1
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Block M, Klein HU. [History of the implantable cardioverter-defibrillator in Germany]. Herzschrittmacherther Elektrophysiol 2024; 35:55-67. [PMID: 38421401 PMCID: PMC10923992 DOI: 10.1007/s00399-024-01001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
The implantable cardioverter-defibrillator (ICD) was a breakthrough in the prevention of sudden cardiac death. After years of technical development in the USA, Michel Mirowski succeeded in proving reliable automatic defibrillation of ventricular tachyarrhythmias through initial human implantations in 1980, despite many obstacles. Nearly 4 years later, the first patients received ICDs at multiple centers in Germany. Subsequently, outside the USA, Germany became the country with highest implantation rates. The absolute number of implantations remained small as long as implantations required epicardial defibrillation electrodes and therefore thoracotomy by cardiac surgeons. Pacemaker-like implantation using a transvenous defibrillation electrode with a pectoral ICD became feasible in the early 1990s pushing implantation rates to the next level. Technical advancements were accompanied by clinical research in Germany, and often, the first-in-human studies were conducted in Germany. In 1991, the first guidelines for indications were established in the USA and Germany. Several randomized studies on indications were published between 1996 and 2009, mostly led by American teams with German participation, but also under German leadership (CASH, CAT, DINAMIT, IRIS). The DANISH study in 2016 questioned the results of these long-standing studies. Instead of providing ICDs to patients using a broad indication, future efforts aim to identify patients who, despite optimal medical therapy, cardiac resynchronization therapy (CRT), and/or catheter ablation, need protection against sudden cardiac death. Risk scores incorporating myocardial scars in magnetic resonance imaging (MRI) and genetic information are expected to contribute to more individualized and effective indications.
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2
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Younis A, Wilkoff BL. Implantable Cardioverter-Defibrillator for Primary Prevention in Asia. JACC. ASIA 2023; 3:321-334. [PMID: 37323870 PMCID: PMC10261897 DOI: 10.1016/j.jacasi.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
In a contemporary setting, where the risk of sudden cardiac death (SCD) is low, heart failure management is improved, and technology is advanced, identifying the patients who would benefit the most from an implantable cardioverter-defibrillator (ICD) treatment for primary prevention remains a challenge. The prevalence of SCD is lower in Asia when compared with the United States/Europe (35-45 per 100,000 person-years vs 55-100 per 100,000 person-years, respectively). Nevertheless, this should not explain the enormous gap in ICD's utilization among eligible candidates (∼12% in Asia vs ∼45% in the United States/Europe). The disparity between Asia and Western countries, together with significant variation among the Asian population and the previously mentioned challenges, requires an individualized approach and specific regional recommendation, especially in countries with limited resources where ICDs are being extremely underutilized This review focuses on the current knowledge of ICD therapy for SCD prevention and how to improve patient and device selection.
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Affiliation(s)
| | - Bruce L. Wilkoff
- Address for correspondence: Dr Bruce L. Wilkoff, Department of Cardiovascular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Desk J2-2, Cleveland, Ohio 44195, USA. @BruceWilkoff
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3
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Hindricks G, Theuns DA, Bar-Lev D, Anguera I, Ayala Paredes FA, Arnold M, Geller JC, Merkely B, Dyrda KM, Perings C, Maglia G, Ploux S, Meyhöfer J, Blomström-Lundqvist C, Karjalainen P, Liang Y, Diemberger I, Wranicz JK, Barr C, Quartieri F, Timmel T, Bollmann A. Ability to remotely monitor atrial high-rate episodes using a single-chamber implantable cardioverter-defibrillator with a floating atrial sensing dipole. Europace 2023; 25:euad061. [PMID: 37038759 PMCID: PMC10227664 DOI: 10.1093/europace/euad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/06/2022] [Indexed: 04/12/2023] Open
Abstract
