition in which a device is manipulated by the patient after implantation leading to lead twisting and retraction. Device manipulation has been reported multiple times in transvenous pacing systems and occasionally leads to inappropriate discharges from implanted defibrillators. However, little has been reported about device manipulation in S-ICD devices. Case summary We present the case of a 16-year-old who underwent insertion of an S-ICD for idiopathic dilated cardiomyopathy. He represented for a pacing check following a discharge from the device. This showed a significant change in the sensed vectors. Chest radiographs confirmed lead retraction and suggested device manipulation. The device was turned off to prevent further inappropriate shocks. The patient underwent successful reimplantation of a S-ICD device. Discussion This case highlights that twiddler’s syndrome can occur in those with an S-ICD and lead to an inappropriate device discharge. The patient in this case had a number of risk factors that have been previously associated with twiddler’s syndrome.
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Affiliation(s)
- C Fielder Camm
- Department of Cardiology, Royal Berkshire NHS Foundation Trust, London Road, Reading, RG1 5AN, UK
| | - Kim Rajappan
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
| | - Mark Curson
- Department of Cardiology, Royal Berkshire NHS Foundation Trust, London Road, Reading, RG1 5AN, UK
| | - Lindsey Tilling
- Department of Cardiology, Royal Berkshire NHS Foundation Trust, London Road, Reading, RG1 5AN, UK
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15
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CMR and CT of the Patient With Cardiac Devices. JACC Cardiovasc Imaging 2019; 12:890-903. [DOI: 10.1016/j.jcmg.2018.09.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/24/2018] [Accepted: 09/13/2018] [Indexed: 01/15/2023]
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16
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Hayase J, Do DH, Boyle NG. Defibrillation Threshold Testing: Current Status. Arrhythm Electrophysiol Rev 2018; 7:288-293. [PMID: 30588318 DOI: 10.15420/aer.2018.54.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/15/2018] [Indexed: 11/04/2022] Open
Abstract
When the transvenous ICD initially came into use for primary and secondary prevention of sudden cardiac death, defibrillation threshold (DFT) testing was universally performed. However, DFT testing is no longer routinely recommended for transvenous ICD implantation except in certain situations. Risk scores can help guide the decision to perform DFT testing. The subcutaneous ICD represents an area of uncertainty, with limited data available regarding the role of DFT testing in these devices. Current guidelines give a class I recommendation for performing DFT testing at the time of implant. Further studies are needed before this recommendation can be safely dismissed.
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Affiliation(s)
- Justin Hayase
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA Los Angeles, CA, USA
| | - Duc H Do
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA Los Angeles, CA, USA
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA Los Angeles, CA, USA
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Migliore F, Pelliccia F, Autore C, Bertaglia E, Cecchi F, Curcio A, Bontempi L, Curnis A, De Filippo P, D’Onofrio A, Francia P, Maurizi N, Musumeci B, Proclemer A, Zorzi A, Corrado D. Subcutaneous implantable cardioverter defibrillator in cardiomyopathies and channelopathies. J Cardiovasc Med (Hagerstown) 2018; 19:633-642. [DOI: 10.2459/jcm.0000000000000712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Lüscher TF. Causes and prevention of sudden cardiac death: ECG, electroanatomical mapping, fibrosis, and channelopathies. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy545] [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: 11/12/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Consultant and Director of Research, Education & Development, Royal Brompton and Harefield Hospital Trust, London, UK
- Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland
- EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
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19
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Silvetti MS, Pazzano V, Verticelli L, Battipaglia I, Saputo FA, Albanese S, Lovecchio M, Valsecchi S, Drago F. Subcutaneous implantable cardioverter-defibrillator: is it ready for use in children and young adults? A single-centre study. Europace 2018; 20:1966-1973. [DOI: 10.1093/europace/euy139] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/28/2018] [Indexed: 01/30/2023] Open
Affiliation(s)
- Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
| | - Vincenzo Pazzano
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
| | - Letizia Verticelli
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
| | - Irma Battipaglia
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
| | - Fabio Anselmo Saputo
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
| | - Sonia Albanese
