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Hayashi K, Tsurugi T, Koyama J, Okumura K, Abe H, Wilkoff BL. Successful defibrillation by modifying from fixed-tilt to tuned-duration defibrillation waveform: When less is more? HeartRhythm Case Rep 2022; 8:702-706. [PMID: 36310725 PMCID: PMC9596389 DOI: 10.1016/j.hrcr.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Lavon O, Goldman R. Adherence to Monitoring Guidelines of Amiodarone Adverse Reactions. Health Serv Res Manag Epidemiol 2019; 6:2333392819844635. [PMID: 31024983 PMCID: PMC6472159 DOI: 10.1177/2333392819844635] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 03/18/2019] [Indexed: 12/05/2022] Open
Abstract
Background: Amiodarone treatment frequently causes adverse reactions. Clinical guidelines warrant a
comprehensive assessment prior to chronic treatment with amiodarone and repeated
monitoring for the appearance of adverse reactions. Objective: To evaluate adherence to these guidelines. Methods: A retrospective chart review of electronic medical records of adult patients treated
with oral amiodarone for at least 12 months. Results: One hundred patient records were analyzed; 97% of patients were evaluated for thyroid
and liver functions prior to treatment. Liver functions were properly monitored every 6
months in 96% of patients and thyroid function in only 59%. Most (84%) patients
completed a chest X-ray before treatment; only 2% completed a respiratory function test.
None have performed a chest X-ray annually. Sixty-four percent of the patients were
examined by an ophthalmologist prior to treatment; periodic ophthalmic surveillance was
not consistent. Neurological and dermatological evaluations were not recorded for any of
the patients, unless symptoms appeared. Only 50% were adherent to annual cardiac
reassessment. Conclusions: Adherence to recommended clinical guidelines for monitoring amiodarone adverse
reactions is poor. Interventions to improve compliance with these guidelines are
needed.
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Affiliation(s)
- Ophir Lavon
- Clinical Pharmacology and Toxicology Unit, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ron Goldman
- Clinical Pharmacology and Toxicology Unit, Carmel Medical Center, Haifa, Israel
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Dan GA, Martinez-Rubio A, Agewall S, Boriani G, Borggrefe M, Gaita F, van Gelder I, Gorenek B, Kaski JC, Kjeldsen K, Lip GYH, Merkely B, Okumura K, Piccini JP, Potpara T, Poulsen BK, Saba M, Savelieva I, Tamargo JL, Wolpert C, Sticherling C, Ehrlich JR, Schilling R, Pavlovic N, De Potter T, Lubinski A, Svendsen JH, Ching K, Sapp JL, Chen-Scarabelli C, Martinez F. Antiarrhythmic drugs–clinical use and clinical decision making: a consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group on Cardiovascular Pharmacology, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and International Society of Cardiovascular Pharmacotherapy (ISCP). Europace 2018; 20:731-732an. [DOI: 10.1093/europace/eux373] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/11/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Gheorghe-Andrei Dan
- Colentina University Hospital, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | - Antoni Martinez-Rubio
- University Hospital of Sabadell (University Autonoma of Barcelona), Plaça Cívica, Campus de la UAB, Barcelona, Spain
| | - Stefan Agewall
- Oslo University Hospital Ullevål, Norway
- Institute of Clinical Sciences, University of Oslo, Søsterhjemmet, Oslo, Norway
| | - Giuseppe Boriani
- Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Martin Borggrefe
- Universitaetsmedizin Mannheim, Medizinische Klinik, Mannheim, Germany
| | - Fiorenzo Gaita
- Department of Medical Sciences, University of Turin, Citta' della Salute e della Scienza Hospital, Turin, Italy
| | - Isabelle van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bulent Gorenek
- Department of Cardiology, Eskisehir Osmangazi University, Büyükdere Mahallesi, Odunpazarı/Eskişehir, Turkey
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
| | - Keld Kjeldsen
- Copenhagen University Hospital (Holbæk Hospital), Holbæk, Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Centre For Cardiovascular Sciences, City Hospital, Birmingham, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ken Okumura
- Saiseikai Akumamoto Hospital, Kumamoto, Japan
| | | | - Tatjana Potpara
- School of Medicine, Belgrade University; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Magdi Saba
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
| | - Irina Savelieva
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
| | - Juan L Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense Madrid, Madrid, Spain
