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Boursiquot BC, Young R, Alhanti B, Sullivan LT, Maul AJ, Khedagi A, Sears SF, Jackson LR, Thomas KL. Depression and Implantable Cardioverter-Defibrillator Implantation in Black Patients at Risk for Sudden Cardiac Death. J Am Heart Assoc 2024; 13:e033291. [PMID: 38979811 PMCID: PMC11292748 DOI: 10.1161/jaha.123.033291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/18/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Black patients meeting indications for implantable cardioverter-defibrillators (ICDs) have lower rates of implantation compared with White patients. There is little understanding of how mental health impacts the decision-making process among Black patients considering ICDs. Our objective was to assess the association between depressive symptoms and ICD implantation among Black patients with heart failure. METHODS AND RESULTS This is a secondary analysis of the VIVID (Videos to Address Racial Disparities in ICD Therapy via Innovative Designs) randomized trial, which enrolled self-identified Black individuals with chronic systolic heart failure. Depressive symptoms were assessed by the Patient Health Questionnaire-2 and the Mental Component Summary of the 12-Item Short-Form Health Survey. Decisional conflict was measured by an adapted Decisional Conflict Scale (DCS). ANCOVA was used to assess differences in Decisional Conflict Scale scores. Multivariable logistic regression was used to examine the association between depressive symptoms and ICD implantation. Among 306 participants, 60 (19.6%) reported depressed mood, and 142 (46.4%) reported anhedonia. Participants with the lowest Mental Component Summary of the 12-Item Short-Form Health Survey scores (poorer mental health and higher likelihood of depression) had greater decisional conflict regarding ICD implantation compared with those with the highest Mental Component Summary of the 12-Item Short-Form Health Survey scores (adjusted mean difference in Decisional Conflict Scale score, 3.2 [95% CI, 0.5-5.9]). By 90-day follow-up, 202 (66.0%) participants underwent ICD implantation. There was no association between either the Patient Health Questionnaire-2 score or the Mental Component Summary of the 12-Item Short-Form Health Survey score and ICD implantation. CONCLUSIONS Depressed mood and anhedonia were prevalent among ambulatory Black patients with chronic systolic heart failure considering ICD implantation. The presence of depressive symptoms did not impact the likelihood of ICD implantation in this population.
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Affiliation(s)
| | | | | | | | | | | | | | - Larry R. Jackson
- Duke Clinical Research InstituteDurhamNCUSA
- Duke University Medical CenterDurhamNCUSA
| | - Kevin L. Thomas
- Duke Clinical Research InstituteDurhamNCUSA
- Duke University Medical CenterDurhamNCUSA
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Yanagi H, Konishi H, Omae K, Yamamoto K, Murata M, Ueda N, Ishibashi K, Noguchi T, Kusano K. Association Between Adherence to a 3-Month Cardiac Rehabilitation Program and Long-Term Clinical Outcomes in Japanese Patients With Cardiac Implantable Electronic Devices. J Cardiopulm Rehabil Prev 2024; 44:248-256. [PMID: 38836846 DOI: 10.1097/hcr.0000000000000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
PURPOSE The objective of this study was to evaluate the association between comprehensive cardiac rehabilitation (CCR) completion and long-term clinical outcomes in patients with cardiac implantable electronic devices (CIED). METHODS This retrospective cohort study included 834 patients with CIED who participated in CCR, which included a cardiopulmonary exercise test or 6-min walk test. Patients with a left ventricular ejection fraction ≤40%, predicted peak oxygen uptake ≤80%, or B-type natriuretic peptide level ≥80 pg/mL were eligible. The primary outcome was all-cause mortality. RESULTS After excluding 241 patients with duplicate records and 69 who underwent CCR in the outpatient department, the data of 524 patients were analyzed. Mean age was 64 ± 15 yr, 389 (74%) patients were men, left ventricular ejection fraction was 31 ± 15%, and 282 (54%) patients had a history of hospitalization for worsening heart failure. Of the patients referred for CCR, 294 (56%) completed the program, and an additional 230 patients started but did not complete CCR. Over a 3.7-yr median follow-up period, all-cause mortality occurred in 156 (30%) patients. Completers had lower all-cause mortality rates than non-completers (log-rank 15.77, P < .001). After adjusting for prognostic baseline characteristics, completers had 58% lower all-cause mortality risks than non-completers (HR = 0.42; 95% CI, 0.27-0.64, P < .001). CONCLUSIONS Three-mo CCR program completion was associated with lower mortality risks in patients with CIED. New programs or management methods are needed to decrease mortality risks, especially for those who cannot complete CCR programs.
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Affiliation(s)
- Hidetoshi Yanagi
- Authors Affiliations: Department of Cardiovascular Rehabilitation (Drs Yanagi, Yamamoto, and Murata), Department of Nursing (Ms Konishi), Data Science (Dr Omae), Department of Cardiovascular Medicine (Drs Murata, Ueda, Ishibashi, Noguchi, Kusano), National Cerebral and Cardiovascular Center, Suita, Japan
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Rosenkranz SH, Wichmand CH, Smedegaard L, Møller S, Bjerre J, Schou M, Torp-Pedersen C, Philbert BT, Larroudé C, Melchior TM, Nielsen JC, Johansen JB, Riahi S, Holmberg T, Gislason G, Ruwald AC. Workforce affiliation in primary and secondary prevention implantable cardioverter defibrillator patients: a nationwide Danish study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:314-325. [PMID: 37682525 DOI: 10.1093/ehjqcco/qcad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND AND AIM There are a paucity of studies investigating workforce affiliation in connection with first-time implantable cardioverter defibrillator (ICD)-implantation. This study explored workforce affiliation and risk markers associated with not returning to work in patients with ICDs. METHODS Using the nationwide Danish registers, patients with a first-time ICD-implantation between 2007 and 2017 and of working age (30-65 years) were identified. Descriptive statistic and logistic regression models were used to describe workforce affiliation and to estimate risk markers associated with not returning to work, respectively. All analyses were stratified by indication for implantation (primary and secondary prevention). RESULTS Of the 4659 ICD-patients of working age, 3300 patients (71%) were members of the workforce (employed, on sick leave or unemployed) (primary: 1428 (43%); secondary:1872 (57%)). At baseline, 842 primary and 1477 secondary prevention ICD-patients were employed. Of those employed at baseline, 81% primary and 75% secondary prevention ICD-patients returned to work within 1 year, whereof more than 80% remained employed the following year. Among patients receiving sick leave benefits at baseline, 25% were employed after 1 year. Risk markers of not returning to work were 'younger age' in primary prevention ICD-patients, while 'female sex', left ventricular ejection fraction 'LVEF ≤40', 'lower income', and '≥3 comorbidities' were risk markers in secondary prevention ICD-patients. Lower educational level was a risk marker in both patient groups. CONCLUSION High return-to-work proportions following ICD-implantation, with a subsequent high level of employment maintenance were found. Several significant risk markers of not returning to work were identified including 'lower educational level' that posed a risk in both patient groups. TRIAL REGISTRATION NUMBER Capital Region of Denmark, P-2019-051.
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Affiliation(s)
- Simone H Rosenkranz
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
| | - Charlotte H Wichmand
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
| | - Lærke Smedegaard
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
| | - Sidsel Møller
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- The Emergency Medical Services Copenhagen, Capital Region of Denmark
| | - Jenny Bjerre
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
| | - Christian Torp-Pedersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Berit T Philbert
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Larroudé
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
| | - Thomas M Melchior
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens B Johansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Christine Ruwald
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
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Lenarczyk R, Zeppenfeld K, Tfelt-Hansen J, Heinzel FR, Deneke T, Ene E, Meyer C, Wilde A, Arbelo E, Jędrzejczyk-Patej E, Sabbag A, Stühlinger M, di Biase L, Vaseghi M, Ziv O, Bautista-Vargas WF, Kumar S, Namboodiri N, Henz BD, Montero-Cabezas J, Dagres N. Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC-endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society. Europace 2024; 26:euae049. [PMID: 38584423 PMCID: PMC10999775 DOI: 10.1093/europace/euae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/09/2024] Open
Abstract
Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electrical storm mainly affects patients with structural or primary electrical heart disease, often with an implantable cardioverter-defibrillator (ICD). Management of ES requires a multi-faceted approach and the involvement of multi-disciplinary teams, but despite advanced treatment and often invasive procedures, it is associated with high morbidity and mortality. With an ageing population, longer survival of heart failure patients, and an increasing number of patients with ICD, the incidence of ES is expected to increase. This European Heart Rhythm Association clinical consensus statement focuses on pathophysiology, clinical presentation, diagnostic evaluation, and acute and long-term management of patients presenting with ES or clustered VA.
