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Meda NS, Makhumalo W, Groninger H, Pettit C. The Presence of Implantable Cardioverter Defibrillators is Rarely Addressed During Code Status Change. Am J Hosp Palliat Care 2024:10499091241264532. [PMID: 38907688 DOI: 10.1177/10499091241264532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
Background: Implantable Cardioverter Defibrillators (ICDs) are used to prevent sudden cardiac death, but they may provide unwanted shocks during end-of-life care. We aimed to study the frequency at which Do Not Resuscitate (DNR) discussions address ICD preferences in high-risk patients. Methods: A retrospective chart review was performed on patient hospitalizations with the presence of an ICD, a change in code status to DNR, and a subsequent death during that hospitalization. Data collected included demographics, significant comorbidities, if and when ICD was discussed, and who performed code status discussions, and were analyzed for statistical significance. Results: 129 patients met study criteria, and 110 patients (85.3%) did not have a documented discussion addressing ICD deactivation. There were no statistically significant differences in patient characteristics between patients with ICD addressed or not addressed, nor were there differences noted between discussions performed by residents vs staff or with the presence of cardiology, critical care status, or with palliative care consultation. It was noted that specifically discussing intubation or cardioversion was associated with the discussion of ICD deactivation. Conclusion: ICD discussions were rarely documented in our high-risk population, highlighting a potential need for better in-chart visibility of ICDs and for focused education of clinicians who care for these patients at end of life.
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Affiliation(s)
| | - Watipa Makhumalo
- Department of Internal Medicine, George Washington University, Washington, DC, USA
| | - Hunter Groninger
- Department of Internal Medicine, Section of Palliative Care, MedStar Washington Hospital Center, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | - Clint Pettit
- Department of Internal Medicine, Section of Palliative Care, MedStar Washington Hospital Center, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
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Smith AB, Jung M, Pressler SJ. Pain and Heart Failure During Transport by Emergency Medical Services and Its Associated Outcomes: Hospitalization, Mortality, and Length of Stay. West J Nurs Res 2024; 46:172-182. [PMID: 38230416 PMCID: PMC10922995 DOI: 10.1177/01939459231223128] [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] [Indexed: 01/18/2024]
Abstract
BACKGROUND Over 22% of patients with heart failure (HF) are transported by emergency medical services (EMSs) for a primary complaint of pain. The relationship between a primary complaint of pain on hospitalization status, mortality, or length of stay following transport by EMS is understudied. OBJECTIVES The objective of this study was to determine whether a primary complaint of pain during EMS transport predicted hospitalization status, mortality, or inpatient length of stay. METHODS In this retrospective longitudinal cohort study, data were analyzed from electronic health records of 3539 patients with HF. Descriptive statistics and multivariate logistic and linear regression analyses were used to achieve study objectives. RESULTS Demographics were mean age 64.83 years (standard deviation [SD] = 14.58); gender 57.3% women, 42.7% men; self-reported race 56.2% black, 43.2% white, and 0.7% other. Of 3539 patients, 2346 (66.3%) were hospitalized, 149 (4.2%) died, and the mean length of stay was 6.02 (SD = 7.55) days. A primary complaint of pain did not predict increased odds of in-hospital mortality but did predict 39% lower odds of hospitalization (p < .001), and 26.7% shorter length of stay (p < .001). Chest pain predicted 49% lower odds of hospitalization (p < .001) and 34.1% (p < .001) shorter length of stay, whereas generalized pain predicted 45% lower odds of hospitalization (p = .044) following post-hoc analysis. CONCLUSIONS A primary complaint of chest pain predicted lower odds of hospitalization and shorter length of stay, possibly due to established treatment regimens. Additional research is needed to examine chronic pain rather than a primary complaint of pain.