| | - Christian Wolpert
- Department of Medicine - Cardiology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | | | - Joachim R Ehrlich
- Medizinische Klinik I-Kardiologie, Angiologie, Pneumologie, Wiesbaden, Germany
| | - Richard Schilling
- Barts Heart Centre, Trustee Arrhythmia Alliance and Atrial Fibrillation Association, London, UK
| | - Nikola Pavlovic
- Department of Cardiology, University Hospital Centre Sestre milosrdnice, Croatia
| | | | - Andrzej Lubinski
- Uniwersytet Medyczny w Łodzi, Kierownik Kliniki Kardiologii Interwencyjnej, i Zaburzeń Rytmu Serca, Kierownik Katedry Chorób Wewnętrznych i Kardiologii, Uniwersytecki Szpital Kliniczny im WAM-Centralny Szpital Weteranów, Poland
| | | | - Keong Ching
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | | | - Felipe Martinez
- Instituto DAMIC/Fundacion Rusculleda, Universidad Nacional de Córdoba, Córdoba, Argentina
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Ito H, Kawamura M, Badhwar N, Vedantham V, Tseng ZH, Lee BK, Lee RJ, Marcus GM, Gerstenfeld EP, Scheinman MM. The Effect of Direct Current Stimulation versus T-Wave Shock on Defibrillation Threshold Testing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1173-80. [PMID: 26137999 DOI: 10.1111/pace.12684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/03/2015] [Accepted: 06/22/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There are several methods to induce ventricular fibrillation (VF) during defibrillation threshold (DFT) testing. Delivering a shock at a critical time during the T wave (T-shock) is the conventional approach, while delivering a constant direct current voltage (DC stim) from the implantable cardioverter defibrillator is an alternative method. Only a few reports compare VF induction methods. The purpose of this study was to evaluate the effects and safety of DC stim versus T-shock. METHODS We retrospectively investigated 414 consecutive patients undergoing DFT testing. We compared the two groups (DC stim and T-shock) with respect to clinical characteristics, electrocardiogram (ECG) changes, and complications. RESULTS Ventricular arrhythmia, including ventricular tachycardia (VT) and VF, was induced by DC stim in 93 patients or T-shock in 321 patients. No more than three attempts were performed during one procedure. There was no significant difference in the baseline ECG, induced tachycardia cycle length (TCL), or complications between the two groups. However, the induced TCL was significantly shorter than the clinical TCL regardless of induction method (P = 0.001). Five patients suffered major complications (i.e., electromechanical dissociation or incessant VT). A history of atrial fibrillation was significantly greater in patients with major complications than the others (80% vs 24%, P = 0.004), and was an independent predictor on multivariate analysis. CONCLUSIONS There is no significant difference in induced TCL or complications between the DC stim and T-shock. The induced TCL is significantly shorter than clinical TCL regardless of induction method.
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Affiliation(s)
- Hiroyuki Ito
- Division of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | - Mitsuharu Kawamura
- Division of Cardiology, Department of Medicine, Showa University, Tokyo, Japan
| | - Nitish Badhwar
- Division of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | - Vasanth Vedantham
- Division of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | - Zian H Tseng
- Division of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | - Byron K Lee
- Division of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | - Randall J Lee
- Division of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | - Gregory M Marcus
- Division of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | - Edward P Gerstenfeld
- Division of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
| | - Melvin M Scheinman
- Division of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California
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Russo AM, Chung MK. Is Defibrillation Testing Necessary for Implantable Transvenous Defibrillators? Circ Arrhythm Electrophysiol 2014; 7:337-46. [DOI: 10.1161/circep.113.000371] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea M. Russo
- From the Cooper Medical School of Rowan University, Camden, NJ (A.M.R.); and Cleveland Clinic Foundation, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (M.K.C.)
| | - Mina K. Chung
- From the Cooper Medical School of Rowan University, Camden, NJ (A.M.R.); and Cleveland Clinic Foundation, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (M.K.C.)