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Affiliation(s)
- Radosław Lenarczyk
- Medical University of Silesia, Division of Medical Sciences, Department of Cardiology and Electrotherapy, Silesian Center for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- The Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frank R Heinzel
- Cardiology, Angiology, Intensive Care, Städtisches Klinikum Dresden Campus Friedrichstadt, Dresden, Germany
| | - Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
- Clinic for Electrophysiology, Klinikum Nuernberg, University Hospital of the Paracelsus Medical University, Nuernberg, Germany
| | - Elena Ene
- Clinic for Interventional Electrophysiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Christian Meyer
- Division of Cardiology/Angiology/Intensive Care, EVK Düsseldorf, Teaching Hospital University of Düsseldorf, Düsseldorf, Germany
| | - Arthur Wilde
- Department of Cardiology, Amsterdam UMC University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Tel Hashomer, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Markus Stühlinger
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Luigi di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrythmia Center, Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Ohad Ziv
- Case Western Reserve University, Cleveland, OH, USA
- The MetroHealth System Campus, Cleveland, OH, USA
| | | | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | | | - Benhur Davi Henz
- Instituto Brasilia de Arritmias-Hospital do Coração do Brasil-Rede Dor São Luiz, Brasilia, Brazil
| | - Jose Montero-Cabezas
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Sergi CM. Sudden cardiac death and post-traumatic stress disorder: More research is needed. Contemp Clin Trials Commun 2024; 37:101252. [PMID: 38312475 PMCID: PMC10837689 DOI: 10.1016/j.conctc.2023.101252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/22/2023] [Indexed: 02/06/2024] Open
Abstract
Sudden cardiac death is an event which is traumatic for the individuals, who survive and their relatives. Very few research is concentrated on these survivals and the symptoms arising from post-traumatic stress disorders. In this journal, Birk et al. report on twelve eligible cardiac arrest survivors contacted, of which ten were enrolled. The authors report on heart rate variability biofeedback, which is, according to the authors, a promising non-pharmacologic approach for reducing anxiety. The intervention was comprised of daily sessions of diaphragmatic paced breathing and real-time monitoring of cardiac activity guided by a smartphone app and heart rate monitor. Ninety percent of the patients had good scores for intervention acceptability and feasibility, and 80 % reported good scores for its appropriateness and usability for reducing fear. Trait anxiety decreased significantly pre-to-post intervention. We comment on this finding highlighting other studies targeting sudden cardiac death and supporting that more research with very large randomized clinical trials is needed.
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Affiliation(s)
- Consolato M Sergi
- Anatomic Pathology Division, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
- Department of Laboratory Medicine and Pathology, Stollery Children's Hospital, Edmonton, AB, Canada
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Helmark C, Egholm CL, Rottmann N, Skovbakke SJ, Andersen CM, Johansen JB, Nielsen JC, Larroudé CE, Riahi S, Brandt CJ, Pedersen SS. A web-based intervention for patients with an implantable cardioverter defibrillator - A qualitative study of nurses' experiences (Data from the ACQUIRE-ICD study). PEC INNOVATION 2023; 2:100110. [PMID: 37214535 PMCID: PMC10194258 DOI: 10.1016/j.pecinn.2022.100110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 11/08/2022] [Accepted: 11/26/2022] [Indexed: 05/24/2023]
Abstract
Objective The aim of this study was to explore cardiac nurses' experiences with a comprehensive web-based intervention for patients with an implantable cardioverter defibrillator. Methods We conducted an explorative qualitative study based on individual semi-structured interviews with 9 cardiac nurses from 5 Danish university hospitals. Results We found one overall theme: "Between traditional nursing and modern eHealth". This theme was derived from the following six categories: (1) comprehensive content in the intervention, (2) patient-related differences in engagement, (3) following the protocol is a balancing act, (4) online communication challenges patient contact, (5) professional collaboration varies, and (6) an intervention with potential. Cardiac nurses were positive towards the web-based intervention and believe it holds a large potential. However, they felt challenged by not having in-person and face-to-face contact with patients, which they found valuable for assessing patients' wellbeing and psychological distress. Conclusion Specific training in eHealth communication seems necessary as web-based care entails a shift in the nursing role and requires a different way of communication.InnovationFocusing on the user experience in web-based care from the perspective of cardiac nurses is innovative, and by applying implementation science this leads to new knowledge to consider when developing and implementing web-based care.
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Affiliation(s)
- Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Cecilie L. Egholm
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Nina Rottmann
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Søren J. Skovbakke
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Christina M. Andersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
| | - Jens B. Johansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jens C. Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
- Denmark and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte E. Larroudé
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Carl J. Brandt
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Susanne S. Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 300] [Impact Index Per Article: 300.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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F SS, R H, A S, E J, S A, Z H, R N. Addressing PTSD in Implantable Cardioverter Defibrillator Patients: State-of-the-Art Management of ICD Shock and PTSD. Curr Cardiol Rep 2023; 25:1029-1039. [PMID: 37486571 DOI: 10.1007/s11886-023-01924-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE OF REVIEW This paper reviews the unique processes and treatments of post-traumatic stress in implantable cardioverter-defibrillator (ICD) patients and posits specific clinical management recommendations. RECENT FINDINGS PTSD is a common presenting problem for a prospective ICD patient and is a common response to ICD shocks. Approximately 32% of patients with sudden cardiac arrest report significant PTSD symptoms. Following ICD shock, approximately 20% experience PTSD from the shocks. Regardless, PTSD can interrupt and undermine clinical management from a cardiologist perspective and create significant disturbance in patients and families. Few cardiology clinics are outfitted to effectively manage psychological distress, in general, and PTSD, in particular. Effective management of PTSD patients can be achieved with both direct care in the cardiac clinic, as well as indirect care via multidisciplinary consultation and expertise. The importance of emotional validation, return to physical activity, and family engagement is emphasized in current management.
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Affiliation(s)
- Sears S F
- Department of Psychology, East Carolina University, Greenville, NC, USA.
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA.
| | - Harrell R
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Sorrell A
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Jordan E
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Anthony S
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Hashmath Z
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Nekkanti R
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
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Trancuccio A, Kukavica D, Sugamiele A, Mazzanti A, Priori SG. Prevention of Sudden Death and Management of Ventricular Arrhythmias in Arrhythmogenic Cardiomyopathy. Card Electrophysiol Clin 2023; 15:349-365. [PMID: 37558305 DOI: 10.1016/j.ccep.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Arrhythmogenic cardiomyopathy is an umbrella term for a group of inherited diseases of the cardiac muscle characterized by progressive fibro-fatty replacement of the myocardium. As suggested by the name, the disease confers electrical instability to the heart and increases the risk of the development of life-threatening arrhythmias, representing one of the leading causes of sudden cardiac death (SCD), especially in young athletes. In this review, the authors review the current knowledge of the disease, highlighting the state-of-the-art approaches to the prevention of the occurrence of SCD.
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Affiliation(s)
- Alessandro Trancuccio
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Deni Kukavica
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Andrea Sugamiele
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Andrea Mazzanti
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Silvia G Priori
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy.
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Mumtaz M, Downar E, Kawada S, Zammit-Burg M, Anderson R, Massé S, Nair MKK, Nanthakumar J, Ghauri FM, Sánchez AP, Bhaskaran A. Utility of Substrate Mapping Using Extrasystole to Localise Comprehensive Ventricular Tachycardia Circuits: Results From Intra-operative Mapping Studies. Can J Cardiol 2023; 39:912-921. [PMID: 36918097 DOI: 10.1016/j.cjca.2023.02.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/28/2023] [Accepted: 02/21/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Substrate mapping-based identification of all ventricular tachycardia (VT) circuits (diastolic activation), including partial and complete diastolic circuits in clinical and nonclinical VT, could be beneficial in guiding VT ablation to prevent VT recurrence. The utility of extrasystole induced late potentials has not been compared with late potentials in sinus rhythm (SR) and right ventricular pacing (RVp). METHODS Intraoperative simultaneous panoramic endocardial mapping of 21 VTs in 16 ischemic heart disease patients was performed with the use of a 112-bipole endocardial balloon. The decrement of near-field electrogram later than surface QRS during extrasystole (eLP) was studied. RESULTS Patients had a mean age of 52 ± 9 years and were predominantly (75%) male. The mean sensitivity of eLP (0.75 [95% confidence interval [CI] 0.72-0.78]) to detect VT circuits was better than SR (0.33 [0.30-0.36]; P < 0.001) and RVp (0.36 [0.33-0.39]; P < 0.001) without significant differences in specificity, eLP (0.77 [0.74-0.81], SR (0.82 [0.80-0.84]; P = 0.23), and RVp (0.81 [0.78-0.83]; P = 0.11). Both negative (NPV) and positivie (PPV) predictive values were significantly better for eLP mapping. The mean NPV was 0.77 (95% CI 0.74-0.81), 0.57 (0.55-0.59), and 0.58 (0.55-0.61) for eLP, SR, and RVp, respectively (P < 0.0001). PPV was 0.75 (95% CI 0.72-0.78), 0.63 (0.59-0.67), and 0.63 (0.59-0.67) for eLP, SR, and RVp, respectively (P < 0.001). Overall diagnostic performance (area under the receiver operating characteristic curve) was significantly better for eLP (0.85 [95% CI 0.80-0.90] compared with SR (0.63 [0.56-0.72]; P < 0.001) or RVp (0.61 [0.52-0.74]; P < 0.001). CONCLUSIONS Evoked late potential mapping is a better tool to detect comprehensive diastolic circuits activated during VT, compared with eLP mapping in sinus rhythm or RV pacing.
