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Schupp T, Rusnak J, Weidner K, Bertsch T, Mashayekhi K, Tajti P, Akin I, Behnes M. Prognostic Impact of Different Types of Ventricular Tachyarrhythmias Stratified by Underlying Cardiac Disease. J Pers Med 2022; 12:jpm12122023. [PMID: 36556245 PMCID: PMC9784877 DOI: 10.3390/jpm12122023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Limited data regarding the outcome of patients with different types of ventricular tachyarrhythmias is available. This study sought to assess the prognostic impact of different types of ventricular tachyarrhythmias stratified by underlying cardiac disease. A large retrospective registry was used including all consecutive patients presenting with ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016. Patients with non-sustained VT (ns-VT), sustained VT (s-VT) and VF were compared using uni- and multivariable Cox regression models. Risk stratification was performed after stratification by underlying cardiac disease (i.e., acute myocardial infarction (AMI), ischemic heart disease (IHD), non-ischemic cardiomyopathy (NICM) and patients considered as lower-risk for ventricular tachyarrhythmias). The primary endpoint was defined as all-cause mortality at 2.5 years. Secondary endpoints were cardiac death at 24 h, all-cause mortality at 5 years, cardiac rehospitalization and a composite arrhythmic endpoint at 2.5 years. In 2422 consecutive patients with ventricular tachyarrhythmias, most patients were admitted with VF (44%), followed by ns-VT (30%) and s-VT (26%). Patients with VF suffered most commonly from AMI (42%), whereas heart failure was more common in s-VT patients (32%). In patients with AMI (HR = 1.146; 95% CI 0.751-1.750; p = 0.527) and in the lower-risk group (HR = 1.357; 95% CI 0.702-2.625; p = 0.364), the risk of all-cause mortality did not differ in VF and s-VT patients. In IHD patients, VF was associated with impaired prognosis compared to s-VT (HR = 2.502; 95% CI 1.936-3.235; p = 0.001). In conclusion, VF was associated with worse long-term prognosis compared to s-VT in IHD patients, whereas the risk of all-cause mortality among VF and s-VT patients did not differ in patients with AMI, NICM and in patients considered at lower risk for ventricular tachyarrhythmias.
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Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, 77933 Lahr, Germany
| | - Péter Tajti
- Gottsegen György National Cardiovascular Center, 1096 Budapest, Hungary
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
- Correspondence: ; Tel.: +49-621-383-6239
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Masini M, Elia E, Vianello PF, Bertero G, Rossi P, Ameri P, Chiarella F, Brunelli C, Porto I, Sartori P, Canepa M. Frequency, predictors and prognostic impact of implantable cardioverter defibrillator shocks in a primary prevention population with heart failure and reduced ejection fraction. J Cardiovasc Med (Hagerstown) 2021; 22:118-125. [PMID: 32941323 DOI: 10.2459/jcm.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The role of the implantable cardioverter defibrillator (ICD) in primary prevention real-world population is debated. We sought to evaluate the incidence, predictors and prognostic impact of ICD shocks in consecutive heart failure patients implanted for primary prevention at our tertiary institution. METHODS AND RESULTS We retrospectively selected a sample of 497 patients (mean age 64.8 years, 82.1% men, average left ventricular ejection fraction, LVEF, 27.1%). At long-term follow-up (median time 70.4 months), total mortality was 40.8%, and 16.5% of patients had received at least one appropriate shock (3.12%/year). Inappropriate shock [odds ratio (OR) 1.93, 95% confidence interval (95% CI) 1.08-3.47; P = 0.027] and length of follow-up (1 year, OR 1.01, 95% CI 1.00-1.01; P = 0.0031) were associated with the occurrence of appropriate shock, whereas atrial fibrillation (OR 2.65, 95% CI 1.55-4.51, P < 0.001), length of follow-up (1-year OR 1.01, 95% CI 1.00-1.01, P < 0.001) and appropriate shock (OR 1.93, 95% CI 1.08-3.47, P = 0.027) were associated with the occurrence of inappropriate shock. Neither appropriate nor inappropriate shock independently increased mortality risk, whereas older age (hazard ratio 1.05; 95% CI 1.04-1.07; P < 0.001), atrial fibrillation (hazard ratio 2.25; 95% CI 1.67-3.02; P < 0.001) and lower LVEF (hazard ratio 0.97; 95% CI 0.94-0.99; P = 0.004) did. CONCLUSION Incidence of shocks in real-world primary prevention ICD recipients might be lower than expected, and the association between ICD shocks and prolongation of survival is not as clear-cut as might be perceived. Further investigations from larger real-world samples are warranted.