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Uyguanco ER, Berger A, Budzikowski AS, Gunsburg M, Kassotis J. Management of high defibrillation threshold. Expert Rev Cardiovasc Ther 2014; 6:1237-48. [DOI: 10.1586/14779072.6.9.1237] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rubenstein JC, Gupta MS, Kim MH. Effectiveness of VF induction with DC fibber versus conventional induction methods in patients on chronic amiodarone therapy. J Interv Card Electrophysiol 2013; 38:137-41. [PMID: 24013703 DOI: 10.1007/s10840-013-9819-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/18/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Amiodarone therapy, especially chronic, can result in difficult ventricular fibrillation (VF) inductions during implantable cardioverter defibrillator (ICD) testing. The efficacy of various VF induction methods on patients treated with amiodarone has not been well described. This prospective analysis evaluated the impact of direct current (DC) fibber, burst fibber, and synchronized T-wave shock VF induction methods. METHODS Data were collected from one study and two enrolling centers totaling 14 ICD patients (92.9 % male, age 64.3 years (range 23.6-81.2)). A minimum of two successful VF inductions from each patient were required to be included in the study analysis. Each VF induction method was attempted in each patient. Non-sustained VF resulting in an aborted shock was considered an induction failure. All 14 patients were on chronic amiodarone therapy. RESULTS From a total of 42 attempted inductions, 25 (59.5 %) were successful at inducing VF. The success rates of effective induction of VF during the first attempt using DC, burst, and Shock-on-T are 100, 50, and 28.6 %, respectively. DC fibber had significantly higher VF induction rates than Shock-on-T (p = 0.004) or burst fibber (p = 0.02). There was no difference between Shock-on-T and burst fibber (p = 0.45). CONCLUSION The success rate of VF induction using DC fibber method is significantly higher than either Shock-on-T or burst fibber induction methods for patients on chronic amiodarone therapy. This may facilitate defibrillation threshold testing in such patients.
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Affiliation(s)
- Jason C Rubenstein
- Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Incidence and clinical predictors of low defibrillation safety margin at time of implantable defibrillator implantation. J Interv Card Electrophysiol 2012; 34:93-100. [DOI: 10.1007/s10840-011-9648-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 11/15/2011] [Indexed: 11/27/2022]
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[Is the determination of the defibrillation threshold in patients with an implantable cardioverter-defibrillator still required?]. Herzschrittmacherther Elektrophysiol 2011; 22:209-13. [PMID: 22080419 DOI: 10.1007/s00399-011-0150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 09/06/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intraoperative testing of implantable cardioverter-defibrillators (ICDs) is time consuming and associated with risks. In the present study, we elucidated whether the initial implantation of an ICD with high energy output makes intraoperative defibrillation threshold testing (DFTT) unnecessary even though antiarrhythmic (AA) therapy is needed in the future. METHODS A total of 111 patients (94 men, 17 women) receiving an ICD with subsequent AA therapy (mexiletine, amiodarone, sotalol, flecainide) were analyzed retrospectively. DFT was performed during ICD implantation and after AA drug therapy. In a second step, DFT results from the study cohort were analyzed for implantation of virtual ICDs with either low (≤ 30 J, LOD), intermediate (34 J, IOD), or high energy output (36 J, HOD). RESULTS In the study cohort, all patients reached the safety margin (SM) of 10 J between DFT and maximal shock energy of the ICD. After loading of AA agents, 6 patients (12%) with a LOD, 3 patients (11%) with an IOD, and 3 (13%) patients with a HOD failed the 10 J SM. Using virtual ICDs, 6 (5.5%) patients with a LOD, 1 patient (1%) with an IOD, and no patients with a HOD would have failed the 10 J SM. After loading of AA agents, 18 patients (16%) with a virtual LOD, 12 patients (10.8%) with an IOD, and still 9 patients (8%) with a HOD would have failed the 10 J SM. CONCLUSION Our results demonstrate that the 10 J SM would have been achieved intraoperatively in all patients with virtual HOD ICDs. Thus, determination of the DFT during implantation does not seem to be obligatory. However, in patients receiving AA agents, DFT testing is still required.