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Affiliation(s)
- Asa B. Smith
- School of Nursing, Indiana University, Indiana USA
| | - Miyeon Jung
- School of Nursing, Indiana University, Indiana USA
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Wahedi R, Willems S, Feldhege J, Jularic M, Hartmann J, Anwar O, Dickow J, Harloff T, Gessler N, Gunawardene MA. Pulsed-field versus cryoballoon ablation for atrial fibrillation-Impact of energy source on sedation and analgesia requirement. J Cardiovasc Electrophysiol 2024; 35:162-170. [PMID: 38009545 DOI: 10.1111/jce.16141] [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: 07/27/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Pulsed field ablation (PFA) represents a novel, nonthermal energy modality that can be applied for single-shot pulmonary vein isolation (PVI) in atrial fibrillation (AF). Comparative data with regard to deep sedation to established single-shot modalities such as cryoballoon (CB) ablation are scarce. The aim of this study was to compare a deep sedation protocol in patients receiving PVI with either PFA or CB. METHODS Prospective, consecutive AF patients undergoing PVI with a pentaspline PFA catheter were compared to a retrospective CB-PVI cohort of the same timeframe. Study endpoints were the requirements of analgesics, cardiorespiratory stability, and sedation-associated complications. RESULTS A total of 100 PVI patients were included (PFA n = 50, CB n = 50, mean age 66 ± 10.6, 61% male patients, 65% paroxysmal AF). Requirement of propofol, midazolam, and sufentanyl was significantly higher in the PFA group compared to CB [propofol 0.14 ± 0.04 mg/kg/min in PFA vs. 0.11 ± 0.04 mg/kg/min in CB (p = .001); midazolam 0.00086 ± 0.0004 mg/kg/min in PFA vs. 0.0006295 ± 0.0003 mg/kg/min in CB (p = .002) and sufentanyl 0.0013 ± 0.0007 µg/kg/min in PFA vs. 0.0008 ± 0.0004 µg/kg/min in CB (p < .0001)]. Sedation-associated complications did not differ between both groups (PFA n = 1/50 mild aspiration pneumonia, CB n = 0/50, p > .99). Nonsedation-associated complications (PFA: n = 2/50, 4%, CB: n = 1/50, 2%, p > .99) and procedure times (PFA 75 ± 31, CB 84 ± 32 min, p = .18) did not differ between groups. CONCLUSIONS PFA is associated with higher sedation and especially analgesia requirements. However, the safety of deep sedation does not differ to CB ablation.
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Affiliation(s)
- Rahin Wahedi
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Stephan Willems
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | | | - Mario Jularic
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Jens Hartmann
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Omar Anwar
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Jannis Dickow
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Tim Harloff
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Nele Gessler
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
- Asklepios Proresearch, Hamburg, Germany
| | - Melanie A Gunawardene
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
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Aron M, Lilienkamp T, Luther S, Parlitz U. Optimising low-energy defibrillation in 2D cardiac tissue with a genetic algorithm. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1172454. [PMID: 37555132 PMCID: PMC10406519 DOI: 10.3389/fnetp.2023.1172454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/28/2023] [Indexed: 08/10/2023]
Abstract
Sequences of low-energy electrical pulses can effectively terminate ventricular fibrillation (VF) and avoid the side effects of conventional high-energy electrical defibrillation shocks, including tissue damage, traumatic pain, and worsening of prognosis. However, the systematic optimisation of sequences of low-energy pulses remains a major challenge. Using 2D simulations of homogeneous cardiac tissue and a genetic algorithm, we demonstrate the optimisation of sequences with non-uniform pulse energies and time intervals between consecutive pulses for efficient VF termination. We further identify model-dependent reductions of total pacing energy ranging from ∼4% to ∼80% compared to reference adaptive-deceleration pacing (ADP) protocols of equal success rate (100%).