- Heart Surgery Team, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Rome, Italy
| | | | - Sergio Valsecchi
- Heart Surgery Team, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Rome, Italy
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
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20
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Raatikainen MJP, Arnar DO, Merkely B, Nielsen JC, Hindricks G, Heidbuchel H, Camm J. A Decade of Information on the Use of Cardiac Implantable Electronic Devices and Interventional Electrophysiological Procedures in the European Society of Cardiology Countries: 2017 Report from the European Heart Rhythm Association. Europace 2018; 19:ii1-ii90. [PMID: 28903470 DOI: 10.1093/europace/eux258] [Citation(s) in RCA: 198] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 12/19/2022] Open
Abstract
Aims The aim of this analysis was to provide comprehensive information on invasive cardiac arrhythmia therapies in the European Society of Cardiology (ESC) area over the past 10 years. Methods and results The European Heart Rhythm Association (EHRA) has collected data on invasive arrhythmia therapies since 2008. This year 53 of the 56 ESC member countries provided data for the EHRA White Book. Here we present updated data on procedure rates together with information on demographics, economy, vital statistics, local healthcare systems and training activities. Considerable heterogeneity in the access to invasive arrhythmia therapies still exists across the five geographical ESC regions. In 2016, the device implantation rates per million population were 3-6 times higher in the Western region than in the non-European and Eastern ESC member countries. Catheter ablation activity was highest in the Western countries followed by the Northern and Southern areas. In the non-European countries, atrial fibrillation ablation rate was more than tenfold lower than in the European countries. On the other hand, the growth rate over the past ten years was highest in the non-European and Eastern countries. In some Eastern European countries with relative low gross domestic product the procedure rates exceeded the average values. Conclusion It was encouraging to note that during the past decade the growth in invasive arrhythmia therapies was greatest in the areas historically with relatively low activity. Nevertheless, there is substantial disparity and continued efforts are needed to improve harmonization of cardiac arrhythmia therapies in the ESC area.
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Affiliation(s)
| | - David O Arnar
- Division of Cardiology, Department of Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Bela Merkely
- Semmelweis University of Budapest, Heart and Vascular Center, Budapest, Hungary
| | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Centre, University of Leipzig, Leipzig
| | - Hein Heidbuchel
- Cardiology - Electrophysiology, Antwerp University and University Hospital, Antwerp, Belgium
| | - John Camm
- Division of Cardiovascular Sciences, St George's University of London, London, United Kingdom; ICMS, Imperial College, London, United Kingdom
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Khazen C, Magnusson P, Flandorfer J, Schukro C. The subcutaneous implantable cardioverter-defibrillator: A tertiary center experience. Cardiol J 2018; 26:543-549. [PMID: 29718532 DOI: 10.5603/cj.a2018.0050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/05/2018] [Accepted: 04/02/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate subcutaneous implantable cardioverter-defibrillator (S-ICD) patients with regard to underlying etiology, peri-procedural outcome, appropriate/inappropriate shocks, and complications during follow-up. METHODS All patients who underwent S-ICD implantation from February 2013 to March 2017 at an academic hospital in Vienna were included. Medical records were examined and follow-up interrogations of devices were conducted. RESULTS A total of 79 S-ICD patients (58.2% males) with a mean age of 44.5 ± 17.2 years were followed for a mean duration of 12.8 ± 13.7 months. A majority of patients (58.2%) had S-ICD for primary prevention of sudden cardiac death. The most common of the 16 underlying etiologies were ischemic cardiomyopathy, non-ischemic cardiomyopathy, and idiopathic ventricular fibrillation. The lead was implanted to the left sternal border in 96.2% of cases, between muscular layers in 72.2%. Mean implant time was 45 min, 3 patients were induced, and all patients except one were programmed to two zones. Six (7.6%) patients experienced at least one appropriate therapy for ventricular arrhythmias and the time to first event ranged from 1 to 52 months. Seven patients experienced inappropriate shocks due to T-wave oversensing, atrial tachycardia with rapid atrioventricular conduction, external electromagnetic interference, and/or baseline oversensing due to lead movement. Four patients underwent revision for lead repositioning (n = 1), loose device suture (n = 1), and infection (n = 2). CONCLUSIONS While S-ICDs are a feasible and effective treatment, issues remain with inappropriate shock and infection.