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Köbe J, Reinke F, Dechering DG, Breithardt G, Eckardt L. Evaluation of defibrillation safety margin in modern implantable cardioverter defibrillators after administration of amiodarone. Clin Res Cardiol 2011; 101:185-90. [PMID: 22057653 DOI: 10.1007/s00392-011-0379-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 10/27/2011] [Indexed: 11/30/2022]
Abstract
AIM The adjunctive medication with amiodarone plays a major role in patients with an implantable cardioverter defibrillator (ICD). Amiodarone as class III antiarrhythmic drug may significantly alter the defibrillation threshold (DFT). Conflicting results exist on the clinical relevance of a DFT rise on amiodarone. The only prospective study on this issue included only a small number of patients on amiodarone. The purpose of this study was to assess the safety and clinical relevance of repeat defibrillator testing after initiation of amiodarone in modern defibrillator systems. METHODS AND RESULTS We assessed risks and clinical consequences of retesting defibrillation safety margin after initiation of amiodarone in 130 consecutive patients. All patients underwent intraoperative testing at the time of first ICD implantation. A repeated VF induction and defibrillator test (by protocol with a single shock and 10 J safety margin) after a total dose of at least 10 g amiodarone 4-6 weeks after initiation of medication was performed. DFT testing after initiation of amiodarone was safe as there were no complications that led to a prolonged hospital stay. In 4 of 114 patients with a left-sided device (1.6%) and 3 of 7 patients with a right-sided device (42.8%), a 10 J safety margin could not be achieved. As a result 4 patients (3.1% of study collective) had a revision of the system. CONCLUSION Repeat defibrillation testing after administration of amiodarone therapy rarely fails in patients with left-sided devices. We observed a higher test failure in patients with a device in the right-subpectoral position although this subgroup was small. Repeat defibrillator testing is safe as no relevant complications were observed.
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Affiliation(s)
- Julia Köbe
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany.
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Strauss M, Kleemann T, Weisse U, Sack FU, Zahn R. Additional coronary sinus defibrillation lead with a right pectoral ICD and high DFT : a case report. Herzschrittmacherther Elektrophysiol 2011; 22:121-3. [PMID: 21479600 DOI: 10.1007/s00399-011-0134-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
Abstract
We report the case of a 63-year-old man with ischemic cardiomyopathy having an implantable cardioverter defibrillator (ICD) implanted for repeated ventricular tachycardia (VT). After several revisions of the ICD lead, a thrombosis of the left venous system was diagnosed. A right pectoral ICD device was implanted, and a sufficient defibrillation threshold (DFT) could not be achieved during the operation. Thus, a further defibrillation lead was implanted into the coronary sinus, which successfully terminated ventricular fibrillation.
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Affiliation(s)
- M Strauss
- Arrhythmia Institute at the Heart Center Ludwigshafen, Cardiology, Deutschland.