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Affiliation(s)
- Marcel Aron
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen, Germany
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Institute for the Dynamics of Complex Systems, Georg-August-Universität Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Thomas Lilienkamp
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Computational Physics for Life Science, Nuremberg Institute of Technology Georg Simon Ohm, Nuremberg, Germany
| | - Stefan Luther
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Göttingen, Germany
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Institute for the Dynamics of Complex Systems, Georg-August-Universität Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ulrich Parlitz
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
- Institute for the Dynamics of Complex Systems, Georg-August-Universität Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
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Sung YL, Wang TW, Lin TT, Lin SF. Optogenetics in cardiology: methodology and future applications. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-022-00060-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractOptogenetics is an emerging biological approach with the unique capability of specific targeting due to the precise light control with high spatial and temporal resolution. It uses selected light wavelengths to control and modulate the biological functions of cells, tissues, and organ levels. Optogenetics has been instrumental in different biomedical applications, including neuroscience, diabetes, and mitochondria, based on distinctive optical biomedical effects with light modulation. Nowadays, optogenetics in cardiology is rapidly evolving for the understanding and treatment of cardiovascular diseases. Several in vitro and in vivo research for cardiac optogenetics demonstrated visible progress. The optogenetics technique can be applied to address critical cardiovascular problems such as heart failure and arrhythmia. To this end, this paper reviews cardiac electrophysiology and the technical progress about experimental and clinical cardiac optogenetics and provides the background and evolution of cardiac optogenetics. We reviewed the literature to demonstrate the servo type, transfection efficiency, signal recording, and heart disease targets in optogenetic applications. Such literature review would hopefully expedite the progress of optogenetics in cardiology and further expect to translate into the clinical terminal in the future.
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Abstract
BACKGROUND Pain is a common but understudied symptom among patients with heart failure (HF) transported by emergency medical services (EMS). The aims were to determine explanatory factors of a primary complaint of pain and pain severity, and characterize pain among patients with HF transported by EMS. METHODS Data from electronic health records of patients with HF transported by EMS within a midwestern United States county from 2009 to 2017 were analyzed. Descriptive statistics, χ 2 , analysis of variance, and logistic and multiple linear regression analyses were used. RESULTS The sample (N = 4663) was predominantly women (58.1%) with self-reported race as Black (57.7%). The mean age was 64.2 ± 14.3 years. Pain was the primary complaint in 22.2% of the sample, with an average pain score of 6.8 ± 3.1 out of 10. The most common pain complaint was chest pain (68.1%). Factors associated with a primary pain complaint were younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.96-0.97), history of myocardial infarction (OR, 1.96; 95% CI, 1.55-2.49), and absence of shortness of breath (OR, 0.67; 95% CI, 0.58-0.77). Factors associated with higher pain severity were younger age ( b = -0.05, SE = 0.013), being a woman ( b = 1.17, SE = 0.357), and White race ( b = -1.11, SE = 0.349). CONCLUSIONS Clinical and demographic factors need consideration in understanding pain in HF during EMS transport. Additional research is needed to examine these factors to improve pain management and reduce transports due to pain.
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Christie M, Coyne E, Mitchell M. The educational experiences and needs of patients with an internal cardiac defibrillator: An interpretive phenomenological study. Collegian 2021. [DOI: 10.1016/j.colegn.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Trussler A, Alexander B, Campbell D, Alhammad N, Enriquez A, Chacko S, Garrett T, Simpson C, Redfearn D, Abdollah H, Herx L, Baranchuk A. Deactivation of Implantable Cardioverter Defibrillator in Patients With Terminal Diagnoses. Am J Cardiol 2019; 124:1064-1068. [PMID: 31353003 DOI: 10.1016/j.amjcard.2019.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 11/29/2022]
Abstract
Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death. However, in patients with terminal illnesses, these devices may disrupt the dying process. This study was undertaken to review our current strategies surrounding device deactivation. A retrospective chart review was performed at Kingston Health Sciences Centre of patients with an ICD who died from 2015 to 2018. Data collected included patient demographics, clinical details surrounding device implantation, patient co-morbidities leading to deactivation, time to deactivation, physical place of deactivation, and device programming information. Ethics approval was obtained from the Queen's University Health Sciences Research Ethics Board. A total of 49 patients were included for analysis. Mean age at the time of death was 77.5 years (range: 57 to 94 years) and 12.2% (6/49) were women. The indications for ICD implantation were primary prevention of sudden cardiac death in 69.4% (34/49) and secondary prevention in 30.6% (15/49). Deactivation as part of end-of-life care was performed in 32.7% of patients (16/49). Deactivations occurred in clinic in 6.1% (3/49) of patients, on hospital inpatient wards in 12.2% (6/49) of patients, and in critical care settings in 14.2% (7/49) of patients. The remaining 67.3% (33/49) of patients died with fully functioning devices in place. The most prevalent terminal diagnoses were metastatic cancer (22.4%) and end-stage congestive heart failure (20.4%). On average, patients had their devices deactivated 13 months (range: 0 to 62 months) after their terminal diagnosis was established. Once a patient was documented as Do Not Resuscitate (DNR), deactivation was discussed and carried out within a mean time of 38 days (range: 0 to 400 days). Seven patients had their device active for more than 1 month after being documented as DNR. Ten patients (20.4%) received ICD shocks after their terminal diagnosis, 9 received shocks in the month before death, and 2 received shocks after formal DNR orders were in place. Approximately one-third of patients with ICDs received deactivation of their cardioversion/defibrillation therapies as part of their end-of-life care plan. A relatively high proportion of patients (20%) received an ICD shock in the last month of life. In conclusion, addressing device programming needs, including deactivation of cardioversion/defibrillation therapies, should be considered in the context of a patient's goals of care in every patient with an ICD who has a co-existing life-limiting diagnosis.