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Affiliation(s)
- Marta Masini
- Department of Internal Medicine, University of Genova
| | - Edoardo Elia
- Department of Internal Medicine, University of Genova
| | | | - Giovanni Bertero
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
| | - Paolo Rossi
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova.,Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
| | - Francesco Chiarella
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
| | | | - Italo Porto
- Department of Internal Medicine, University of Genova.,Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
| | - Paolo Sartori
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
| | - Marco Canepa
- Department of Internal Medicine, University of Genova.,Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
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Driessen S, Napp A, Schmiedchen K, Kraus T, Stunder D. Electromagnetic interference in cardiac electronic implants caused by novel electrical appliances emitting electromagnetic fields in the intermediate frequency range: a systematic review. Europace 2020; 21:219-229. [PMID: 29992289 PMCID: PMC6365808 DOI: 10.1093/europace/euy155] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/07/2018] [Indexed: 11/14/2022] Open
Abstract
Electromagnetic fields (EMF) in the intermediate frequency (IF) range are generated by many novel electrical appliances, including electric vehicles, radiofrequency identification systems, induction hobs, or energy supply systems, such as wireless charging systems. The aim of this systematic review is to evaluate whether cardiovascular implantable electronic devices (CIEDs) are susceptible to electromagnetic interference (EMI) in the IF range (1 kHz-1 MHz). Additionally, we discuss the advantages and disadvantages of the different types of studies used to investigate EMI. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, we collected and evaluated studies examining EMI in in vivo studies, in vitro studies (phantom studies, benchmark tests), and simulation studies. Our analysis revealed that cardiac implants are susceptible to malfunction induced by EMF in the IF range. Electromagnetic interference may in particular be provoked by security systems and induction hobs. The results of the studies evaluated in this systematic review further indicate that the likelihood for EMI is dependent on exposure-related parameters (field strength, frequency, and modulation) and on implant- as well as on lead-related parameters (model, type of implant, implant sensitivity setting, lead configuration, and implantation site). The review shows that the factors influencing EMI are not sufficiently characterized and EMF limit values for CIED patients cannot be derived yet. Future studies should therefore, consider exposure-related parameters as well as implant- and lead-related parameters systematically. Additionally, worst-case scenarios should be considered in all study types where possible.
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Affiliation(s)
- Sarah Driessen
- Research Center for Bioelectromagnetic Interaction (femu), Institute of Occupational, Social and Environmental Medicine, University Hospital, RWTH Aachen University, Pauwelsstr. 30, Aachen, Germany
| | - Andreas Napp
- Department of Internal Medicine I (Cardiology, Angiology, Pneumology and Internal Intensive Care Medicine), University Hospital, RWTH Aachen University, Aachen, Germany
| | - Kristina Schmiedchen
- Research Center for Bioelectromagnetic Interaction (femu), Institute of Occupational, Social and Environmental Medicine, University Hospital, RWTH Aachen University, Pauwelsstr. 30, Aachen, Germany
| | - Thomas Kraus
- Research Center for Bioelectromagnetic Interaction (femu), Institute of Occupational, Social and Environmental Medicine, University Hospital, RWTH Aachen University, Pauwelsstr. 30, Aachen, Germany
| | - Dominik Stunder
- Research Center for Bioelectromagnetic Interaction (femu), Institute of Occupational, Social and Environmental Medicine, University Hospital, RWTH Aachen University, Pauwelsstr. 30, Aachen, Germany
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Dorian P, Yan AT, Connelly KA. Predicting Sudden Death in Dilated Cardiomyopathy: The Potential Power of Magnetic Resonance Imaging as a Critical Tool. Can J Cardiol 2020; 36:1006-1008. [DOI: 10.1016/j.cjca.2019.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 11/27/2022] Open
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Doshi RN. Morphology discrimination and ICD programming: Can we do better? J Cardiovasc Electrophysiol 2020; 31:1507-1508. [DOI: 10.1111/jce.14519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Rahul N. Doshi
- Electrophysiology and Complex Arrhythmia Management, Cardiovascular Center of Excellence, HonorHealth Scottsdale Arizona
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Kapoor R, Tyagi S, Dohmen C, Oujiri J, Roth J, Rubenstein JC, Berger M. Tachyarrhythmia discriminator for implantable cardioverter-defibrillators in bundle branch block. Heart Rhythm 2020; 17:1561-1565. [PMID: 32353586 DOI: 10.1016/j.hrthm.2020.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Inaccurate arrhythmia classification by implantable cardioverter-defibrillators (ICDs) contributes to inappropriate shocks and increased health care utilization. OBJECTIVE The purpose of this study was to evaluate the ability of a novel discriminator using far-field (FF) and near-field (NF) right ventricular lead electrograms (EGMs) to differentiate ventricular tachycardia (VT) from supraventricular tachycardia (SVT) in patients with underlying conducted narrow QRS, right bundle branch block (RBBB), and left bundle branch block (LBBB). METHODS ICD interrogations were reviewed, identifying subjects with tachycardia events at least 5 beats in duration with stable morphology and cycle length. FF to NF (FF-NF) EGM intervals during tachycardia and baseline conducted rhythm were measured using digital calipers. Events with uncertain tachycardia rhythm mechanism were excluded. RESULTS Ninety-five subjects were included. Mean FF-NF interval during tachycardia was significantly lower during SVT than VT (25.8 ± 12.0 ms vs 91.0 ± 37.2 ms; P <.001). Participants with LBBB (n = 22) and RBBB (n = 21) had significantly lower mean FF-NF intervals during SVT compared with VT (LBBB 25.6 ± 7.26 ms vs 93.1 ± 41.5 ms; P <.001; RBBB 30.0 ± 16.6 ms vs 101.7 ± 34.3 ms; P <.001). In this cohort, FF-NF interval cutoff of 100 ms was 100% specific for VT discrimination regardless of underlying QRS morphology, with sensitivity of 46%, 50%, and 38% for LBBB, RBBB, and narrow QRS, respectively. CONCLUSION Prolonged FF-NF interval on intracardiac EGM during tachycardia is a highly specific discriminator for VT, regardless of baseline QRS morphology.