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Affiliation(s)
- Maroosh Mumtaz
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada; Department of Medicine, Cardiology, University of Toronto, Ontario, Canada
| | - Eugene Downar
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Satoshi Kawada
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Melanie Zammit-Burg
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Robert Anderson
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Stéphane Massé
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Madhav Krishna Kumar Nair
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Jared Nanthakumar
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | | | - Andreu Porta- Sánchez
- Arrhythmia Unit, Hospital Universitario Quirónsalud Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain.
| | - Abhishek Bhaskaran
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network Toronto, Ontario, Canada.
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11
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Biasi N, Seghetti P, Mercati M, Tognetti A. A smoothed boundary bidomain model for cardiac simulations in anatomically detailed geometries. PLoS One 2023; 18:e0286577. [PMID: 37294777 PMCID: PMC10256234 DOI: 10.1371/journal.pone.0286577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/18/2023] [Indexed: 06/11/2023] Open
Abstract
This manuscript presents a novel finite difference method to solve cardiac bidomain equations in anatomical models of the heart. The proposed method employs a smoothed boundary approach that represents the boundaries between the heart and the surrounding medium as a spatially diffuse interface of finite thickness. The bidomain boundary conditions are implicitly implemented in the smoothed boundary bidomain equations presented in the manuscript without the need of a structured mesh that explicitly tracks the heart-torso boundaries. We reported some significant examples assessing the method's accuracy using nontrivial test geometries and demonstrating the applicability of the method to complex anatomically detailed human cardiac geometries. In particular, we showed that our approach could be employed to simulate cardiac defibrillation in a human left ventricle comprising fiber architecture. The main advantage of the proposed method is the possibility of implementing bidomain boundary conditions directly on voxel structures, which makes it attractive for three dimensional, patient specific simulations based on medical images. Moreover, given the ease of implementation, we believe that the proposed method could provide an interesting and feasible alternative to finite element methods, and could find application in future cardiac research guiding electrotherapy with computational models.
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Affiliation(s)
- Niccolò Biasi
- Information Engineering Department, University of Pisa, Pisa, Italy
| | - Paolo Seghetti
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, Pisa, Italy
- National Research Council, Institute of Clinical Physiology, Pisa, Italy
| | - Matteo Mercati
- Information Engineering Department, University of Pisa, Pisa, Italy
| | - Alessandro Tognetti
- Information Engineering Department, University of Pisa, Pisa, Italy
- Research Centre “E. Piaggio”, University of Pisa, Pisa, Italy
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12
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Bourier F. [Catheter ablation of ventricular tachycardia-Update 2023]. Herz 2023:10.1007/s00059-023-05167-5. [PMID: 37130946 DOI: 10.1007/s00059-023-05167-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 05/04/2023]
Abstract
The management of ventricular tachycardias (VT), which are often associated with severe cardiac disease, is a challenging clinical task. The structural damage to the myocardium associated with cardiomyopathy is crucial to the occurrence of VT and plays a fundamental role in arrhythmia mechanisms. The goal of catheter ablation is to develop an accurate understanding of the patient-specific arrhythmia mechanism as a first procedural step. As a second step, the ventricular areas that maintain the arrhythmia mechanism can be ablated and thereby electrically inactivated. Catheter ablation thereby enables causal therapy of VT by modifying the areas of the affected myocardium in such a way that VT can no longer be triggered. The procedure is an effective treatment option for affected patients.
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Affiliation(s)
- Felix Bourier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland.
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13
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Katyal A, Li COY, Franciosi S, Sanatani S. The safety of sports in children with inherited arrhythmia substrates. Front Pediatr 2023; 11:1151286. [PMID: 37124180 PMCID: PMC10132466 DOI: 10.3389/fped.2023.1151286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Sudden cardiac death (SCD) is a rare and devastating event in children and remains a leading cause of death in young athletes. Channelopathies and cardiomyopathies, in particular long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), hypertrophic cardiomyopathy (HCM), and arrhythmogenic cardiomyopathy (ACM) are associated with exercise-related SCD. Implantable cardioverter-defibrillators (ICDs) are often placed for secondary prevention for athletes with cardiomyopathy or channelopathy. There remains concern regarding the safety of return to participation with an ICD in place. Guidelines have historically recommended that patients with inherited heart rhythm disorders be restricted from competitive sports participation. Increasing evidence suggests a lower risk of exercise-related cardiac events in young athletes with inherited heart rhythm disorders. In this review, we highlight current knowledge, evolving guidelines, and present a multidisciplinary approach involving shared decision-making and appropriate planning for safe sports participation of children with inherited heart rhythm disorders.
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14
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Sex differences on outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease: A real-world systematic review and meta-analysis. Heart Rhythm O2 2022; 3:847-856. [PMID: 36588991 PMCID: PMC9795314 DOI: 10.1016/j.hroo.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Sex differences have diversely affected cardiac diseases. Little is known whether these differences impact outcomes of catheter ablation of ventricular tachycardia (VT). Objectives To assess the impact of sex differences on outcomes of catheter ablation of VT. Methods Databases were searched from inception through December 2021. Effect estimates from individual studies were extracted and combined using the random-effects, generic inverse variance method of DerSimonian and Laird. The outcomes of interest included VT recurrence rates, all-cause mortality, and composite outcomes of mortality, left ventricular assistant device use, and heart transplantation following VT ablation. Results Our analysis included 22 observational studies. There were 10,206 patients, of which 12.8% were women. We found no statistical difference between sexes for VT recurrence rate (pooled hazard ratio [HR] 1.04, P = .57, I 2 = 14.9%). Similarly, there was statistical difference in neither all-cause mortality nor composite outcomes (pooled HR 0.93, P = .75, I 2 = 59.1% and pooled HR 0.9, P = .33, I 2 = 0%, respectively). There was a trend toward an increase in women undergoing VT ablation in the recent registries (P = .071). Conclusion Our contemporary analysis suggests that sex may have no impact on clinical outcomes of catheter ablation of VT in patients with structural heart disease, though women are the underrepresented. However, recent VT ablation registries have involved more women in their studies. Future studies with a higher proportion of women are encouraged to verify the current perception.
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15
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Goldenberg L, Huang DT. Subcutaneous implantable cardioverter defibrillator for the prevention of sudden cardiac death: ready for prime-time? Eur Heart J 2022; 43:4884-4886. [PMID: 36380686 DOI: 10.1093/eurheartj/ehac652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Llan Goldenberg
- The Clinical Cardiovascular Research Center, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, 265 Crittenden Blvd CU 420653, Rochester, NY 14642, USA
| | - David T Huang
- The Clinical Cardiovascular Research Center, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, 265 Crittenden Blvd CU 420653, Rochester, NY 14642, USA
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16
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Abstract
Depression is a well-known risk factor for adverse cardiovascular outcomes in patients with cardiovascular diseases. The prevalence of depression in patients with cardiovascular diseases has been reported to be approximately 20 %. A two-step depression screening protocol using the 2-item Patient Health Questionnaire (PHQ-2) and the 9-item Patient Health Questionnaire (PHQ-9) is recommended for patients with cardiovascular diseases. Cardiovascular diseases and depression share a common pathology, including increased activity of the sympathetic nervous system, hyperactivity of hypothalamic-pituitary-adrenal axis, and inflammation. Psychosocial and environmental factors are also associated with depression and cardiovascular outcomes. Randomized controlled trials of antidepressant treatment for patients with depression and cardiovascular diseases have shown no advantage regarding cardiovascular outcomes. However, improvement in depressive symptoms, regardless of the method, may lead to a reduction in subsequent cardiovascular events. A collaborative approach between cardiologists and psychiatrists is recommended to manage depression in patients with cardiovascular diseases. Future research should identify more specific targets for treating patients with cardiovascular diseases, involve collaboration with professionals across fields, and establish community support systems.