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Affiliation(s)
- Alexander Trussler
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Bryce Alexander
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Debra Campbell
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Nasser Alhammad
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Andrés Enriquez
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Sanoj Chacko
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Timothy Garrett
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Chris Simpson
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Leonie Herx
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada.
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Garnreiter JM. Inappropriate ICD Shocks in Pediatric and Congenital Heart Disease Patients. J Innov Card Rhythm Manag 2017; 8:2898-2906. [PMID: 32494433 PMCID: PMC7252892 DOI: 10.19102/icrm.2017.081104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/18/2017] [Indexed: 11/06/2022] Open
Abstract
Although implantable cardioverter-defibrillators (ICDs) have proven to be life-saving devices, there are frequent complications associated with their use, especially in the pediatric and congenital heart disease populations. Inappropriate shocks are a particularly frequent complication in these groups. This review discusses the causes and implications of inappropriate ICD shocks, and presents potential interventions that may assist in safely reducing the rates of inappropriate shocks in pediatric and congenital heart disease patients with ICDs.
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Affiliation(s)
- Jason M Garnreiter
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO, USA
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Perini AP, Kutyifa V, Veazie P, Daubert JP, Schuger C, Zareba W, McNitt S, Rosero S, Tompkins C, Padeletti L, Moss AJ. Effects of implantable cardioverter/defibrillator shock and antitachycardia pacing on anxiety and quality of life: A MADIT-RIT substudy. Am Heart J 2017. [PMID: 28625384 DOI: 10.1016/j.ahj.2017.03.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Effects of implantable cardioverter/defibrillator (ICD) shocks and antitachycardia pacing (ATP) on anxiety and quality of life (QoL) in ICD patients are poorly understood. METHODS We evaluated changes in QoL from baseline to 9-month follow-up using the EQ-5D questionnaire in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) (n=1,268). We assessed anxiety levels using the Florida Shock Anxiety Scale (1-10 score) in patients with appropriate or inappropriate shocks or ATP compared to those with no ICD therapy during the first 9 months postimplant. The analysis was stratified by number of ATP or shocks (0-1 vs ≥2) and adjusted for covariates. RESULTS In MADIT-RIT, 15 patients (1%) had ≥2 appropriate shocks, 38 (3%) had ≥2 appropriate ATPs. Two or more inappropriate shocks were delivered in 16 patients (1%); ≥2 inappropriate ATPs, in 70. In multivariable analysis, patients with ≥2 appropriate shocks had higher levels of shock-related anxiety than those with ≤1 appropriate shock (P<.01). Furthermore, ≥2 inappropriate shocks produced more anxiety than ≤1 inappropriate shock (P=.005). Consistently, ≥2 appropriate ATPs resulted in more anxiety than ≤1 (P=.028), whereas the number of inappropriate ATPs showed no association with anxiety levels (P=.997). However, there was no association between QoL and appropriate or inappropriate ATP/shock (all P values > .05). CONCLUSIONS In MADIT-RIT, ≥2 appropriate or inappropriate ICD shocks and ≥2 appropriate ATPs are associated with more anxiety at 9-month follow-up despite no significant changes in the assessment of global QoL by the EQ-5D questionnaire. Innovative ICD programming reducing inappropriate therapies may help deal with patient concerns about the device.