AIMS To allow timely initiation of anticoagulation therapy for the prevention of stroke, the European guidelines on atrial fibrillation (AF) recommend remote monitoring (RM) of device-detected atrial high-rate episodes (AHREs) and progression of arrhythmia duration along pre-specified strata (6 min…<1 h, 1 h…<24 h, ≥ 24 h). We used the MATRIX registry data to assess the capability of a single-lead implantable cardioverter-defibrillator (ICD) with atrial sensing dipole (DX ICD system) to follow this recommendation in patients with standard indication for single-chamber ICD. METHODS AND RESULTS In 1841 DX ICD patients with daily automatic RM transmissions, electrograms of first device-detected AHREs per patient in each duration stratum were adjudicated, and the corresponding positive predictive values (PPVs) for the detections to be true atrial arrhythmia were calculated. Moreover, the incidence and progression of new-onset AF was assessed in 1451 patients with no AF history. A total of 610 AHREs ≥6 min were adjudicated. The PPV was 95.1% (271 of 285) for episodes 6min…<1 h, 99.6% (253/254) for episodes 1 h…<24 h, 100% (71/71) for episodes ≥24 h, or 97.5% for all episodes (595/610). The incidence of new-onset AF was 8.2% (119/1451), and in 31.1% of them (37/119), new-onset AF progressed to a higher duration stratum. Nearly 80% of new-onset AF patients had high CHA2DS2-VASc stroke risk, and 70% were not on anticoagulation therapy. Age was the only significant predictor of new-onset AF. CONCLUSION A 99.7% detection accuracy for AHRE ≥1 h in patients with DX ICD systems in combination with daily RM allows a reliable guideline-recommended screening for subclinical AF and monitoring of AF-duration progression.
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Affiliation(s)
- Gerhard Hindricks
- Department of Electrophysiology, Heart Centre Leipzig and Leipzig Heart Institute, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Dominic A Theuns
- Erasmus University Medical Center,‘s-Gravendijkwal 230, 3015 GD Rotterdam, TheNetherlands
| | - David Bar-Lev
- Chaim Sheba Medical Center,52621 Tel Hashomer, Israel
| | - Ignasi Anguera
- Arrhythmia Unit, Heart Diseases Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, Feixa Llarga, 08907 L'Hospitalet, Barcelona, Spain
| | | | - Martin Arnold
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - J Christoph Geller
- Zentralklinik Bad Berka GmbH,Robert-Koch-Allee 9, 99437 Bad Berka, Germany
| | - Béla Merkely
- Semmelweis Medical University, Városmajorutca 68, 1122 Budapest, Hungary
| | - Katia Marjolaine Dyrda
- Montreal Heart Institute affiliated with Université de Montréal, 5000, rue Belanger, H1T 1C8 Montréal, Québec, Canada
| | | | - Giampiero Maglia
- Azienda Ospedaliera Pugliese Ciaccio, Via Vinicio Cortese 25, 88100 Catanzaro, Italia
| | - Sylvain Ploux
- Hôpital Haut Lévêque (CHU), 1 avenue de Magellan, 33600 Pessac Cedex, France
| | - Jürgen Meyhöfer
- Maria Heimsuchung—Caritas-Klinik Pankow,Breite Str. 46/47, 13187 Berlin, Germany
| | - Carina Blomström-Lundqvist
- Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
- Department of Medical Science and Cardiology, Uppsala University, S-751 85 Uppsala, Sweden
| | - Pasi Karjalainen
- Satakunta Central Hospital, Sydänyksikkö, Sairaalantie 3, 28500 Pori, Finland
| | - Yanchun Liang
- General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, 110016 Shenyang, China
| | - Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italia
| | - Jerzy Krzysztof Wranicz
- Department of Electrocardiology, Medical University of Lodz, Ul. Pomorska 251, 92-213 Łódź, Poland
| | - Craig Barr
- Russells Hall Hospital, Pensett Road, DY1 2HQ Dudley, UK
| | - Fabio Quartieri
- Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italia
| | - Tobias Timmel
- Biotronik SE & Co. KG,Woermannkehre 1, 12359 Berlin, Germany
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4
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Ballantyne BA, Chew DS, Vandenberk B. Paradigm Shifts in Cardiac Pacing: Where Have We Been and What Lies Ahead? J Clin Med 2023; 12:jcm12082938. [PMID: 37109274 PMCID: PMC10146747 DOI: 10.3390/jcm12082938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
The history of cardiac pacing dates back to the 1930s with externalized pacing and has evolved to incorporate transvenous, multi-lead, or even leadless devices. Annual implantation rates of cardiac implantable electronic devices have increased since the introduction of the implantable system, likely related to expanding indications, and increasing global life expectancy and aging demographics. Here, we summarize the relevant literature on cardiac pacing to demonstrate the enormous impact it has had within the field of cardiology. Further, we look forward to the future of cardiac pacing, including conduction system pacing and leadless pacing strategies.