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Droogan C, Patel C, Yan GX, Kowey PR. Role of Antiarrhythmic Drugs: Frequent Implantable Cardioverter-Defibrillator Shocks, Risk of Proarrhythmia, and New Drug Therapy. Heart Fail Clin 2011; 7:195-205, viii. [DOI: 10.1016/j.hfc.2010.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kroll MW, Schwab JO. Achieving low defibrillation thresholds at implant: pharmacological influences, RV coil polarity and position, SVC coil usage and positioning, pulse width settings, and the azygous vein. Fundam Clin Pharmacol 2010; 24:561-73. [DOI: 10.1111/j.1472-8206.2010.00848.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Patel C, Yan GX, Kocovic D, Kowey PR. Should catheter ablation be the preferred therapy for reducing ICD shocks?: Ventricular tachycardia ablation versus drugs for preventing ICD shocks: role of adjuvant antiarrhythmic drug therapy. Circ Arrhythm Electrophysiol 2010; 2:705-11; discussion 712. [PMID: 20009081 DOI: 10.1161/circep.109.893628] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chinmay Patel
- Main Line Health Heart Center and Lankenau Hospital, Wynnewood, PA 19096, USA
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GOLD MICHAELR, KROLL MARKW, ELLENBOGEN KENNETHA. Defibrillation Testing at ICD Implantation: Are We Asking the Wrong Question? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:567-9. [DOI: 10.1111/j.1540-8159.2009.02327.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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SIMON RONDB, STURDIVANT JLACY, LEMAN ROBERTB, WHARTON JMARCUS, GOLD MICHAELR. The Effect of Dofetilide on Ventricular Defibrillation Thresholds. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:24-8. [DOI: 10.1111/j.1540-8159.2009.02172.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kapetanopoulos A, Katsetos MC, Kluger J. Intraoperative hypothermia increased defibrillation energy requirements. J Cardiovasc Med (Hagerstown) 2007; 8:741-3. [PMID: 17700410 DOI: 10.2459/jcm.0b013e3280101df8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe two patients with newly implanted automatic implantable cardioverter-defibrillators that had excessive defibrillation thresholds associated with hypothermia at intraoperative defibrillation threshold testing. Normal defibrillation threshold levels were obtained during postoperative non-invasive electrophysiology testing in an electrophysiology laboratory when the patients were normothermic. We hypothesize that inadvertent intraoperative hypothermia during device implantation may increase the defibrillation threshold.
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Affiliation(s)
- Athanasios Kapetanopoulos
- Henry Low Heart Center, Hartford Hospital, University of Connecticut School of Medicine, Farmington, CT, USA.
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Swerdlow CD, Russo AM, Degroot PJ. The dilemma of ICD implant testing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:675-700. [PMID: 17461879 DOI: 10.1111/j.1540-8159.2007.00730.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ventricular fibrillation (VF) has been induced at implantable cardioverter defibrillator (ICD) implant to ensure reliable sensing, detection, and defibrillation. Despite its risks, the value was self-evident for early ICDs: failure of defibrillation was common, recipients had a high risk of ventricular tachycardia (VT) or VF, and the only therapy for rapid VT or VF was a shock. Today, failure of defibrillation is rare, the risk of VT/VF is lower in some recipients, antitachycardia pacing is applied for fast VT, and vulnerability testing permits assessment of defibrillation efficacy without inducing VF in most patients. This review reappraises ICD implant testing. At implant, defibrillation success is influenced by both predictable and unpredictable factors, including those related to the patient, ICD system, drugs, and complications. For left pectoral implants of high-output ICDs, the probability of passing a 10 J safety margin is approximately 95%, the probability that a maximum output shock will defibrillate is approximately 99%, and the incidence of system revision based on testing is < or = 5%. Bayes' Theorem predicts that implant testing identifies < or = 50% of patients at high risk for unsuccessful defibrillation. Most patients who fail implant criteria have false negative tests and may undergo unnecessary revision of their ICD systems. The first-shock success rate for spontaneous VT/VF ranges from 83% to 93%, lower than that for induced VF. Thus, shocks for spontaneous VT/VF fail for reasons that are not evaluated at implant. Whether system revision based on implant testing improves this success rate is unknown. The risks of implant testing include those related to VF and those related to shocks alone. The former may be due to circulatory arrest alone or the combination of circulatory arrest and shocks. Vulnerability testing reduces risks related to VF, but not those related to shocks. Mortality from implant testing probably is 0.1-0.2%. Overall, VF should be induced to assess sensing in approximately 5% of ICD recipients. Defibrillation or vulnerability testing is indicated in 20-40% of recipients who can be identified as having a higher-than-usual probability of an inadequate defibrillation safety margin based on patient-specific factors. However, implant testing is too risky in approximately 5% of recipients and may not be worth the risks in 10-30%. In 25-50% of ICD recipients, testing cannot be identified as either critical or contraindicated.