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17
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Tavazzi G, Dammassa V, Colombo CNJ, Arbustini E, Castelein T, Balik M, Vandenbriele C. Mechanical circulatory support in ventricular arrhythmias. Front Cardiovasc Med 2022; 9:987008. [PMID: 36304552 PMCID: PMC9593033 DOI: 10.3389/fcvm.2022.987008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/15/2022] [Indexed: 11/27/2022] Open
Abstract
In atrial and ventricular tachyarrhythmias, reduced time for ventricular filling and loss of atrial contribution lead to a significant reduction in cardiac output, resulting in cardiogenic shock. This may also occur during catheter ablation in 11% of overall procedures and is associated with increased mortality. Managing cardiogenic shock and (supra) ventricular arrhythmias is particularly challenging. Inotropic support may exacerbate tachyarrhythmias or accelerate heart rate; antiarrhythmic drugs often come with negative inotropic effects, and electrical reconversions may risk worsening circulatory failure or even cardiac arrest. The drop in native cardiac output during an arrhythmic storm can be partly covered by the insertion of percutaneous mechanical circulatory support (MCS) devices guaranteeing end-organ perfusion. This provides physicians a time window of stability to investigate the underlying cause of arrhythmia and allow proper therapeutic interventions (e.g., percutaneous coronary intervention and catheter ablation). Temporary MCS can be used in the case of overt hemodynamic decompensation or as a “preemptive strategy” to avoid circulatory instability during interventional cardiology procedures in high-risk patients. Despite the increasing use of MCS in cardiogenic shock and during catheter ablation procedures, the recommendation level is still low, considering the lack of large observational studies and randomized clinical trials. Therefore, the evidence on the timing and the kinds of MCS devices has also scarcely been investigated. In the current review, we discuss the available evidence in the literature and gaps in knowledge on the use of MCS devices in the setting of ventricular arrhythmias and arrhythmic storms, including a specific focus on pathophysiology and related therapies.
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Affiliation(s)
- Guido Tavazzi
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy,Department of Anaesthesia, Intensive Care and Pain Therapy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy,*Correspondence: Guido Tavazzi
| | - Valentino Dammassa
- PhD in Experimental Medicine, University of Pavia, Pavia, Italy,Adult Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom
| | | | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Thomas Castelein
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Martin Balik
- Department of Anesthesiology and Intensive Care, First Medical Faculty and General University Hospital, Charles University in Prague, Prague, Czechia
| | - Christophe Vandenbriele
- Adult Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom,Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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18
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Freedenberg VA, Berul CI. Potential for shock leads to potential for stress. Heart Rhythm 2022; 19:1530-1531. [PMID: 35817253 DOI: 10.1016/j.hrthm.2022.07.004] [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: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Vicki A Freedenberg
- Children's National Hospital, Washington, District of Columbia; George Washington University School of Medicine, Washington, District of Columbia
| | - Charles I Berul
- Children's National Hospital, Washington, District of Columbia; George Washington University School of Medicine, Washington, District of Columbia.
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19
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Brown G, Conway S, Ahmad M, Adegbie D, Patel N, Myneni V, Alradhawi M, Kumar N, Obaid DR, Pimenta D, Bray JJH. Role of artificial intelligence in defibrillators: a narrative review. Open Heart 2022; 9:openhrt-2022-001976. [PMID: 35790317 PMCID: PMC9258481 DOI: 10.1136/openhrt-2022-001976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/17/2022] [Indexed: 02/01/2023] Open
Abstract
Automated external defibrillators (AEDs) and implantable cardioverter defibrillators (ICDs) are used to treat life-threatening arrhythmias. AEDs and ICDs use shock advice algorithms to classify ECG tracings as shockable or non-shockable rhythms in clinical practice. Machine learning algorithms have recently been assessed for shock decision classification with increasing accuracy. Outside of rhythm classification alone, they have been evaluated in diagnosis of causes of cardiac arrest, prediction of success of defibrillation and rhythm classification without the need to interrupt cardiopulmonary resuscitation. This review explores the many applications of machine learning in AEDs and ICDs. While these technologies are exciting areas of research, there remain limitations to their widespread use including high processing power, cost and the ‘black-box’ phenomenon.
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Affiliation(s)
- Grace Brown
- Cardiology Department, Royal Free Hospital, London, UK
| | - Samuel Conway
- Cardiology Department, Royal Free Hospital, London, UK
| | - Mahmood Ahmad
- Medical Sciences, University College London, London, UK
| | - Divine Adegbie
- Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | - Nishil Patel
- Cardiology Department, North Middlesex University Hospital, London, UK
| | | | | | - Niraj Kumar
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiology Department, Barts Health NHS Trust, London, UK
| | - Daniel R Obaid
- Institute of Life Sciences, Swansea University, Swansea, UK
| | - Dominic Pimenta
- Cardiology Department, Richmond Research Institute, London, UK
| | - Jonathan J H Bray
- Cardiff University College of Biomedical and Life Sciences, Cardiff, UK
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20
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Friedman DJ, Tully AS, Zeitler EP. Subcutaneous and Transvenous ICDs: an Update on Contemporary Questions and Controversies. Curr Cardiol Rep 2022; 24:947-958. [PMID: 35639275 DOI: 10.1007/s11886-022-01712-6] [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] [Accepted: 04/26/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW While the subcutaneous (S-) implantable cardioverter-defibrillator (ICDs) is an alternative to the transvenous (TV-) ICD in many patients, optimal use remains unclear. In this review, we summarize recent clinically relevant data on sensing algorithms, inappropriate shocks, defibrillation testing, and battery and electrode failures. RECENT FINDINGS Changes in sensing algorithms and S-ICD programming have significantly decreased inappropriate shock rates. Avoiding fat below the S-ICD coil and can is key for reducing the defibrillation threshold. While S-ICD battery and electrode failures have resulted in recalls, system components remain commercially available since failure rates are low and no other similar devices are available. The S-ICD is a good alternative to the TV-ICD for many patients, and particularly in light of recently developed device algorithms and improvements in implant technique. Future research will need to better understand: the impact of S-ICD electrode and battery failures and the potential for integrating leadless pacing into a modular S-ICD platform.
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Affiliation(s)
- Daniel J Friedman
- Electrophysiology Section, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA.
| | - Albert S Tully
- The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Emily P Zeitler
- The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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21
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Franciosi S, Abrams DJ, Ingles J, Sanatani S. Sudden Cardiac Arrest in the Paediatric Population. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:45-59. [PMID: 37969243 PMCID: PMC10642157 DOI: 10.1016/j.cjcpc.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2023]
Abstract
Sudden cardiac arrest in the young is a rare event with a range of potential causes including cardiomyopathies, ion channelopathies, and autonomic nervous system dysfunction. Investigations into the cause involve a multidisciplinary team, including cardiologists, geneticists, and psychologists. In addition to a detailed medical history, family history and circumstances surrounding the event are important in determining the cause. Clinical investigations including an electrocardiogram are fundamental in diagnosis and should be interpreted cautiously because some children may have atypical presentations and an evolving phenotype. The potential for misdiagnosis exists that could lead to incorrect long-term management strategies. If an inherited condition is suspected, genetic testing of the patient and cascade screening of family members is recommended with genetic counselling and psychological support. Medical management is left to the treating physician acknowledging that a clear diagnosis cannot be made in approximately half of cases. Secondary prevention implantable defibrillators are widely deployed but can be associated with complications in young patients. A plan for safe return to activity is recommended along with a proper transition of care into adulthood. Broad screening of the general population for arrhythmia syndromes is not recommended; preventative measures include screening paediatric patients for risk factors by their primary care physician. Several milestone events or activities that take place in youth could be used as opportunities to promote safety. Further work into risk stratification of this paediatric population through patient registries and greater awareness of cardiopulmonary resuscitation and automated external defibrillator use in saving lives is warranted.
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Affiliation(s)
- Sonia Franciosi
- BC Children’s Hospital Heart Centre, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dominic J. Abrams
- Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Population Genomics, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Shubhayan Sanatani
- BC Children’s Hospital Heart Centre, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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22
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Wiles BM, Li AC, Waight MC, Saba MM. Contemporary Management of Complex Ventricular Arrhythmias. Arrhythm Electrophysiol Rev 2022; 11:e04. [PMID: 35734144 PMCID: PMC9194914 DOI: 10.15420/aer.2021.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/06/2022] [Indexed: 12/02/2022] Open
Abstract
Percutaneous catheter ablation is an effective and safe therapy that can eliminate ventricular tachycardia, reducing the risks of both recurrent arrhythmia and shock therapies from a defibrillator. Successful ablation requires accurate identification of arrhythmic substrate and the effective delivery of energy to the targeted tissue. A thorough pre-procedural assessment is needed before considered 3D electroanatomical mapping can be performed. In contemporary practice, this must combine traditional electrophysiological techniques, such as activation and entrainment mapping, with more novel physiological mapping techniques for which there is an ever-increasing evidence base. Novel techniques to maximise energy delivery to the tissue must also be considered and balanced against their associated risks of complication. This review provides a comprehensive appraisal of contemporary practice and the evidence base that supports recent developments in mapping and ablation, while also considering potential future developments in the field.