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Affiliation(s)
- Brennan A Ballantyne
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Derek S Chew
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium
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5
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Januszkiewicz Ł, Barra S, Marijon E, Providencia R, de Asmundis C, Chun JKR, Farkowski MM, Conte G, Boveda S. Major gaps in the information provided to patients before implantation of cardioverter defibrillators: a prospective patient European evaluation. Europace 2023; 25:1144-1151. [PMID: 36691111 PMCID: PMC10062348 DOI: 10.1093/europace/euac275] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/06/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS Information provided to patients prior to implantable cardioverter-defibrillator (ICD) insertion and their participation in the decision-making process are crucial for understanding ICD function and accepting this lifelong therapy. The aim of this study is to evaluate the extent to which different aspects related to ICD and quality of life were transmitted to patients prior to ICD implantation. METHODS AND RESULTS Prospective, multicenter European study with an online questionnaire initiated by the European Heart Rhythm Association. The questionnaire was filled-in directly and personally by the ICD patients who were invited to participate. A total of 1809 patients (majority in their 40s-70s, with 624 women, 34.5%) from 10 European countries participated in the study. The median time from first ICD implantation was 5 years (interquartile range 2-10). Overall, 1155 patients (71.5%) felt optimally informed at the time of device implantation, however many respondents received no information about ICD-related complications (n = 801, 49.6%), driving restrictions (n = 718, 44.5%), and possibility of end-of-life ICD deactivation (n = 408, 25.4%). Of note, women were less frequently involved in the decision-making process than men (47.3% vs. 55.9%, P = 0.003) and reported to be less often optimally informed before ICD implantation than men (61.2% vs. 76.8%, P < 0.001). More women mentioned the desire to have learned more about ICD therapy and the benefit/risk balance (45.4% vs. 33.7% of men; P < 0.001). CONCLUSIONS This patient-based evaluation provides alarming findings on the lack of information provided to patients prior ICD implantation, particularly for women.
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Affiliation(s)
| | - Sérgio Barra
- Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal
| | - Eloi Marijon
- University of Paris, Paris, France
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
- Paris Cardiovascular Research Center, INSERM Unit 970, 56 Rue Leblanc, 75015, Paris, France
| | - Rui Providencia
- Barts Heart Centre, St. Bartholomew’s Hospital, London, UK
- Institute of Health Informatics Research, University College London, London, UK
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Julian K R Chun
- CCB, Cardiology, Med. Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Michał M Farkowski
- 2nd Department of Heart Arrhythmia, National Institute of Cardiology, Warsaw, Poland
| | - Giulio Conte
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland
- Università della Svizzera italiana, Lugano, Switzerland
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
- Paris Cardiovascular Research Center, INSERM Unit 970, 56 Rue Leblanc, 75015, Paris, France
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
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6
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Khanra D, Panchal G, Dowd R, Chandan N, Petkar S. More Is Not Always More: A Timely Reminder Why Not to Use Too Much Hardware. J Cardiovasc Imaging 2022; 30:84-85. [PMID: 35086174 PMCID: PMC8792722 DOI: 10.4250/jcvi.2021.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/16/2021] [Accepted: 06/27/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Dibbendhu Khanra
- Heart and Lung Centre, Department of Electrophysiology and Devices, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Gaurav Panchal
- Department of Cardiology, The Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Rory Dowd
- Heart and Lung Centre, Department of Electrophysiology and Devices, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Nakul Chandan
- Heart and Lung Centre, Department of Electrophysiology and Devices, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Sanjiv Petkar
- Heart and Lung Centre, Department of Electrophysiology and Devices, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
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7
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Burri H, Starck C, Auricchio A, Biffi M, Burri M, D'Avila A, Deharo JC, Glikson M, Israel C, Lau CP, Leclercq C, Love CJ, Nielsen JC, Vernooy K, Dagres N, Boveda S, Butter C, Marijon E, Braunschweig F, Mairesse GH, Gleva M, Defaye P, Zanon F, Lopez-Cabanillas N, Guerra JM, Vassilikos VP, Martins Oliveira M. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin-American Heart Rhythm Society (LAHRS). Europace 2021; 23:983-1008. [PMID: 33878762 DOI: 10.1093/europace/euaa367] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
With the global increase in device implantations, there is a growing need to train physicians to implant pacemakers and implantable cardioverter-defibrillators. Although there are international recommendations for device indications and programming, there is no consensus to date regarding implantation technique. This document is founded on a systematic literature search and review, and on consensus from an international task force. It aims to fill the gap by setting standards for device implantation.