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Affiliation(s)
- Charles D Swerdlow
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, and the David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
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Hasan A, Yancy CW. Treatment of Ventricular Dysrhythmias and Sudden Cardiac Death: A Guideline-Based Approach for Patients With Chronic Left Ventricular Dysfunction. ACTA ACUST UNITED AC 2007; 13:228-35. [PMID: 17673876 DOI: 10.1111/j.1527-5299.2007.07329.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
With the rise in the use of device therapy implants, we are better identifying appropriate chronic heart failure patients for primary implantable defibrillator therapy who are at risk of ventricular arrhythmia. As our knowledge expands, however, controversial issues emerge. Guidelines have been endorsed by the major international societies, such as the American College of Cardiology (ACC), the American Heart Association (AHA), and the European Society of Cardiology. In view of certain variances in recommendations and new data, a recent joint guideline statement has been issued from these 3 societies regarding management of ventricular arrhythmia and preventing sudden cardiac death in patients with left ventricular dysfunction and heart failure. In this review, the recent joint statement is compared with those from the Heart Failure Society of America (Heart Failure Practice Guidelines 2006) and ACC/AHA (Heart Failure Guidelines 2005), with a special emphasis on new expanded criteria for primary prevention in both ischemic and nonischemic heart disease. In addition, the authors review current guidelines for electrophysiology testing in chronic left ventricular dysfunction and the emerging role of microvolt T-wave alternans as a means of risk stratification.
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MESH Headings
- Adrenergic beta-Antagonists/therapeutic use
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electrophysiologic Techniques, Cardiac
- Heart Failure/complications
- Heart Failure/therapy
- Humans
- Potassium Channel Blockers/therapeutic use
- Practice Guidelines as Topic
- Primary Prevention
- Risk Assessment
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/prevention & control
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/therapy
- Ventricular Fibrillation/etiology
- Ventricular Fibrillation/prevention & control
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Affiliation(s)
- Ayesha Hasan
- Division of Cardiovascular Medicine, Heart Failure Devices Clinic, Ohio State University College of Medicine, Columbus, OH 43210-1252, USA.
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Kurita T, Mitamura H, Aizawa Y, Nitta T, Aonuma K, Tsuboi N, Chinushi M, Kobayashi Y, Soejima K, Satomi K, Furushima H, Ohe T, Ogawa S, Kodama I, Ohtsu H, Yamazaki T. Japanese randomized trial for investigation of a combined therapy of amiodarone and implantable cardioverter defibrillator in patients with ventricular tachycardia and fibrillation: the Nippon ICD Plus Pharmachologic Option Necessity study design. Circ J 2006; 70:316-20. [PMID: 16501299 DOI: 10.1253/circj.70.316] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) are the most effective therapy in reducing the mortality of patients with life-threatening ventricular tachyarrhythmias. However, the ICD cannot prevent the recurrence of tachycarida attacks and that limits the clinical usefulness of them. The Nippon ICD Plus Pharmachologic Option Necessity (NIPPON) trial was designed as the first prospective randomized study to test the hypothesis whether amiodarone could improve the patient's clinical outcome by reducing the amount of ICD therapy in the Japanese patient population. METHODS AND RESULTS Approximately 400 patients with organic heart disease and spontaneous episode(s) of sustained ventricular tachycardia/fibrillation (VT/VF) will be randomly assigned to one of 2 groups; the amiodarone group and non-amiodarone group. Both groups of patients will be followed at least for 24 months. The end-point committee will adjudicate events in a blinded fashion. The primary end-points of this study are determination of the appropriate therapy from the ICD and alteration of the assigned treatment because of its harmful effects and/or frequent ICD therapies. CONCLUSION The NIPPON study is expected to confirm our understanding of the prognostic and therapeutic usefulness of adjuvant amiodarone therapy for patients with an ICD and with a history of sustained VT/VF.