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Affiliation(s)
- Ridhima Kapoor
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Sudhi Tyagi
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Claire Dohmen
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James Oujiri
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James Roth
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jason C Rubenstein
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcie Berger
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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7
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Boveda S, Garcia R, Defaye P, Piot O, Narayanan K, Barra S, Gras D, Providencia R, Algalarrondo V, Beganton F, Perier MC, Jacob S, Bordachar P, Babuty D, Klug D, Leclercq C, Fauchier L, Sadoul N, Deharo JC, Marijon E. Implantable cardioverter defibrillator therapy for primary prevention of sudden cardiac death in the real world: Main findings from the French multicentre DAI-PP programme (pilot phase). Arch Cardiovasc Dis 2019; 112:523-531. [PMID: 31471226 DOI: 10.1016/j.acvd.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/21/2019] [Indexed: 11/15/2022]
Abstract
This review summarizes the main findings of the French multicentre DAI-PP pilot programme, and discusses the related clinical and research perspectives. This project included retrospectively (2002-2012 period) more than 5000 subjects with structural heart disease who received an implantable cardioverter defibrillator (ICD) for primary prevention of sudden cardiac death, and were followed for a mean period of 3 years. The pilot phase of the DAI-PP programme has provided valuable information on several practical and clinically relevant aspects of primary prevention ICD implantation in the real-world population, which are summarized in this review. This pilot has led to a prospective evaluation that started in May 2018, assessing ICD therapy in primary and secondary prevention in patients with structural and electrical heart diseases, with remote monitoring follow-up using a dedicated platform. This should further enhance our understanding of sudden cardiac death, to eventually optimize the field of preventative actions.
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Affiliation(s)
| | - Rodrigue Garcia
- CHU de Poitiers, 86021 Poitiers, France; Université de Poitiers, 86073 Poitiers, France
| | | | - Olivier Piot
- Centre cardiologique du Nord, 93200 Saint-Denis, France
| | - Kumar Narayanan
- Paris Cardiovascular Research Centre (Inserm U970), 75015 Paris, France; Maxcure Hospitals, 500081 Hyderabad, Telangana, India
| | - Sergio Barra
- Royal Papworth Hospital NHS Foundation Trust, Cambridge University Health Partners, CB2 0AY Cambridge, UK; Hospital da Luz Arrabida, 4400-346 Vila Nova de Gaia, Portugal
| | - Daniel Gras
- Hopital privé du Confluent, 44000 Nantes, France
| | - Rui Providencia
- Clinique Pasteur, 31076 Toulouse, France; Barts Heart Centre, Barts Health NHS Trust, EC1A 7BE London, UK
| | | | - Frankie Beganton
- Paris Cardiovascular Research Centre (Inserm U970), 75015 Paris, France
| | | | | | | | | | | | | | | | | | | | - Eloi Marijon
- Paris Cardiovascular Research Centre (Inserm U970), 75015 Paris, France; Unité de Rythmologie, Hôpital européen Georges Pompidou, 20-40, rue Leblanc, 75908 Paris cedex 15, France; Paris Descartes University, 75006 Paris, France.