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Affiliation(s)
- Benedict M Wiles
- Advanced Ventricular Arrhythmia Training and Research (AVATAR) Program, St George's University Hospitals NHS Foundation Trust, London, UK.,Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Anthony C Li
- Advanced Ventricular Arrhythmia Training and Research (AVATAR) Program, St George's University Hospitals NHS Foundation Trust, London, UK.,Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Michael C Waight
- Advanced Ventricular Arrhythmia Training and Research (AVATAR) Program, St George's University Hospitals NHS Foundation Trust, London, UK.,Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Magdi M Saba
- Advanced Ventricular Arrhythmia Training and Research (AVATAR) Program, St George's University Hospitals NHS Foundation Trust, London, UK.,Cardiology Clinical Academic Group, St George's University of London, London, UK
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23
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Bourier F, Busch S, Sommer P, Maurer T, Althoff T, Shin DI, Duncker D, Johnson V, Estner H, Rillig A, Bertagnolli L, Iden L, Deneke T, Tilz R, Metzner A, Chun J, Steven D. [Catheter ablation of ventricular tachycardias in patients with ischemic cardiomyopathy]. Herzschrittmacherther Elektrophysiol 2022; 33:88-97. [PMID: 35157112 DOI: 10.1007/s00399-022-00845-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
Radiofrequency (RF) ablation is an effective treatment option of scar-related ventricular tachycardias (VT) in patients with ischemic cardiomyopathy. Several studies proved the benefit of VT catheter ablation, which has become routine in most electrophysiology laboratories. This article provides practical instructions to perform a VT catheter ablation. The authors describe conventional and substrate-based mapping and ablation strategies as well as concepts for image integration. This article continues a series of publications created for education in advanced electrophysiology.
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Affiliation(s)
- Felix Bourier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, München, Deutschland.
| | - Sonia Busch
- Medizinische Klinik, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Tilman Maurer
- Klinik für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - Till Althoff
- Med. Klinik m.S. Kardiologie u. Angiologie, Charité - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland.,Center for Clinical Medicine Witten-Herdecke, University Faculty of Health, Wuppertal, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Livio Bertagnolli
- Abteilung für Rhythmologie, Herzzentrum HELIOS Leipzig, Leipzig, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Thomas Deneke
- Klinik für Kardiologie, Rhön-Klinikum, Campus Bad Neustadt, Bad Neustadt a. d. Saale, Deutschland
| | - Roland Tilz
- Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Julian Chun
- Cardioangiologisches Centrum Bethanien - CCB, Frankfurt, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
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24
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Thienel M, Haum M, Sadoni S, Novotny J, Estner HL, Fichtner S, Lackermair K. Impairment of Quality of Life in Patients with Implanted Subcutaneous Cardioverter Defibrillator (S-ICD) Compared to Implanted Transvenous Cardioverter Defibrillator Therapy. Patient Prefer Adherence 2022; 16:3027-3033. [PMID: 36387054 PMCID: PMC9645128 DOI: 10.2147/ppa.s378741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The subcutaneous cardioverter defibrillator (S-ICD) has been shown to be a viable alternative to transvenous ICDs (TV-ICD) in all patients at risk of sudden cardiac death (SCD) but without pacing indication. AIM The aim of this study was to examine the impact of therapy with current S-ICD devices on quality of life (QoL) in comparison to patients with TV-ICD devices. METHODS In our single-centre study, 52 consecutive patients with S-ICD and 52 matched patients with TV-ICD were analysed. QoL has been assessed by a standardized questionnaire (EQ-5D-3L, modified). Additionally, clinical baseline and follow-up data were evaluated. RESULTS Two-thirds of the total study population reported restrictions in daily routine compared to their life before ICD implantation. A total of 27.7% of S-ICD patients stated to expect an improvement of QoL by deactivation or explantation of their defibrillator compared to only 6.4% of patients with TV-ICD (p=0.006), which was mainly caused by discomfort and pain from the S-ICD pocket (relevant discomfort and pain in 32.6% vs 11.5%; p<0.01). LIMITATIONS Main limitation of the study is that quality of life was assessed for one single time point only and time since implantation differed significantly between S-ICD and TV-ICD. Furthermore our collective is younger, and, due to the high proportion of patients without cardiomyopathy, the mean EF is better than usual ICD collective. The absence of heart failure in about the half of our patients might have relevant impact on our QoL analysis. CONCLUSION A relevant proportion of S-ICD patients expects an improvement of QoL by explantation of the device. Of note, this impression was not driven by the fear of receiving shocks but mainly by discomfort and pain caused by the pulse generator.
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Affiliation(s)
- Manuela Thienel
- Department of Medicine I, Munich University Hospital, Ludwig-Maximilian-University, Munich, Germany
| | - Magda Haum
- Department of Medicine I, Munich University Hospital, Ludwig-Maximilian-University, Munich, Germany
| | - Sebastian Sadoni
- Department of Cardiac Surgery, Munich University Hospital, Ludwig-Maximilian-University, Munich, Germany
| | - Julia Novotny
- Department of Medicine I, Munich University Hospital, Ludwig-Maximilian-University, Munich, Germany
| | - Heidi L Estner
- Department of Medicine I, Munich University Hospital, Ludwig-Maximilian-University, Munich, Germany
| | - Stephanie Fichtner
- Department of Medicine I, Munich University Hospital, Ludwig-Maximilian-University, Munich, Germany
| | - Korbinian Lackermair
- Department of Medicine I, Munich University Hospital, Ludwig-Maximilian-University, Munich, Germany
- Correspondence: Korbinian Lackermair, Department of Medicine I, Munich University Hospital, Ludwig-Maximilian-University, Marchioninistr. 15, Munich, 81377, Germany, Email
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25
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Moreno A, Walton RD, Bernus O, Vigmond EJ, Bayer JD. Low-energy, single-pulse surface stimulation defibrillates large mammalian ventricles. Heart Rhythm 2021; 19:308-317. [PMID: 34648972 DOI: 10.1016/j.hrthm.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/27/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Strong electric shocks are the gold standard for ventricular defibrillation but are associated with pain and tissue damage. We hypothesized that targeting the excitable gap (EG) of reentry with low-energy surface stimulation is a less damaging and painless alternative for ventricular defibrillation. OBJECTIVE The purpose of this study was to determine the conditions under which low-energy surface stimulation defibrillates large mammalian ventricles. METHODS Low-energy surface stimulation was delivered with five electrodes that were 7 cm long and placed 1-2 cm apart on the endocardial and epicardial surfaces of perfused pig left ventricle (LV). Rapid pacing (>4 Hz) was used to induce reentry from a single electrode. A 2 ms defibrillation pulse ≤0.5 A was delivered from all electrodes with a varied time delay from the end of the induction protocol (0.1-5 seconds). Optical mapping was performed and arrhythmia dynamics analyzed. For mechanistic insight, simulations of the VF induction and defibrillation protocols were performed in silico with an LV model emulating the experimental conditions and electrodes placed 0.25-2 cm apart. RESULTS In living LV, reentry was induced with varying complexity and dominant frequencies ranging between 3.5 to 6.2 Hz over 8 seconds postinitiation. Low-energy defibrillation was achieved with energy <60 mJ and electrode separations up to 2 cm for less complex arrhythmia. In simulations, defibrillation consistently occurred when stimulation captured >75% of the EG, which blocked reentry <2.9 mm in front of the leading reentrant wavefront. CONCLUSION Defibrillation with low-energy, single-pulse surface stimulation is feasible with energies below the human pain threshold (100 mJ). Optimal defibrillation occurs when arrhythmia complexity is minimal and electrodes capture >75% of the EG.
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Affiliation(s)
- Angel Moreno
- IHU-LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, Bordeaux, France; Centre National De La Recherche Scientifique, Institut de Mathématiques de Bordeaux, UMR5251, Bordeaux, France
| | - Richard D Walton
- IHU-LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, Bordeaux, France; Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, U1045, Bordeaux, France; INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Olivier Bernus
- IHU-LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, Bordeaux, France; Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, U1045, Bordeaux, France; INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Edward J Vigmond
- IHU-LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, Bordeaux, France; Centre National De La Recherche Scientifique, Institut de Mathématiques de Bordeaux, UMR5251, Bordeaux, France
| | - Jason D Bayer
- IHU-LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, Bordeaux, France; Centre National De La Recherche Scientifique, Institut de Mathématiques de Bordeaux, UMR5251, Bordeaux, France.