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Affiliation(s)
- Takashi Kurita
- Department of Cardiovascular Medicine, National Cardiovascular Center, Suita, Japan.
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Swerdlow CD, Friedman PA. Advanced ICD Troubleshooting: Part II. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:70-96. [PMID: 16441722 DOI: 10.1111/j.1540-8159.2006.00300.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Satomi K, Kurita T, Takatsuki S, Yokoyama Y, Chinushi M, Tsuboi N, Nitta T, Shoda M, Mitamura H. Amiodarone Therapy in Patients Implanted With Cardioverter-Defibrillator for Life-Threatening Ventricular Arrhythmias. Circ J 2006; 70:977-84. [PMID: 16864928 DOI: 10.1253/circj.70.977] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Whether amiodarone can improve the patient's clinical outcome by reducing implantable cardioverter-defibrillator (ICD) therapy deliveries for ventricular tachycardia or fibrillation (VT/VF) has not been clearly evaluated. METHODS AND RESULTS A total of 507 patients with VT/VF due to organic heart disease who had ICDs implanted were enrolled in this study. The patients were divided into 3 groups: Amiodarone (n=247), Class I anti-arrhythmic drug (n=103) and CONTROL (n=157) groups, and the total cause mortality and arrhythmic event free survival rates were evaluated between the groups. The mean follow-up period was 38+/-27 months. The left ventricular ejection fraction was significantly decreased in the Amiodarone group (Amiodarone: 37+/-15%; Class I: 39+/-16%; CONTROL 44+/-17%). The mortality and arrhythmic events were significantly higher in the Class I group than the Amiodarone group (p<0.05), but there was no significant difference between the Amiodarone and CONTROL groups (arrhythmic event free rate at 5 years: Amiodarone: 53%; Class I: 35%; CONTROL 48%; 5 year survival: 86%, 74% and 77%, respectively). Side effects from amiodarone were found in 12% of the patients, but no fatal events were observed. CONCLUSIONS The present study could not demonstrate the benefit of amiodarone in ICD patients, probably due to a significant clinical bias exerted in selecting this drug.
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Affiliation(s)
- Kazuhiro Satomi
- Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center, Suita, Japan
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Almquist AK, Montgomery JV, Haas TS, Maron BJ. Cardioverter-defibrillator implantation in high-risk patients with hypertrophic cardiomyopathy. Heart Rhythm 2005; 2:814-9. [PMID: 16051115 DOI: 10.1016/j.hrthm.2005.05.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 05/10/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) are used with increasing frequency in hypertrophic cardiomyopathy (HCM) patients of all ages for primary and secondary sudden death prevention. Concerns may arise regarding the safety of device implantation because of unique clinical and phenotypic expressions of HCM. OBJECTIVES The purpose of this study was to assess the efficacy and safety of ICD placement in high-risk patients with HCM. METHODS We analyzed the experience with ICDs and transvenous lead systems in 75 consecutive HCM patients at the Minneapolis Heart Institute from 1993 to 2004. RESULTS The age of the study group patients was 12 to 79 years (mean 36 +/- 16). Patients received ICDs for secondary (n = 4, after cardiac arrest) or primary prevention (n = 71, with > or = 1 risk factor). Thirty-one patients demonstrated disease features that potentially impacted methodology and safety of the implant procedure, most commonly massive left ventricular (LV) hypertrophy and outflow obstruction > or = 50 mmHg. There were no procedure-related deaths; defibrillator implants were successful and uneventful in 71 of 75 patients (95%). In 3 of the 75 patients (4%), defibrillation was unsuccessful because of high thresholds, associated with extreme hypertrophy (wall thickness > 45 mm) and/or ongoing amiodarone therapy. In two of these patients, thoracotomy with epicardial lead placement achieved successful defibrillation; ICD therapy was abandoned in the other patient. CONCLUSION ICD placement in children and adults with HCM is generally safe and effective. However, in some patients with massive LV hypertrophy and/or prior administration of amiodarone, transvenous defibrillation proved difficult, and epicardial lead placement was required. High-energy ICD devices and defibrillation threshold testing are recommended for most high-risk HCM patients.