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Thomas G, Choi DY, Doppalapudi H, Richards M, Iwai S, Daoud EG, Houmsse M, Kanagasundram AN, Mainigi SK, Lubitz SA, Cheung JW. Subclinical atrial fibrillation detection with a floating atrial sensing dipole in single lead implantable cardioverter-defibrillator systems: Results of the SENSE trial. J Cardiovasc Electrophysiol 2019; 30:1994-2001. [PMID: 31328298 PMCID: PMC6852241 DOI: 10.1111/jce.14081] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/07/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Subclinical atrial fibrillation (AF), in the form of cardiac implantable device-detected atrial high rate episodes (AHREs), has been associated with increased thromboembolism. An implantable cardioverter-defibrillator (ICD) lead with a floating atrial dipole may permit a single lead (DX) ICD system to detect AHREs. We sought to assess the utility of the DX ICD system for subclinical AF detection in patients, with a prospective multicenter, cohort-controlled trial. METHODS AND RESULTS One hundred fifty patients without prior history of AF (age 59 ± 13 years; 108 [72%] male) were enrolled into the DX cohort and implanted with a Biotronik DX ICD system at eight centers. Age-, sex-, and left ventricular ejection fraction-matched single- and dual-chamber ICD cohorts were derived from a Cornell database and from the IMPACT trial, respectively. The primary endpoint were AHRE detection at 12 months. During median 12 months follow-up, AHREs were detected in 19 (13%) patients in the DX, 8 (5.3%) in the single-chamber, and 19 (13%) in the dual-chamber cohorts. The rate of AHRE detection was significantly higher in the DX cohort compared to the single-chamber cohort (P = .026), but not significantly different compared to the dual-chamber cohort. There were no inappropriate ICD therapies in the DX cohort. At 12 months, only 3.0% of patients in the DX cohort had sensed atrial amplitudes less than 1.0 mV. CONCLUSION Use of a DX ICD lead allows subclinical AF detection with a single lead DX system that is superior to that of a conventional single-chamber ICD system.
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Affiliation(s)
- George Thomas
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Daniel Y Choi
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Harish Doppalapudi
- Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Sei Iwai
- Division of Cardiology, Westchester Medical Center, Valhalla, New York
| | - Emile G Daoud
- Division of Cardiovascular Medicine, The Ohio State University Medical Center, Columbus, Ohio
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, The Ohio State University Medical Center, Columbus, Ohio
| | | | - Sumeet K Mainigi
- Department of Cardiology and Electrophysiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Steven A Lubitz
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jim W Cheung
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
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Migliore F, Mattesi G, De Franceschi P, Allocca G, Crosato M, Calzolari V, Fantinel M, Ortis B, Facchin D, Daleffe E, Fabris T, Marras E, De Lazzari M, Zanon F, Marcantoni L, Siciliano M, Corrado D, Iliceto S, Bertaglia E, Zecchin M. Multicentre experience with the second-generation subcutaneous implantable cardioverter defibrillator and the intermuscular two-incision implantation technique. J Cardiovasc Electrophysiol 2019; 30:854-864. [PMID: 30827041 PMCID: PMC6850019 DOI: 10.1111/jce.13894] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/14/2019] [Accepted: 02/25/2019] [Indexed: 11/27/2022]
Abstract
Introduction The recently developed second‐generation subcutaneous implantable cardioverter defibrillator (S‐ICD) and the intermuscular two‐incision implantation technique demonstrate potential favorable features that reduce inappropriate shocks and complications. However, data concerning large patient populations are lacking. The aim of this multicentre prospective study was to evaluate the safety and outcome of second‐generation S‐ICD using the intermuscular two‐incision technique in a large population study. Methods and Results The study population included 101 consecutive patients (75% male; mean age, 45 ± 13 years) who received second‐generation S‐ICD (EMBLEM; Boston Scientific, Marlborough, MA) implantation using the intermuscular two‐incision technique as an alternative to the standard implantation technique. Twenty nine (29%) patients were implanted for secondary prevention. Twenty four (24%) patients had a previously implanted transvenous ICD. All patients were implanted without any procedure‐related complications. Defibrillation testing was performed in 80 (79%) patients, and ventricular tachycardia was successfully converted at less than or equal to 65 J in 98.75% (79/80) of patients without pulse generator adjustments. During a median follow‐up of 21 ± 10 months, no complications requiring surgical revision or local or systemic device‐related infections were observed. Ten patients (9.9%) received appropriate and successful shocks for ventricular arrhythmias. Three (2.9%) patients experienced inappropriate shocks due to oversensing the cardiac signal (n = 1), noncardiac signal (n = 1), and a combination of both cardiac and noncardiac signals (n = 1), with one patient requiring device explantation. No patients required device explantation due to antitachycardia pacing indications. Conclusions According to our multicentre study, second‐generation S‐ICD implanted with the intermuscular two‐incision technique is an available safe combination and appears to be associated with a low risk of complications, such as inappropriate shocks.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Giulia Mattesi