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11
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Ng CY, Mela T. A Primer on Cardiac Devices: Psychological and Pharmacological Considerations. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20161107-01] [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: 11/20/2022]
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Karathanos TV, Boyle PM, Trayanova NA. Light-based Approaches to Cardiac Arrhythmia Research: From Basic Science to Translational Applications. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2016; 10:47-60. [PMID: 27840581 PMCID: PMC5094582 DOI: 10.4137/cmc.s39711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/27/2016] [Accepted: 10/09/2016] [Indexed: 02/06/2023]
Abstract
Light has long been used to image the heart, but now it can be used to modulate its electrophysiological function. Imaging modalities and techniques have long constituted an indispensable part of arrhythmia research and treatment. Recently, advances in the fields of optogenetics and photodynamic therapy have provided scientists with more effective approaches for probing, studying and potentially devising new treatments for cardiac arrhythmias. This article is a review of research toward the application of these techniques. It contains (a) an overview of advancements in technology and research that have contributed to light-based cardiac applications and (b) a summary of current and potential future applications of light-based control of cardiac cells, including modulation of heart rhythm, manipulation of cardiac action potential morphology, quantitative analysis of arrhythmias, defibrillation and cardiac ablation.
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Affiliation(s)
- Thomas V. Karathanos
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick M. Boyle
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Natalia A. Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Bruegmann T, Boyle PM, Vogt CC, Karathanos TV, Arevalo HJ, Fleischmann BK, Trayanova NA, Sasse P. Optogenetic defibrillation terminates ventricular arrhythmia in mouse hearts and human simulations. J Clin Invest 2016; 126:3894-3904. [PMID: 27617859 DOI: 10.1172/jci88950] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/04/2016] [Indexed: 11/17/2022] Open
Abstract
Ventricular arrhythmias are among the most severe complications of heart disease and can result in sudden cardiac death. Patients at risk currently receive implantable defibrillators that deliver electrical shocks to terminate arrhythmias on demand. However, strong electrical shocks can damage the heart and cause severe pain. Therefore, we have tested optogenetic defibrillation using expression of the light-sensitive channel channelrhodopsin-2 (ChR2) in cardiac tissue. Epicardial illumination effectively terminated ventricular arrhythmias in hearts from transgenic mice and from WT mice after adeno-associated virus-based gene transfer of ChR2. We also explored optogenetic defibrillation for human hearts, taking advantage of a recently developed, clinically validated in silico approach for simulating infarct-related ventricular tachycardia (VT). Our analysis revealed that illumination with red light effectively terminates VT in diseased, ChR2-expressing human hearts. Mechanistically, we determined that the observed VT termination is due to ChR2-mediated transmural depolarization of the myocardium, which causes a block of voltage-dependent Na+ channels throughout the myocardial wall and interrupts wavefront propagation into illuminated tissue. Thus, our results demonstrate that optogenetic defibrillation is highly effective in the mouse heart and could potentially be translated into humans to achieve nondamaging and pain-free termination of ventricular arrhythmia.