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Affiliation(s)
- Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion, Berlin, Germany
| | - Angelo Auricchio
- Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland
| | - Mauro Biffi
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Mafalda Burri
- Division of Scientific Information, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
| | - Andre D'Avila
- Serviço de Arritmia Cardíaca-Hospital SOS Cardio, 2 Florianópolis, SC, Brazil.,Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Carsten Israel
- Department of Cardiology, Bethel-Clinic Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany
| | - Chu-Pak Lau
- Division of Cardiology, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | | | - Charles J Love
- Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Chefarzt, Abteilung Kardiologie, Berlin, Germany
| | - Eloi Marijon
- University of Paris, Head of Cardiac Electrophysiology Section, European Georges Pompidou Hospital, 20 Rue Leblanc, 75908 Paris Cedex 15, France
| | | | - Georges H Mairesse
- Department of Cardiology-Electrophysiology, Cliniques du Sud Luxembourg-Vivalia, rue des Deportes 137, BE-6700 Arlon, Belgium
| | - Marye Gleva
- Washington University in St Louis, St Louis, MO, USA
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie, Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Vassilios P Vassilikos
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,3rd Cardiology Department, Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
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8
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Heidbuchel H, Arbelo E, D'Ascenzi F, Borjesson M, Boveda S, Castelletti S, Miljoen H, Mont L, Niebauer J, Papadakis M, Pelliccia A, Saenen J, Sanz de la Garza M, Schwartz PJ, Sharma S, Zeppenfeld K, Corrado D. Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part 2: ventricular arrhythmias, channelopathies, and implantable defibrillators. Europace 2021; 23:147-148. [PMID: 32596731 DOI: 10.1093/europace/euaa106] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This paper belongs to a series of recommendation documents for participation in leisure-time physical activity and competitive sports by the European Association of Preventive Cardiology (EAPC). Together with an accompanying paper on supraventricular arrhythmias, this second text deals specifically with those participants in whom some form of ventricular rhythm disorder is documented, who are diagnosed with an inherited arrhythmogenic condition, and/or who have an implanted pacemaker or cardioverter defibrillator. A companion text on recommendations in athletes with supraventricular arrhythmias is published in the European Journal of Preventive Cardiology. Since both texts focus on arrhythmias, they are the result of a collaboration between EAPC and the European Heart Rhythm Association (EHRA). The documents provide a framework for evaluating eligibility to perform sports, based on three elements, i.e. the prognostic risk of the arrhythmias when performing sports, the symptomatic impact of arrhythmias while performing sports, and the potential progression of underlying structural problems as the result of sports.