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Psychological Backgrounds of Medically Compromised Patients and Its Implication in Dentistry: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168792. [PMID: 34444548 PMCID: PMC8392062 DOI: 10.3390/ijerph18168792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022]
Abstract
The number of medically compromised dental patients is increasing every year with the increase in the super-aged population. Many of these patients have underlying psychiatric problems and diseases, which need to be recognized by dental professionals for better treatment outcomes. The aim of this narrative review article is to summarize the psychological and psychiatric backgrounds of medically compromised patients who are frequently visited and taken care of by dentists using findings from recent systematic reviews and meta-analyses. Anxiety and symptoms of depression, post-traumatic stress disorders, panic disorders, poor cognitive functions, and poor quality of life were some of the common psychological backgrounds in medically compromised patients. Additionally, the consequences of these psychological problems and the considerations that need to be taken by the dentist while treating these patients have been discussed. Dental professionals should be aware of and recognize the different psychological backgrounds of medically compromised dental patients in order to provide appropriate dental treatment and to prevent oral conditions from worsening.
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Murray K, Buttigieg K, Todd M, McKechnie V. Delivering an efficient and effective support group for patients with implantable cardioverter-defibrillators (ICDs): patient perspectives of key concerns and predictors of inclination to attend. BMC Health Serv Res 2021; 21:745. [PMID: 34315446 PMCID: PMC8314849 DOI: 10.1186/s12913-021-06735-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A subset of patients experience psychological distress following insertion of an implantable cardioverter-defibrillator (ICD) and ICD support groups are recommended, however access to these groups is limited. This study aimed: to gauge a better understanding of patients' key ICD-related concerns; to determine patient interest in a support group and topics deemed helpful to address in a support group; and to examine factors which affect patient inclination to attend. METHODS One hundred and thirty nine patients completed the ICD Patient Concerns Questionnaire - Brief (ICDC-B) and a semi-structured survey. Non-parametric tests were used to examine associations and differences in the quantitative data. Qualitative data were analysed using thematic analysis. RESULTS 42% of respondents said they would attend a support group and inclination to attend was associated with higher ICD concerns and a shorter time since implant. Topics considered important to address in a group were information about heart conditions and devices, the impact of an ICD on daily life and coping with fear of shocks. CONCLUSION We concluded that there is interest in further support amongst many patients and that ICD support groups may be delivered efficiently by targeting patients who have higher levels of ICD concerns and within the first few years after implant.
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Affiliation(s)
- Kathryn Murray
- Department of Clinical Health Psychology and Neuropsychology, Imperial College Healthcare NHS Trust, London, UK. .,West London NHS Trust, London, UK.
| | - Kelly Buttigieg
- Department of Clinical Health Psychology and Neuropsychology, Imperial College Healthcare NHS Trust, London, UK.,West London NHS Trust, London, UK
| | - Michelle Todd
- Department of Cardiac Investigations, Imperial College Healthcare NHS Trust & West London NHS Trust, London, UK
| | - Vicky McKechnie
- Department of Clinical Health Psychology and Neuropsychology, Imperial College Healthcare NHS Trust, London, UK.,West London NHS Trust, London, UK
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Long-term evaluation of sensing variability of a floating atrial dipole in a single‑lead defibrillator: The mechanistic basis of long-term stability of amplified atrial electrogram. Int J Cardiol 2021; 336:67-72. [PMID: 33992702 DOI: 10.1016/j.ijcard.2021.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/25/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND A single‑lead implantable cardioverter-defibrillator (ICD) with a floating atrial dipole has been developed to enhance the diagnostic capability of atrial arrhythmias and to facilitate adjudication of arrhythmic events without the additional effort required for atrial lead insertion. However, there have been concerns about the long-term reliability of atrial sensing. METHODS We enrolled patients with the single-chamber ICD with atrial-sensing electrodes from 4 tertiary university hospitals in Korea. Minimal, maximal, and mean P wave amplitudes were collected at 3-6 months, 6-12 months, and 12-24 months after implantation. The difference between the minimal and maximal sensing amplitudes was calculated as an indicator of the variability of atrial sensing, while the atrial sensing stability was assessed using the mean amplitude. RESULTS A total of 86 patients were included for analysis. The variability of atrial sensing amplitudes significantly decreased at 12-24 months compared to 3-6 months (p = 0.01), while mean atrial amplitudes were stable throughout the mean follow-up duration of 17.4 months. Nine patients (10.5%) experienced inappropriate ICD therapy mostly due to misclassification of supraventricular tachycardia. CONCLUSIONS Under the hypothesis that sensing stability can be guaranteed as the variability decreases with time, we suggest that the concern about long-term sensing stability of a floating dipole can be abated with an ICD that has been implanted for over 2 years.
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Anzai T, Sato T, Fukumoto Y, Izumi C, Kizawa Y, Koga M, Nishimura K, Ohishi M, Sakashita A, Sakata Y, Shiga T, Takeishi Y, Yasuda S, Yamamoto K, Abe T, Akaho R, Hamatani Y, Hosoda H, Ishimori N, Kato M, Kinugasa Y, Kubozono T, Nagai T, Oishi S, Okada K, Shibata T, Suzuki A, Suzuki T, Takagi M, Takada Y, Tsuruga K, Yoshihisa A, Yumino D, Fukuda K, Kihara Y, Saito Y, Sawa Y, Tsutsui H, Kimura T. JCS/JHFS 2021 Statement on Palliative Care in Cardiovascular Diseases. Circ J 2021; 85:695-757. [PMID: 33775980 DOI: 10.1253/circj.cj-20-1127] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Takuma Sato
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takahiro Abe
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Hayato Hosoda
- Department of Cardiovascular Medicine, Chikamori Hospital
| | - Naoki Ishimori
- Department of Community Heart Failure Healthcare and Pharmacy, Hokkaido University Graduate School of Medicine
| | - Mika Kato
- Nursing Department, Hokkaido University Hospital
| | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shogo Oishi
- Department of Cardiovascular Medicine, Hyogo Brain and Heart Center
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | | | - Masahito Takagi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuko Takada
- Nursing Department, National Cerebral and Cardiovascular Center
| | | | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | | | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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Khalsa SS, Clausen AN, Shahabi L, Sorg J, Gonzalez SE, Naliboff B, Shivkumar K, Ajijola OA. Cardiac sympathetic denervation and mental health. Auton Neurosci 2021; 232:102787. [PMID: 33631539 DOI: 10.1016/j.autneu.2021.102787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bilateral cardiac sympathetic denervation (BCSD) is a surgical treatment for refractory ventricular arrhythmias. Although the procedure has shown efficacy at reducing cardiac arrhythmias, its impact on mental health is unknown. In the current study we examined associations between the BCSD procedure and mental health. METHODS 10 ventricular arrhythmia patients undergoing BCSD completed assessments of anxiety, depression, and posttraumatic stress symptoms at pre- and post-BCSD time points. Wilcoxon signed rank and Mann-Whitney U tests were used to examine differences in mental health symptoms in the pre- and post-BSCD states. Point biserial correlations were used to explore associations between BCSD response and mental health symptoms. RESULTS A significant reduction of anxiety symptoms was observed from pre- to post-BCSD. At the post-BCSD assessment, participants who successfully responded to the BCSD procedure exhibited lower anxiety symptoms compared to non-responders. However, no significant relationships were identified for depressive or PTSD symptoms. CONCLUSION The BCSD procedure is associated with reduced anxiety shortly after successful treatment for refractory ventricular arrhythmias in a small sample. Longitudinal surveillance of mental health symptoms after BCSD may be warranted to monitor the impact of this procedure on mental health.