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Pietro De Franceschi
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Giuseppe Allocca
- Department of Cardiology, Hospital of Conegliano, Treviso, Italy
| | - Martino Crosato
- Department of Cardiology, Ca´ Foncello, Civil Hospital, Treviso, Italy
| | | | - Mauro Fantinel
- Department of Cardiology, Civil Hospital, Feltre, Belluno, Italy
| | - Benedetta Ortis
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | - Domenico Facchin
- Cardiology Division, Azienda Sanitaria Universitaria Integrata di Udine and IRCAB Foundation, P.le Santa Maria della Misericordia, Udine, Italy
| | - Elisabetta Daleffe
- Cardiology Division, Azienda Sanitaria Universitaria Integrata di Udine and IRCAB Foundation, P.le Santa Maria della Misericordia, Udine, Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Elena Marras
- Department of Cardiology, Dell´Angelo Hospital, Mestre, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Francesco Zanon
- Cardiology Department, Arrhythmia And Electrophysiology Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Lina Marcantoni
- Cardiology Department, Arrhythmia And Electrophysiology Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | | | - Domenico Corrado
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Massimo Zecchin
- Cardiovascular Department, University of Trieste, Trieste, Italy
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Laksman Z, Barichello S, Roston TM, Deyell MW, Krahn AD. Acute Management of Ventricular Arrhythmia in Patients With Suspected Inherited Heart Rhythm Disorders. JACC Clin Electrophysiol 2019; 5:267-283. [DOI: 10.1016/j.jacep.2019.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/02/2019] [Accepted: 02/03/2019] [Indexed: 02/08/2023]
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Bhaskaran A, Tung R, Stevenson WG, Kumar S. Catheter Ablation of VT in Non-Ischaemic Cardiomyopathies: Endocardial, Epicardial and Intramural Approaches. Heart Lung Circ 2019; 28:84-101. [DOI: 10.1016/j.hlc.2018.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023]
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Al-Zaiti SS, Pietrasik G, Carey MG, Alhamaydeh M, Canty JM, Fallavollita JA. The role of heart rate variability, heart rate turbulence, and deceleration capacity in predicting cause-specific mortality in chronic heart failure. J Electrocardiol 2018; 52:70-74. [PMID: 30476644 DOI: 10.1016/j.jelectrocard.2018.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/29/2018] [Accepted: 11/05/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The volume of regional denervated myocardium (D-M) on positron emission tomography has been recently suggested as a strong independent predictor of cause-specific mortality from sudden cardiac arrest (SCA) in chronic heart failure. We sought to evaluate whether ECG indices of global autonomic function predict risk of SCA to a similar degree as regional D-M. METHODS Subjects enrolled in the Prediction of Arrhythmic Events using Positron Emission Tomography (PAREPET) study were included in this study. Patients completed a 24-hour Holter ECG at enrollment and were followed up at 3-month intervals. SCA events were adjudicated by two board-certified cardiologists. Other cardiovascular death events were classified as nonsudden cardiac death (NSCD). Eight measures of heart rate variability were analyzed: SDNN, RMSSD, low-frequency (LF) and high-frequency (HF) power, heart rate turbulence onset and slope, and acceleration and deceleration capacity. We used competing risk regression to delineate cause-specific mortality from SCA versus NSCD. RESULTS Our sample included 127 patients (age 67 ± 12, 92% male). After a median follow-up of 4.1 years, there were 22 (17%) adjudicated SCA and 18 (14%) adjudicated NSCD events. In multivariate Cox-regression, LF power was the only HRV parameter to predict time-to-SCA. However, in competing risk analysis, reduced LF power was preferentially associated with NSCD rather than SCA (HR = 0.92 [0.85-0.98], p = 0.019). CONCLUSION Depressed LF power might indicate impaired vagal reflex, which suggests that increasing vagal tone in these patients would have a protective effect against NSCD beyond that achieved by the mere slowing of heart rate using β-blockers.
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Affiliation(s)
- Salah S Al-Zaiti
- University of Pittsburgh, Pittsburgh, PA, United States of America.
