Ambulatory monitoring of the automatic implantable cardioverter-defibrillator: a practical guide

[Spanish Society of Cardiology practice guidelines on ambulatory monitoring of electrocardiogram and blood pressure]

In the present paper, a historical review and a clinical up-date are done on two procedures of great medical interest: Holter electrocardiography and ambulatory blood pressure monitoring. Technical and methodological characteristics of each procedure are carefully exposed, emphasizing each the lack of an international agreement in order to establish regulations that make all the equipment homogeneous and reliable in order to increase both accuracy and reliability in diagnosis. Based on published international scientific documents and the personal experience of the authors, guidelines for clinical applications, indications and limitations of each technique are analyzed in relation to capacities of the Spanish political and social public health system profile. New concepts and dynamics of developments such as; dynamic QT, RR variability or pulse wave velocity are exposed, in the frame of the present time and future for improving efficiency and clinical application.

Exercise testing and training of patients with malignant ventricular arrhythmias

Malignant ventricular arrhythmias account for a significant number of deaths annually. Improved therapies have increased survival for this patient population. These patients, however, remain at high risk due to their history of sudden cardiac death and the preponderance of poor ventricular function in this population. This high risk status may have excluded them from participation in cardiac rehabilitation programs or from undergoing exercise testing in some medical centers. Although the risk of complications, especially arrhythmias, is quite real, the experience in some centers has indicated that it is manageable. This experience and some guidelines for exercise testing and training of patients with malignant ventricular arrhythmias are reviewed in this paper.

Use of the elective replacement indicator in predicting time of automatic implantable cardioverter-defibrillator battery depletion

The elective replacement indicator (ERI) of an automatic implantable cardioverter-defibrillator (AICD) is intended to be utilized as strict criteria for the appropriate timing of pulse generator replacement. The manufacturer's newest recommendations suggest replacement within 3 months post-ERI attainment and this applies to both AID-B units and the latest Ventak models currently being implanted with expectations or increased battery longevity. Twelve patients with the AID-B model were prospectively evaluated in regard to (a) time from attainment of ERI to generator exchange and (b) total battery life with respect to the presence or absence of spontaneous discharges. In the overall group, the ERI was reached at 18.9 +/- 3.9 months (mean +/- standard deviation). The time from ERI attainment to generator exchange due to battery depletion was 8.1 +/- 5.1 months, and total battery life was 27.3 +/- 3.1 months. In the group with spontaneous discharges, the duration of time (months) post-ERI to generator exchange was 5.7 +/- 2.6 but was 11.4 +/- 6.1 in the others (P = 0.052); battery life was 25.7 +/- 2.4 and 29.4 +/- 2.7, respectively (P = 0.03). We conclude that the current ERI recommendation seems overly conservative in planning generator exchange for patients without the occurrence of spontaneous discharges and appropriate for patients with such discharges.