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Affiliation(s)
- Adrian K Almquist
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota 55407, USA
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Abstract
This brief overview serves as an introduction to the vast array of basic and clinical concepts that are pertinent to the basic understanding of ventricular fibrillation, its genesis, and its clinical management.
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Affiliation(s)
- Frank A Fish
- Division of Pediatric Cardiology, MCN D2220, Vanderbilt University, Nashville, TN 37232-2572, USA.
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Frykman V, Darpo B, Ayers GM, Bergfeldt L, Linde C, Rosenqvist M. Rapid atrial pacing does not decrease the atrial defibrillation threshold. Pacing Clin Electrophysiol 2003; 26:1461-6. [PMID: 12914622 DOI: 10.1046/j.1460-9592.2003.t01-1-00211.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the study was to evaluate the effect of preshock atrial pacing on the atrial defibrillation threshold (DFT) during internal cardioversion of AF. The implantable atrial defibrillator has been added to the therapeutic options for patients with recurrent episodes of persistent AF. Although the device is efficient in restoring sinus rhythm, patient discomfort is a limitation. Methods that lower the ADFT are needed. Eleven patients with AF underwent internal cardioversion. In a randomized, crossover design, ADFT testing was performed, applying a step-up protocol starting at 100 V. Rapid atrial pacing was performed with a right atrial catheter for 20 seconds at 90% of the average cycle length of the fibrillatory waves and was immediately followed by a biphasic defibrillation shock. At each energy level, pacing + shock was compared to shock only, until the level at which sinus rhythm was restored by both modes. The step-up protocol was thereafter repeated using the inverse sequence of the two modes. A total of 19 ADFTs were obtained. For 10 the ADFT was lower with pacing + shock, in 4 equal and in 5 higher, than with shock only. The ADFT (mean +/- SD) with pacing + shock was 260 +/- 84 V(3.4 +/- 2.9 J) and did not differ from shock only: 268 +/- 85 V(3.8 +/- 3.0 J) (P > 0.05). The coefficient of variation and the coefficient of reproducibility for pacing + shock was 16% and 60 V, respectively, and for shock only 17% and 61 V. Rapid atrial pacing did not influence the internal ADFT in AF. The randomized, crossover protocol used was reproducible between different modes, and seems useful when testing the impact of different interventions on the ADFT.
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Affiliation(s)
- Viveka Frykman
- Department of Cardiology, Karolinska Hospital, Stockholm Sweden.
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Boriani G, Rapezzi C, Biffi M, Branzi A. Hypertrophic cardiomyopathy with massive hypertrophy, amiodarone treatment and high defibrillation threshold at cardioverter-defibrillator implant. Int J Cardiol 2002; 83:171-3. [PMID: 12007691 DOI: 10.1016/s0167-5273(02)00036-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Nielsen TD, Hamdan MH, Kowal RC, Barbera SJ, Page RL, Joglar JA. Effect of acute amiodarone loading on energy requirements for biphasic ventricular defibrillation. Am J Cardiol 2001; 88:446-8. [PMID: 11545776 DOI: 10.1016/s0002-9149(01)01701-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- T D Nielsen
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Texas 75390-9047, USA
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