| | | | - Mary G Carey
- Strong Memorial Hospital at University of Rochester Medical Center, Rochester, NY, United States of America
| | | | - John M Canty
- State University of New York, Buffalo, NY, United States of America; VA Western NY Health Care System, Buffalo, NY, United States of America
| | - James A Fallavollita
- State University of New York, Buffalo, NY, United States of America; VA Western NY Health Care System, Buffalo, NY, United States of America
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Corrado D, Migliore F, Zorzi A. Sport activity in patients with implantable defibrillator: Playing with death? Eur J Prev Cardiol 2018; 26:760-763. [PMID: 30335508 DOI: 10.1177/2047487318805584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Italy
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Caldwell J, Gula L, Ali FS, Miranda RI, Abdollah H, Baranchuk A, Michael K, Simpson C, Redfearn DP. Relative timing of near-field and far-field electrograms can determine the tachyarrhythmia site of origin. Heart Rhythm 2018; 15:530-535. [DOI: 10.1016/j.hrthm.2017.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Indexed: 10/18/2022]
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15
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Bergau L, Tichelbäcker T, Kessel B, Lüthje L, Fischer TH, Friede T, Zabel M. Predictors of mortality and ICD shock therapy in primary prophylactic ICD patients-A systematic review and meta-analysis. PLoS One 2017; 12:e0186387. [PMID: 29040341 PMCID: PMC5645142 DOI: 10.1371/journal.pone.0186387] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/30/2017] [Indexed: 01/21/2023] Open
Abstract
Background There is evidence that the benefit of a primary prophylactic ICD therapy is not equal in all patients. Purpose To evaluate risk factors of appropriate shocks and all- cause mortality in patients with a primary prophylactic ICD regarding contemporary studies. Data source PubMed, LIVIVO, Cochrane CENTRAL between 2010 and 2016. Study selection Studies were eligible if at least one of the endpoints of interest were reported. Data extraction All abstracts were independently reviewed by at least two authors. The full text of all selected studies was then analysed in detail. Data synthesis Our search strategy retrieved 608 abstracts. After exclusion of unsuitable studies, 36 papers with a total patient number of 47282 were included in our analysis. All-cause mortality was significantly associated with increasing age (HR 1.41, CI 1.29–1.53), left ventricular function (LVEF; HR 1.21, CI 1.14–1.29), ischemic cardiomyopathy (ICM; HR 1.37, CI 1.14–1.66) and co-morbidities such as impaired renal function (HR 2.30, CI 1.97–2.69). Although, younger age (HR 0.96, CI 0.85–1.09), impaired LVEF (HR 1.26, CI 0.89–1.78) and ischemic cardiomyopathy (HR 2.22, CI 0.83–5.93) were associated with a higher risk of appropriate shocks, none of these factors reached statistical significance. Limitations Individual patient data were not available for most studies. Conclusion In this meta-analysis of contemporary clinical studies, all-cause mortality is predicted by a variety of clinical characteristics including LVEF. On the other hand, the risk of appropriate shocks might be associated with impaired LVEF and ischemic cardiomyopathy. Further prospective studies are required to verify risk factors for appropriate shocks other than LVEF to help select appropriate patients for primary prophylactic ICD-therapy.
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MESH Headings
- Age Factors
- Aged
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/mortality
- Cardiomyopathy, Dilated/therapy
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Female
- Humans
- Male
- Middle Aged
- Myocardial Ischemia/complications
- Myocardial Ischemia/diagnosis
- Myocardial Ischemia/mortality
- Myocardial Ischemia/therapy
- Primary Prevention
- Prognosis
- Prospective Studies
- Risk Factors
- Survival Analysis
- Ventricular Function, Left
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Affiliation(s)
- Leonard Bergau
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Tobias Tichelbäcker
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Barbora Kessel
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Lars Lüthje
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas H. Fischer
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Markus Zabel
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
- * E-mail:
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Boersma L, Barr C, Knops R, Theuns D, Eckardt L, Neuzil P, Scholten M, Hood M, Kuschyk J, Jones P, Duffy E, Husby M, Stein K, Lambiase PD. Implant and Midterm Outcomes of the Subcutaneous Implantable Cardioverter-Defibrillator Registry. J Am Coll Cardiol 2017; 70:830-841. [DOI: 10.1016/j.jacc.2017.06.040] [Citation(s) in RCA: 215] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/08/2017] [Accepted: 06/15/2017] [Indexed: 11/28/2022]
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Long-Term Arrhythmic and Nonarrhythmic Outcomes of Lamin A/C Mutation Carriers. J Am Coll Cardiol 2017; 68:2299-2307. [PMID: 27884249 DOI: 10.1016/j.jacc.2016.08.058] [Citation(s) in RCA: 193] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/12/2016] [Accepted: 08/23/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mutations in LMNA are variably expressed and may cause cardiomyopathy, atrioventricular block (AVB), or atrial arrhythmias (AAs) and ventricular arrhythmias (VA). Detailed natural history studies of LMNA-associated arrhythmic and nonarrhythmic outcomes are limited, and the prognostic significance of the index cardiac phenotype remains uncertain. OBJECTIVES This study sought to describe the arrhythmic and nonarrhythmic outcomes of LMNA mutation carriers and to assess the prognostic significance of the index cardiac phenotype. METHODS The incidence of AVB, AA, sustained VA, left ventricular systolic dysfunction (LVD) (= left ventricular ejection fraction ≤50%), and end-stage heart failure (HF) was retrospectively determined in 122 consecutive LMNA mutation carriers followed at 5 referral centers for a median of 7 years from first clinical contact. Predictors of VA and end-stage HF or death were determined. RESULTS The prevalence of clinical manifestations increased broadly from index evaluation to median follow-up: AVB, 46% to 57%; AA, 39% to 63%; VA, 16% to 34%; and LVD, 44% to 57%. Implantable cardioverter-defibrillators were placed in 59% of patients for new LVD or AVB. End-stage HF developed in 19% of patients, and 13% died. In patients without LVD at presentation, 24% developed new LVD, and 7% developed end-stage HF. Male sex (p = 0.01), nonmissense mutations (p = 0.03), and LVD at index evaluation (p = 0.004) were associated with development of VA, whereas LVD was associated with end-stage HF or death (p < 0.001). Mode of presentation (with isolated or combination of clinical features) did not predict sustained VA or end-stage HF or death. CONCLUSIONS LMNA-related heart disease was associated with a high incidence of phenotypic progression and adverse arrhythmic and nonarrhythmic events over long-term follow-up. The index cardiac phenotype did not predict adverse events. Genetic diagnosis and subsequent follow-up, including anticipatory planning for therapies to prevent sudden death and manage HF, is warranted.