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Affiliation(s)
- Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, University Antwerp, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Mats Borjesson
- Centre for Health and Performance (CHP), Department of Food, Nutrition and Sport Sciences, Gothenburg University, Sweden.,Department of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden
| | - Serge Boveda
- Cardiology Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France
| | - Silvia Castelletti
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy
| | - Hielko Miljoen
- Department of Cardiology, University Hospital Antwerp, University Antwerp, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St. George's University of London, London, UK.,St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Antonio Pelliccia
- National Institute of Sports Medicine, Italian National Olympic Committee, Via dei Campi Sportivi 46, Rome, Italy
| | - Johan Saenen
- Department of Cardiology, University Hospital Antwerp, University Antwerp, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | | | - Peter J Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's University of London, London, UK.,St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Domenico Corrado
- Department of Cardiology, University of Padova, Padova, Italy.,Department of Pathology, University of Padova, Padova, Italy
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9
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Atabekov TA, Batalov RE, Sazonova SI, Krivolapov SN, Khlynin MS, Mishkina AI, Zavadovsky KV, Curnis A, Popov SV. How to get the optimal defibrillation lead parameters using myocardial perfusion scintigraphy in patients with coronary artery disease. Int J Cardiovasc Imaging 2021; 37:3323-3333. [PMID: 34100141 DOI: 10.1007/s10554-021-02308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
The conventional criteria for a defibrillation lead (DL) implantation don't take into account presence of scar or deep ischemia in the myocardium. This may impair a proper functioning of the DL. We sought to optimize the DL implantation placement using rest myocardial perfusion scintigraphy (MPS), which allow detecting areas of myocardial hypoperfusion (MH). To study the influence of MH and scarring, detected by MPS, on the DL parameters in patients with coronary artery disease (CAD). 69 patients (male-65, age 64.8 ± 7.7 years) with CAD and indications for ICD implantation were enrolled. Two days before ICD implantation all patients underwent MPS at rest. Then patients were divided in 2 groups. In the 1st group DL was implanted considering MPS results: to the septal position, if the most significant MH were detected in the apical segments, and to the apical position, if MH were in the septal segments. In the 2nd group DL was implanted using the conventional approach without considering MPS results. Clinical 12 months follow-up was performed with ICD interrogation. Patients of both groups were comparable by clinical and scintigraphic parameters. In the same time, in the 1st group pacing threshold was lower (p < 0.0001) and ventricle signal amplitude was higher (p < 0.0001) comparing with the 2nd group at all control points. The presence of MH detected by MPS in the area of the DL placement worsens its parameters. The results of MPS in patients with CAD can be useful for optimization of DL placement.
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Affiliation(s)
- Tariel A Atabekov
- Department of Surgical Arrhythmology and Cardiac Pacing, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya st., 111a, Tomsk, Russian Federation, 634012.
| | - Roman E Batalov
- Department of Surgical Arrhythmology and Cardiac Pacing, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya st., 111a, Tomsk, Russian Federation, 634012
| | - Svetlana I Sazonova
- Nuclear Medicine Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya street, 111a, Tomsk, Russian Federation
| | - Sergey N Krivolapov
- Department of Surgical Arrhythmology and Cardiac Pacing, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya st., 111a, Tomsk, Russian Federation, 634012
| | - Mikhail S Khlynin
- Department of Surgical Arrhythmology and Cardiac Pacing, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya st., 111a, Tomsk, Russian Federation, 634012
| | - Anna I Mishkina
- Nuclear Medicine Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya street, 111a, Tomsk, Russian Federation
| | - Konstantin V Zavadovsky
- Nuclear Medicine Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya street, 111a, Tomsk, Russian Federation
| | - Antonio Curnis
- Department of Clinical and Experimental Sciences, Università Degli Studi di Brescia, via san Faustino 74b, 25122, Brescia, Italy
| | - Sergey V Popov
- Department of Surgical Arrhythmology and Cardiac Pacing, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya st., 111a, Tomsk, Russian Federation, 634012
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10
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Guía ESC 2020 sobre cardiología del deporte y el ejercicio en pacientes con enfermedad cardiovascular. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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11
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Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021; 42:17-96. [PMID: 32860412 DOI: 10.1093/eurheartj/ehaa605] [Citation(s) in RCA: 722] [Impact Index Per Article: 240.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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12