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Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, United States of America; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States of America.
| | - Ashley N Clausen
- Department of Behavioral Health, Kansas City VA Medical Center, Kansas City, MO, United States of America; Department of Psychiatry and Behavioral Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Leila Shahabi
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Julie Sorg
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Sarah E Gonzalez
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Bruce Naliboff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Oppenheimer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Kalyanam Shivkumar
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Olujimi A Ajijola
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
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Boriani G, Vitolo M. COVID-19 pandemic: complex interactions with the arrhythmic profile and the clinical course of patients with cardiovascular disease. Eur Heart J 2021; 42:529-532. [PMID: 33351891 PMCID: PMC7799155 DOI: 10.1093/eurheartj/ehaa958] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena,Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena,Italy
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Isella C, Gasparini A, Lucca G, Ielmini M, Caselli I, Poloni N, Dajelli Ermolli C, Caravati F, Castiglioni B, De Ponti R, Callegari C. Resilience, Cardiological Outcome, and Their Correlations With Anxious-Depressive Symptoms and Quality of Life in Patients With an Implantable Cardioverter Defibrillator. Front Psychiatry 2021; 12:763726. [PMID: 34899424 PMCID: PMC8653768 DOI: 10.3389/fpsyt.2021.763726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/27/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Resilience is proven as a protective factor against the development of psychiatric disorders, and it has gained clinical relevance in the development and progression of cardiovascular pathology. The authors performed a longitudinal study on patients with implantable cardioverter defibrillator (ICD) with the primary aim to highlight the possible existence of a correlation between individual resilience capacity, depressive and anxiety symptoms, and quality of life in terms of outcomes. The secondary aim was to analyze the differences between patients with major cardiac events in the follow-up and patients without cardiac events with respect to the previous variables. Materials and Methods: A total of 80 patients enrolled in the Cardiology Unit were evaluated at T0 and during the follow-up through the following scales: the 14-item Resilience Scale (RS-14), the Hospital Anxiety and Depression Scale (HADS), and the World Health Organization Quality of Life-Brief Version (WHOQOL-Bref). Results: A significant linear correlation between resilience and all the areas of quality of life at T0, T1, and T2 emerged. A negative correlation between resilience and anxiety and depressive symptoms emerged, as well as between depression and anxiety and quality of life. Patients with cardiac events during the follow up have shown a worse quality of life and the onset of anxiety-depressive symptoms over time, without changes to the resilience scores. Patients without cardiac events showed an increasing trend in resilience scores. Discussion: Given the speed and simplicity of use of the RS-14 scale, it seems promising to further investigate the real clinical usefulness of this instrument in the cardiology field.
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Affiliation(s)
- Celeste Isella
- Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy
| | - Alessandra Gasparini
- Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy
| | - Giulia Lucca
- Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy
| | - Marta Ielmini
- Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy
| | - Ivano Caselli
- Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy
| | - Nicola Poloni
- Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy
| | - Carlo Dajelli Ermolli
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy
| | - Fabrizio Caravati
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy
| | - Battistina Castiglioni
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy
| | - Camilla Callegari
- Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy
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"Why Would I Choose Death?": A Qualitative Study of Patient Understanding of the Role and Limitations of Cardiac Devices. J Cardiovasc Nurs 2020; 34:275-282. [PMID: 30789490 DOI: 10.1097/jcn.0000000000000565] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although cardiology organizations recommend early introduction of palliative care for patients with heart failure (HF), integration has remained challenging, particularly in patients with cardiac devices such as cardiac implantable electronic devices and left ventricular assist devices. Study authors suggest that patients often have limited and erroneous understanding of these devices and their implications for future care. OBJECTIVE The aim of this study was to assess perceptions of cardiac devices in patients with HF and how these perceptions impacted advance care planning and future expectations. METHODS This study used qualitative semistructured interviews with 18 community-dwelling patients with New York Heart Association stage II to IV HF. RESULTS We interviewed 18 patients (mean ejection fraction, 38%; mean age, 64 years; 33% female; 83% white; 39% New York Heart Association class II, 39% class III, and 22% class IV). All had a cardiac implantable electronic device (6% permanent pacemaker, 56% implantable cardioverter-defibrillator, 28% biventricular implantable cardioverter-defibrillator); 11% had left ventricular assist devices. Patients with devices frequently misunderstood the impact of their device on cardiac function. A majority expressed the belief that the device would forestall further deterioration, regardless of whether this was the case. This anticipation of stability was often accompanied by the expectation that emerging technologies would continue to preempt decline. Citing this faith in technology, these patients frequently saw limited value in advance care planning. CONCLUSIONS In our sample, patients with cardiac devices overestimated the impact of their devices on preventing disease progression and death and deprioritized advance care planning as a result.
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Ingles J. Psychological Issues in Managing Families with Inherited Cardiovascular Diseases. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036558. [PMID: 31548222 DOI: 10.1101/cshperspect.a036558] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The field of cardiovascular genetic counseling has evolved dramatically in recent years largely to manage the unique psychological needs of the inherited cardiovascular disease patient population. For many, there can be difficulty in coming to terms with a diagnosis, whether it be adjusting to lifestyle recommendations such as exclusion from competitive sports or living with a small but remarkable risk of sudden cardiac death. For those considered at risk of life-threatening ventricular arrhythmias, the decision to have an implantable cardioverter defibrillator can be difficult. Living with the device, especially for those who are young and those who receive multiple shocks, can precipitate psychological distress and poor adaptation to the device. Family members who experience a sudden cardiac death of a young relative have a significant risk of poor psychological outcomes. The roles of the cardiac genetic counselor in facilitating patients' adaptation to their diagnoses and management and recognizing when additional support from a clinical psychologist is needed are key to ensuring families receive the best possible care.
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Affiliation(s)
- Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Newtown, New South Wales NSW 2042, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales NSW 2000, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales NSW 2050, Australia
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35
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Kwok IB, Mather H, McKendrick K, Gelfman L, Hutchinson MD, Lampert RJ, Lipman HI, Matlock DD, Swetz KM, Kalman J, Pinney S, Morrison RS, Goldstein NE. Evaluation of a Novel Educational Intervention to Improve Conversations About Implantable Cardioverter-Defibrillators Management in Patients with Advanced Heart Failure. J Palliat Med 2020; 23:1619-1625. [PMID: 32609036 DOI: 10.1089/jpm.2020.0022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Implantable cardioverter-defibrillators (ICDs) reduce the incidence of sudden cardiac death for high-risk patients with heart failure (HF), but shocks from these devices can also cause pain and anxiety at the end of life. Although professional society recommendations encourage proactive discussions about ICD deactivation, clinicians lack training in conducting these conversations, and they occur infrequently. Methods: As part of a six-center randomized controlled trial, we evaluated the educational component of a multicomponent intervention shown to increase conversations about ICD deactivation by clinicians who care for a subset of patients with advanced HF. This consisted of a 90-minute training workshop designed to improve the quality and frequency of conversations about ICD management. To characterize its utility as an isolated intervention, we compared HF clinicians' pre- and postworkshop scores (on a 5-point Likert scale) assessing self-reported confidence and skills in specific practices of advance care planning, ICD deactivation discussions, and empathic communication. Results: Forty intervention-group HF clinicians completed both pre- and postworkshop surveys. Preworkshop scores showed high baseline levels of confidence (4.36, standard deviation [SD] = 0.70) and skill (4.08, SD = 0.72), whereas comparisons of pre- and postworkshop scores showed nonsignificant decreases in confidence (-1.16, p = 0.252) and skill (-0.20, p = 0.843) after the training session. Conclusions: Our findings showed no significant changes in self-assessment ratings immediately after the educational intervention. However, our data did demonstrate that HF clinicians had high baseline self-perceptions of their skills in advance care planning conversations and appear to be well-primed for further professional development to improve communication in the setting of advanced HF.
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Affiliation(s)
- Ian B Kwok
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Hospital, New York, New York, USA
| | - Harriet Mather
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Karen McKendrick
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatrics Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Mathew D Hutchinson
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine Tucson, Tucson, Arizona, USA
| | - Rachel J Lampert
- Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Hannah I Lipman
- Department of Internal Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey, USA.,Center for Bioethics, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Daniel D Matlock
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado, USA
| | - Keith M Swetz
- Birmingham Veterans Affairs Medical Center, Department of Medicine and UAB Center for Palliative and Supportive Care, University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Jill Kalman
- Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Sean Pinney
- Division of Cardiology, Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - R Sean Morrison
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatrics Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Nathan E Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatrics Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
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Moore BM, Cao J, Cordina RL, McGuire MA, Celermajer DS. Defibrillators in adult congenital heart disease: Long-term risk of appropriate shocks, inappropriate shocks, and complications. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:746-753. [PMID: 32495949 DOI: 10.1111/pace.13974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/02/2020] [Accepted: 05/31/2020] [Indexed: 12/01/2022]
Abstract
AIMS Sudden cardiac death (SCD) accounts for up to 25% of deaths in the adult congenital heart disease (ACHD) population. Current guidelines for defibrillator implantation are either extrapolated from acquired cardiac disease or are based upon single lesion studies, predominantly Tetralogy of Fallot (TOF). Defibrillator-related morbidity appears to be substantially higher in ACHD patients. METHODS We retrospectively evaluated all patients in our ACHD database who received an implantable cardioverter-defibrillator (ICD) between 2000 and 2019, and who were ≥16 years old at time of implant. Patients were followed for appropriate shocks, inappropriate shocks, and complications. RESULTS Of 4748 patients in our database, 59 patients (1.2%) underwent ICD implantation. ICDs were for primary prevention in 63% and secondary prevention in 37%. Over a median follow-up of 6.6 years, 24% received an appropriate shock, 27% an inappropriate shock, and 42% suffered a device-related complication (annualized risks of 3.2%, 3.6%, and 5.7%, respectively). There were no significant predictors of appropriate shocks or inappropriate shocks. All appropriate shocks in primary prevention patients occurred in TOF or transposition of the great arteries (TGA) with atrial switch, typically in the presence of multiple SCD risk factors. The majority of inappropriate shocks were due to supraventricular arrhythmias. Device-related mortality was 1.7% (0.3% per annum). CONCLUSIONS Appropriate shocks were relatively common in an ACHD ICD population followed in the long term. Device-related morbidity was significant. Although risk factors have been established for TOF, and to a lesser extent TGA, risk stratification for ICD implantation in ACHD remains challenging.