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Park KH, Lee CH, Jung BC, Cho Y, Bae MH, Kim YN, Park HS, Han S, Lee YS, Hyun DW, Kim J, Kim DK, Cha TJ, Shin DG. Effectiveness of Implantable Cardioverter-Defibrillator Therapy for Heart Failure Patients according to Ischemic or Non-Ischemic Etiology in Korea. Korean Circ J 2016; 47:72-81. [PMID: 28154594 PMCID: PMC5287190 DOI: 10.4070/kcj.2016.0242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/25/2016] [Accepted: 09/13/2016] [Indexed: 11/20/2022] Open
Abstract
Background and Objectives This study was performed to describe clinical characteristics of patients with left ventriculars (LV) dysfunction and implantable cardioverter-defibrillator (ICD), and to evaluate the effect of ICD therapy on survival in Yeongnam province of Korea. Subjects and Methods From a community-based device registry (9 centers, Yeongnam province, from November 1999 to September 2012), 146 patients with LV dysfunction and an ICD implanted for primary or secondary prophylaxis, were analyzed. The patients were divided into two groups, based on the etiology (73 with ischemic cardiomyopathy and 73 with non-ischemic cardiomyopathy), and indication for the device implantation (36 for primary prevention and 110 for secondary prevention). The cumulative first shock rate, all cause death, and type and mode of death, were determined according to the etiology and indication. Results Over a mean follow-up of 3.5 years, the overall ICD shock rate was about 39.0%. ICD shock therapy was significantly more frequent in the secondary prevention group (46.4% vs. 16.7%, p=0.002). The cumulative probability of a first appropriate shock was higher in the secondary prevention group (p=0.015). There was no significant difference in the all-cause death, cardiac death, and mode of death between the groups according to the etiology and indication. Conclusion Studies from this multicenter regional registry data shows that in both ischemic and non-ischemic cardiomyopathy patients, the ICD shock therapy rate was higher in the secondary prevention group than primary prevention group.
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Affiliation(s)
- Kyu-Hwan Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Chan-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Byung Chun Jung
- Division of Cardiology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Yongkeun Cho
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Myung Hwan Bae
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yoon-Nyun Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hyoung-Seob Park
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seongwook Han
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Young Soo Lee
- Division of Cardiology, Department of Internal Medicine, Catholic University Medical Center, Daegu, Korea
| | - Dae-Woo Hyun
- Cardiovascular Center, Andong Medical Group, Andong, Korea
| | - Jun Kim
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae Kyeong Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Tae-Jun Cha
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Dong-Gu Shin
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
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WILKE IRIS, WITZEL KATRIN, MÜNCH JULIA, PECHA SIMON, BLANKENBERG STEPHAN, REICHENSPURNER HERMANN, WILLEMS STEPHAN, PATTEN MONICA, AYDIN ALI. High Incidence of De Novo and Subclinical Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy and Cardiac Rhythm Management Device. J Cardiovasc Electrophysiol 2016; 27:779-84. [DOI: 10.1111/jce.12982] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/09/2016] [Accepted: 03/29/2016] [Indexed: 11/27/2022]
Affiliation(s)
- IRIS WILKE
- Department of Cardiology; Reinbek Hospital; St. Adolf-Stift Reinbek Germany
| | - KATRIN WITZEL
- Department of General Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - JULIA MÜNCH
- Department of General Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - SIMON PECHA
- Department of Cardiac Surgery; University Heart Center Hamburg; Hamburg Germany
| | - STEPHAN BLANKENBERG
- Department of General Cardiology; University Heart Center Hamburg; Hamburg Germany
| | | | - STEPHAN WILLEMS
- Department of Electrophysiology; University Heart Center Hamburg; Hamburg Germany
| | - MONICA PATTEN
- Department of General Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - ALI AYDIN
- Department of Cardiology; Reinbek Hospital; St. Adolf-Stift Reinbek Germany
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20
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Abstract
Based on prospective population-based cohort studies from the Netherlands approximately 120,000 sudden cardiac deaths (SCD) have to be assumed in 2014 in Germany for persons older than 55 years of age without an implantable cardioverter defibrillator (ICD). In contrast in 2014 only 30,000 ICD were implanted in Germany. Due to the fact that victims of SCD are difficult to predict many more implantations are actually necessary because only approximately one third of the patients use their ICD during battery running time. Also according to the largest ICD study on ischemic cardiomyopathy at least six patients must be treated with an ICD to save one life after 8 years. Guidelines for ICD implantation are based on 12 randomized studies with more than 9000 patients. In 2014 in Germany 94 % of ICD implantations were carried out in accordance with the guidelines. The most important studies for primary prophylaxis of SCD (MADIT 2 and SCD-HeFT) finished recruitment of patients in 2001 but propensity score-matched ICD patients from a large national data base showed identical survival curves in 2005 and 2006. New ICD developments in recent years, such as suppression of inappropriate ICD therapy by improved programming, cardiac resynchronization, and telemonitoring showed promise for current ICD patients of improved survival in comparison to the original randomized patients from the studies, which led to the indications in the guidelines.