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Long-term outcomes after radiofrequency catheter ablation of the atrioventricular node: The experience of a Portuguese tertiary center. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2020.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Manuel AM, Almeida J, Fonseca P, Monteiro J, Guerreiro C, Barbosa AR, Teixeira P, Ribeiro J, Santos E, Rosas F, Ribeiro J, Dias A, Caeiro D, Sousa O, Teixeira M, Oliveira M, Gonçalves H, Primo J, Braga P. Long-term outcomes after radiofrequency catheter ablation of the atrioventricular node: The experience of a Portuguese tertiary center. Rev Port Cardiol 2021; 40:95-103. [PMID: 33422375 DOI: 10.1016/j.repc.2020.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/08/2020] [Accepted: 05/05/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION In patients with supraventricular arrhythmias and high ventricular rate, unresponsive to rate and rhythm control therapy or catheter ablation, atrioventricular (AV) node ablation may be performed. OBJECTIVES To assess long-term outcomes after AV node ablation and to analyze predictors of adverse events. METHODS We performed a detailed retrospective analysis of all patients who underwent AV node ablation between February 1997 and February 2019, in a single Portuguese tertiary center. RESULTS A total of 123 patients, mean age 69±9 years and 52% male, underwent AV node ablation. Most of them presented atrial fibrillation at baseline (65%). During a median follow-up of 8.5 years (interquartile range 3.8-11.8), patients improved heart failure (HF) functional class (NYHA class III-IV 46% versus 13%, p=0.001), and there were reductions in hospitalizations due to HF (0.98±1.3 versus 0.28±0.8, p=0.001) and emergency department (ED) visits (1.1±1 versus 0.17±0.7, p=0.0001). There were no device-related complications. Despite permanent pacemaker stimulation, left ventricular ejection fraction did not worsen (47±13% vs. 47%±12, p=0.63). Twenty-eight patients died (23%). The number of ED visits due to HF before AV node ablation was an independent predictor of the composite adverse outcome (OR 1.8, 95% CI 1.24-2.61, p=0.002). CONCLUSIONS Despite pacemaker dependency, the clinical benefit of AV node ablation persisted at long-term follow-up. The number of ED visits due to HF before AV node ablation was an independent predictor of the composite adverse outcome. AV node ablation should probably be considered earlier in the treatment of patients with supraventricular arrhythmias and HF, especially in cases that are unsuitable for selective ablation of the specific arrhythmia.
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Affiliation(s)
- Ana Mosalina Manuel
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal.
| | - João Almeida
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Paulo Fonseca
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Joel Monteiro
- Cardiology Department, Funchal Central Hospital, Madeira, Portugal
| | - Cláudio Guerreiro
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Ana Raquel Barbosa
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Pedro Teixeira
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - José Ribeiro
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Elisabeth Santos
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Filipa Rosas
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - José Ribeiro
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Adelaide Dias
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Daniel Caeiro
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Olga Sousa
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Madalena Teixeira
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Marco Oliveira
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Helena Gonçalves
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - João Primo
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
| | - Pedro Braga
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
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14
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Goldenberg I, Huang DT, Nielsen JC. The role of implantable cardioverter-defibrillators and sudden cardiac death prevention: indications, device selection, and outcome. Eur Heart J 2019; 41:2003-2011. [DOI: 10.1093/eurheartj/ehz788] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/09/2019] [Accepted: 10/26/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
Multiple randomized multicentre clinical trials have established the role of the implantable cardioverter-defibrillator (ICD) as the mainstay in the treatment of ventricular tachyarrhythmias and sudden cardiac death (SCD) prevention. These trials have focused mainly on heart failure patients with advanced left ventricular dysfunction and were mostly conducted two decades ago, whereas a more recent trial has provided conflicting results. Therefore, much remains to be determined on how best to balance the identification of patients at high risk of SCD together with who would benefit most from ICD implantation in a contemporary setting. Implantable cardioverter-defibrillators have also evolved from the simple, defibrillation-only devices implanted surgically to more advanced technologies of multi-chamber devices, with physiologic bradycardic pacing, including cardiac resynchronization therapy, atrial and ventricular therapeutic pacing algorithms, and subcutaneous ICDs. These multiple options necessitate individualized approach to device selection and programming. This review will focus on the current knowledge on selection of patients for ICD treatment, device selection and programming, and future directions of implantable device therapy for SCD prevention.