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Affiliation(s)
- Cesar Khazen
- Department of Surgery, Medical University of Vienna, Division of Cardiac Surgery, Vienna, Austria, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Peter Magnusson
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
| | | | - Christoph Schukro
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria, Austria
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22
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Tan NS, Almehmadi F, Tang ASL. Coronary vasospasm-induced polymorphic ventricular tachycardia: a case report and literature review. Eur Heart J Case Rep 2018; 2:yty021. [PMID: 31020100 PMCID: PMC6426052 DOI: 10.1093/ehjcr/yty021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/06/2018] [Indexed: 11/18/2022]
Abstract
Introduction Coronary vasospasm is an uncommon but important cause of myocardial ischaemia and ventricular arrhythmias. Case presentation In this report, we present a striking example of vasospasm manifesting as ST-segment elevation and ventricular tachycardia on Holter monitoring. Later, spasm occurred during a procainamide challenge performed for suspected Brugada syndrome. The patient underwent implantable cardioverter-defibrillator insertion and was successfully treated with oral calcium channel blocker. Discussion We review contemporary data regarding management and outcomes in coronary vasospasm and discuss the use of implantable defibrillator therapy in patients who have sustained a significant arrhythmic event.
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Affiliation(s)
- Nigel S Tan
- Department of Medicine, University of Toronto, 399 Bathurst Street, East Wing 5-470, Toronto, ON M5T2S8, Canada
| | - Fahad Almehmadi
- Division of Cardiology, London Health Sciences Centre and Department of Medicine, Western University, C6-109, 339 Windermere Road, London, ON N6A 5A5, Canada
| | - Anthony S L Tang
- Division of Cardiology, London Health Sciences Centre and Department of Medicine, Western University, C6-109, 339 Windermere Road, London, ON N6A 5A5, Canada
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23
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Bogush N, Espinosa RE, Cannon BC, Wackel PL, Okamura H, Friedman PA, McLeod CJ. Selecting the right defibrillator in the younger patient: Transvenous, epicardial or subcutaneous? Int J Cardiol 2018; 250:133-138. [DOI: 10.1016/j.ijcard.2017.09.213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 09/16/2017] [Accepted: 09/29/2017] [Indexed: 01/22/2023]
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24
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Lüscher TF. An update on arrhythmias: mechanisms and novel devices. Eur Heart J 2017; 38:219-221. [DOI: 10.1093/eurheartj/ehx006] [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: 11/13/2022] Open
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25
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[Updated ESC guideline: innovations for the treatment of ventricular arrhythmias and recommendations for prevention of sudden cardiac death]. Herzschrittmacherther Elektrophysiol 2016; 27:288-94. [PMID: 27581243 DOI: 10.1007/s00399-016-0446-2] [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] [Indexed: 10/21/2022]
Abstract
The 2015 European Society of Cardiology Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death is an update of the former 2006 European/American guidelines. This new consensus document gives a detailed overview on prevention and therapy of ventricular arrhythmias and sudden cardiac death. This includes detailed discussion of channelopathies and various cardiomyopathies. Gaps in evidence are identified and also discussed. DNA analysis and postmortem assessment in sudden cardiac death victims is for the first time part of these new recommendations. In addition, for the first time recommendations on subcutaneous implantable cardioverter-defibrillator (ICD) and the wearable defibrillator are given. The guidelines strengthen the role of ICD therapy in primary and secondary prevention of sudden cardiac death although data used as the basis for these recommendations are 10-15 years old and patients' characteristics including therapeutic options have changed during that time. Systematic reassessment of left ventricular function 6-12 weeks after infarction is also included as a new recommendation. The role of catheter ablation in electrical storm and for those presenting with a first episode of sustained ventricular tachycardia has also been upgraded in the new guidelines. Hopefully, the new guidelines will reach not only cardiologists and help to improve patient care, but also contribute to reducing the high number sudden cardiac deaths in Europe.
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Raatikainen MP, Arnar DO, Merkely B, Camm AJ, Hindricks G. Access to and clinical use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology Countries: 2016 Report from the European Heart Rhythm Association. Europace 2016; 18 Suppl 3:iii1-iii79. [DOI: 10.1093/europace/euw244] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 11/13/2022] Open
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Affiliation(s)
- Christine M Albert
- From Harvard Medical School, Center for Arrhythmia Prevention, Division of Cardiovascular and Preventive Medicine (C.M.A.), and Department of Medicine, Harvard Medical School, Cardiac Arrhythmia Program, Division of Cardiovascular Medicine (W.G.S.), Brigham and Women's Hospital, Boston, MA.
| | - William G Stevenson
- From Harvard Medical School, Center for Arrhythmia Prevention, Division of Cardiovascular and Preventive Medicine (C.M.A.), and Department of Medicine, Harvard Medical School, Cardiac Arrhythmia Program, Division of Cardiovascular Medicine (W.G.S.), Brigham and Women's Hospital, Boston, MA
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