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Affiliation(s)
- M Block
- Innere Medizin - Kardiologie und Intensivmedizin, Klinik Augustinum München, Wolkerweg 16, 81375, München, Deutschland.
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Qian Z, Zhang Z, Guo J, Wang Y, Hou X, Feng G, Zou J. Association of Implantable Cardioverter Defibrillator Therapy with All-Cause Mortality-A Systematic Review and Meta-Analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:81-8. [PMID: 26470761 DOI: 10.1111/pace.12766] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/06/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) have become the standard approach for prevention of sudden cardiac death. Whether ICD therapy is an independent predictor of all-cause mortality is controversial. We made the systematic review and meta-analysis to estimate the impact of ICD therapy on mortality. METHODS We searched the PubMed and Embase databases for studies evaluating the effect of ICD shocks or antitachycardia pacing (ATP) on mortality. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using random effects models. RESULTS Thirteen cohort studies were identified. Mean ejection fraction of the population was 23-35%; 68.0% had ischemic etiology, and 74.5% received a primary prevention ICD implantation. Appropriate shocks were an independent predictor of increased mortality compared with no-shock or no-therapy patients (HR 2.07, 2.76, respectively). In contrast, inconsistent results were obtained during inappropriate-shock analyses: when compared with no-shock patients, inappropriate shocks were associated with an increased risk of death (HR 1.54, 95% CI: 1.25-1.89, P < 0.0001); however, when compared to no-therapy patients, there was no relationship between inappropriate shocks and mortality (HR 1.20, 95% CI: 0.90-1.61, P = 0.22). Subgroup analysis in heart failure patients also did not find any difference in mortality between inappropriate-shock and no-therapy patients. No increased risk of mortality was found in the patients who experienced appropriate or inappropriate ATP only. CONCLUSION Appropriate shocks were associated with an increased mortality in ICD patients. However, whether inappropriate shocks worsened the clinical outcome was controversial, and larger prospective trials are needed to clarify the issue.
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Affiliation(s)
- Zhiyong Qian
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China.,Department of Cardiology, Taixing People's Hospital, Taixing, Jiangsu Province, China
| | - Zhiyong Zhang
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jianghong Guo
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yao Wang
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiaofeng Hou
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Guangzhi Feng
- Department of Cardiology, Taixing People's Hospital, Taixing, Jiangsu Province, China
| | - Jiangang Zou
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
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Gonzalez JE, Sauer WH. Generator exchange in a primary prevention cardiac resynchronziation responder: do you reimplant a defibrillator? Card Electrophysiol Clin 2015; 7:487-96. [PMID: 26304529 DOI: 10.1016/j.ccep.2015.05.017] [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: 11/29/2022]
Abstract
This case-based review discusses the benefits of cardiac resynchronization therapy (CRT) and whether defibrillation function is necessary in CRT responders. An evaluation of the literature and evidence to date is discussed. Recommendations based on these data, expert opinion, and recently published appropriate use criteria are given.
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Affiliation(s)
- Jaime E Gonzalez
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - William H Sauer
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA.
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Napp A, Stunder D, Maytin M, Kraus T, Marx N, Driessen S. Are patients with cardiac implants protected against electromagnetic interference in daily life and occupational environment? Eur Heart J 2015; 36:1798-804. [DOI: 10.1093/eurheartj/ehv135] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 04/02/2015] [Indexed: 11/14/2022] Open
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