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Affiliation(s)
- Ilan Goldenberg
- Division of Cardiology, Department of Medicine, The Clinical Cardiovascular Research Center, University of Rochester Medical Center, 265 Crittenden Blvd CU 420653, Rochester, NY 14642, USA
| | - David T Huang
- Division of Cardiology, Department of Medicine, The Clinical Cardiovascular Research Center, University of Rochester Medical Center, 265 Crittenden Blvd CU 420653, Rochester, NY 14642, USA
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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15
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Safak E, Eckardt L, Jung W, Ince H, Senges J, Hochadel M, Perings C, Spitzer S, Brachmann J, Seidl K, Hink HU, D'Ancona G. Determinants of inappropriate implantable cardioverter-defibrillator shocks: the German Device Registry perspective. J Interv Card Electrophysiol 2019; 56:71-77. [PMID: 31375974 DOI: 10.1007/s10840-019-00600-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/16/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the present study, we have focused upon rates and clinical determinants of inappropriate shock (IS) after implantable cardioverter-defibrillator (ICD). METHODS Data were collected prospectively in the German Device II Registry. RESULTS A total of 783 patients were included. Three sub-groups were identified: non-shock (NS) included 725 patients (92.6%), IS 24 (3.1%), and appropriate shock (AS) 34 (4.3%). IS patients were younger (AS 68 (58-77); IS 59 (51-68); NS 66 (56-75) years; p = 0.03), had been mainly referred for primary prophylaxis (AS 42.4%; IS 70.8%; NS 67.3%; p = 0.01), had a higher resting heart rate (AS 70 (63-80); IS 80 (71-98); NS 70 (60-81) BPM; p = 0.003), had more often atrial fibrillation (AF) (AS 14.7%; IS 45.8%; NS 18.8%; p = 0.006), and shorter QRS duration (AS 100 (90-120); IS 95 (90-100); NS 120 (98-150) msec.; p = 0.001). VVI-ICD was more common in IS (AS 64.7%; IS 83.3%; NS 49.8%; p = 0.002). At a follow-up of 18.2 months (75% IQR 13.6-22.4), no deaths were observed in the IS group, one (2.9%) in the AS, and 36 (4.9%) in the NS (p = 0.9). At logistic regression, VVI-ICD implantation was the strongest IS independent determinant (OR 5.0; 95% CI 1.6-15.9; p = 0.004) together with age < 70 years (OR 4.6; CI 1.4-14.7; p = 0.009), AF at time of ICD implantation (OR 3.5; CI 1.3-9.1; p = 0.01), and resting heart rate > 70/min (OR 2.8; CI 1.0-7.3; p = 0.03). CONCLUSION In a contemporary setting, some specific conditions such as VVI-ICD, younger age, and faster resting heart rates remain important IS determinants after ICD implantation.
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Affiliation(s)
- Erdal Safak
- Vivantes Klinikum Am Urban, Diffenbach strasse, Berlin, Germany.,Rostock University Medical Center, Rostock, Germany
| | - Lars Eckardt
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Münster, Germany
| | - Werner Jung
- Klinik für Innere Medizin III Kardiologie, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
| | - Hüseyin Ince
- Vivantes Klinikum Am Urban, Diffenbach strasse, Berlin, Germany.,Rostock University Medical Center, Rostock, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | | | - Stefan Spitzer
- Praxisklinik Herz und Gefäße Dresden and Institute of Medical Technology, Brandenburg University of Technology Cottbus, Cottbus, Germany
| | | | | | | | - Giuseppe D'Ancona
- Vivantes Klinikum Am Urban, Diffenbach strasse, Berlin, Germany. .,Rostock University Medical Center, Rostock, Germany.
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Neuwirth R, Cvek J, Knybel L, Jiravsky O, Molenda L, Kodaj M, Fiala M, Peichl P, Feltl D, Januška J, Hecko J, Kautzner J. Stereotactic radiosurgery for ablation of ventricular tachycardia. Europace 2019; 21:1088-1095. [DOI: 10.1093/europace/euz133] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/16/2019] [Indexed: 11/13/2022] Open
Abstract
Aims
Stereotactic body radiotherapy (SBRT) for ventricular tachycardias (VTs) could be an option after failed catheter ablation. In this study, we analysed the long-term efficacy and toxicity of SBRT applied as a bail-out procedure.