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MAGNUSSON PETER, GADLER FREDRIK, LIV PER, MÖRNER STELLAN. Hypertrophic Cardiomyopathy and Implantable Defibrillators in Sweden: Inappropriate Shocks and Complications Requiring Surgery. J Cardiovasc Electrophysiol 2015; 26:1088-94. [DOI: 10.1111/jce.12750] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 12/13/2022]
Affiliation(s)
- PETER MAGNUSSON
- Cardiology Research Unit, Department of Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Research and Development; Uppsala University/Region Gävleborg; Gävle Sweden
| | - FREDRIK GADLER
- Cardiology Research Unit, Department of Medicine; Karolinska Institutet; Stockholm Sweden
| | - PER LIV
- Centre for Research and Development; Uppsala University/Region Gävleborg; Gävle Sweden
| | - STELLAN MÖRNER
- Cardiology, Heart Center and Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
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Garnreiter JM, Pilcher TA, Etheridge SP, Saarel EV. Inappropriate ICD shocks in pediatrics and congenital heart disease patients: Risk factors and programming strategies. Heart Rhythm 2015; 12:937-42. [DOI: 10.1016/j.hrthm.2015.01.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Indexed: 11/30/2022]
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Hill L, McIlfatrick S, Taylor B, Dixon L, Harbinson M, Fitzsimons D. Patients' perception of implantable cardioverter defibrillator deactivation at the end of life. Palliat Med 2015; 29:310-23. [PMID: 25239128 DOI: 10.1177/0269216314550374] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Individualised care at the end of life requires professional understanding of the patient's perception of implantable cardioverter defibrillator deactivation. AIM The aim was to evaluate the evidence on patients' perception of implantable cardioverter defibrillator deactivation at end of life. DESIGN Systematic narrative review of empirical studies was published during 2008-2014. DATA SOURCES Data were collected from six databases, citations from relevant articles and expert recommendations. RESULTS In all, 18 studies included with collective population of n = 5810. Concept mapping highlighted three themes: (1) Diverse preferences regarding discussion and deactivation. Deactivation was rarely discussed pre-implantation, with some studies demonstrating patients' reluctance to discuss implantable cardioverter defibrillator deactivation at any stage. Two studies found the majority of patients valued such discussions. Diversity was reflected in patients' willingness to deactivate, ranging from 12% (n = 9) in Irish cohort to 79% (n = 195) in Dutch study. (2) Ethical and legal considerations were predominant in Canadian and American literature as patients wanted to contribute but felt the decision should be a doctor's responsibility. Advance directives were uncommon in Europe, and where they existed the implantable cardioverter defibrillator was not mentioned. (3) 'Living in the now' was evident as despite deteriorating symptoms many patients maintained a positive outlook and anticipated surviving more than 10 years. Several studies asserted living longer was more important than quality of life. CONCLUSION Patients regard the implantable cardioverter defibrillator as a complex and solely beneficial device, with little insight regarding its potential impact on a peaceful death. This review confirms the need for professionals to discuss with patients and families implantable cardioverter defibrillator functionality and deactivation at appropriate opportunities.
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Affiliation(s)
- Loreena Hill
- Institute of Nursing Research, University of Ulster, Jordanstown Campus, Newtownabbey, UK Belfast Health and Social Care Trust, Belfast, UK
| | - Sonja McIlfatrick
- Institute of Nursing Research, University of Ulster, Jordanstown Campus, Newtownabbey, UK All Ireland Institute of Hospice & Palliative Care, Dublin, Ireland
| | - Brian Taylor
- Institute of Nursing Research, University of Ulster, Jordanstown Campus, Newtownabbey, UK
| | - Lana Dixon
- Belfast Health and Social Care Trust, Belfast, UK
| | | | - Donna Fitzsimons
- Institute of Nursing Research, University of Ulster, Jordanstown Campus, Newtownabbey, UK Belfast Health and Social Care Trust, Belfast, UK All Ireland Institute of Hospice & Palliative Care, Dublin, Ireland
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A comprehensive multiscale framework for simulating optogenetics in the heart. Nat Commun 2014; 4:2370. [PMID: 23982300 PMCID: PMC3838435 DOI: 10.1038/ncomms3370] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/26/2013] [Indexed: 02/05/2023] Open
Abstract
Optogenetics has emerged as an alternative method for electrical control of the heart, where illumination is used to elicit a bioelectric response in tissue modified to express photosensitive proteins (opsins). This technology promises to enable evocation of spatiotemporally precise responses in targeted cells or tissues, thus creating new possibilities for safe and effective therapeutic approaches to ameliorate cardiac function. Here, we present a comprehensive framework for multi-scale modelling of cardiac optogenetics, allowing both mechanistic examination of optical control and exploration of potential therapeutic applications. The framework incorporates accurate representations of opsin channel kinetics and delivery modes, spatial distribution of photosensitive cells, and tissue illumination constraints, making possible the prediction of emergent behaviour resulting from interactions at sub-organ scales. We apply this framework to explore how optogenetic delivery characteristics determine energy requirements for optical stimulation and to identify cardiac structures that are potential pacemaking targets with low optical excitation threshold.