Methods and results
Patients with structural heart disease and unsuccessful catheter ablations for VTs underwent SBRT. The planning target volume (PTV) was accurately delineated using exported 3D electroanatomical maps with the delineated critical part of re-entry circuits. This was defined by detailed electroanatomic mapping and by pacing manoeuvres during the procedure. Using the implantable cardioverter-defibrillator lead as a surrogate contrast marker for respiratory movement compensation, 25 Gy was delivered to the PTV using CyberKnife. We evaluated occurrences of sustained VT, electrical storm, antitachycardia pacing, and shock; time to death; and radiation-induced events. From 2014 until March 2017, 10 patients underwent radiosurgical ablation (mean PTV, 22.15 mL; treatment duration, 68 min). After radiosurgery, four patients experienced nausea and one patient presented gradual progression of mitral regurgitation. During the follow-up (median 28 months), VT burden was reduced by 87.5% compared with baseline (P = 0.012) and three patients suffered non-arrhythmic deaths. After the blanking period, VT recurred in eight of 10 patients. The mean time to first antitachycardia pacing and shock were 6.5 and 21 months, respectively.
Conclusion
Stereotactic body radiotherapy appears to show long-term safety and effectiveness for VT ablation in structural heart disease inaccessible to catheter ablation. We report one possible radiation-related toxicity and promising overall survival, warranting evaluation in a prospective multicentre clinical trial.
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Affiliation(s)
- Radek Neuwirth
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jakub Cvek
- Department of Oncology, University Hospital Ostrava, 17. listopadu 1790, Ostrava, Czech Republic
| | - Lukas Knybel
- Department of Oncology, University Hospital Ostrava, 17. listopadu 1790, Ostrava, Czech Republic
| | | | - Lukas Molenda
- Department of Oncology, University Hospital Ostrava, 17. listopadu 1790, Ostrava, Czech Republic
| | - Michal Kodaj
- Cardiology, Podlesi Hospital Trinec, Czech Republic
| | - Martin Fiala
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - David Feltl
- Department of Oncology, General University Hospital, Prague, Czech Republic
| | | | - Jan Hecko
- Cardiology, Podlesi Hospital Trinec, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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17
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Lee JH, Lee SR, Choi EK, Jeong J, Park HD, You SJ, Lee SS, Oh S. Temporal Trends of Cardiac Implantable Electronic Device Implantations: a Nationwide Population-based Study. Korean Circ J 2019; 49:841-852. [PMID: 31074230 PMCID: PMC6713826 DOI: 10.4070/kcj.2018.0444] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/04/2019] [Accepted: 03/27/2019] [Indexed: 12/28/2022] Open
Abstract
Background and Objectives Implantation of cardiac implantable electronic devices (CIED), including permanent pacemakers (PM), implantable cardioverter-defibrillators (ICD), and cardiac resynchronization therapy (CRT) devices, has increased significantly over the past several years. However, limited data exists regarding temporal trends of CIED implantations in Asian population. This study aimed to investigate temporal trends of CIED treatment in Korea. Methods Using the National Health Insurance Service database of the entire Korean adult population, temporal trends of CIED procedures between 2009 and 2016 were evaluated. Additionally, temporal changes in the prevalence of patients' comorbidities were evaluated. Results A total of 35,421 CIED procedures (new implantations: 27,771, replacements: 7,650) were performed during the study period. The mean age of new CIED recipients and the prevalence of comorbidities, including hypertension, diabetes mellitus, heart failure, stroke, and atrial fibrillation, increased substantially with time. Compared to 2009, the number of new implantations of PM, ICD, and CRT devices increased by 2.0 (1,977 to 3,910), 3.6 (230 to 822), and 4.9 (44 to 217) times in 2016, respectively. The annual new implantation rate of CIED also increased accordingly (5.1 to 9.3 for PM, 0.6 to 1.9 for ICD, and 0.1 to 0.5 for CRT devices, per 100,000 persons). Conclusions The number of CIED implantation increased substantially from 2009 to 2016 in Korea. Also, the patients with CIED have been changed to be older and have more comorbidities. Therefore, the burden of health care cost in patients with CIED would be expected to increase in the future.
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Affiliation(s)
- Ji Hyun Lee
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eue Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
| | | | | | | | - Sang Soo Lee
- Medtronic Korea, Ltd., Seoul, Korea.,Graduate School for Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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