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18
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Yang JH, Byeon K, Yim HR, Park JW, Park SJ, Huh J, Kim JS, On YK. Predictors and clinical impact of inappropriate implantable cardioverter-defibrillator shocks in Korean patients. J Korean Med Sci 2012; 27:619-24. [PMID: 22690092 PMCID: PMC3369447 DOI: 10.3346/jkms.2012.27.6.619] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 02/24/2012] [Indexed: 11/20/2022] Open
Abstract
Limited data are available on inappropriate shocks in Korean patients implanted with an implantable cardioverter-defibrillator (ICD). We investigated the impact of inappropriate shocks on clinical outcomes. This retrospective, single-center study included 148 patients treated between October 1999 and June 2011. The primary outcome was a composite event of all-cause mortality or hospitalization for any cardiac reason. The median follow-up duration was 29 months (interquartile range: 8 to 53). One or more inappropriate shocks occurred in 34 (23.0%) patients. A history of atrial fibrillation was the only independent predictor of inappropriate shock (hazard ratio [HR]: 4.16, 95% confidence interval [CI]: 1.89-9.15, P < 0.001). Atrial fibrillation was the most common cause of inappropriate shock (67.7%), followed by supraventricular tachycardia (23.5%), and abnormal sensing (8.8%). A composite event of all-cause mortality or hospitalizations for any cardiac reason during follow-up was not significantly different between patients with or without inappropriate shock (inappropriate shock vs no inappropriate shock: 35.3% vs 35.4%, adjusted HR: 1.06, 95% CI: 0.49-2.29, P = 0.877). Inappropriate shocks do not affect clinical outcomes in patients implanted with an ICD, although the incidence of inappropriate shocks is high.
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Affiliation(s)
- Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongmin Byeon
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Ran Yim
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Wae Park
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Huh
- Department of Pediatrics, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Soo Kim
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Keun On
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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19
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Pedersen SS, Tekle FB, Hoogwegt MT, Jordaens L, Theuns DAMJ. Shock and patient preimplantation type D personality are associated with poor health status in patients with implantable cardioverter-defibrillator. Circ Cardiovasc Qual Outcomes 2012; 5:373-80. [PMID: 22570357 DOI: 10.1161/circoutcomes.111.964197] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) shock is a critical event to patients associated with well-being after implantation, although other factors may play an equally important role. We compared the association of shock and the patient's preimplantation personality with health status, using a prospective study design. METHODS AND RESULTS Consecutively implanted ICD patients (n=383; 79% men) completed the Type D Scale at baseline and the Short-Form Health Survey 36 (SF-36) at baseline and 3, 6, and 12 months. Of all patients, 23.5% had a Type D personality and 13.8% received a shock during follow-up. Shocked patients reported significantly poorer health status, as did Type D patients. Health status patterns were poorest in patients with combined Type D personality and shock during follow-up. Shock during follow-up was a significant independent associate of poorer health status for 4 of 8 subscales of the SF-36 and the Mental Component Summary (all P<.05), with shocked patients scoring between 2.60 to 13.30 points lower than nonshocked patients. Type D personality was an independent associate of poor postimplantation health status for 6 of 8 of the SF-36 subscales and the Mental Component Summary, with Type D patients scoring between 2.12 to 8.02 points lower, adjusting for demographic and clinical characteristics. CONCLUSIONS ICD shock and the patient's preimplantation personality disposition were equally important associates of health status 12 months after implantation. Identification of the patient's personality profile before ICD implantation may help identify subsets of patients who may need additional care, for example, with a psychosocial component.
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Affiliation(s)
- Susanne S Pedersen
- CoRPS, Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
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20
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Sears SF, Hauf JD, Kirian K, Hazelton G, Conti JB. Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient. Circ Arrhythm Electrophysiol 2011; 4:242-50. [PMID: 21505176 DOI: 10.1161/circep.110.957670] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Samuel F. Sears
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Jessica D. Hauf
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Kari Kirian
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Garrett Hazelton
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Jamie B. Conti
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
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