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Affiliation(s)
- Benjamin M Moore
- Sydney Medical School, The University of Sydney, Camperdown, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Jacob Cao
- Sydney Medical School, The University of Sydney, Camperdown, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Rachael L Cordina
- Sydney Medical School, The University of Sydney, Camperdown, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Mark A McGuire
- Sydney Medical School, The University of Sydney, Camperdown, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - David S Celermajer
- Sydney Medical School, The University of Sydney, Camperdown, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia.,Heart Research Institute, Newtown, Australia
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Silva KR, Costa R, Melo GRGDO, Rebustini F, Benedetto MS, Nagumo MM, Sears SF. Validity Evidence of the Brazilian Version of the Florida Shock Anxiety Scale for Patients with Implantable Cardioverter Defibrillators. Arq Bras Cardiol 2020; 114:764-772. [PMID: 32491067 PMCID: PMC8387007 DOI: 10.36660/abc.20190255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/23/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In spite of proven effectiveness of implantable cardioverter defibrillators (ICDs), shock therapy delivered by the device may result in increased levels of anxiety and depression, leading to deleterious effects on quality of life. OBJECTIVE To carry out the translation, cross-cultural adaptation and validation of the Florida Shock Anxiety Scale (FSAS) scale into Brazilian Portuguese. METHODS In this psychometric study, construct validity was performed by exploratory (EFA) and confirmatory (CFA) factor analyses, and by item response theory (IRT). The adjustment indexes of the CFA were: Robust Mean-Scaled Chi Square/df NNFI, CFI (Comparative Fit Index), GFI (Goodness Fit Index), AGFI (Adjusted Goodness Fit Index), RMSEA (Root Mean Square Error of Approximation) and RMSR (Root Mean Square of Residuals). Reliability was evaluated through Cronbach's Alpha, McDonald's Omega and Greatest Lower Bound (GLB). The analyses were carried out with the programs SPSS 23 and Factor 10.8.01. A 5 percent significance level was used. RESULTS The final Portuguese version of the FSAS was administered to 151 ICD patients, with a mean age of 55.7 ± 14.1 years, and predominantly male. The parallel analysis indicated that the FSAS is unidimensional, with an explained variance of 64.4%. The correlations ranged from 0.31 to 0.77, factor loadings from 0.67 to 0.86, and communalities from 0.46 to 0.74. The adjustment indexes of the CFA were above the quality threshold. Satisfactory reliability evidence was provided by the FSAS. CONCLUSIONS The FSAS-Br showed consistent validity and reliability evidence. Therefore, it can be used in ICD patients in Brazil. (Arq Bras Cardiol. 2020; 114(5):764-772).
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Affiliation(s)
- Katia Regina Silva
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo,São Paulo, SP - Brasil
| | - Roberto Costa
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo,São Paulo, SP - Brasil
| | | | - Flávio Rebustini
- Universidade de São Paulo - Escola de Artes, Ciências e Humanidades, São Paulo, SP - Brasil
| | - Marcos Sidney Benedetto
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo,São Paulo, SP - Brasil
| | - Marcia Mitie Nagumo
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo,São Paulo, SP - Brasil
| | - Samuel F Sears
- East Carolina University - Department of Psychology and Cardiovascular Sciences Greenville, North Carolina - USA
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Ritzka D, Petzold C, Wäßnig N, Schmalbach B, Petrowski K. Investigation of the factorial structure and psychometrics of the German version of the Florida Shock Anxiety Scale. PSYCHOL HEALTH MED 2020; 25:344-353. [DOI: 10.1080/13548506.2019.1612077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Desiree Ritzka
- Department of Psychology and Psychotherapy, University Witten/Herdecke, Witten, Germany
- Medical Psychology and Medical Sociology, Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medicine Mainz, Mainz, Germany
| | - Christian Petzold
- Medical Clinic and Cardiology, Heart Center Dresden, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Nadine Wäßnig
- Medical Clinic and Cardiology, Heart Center Dresden, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Bjarne Schmalbach
- Medical Psychology and Medical Sociology, Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medicine Mainz, Mainz, Germany
- Department of Psychology, University of Münster, Münster, Germany
| | - Katja Petrowski
- Medical Psychology and Medical Sociology, Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medicine Mainz, Mainz, Germany
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
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39
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Habibović M, Pedersen SS, Broers ER, Alings M, Theuns DAMJ, van der Voort PH, Bouwels L, Herrman JP, Denollet J. Prevalence of anxiety and risk associated with ventricular arrhythmia in patients with an implantable cardioverter defibrillator. Int J Cardiol 2020; 310:80-85. [PMID: 32046911 DOI: 10.1016/j.ijcard.2020.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/13/2020] [Accepted: 02/02/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Anxiety has been associated with adverse clinical outcomes in patients who have received an implantable cardioverter defibrillator (ICD). However, results are inconclusive likely due to different measures being used to assess anxiety. Hence, the current study aims to examine the prevalence and the association between anxiety, ventricular tachyarrhythmia's (VTa's) and all-cause mortality, respectively. METHODS Patients who received an ICD for the first time were recruited from 6 Dutch referral hospitals as part of the WEBCARE trial. Patients filled in validated questionnaires (GAD-7, STAI-S, HADS-A, ANX4, ICDC, FSAS) to assess their baseline anxiety symptomatology. Logistic regression analysis and Cox Regression analysis were performed to examine the association between anxiety with 1) VTa's and 2) mortality, respectively. RESULTS A total of 214 Patients were included in the analysis with mean age 58.9 and 82.7% being male. The prevalence rates of anxiety varied depending on which questionnaire was used 12.4% (GAD-7), 17.5% (HADS-A), and 28.1% (STAI-S). (Cox) Regression analysis revealed that none of the anxiety measures was associated with VTa's or all-cause mortality in the current sample. Stratifying the sample by gender, the analysis showed that GAD-7, STAI-S, and ANX4 scores were associated with increased risk of VTa's but only in male patients. CONCLUSIONS Prevalence rates of anxiety varied depending on the measurement tool used. No significant association between anxiety and VTa's and all-cause mortality was observed in the total sample. GAD-7, STAI-S, and ANX4 were associated with increased risk for VTa's but only in male patients.
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Affiliation(s)
- M Habibović
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
| | - S S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - E R Broers
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - M Alings
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands
| | - D A M J Theuns
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - P H van der Voort
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - L Bouwels
- Department of Cardiology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - J-P Herrman
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - J Denollet
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
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Thomas KL, Sullivan LT, Al-Khatib SM, LaPointe NA, Sears S, Kosinski AS, Jackson LR, Kutyifa V, Peterson ED. Videos to reduce racial disparities in ICD therapy Via Innovative Designs (VIVID) trial: Rational, design and methodology. Am Heart J 2020; 220:59-67. [PMID: 31785550 DOI: 10.1016/j.ahj.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/12/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite a higher prevalence of sudden cardiac death (SCD), black individuals are less likely than whites to have an implantable cardioverter defibrillator (ICD) implanted. Racial differences in ICD utilization is in part explained by higher refusal rates in black individuals. Decision support can assist with treatment-related uncertainty and prepare patients to make well-informed decisions. METHODS The Videos to reduce racial disparities in ICD therapy Via Innovative Designs (VIVID) study will randomize 350 black individuals with a primary prevention indication for an ICD to a racially concordant/discordant video-based decision support tool or usual care. The composite primary outcome is (1) the decision for ICD placement in the combined video groups compared with usual care and (2) the decision for ICD placement in the racially concordant relative to discordant video group. Additional outcomes include knowledge of ICD therapy and SCD risk; decisional conflict; ICD receipt at 90 days; and a qualitative assessment of ICD decision making in acceptors, decliners, and those undecided. CONCLUSIONS In addition to assessing the efficacy of decision support on ICD acceptance among black individuals, VIVID will provide insight into the role of racial concordance in medical decision making. Given the similarities in the root causes of racial/ethnic disparities in care across health disciplines, our approach and findings may be generalizable to decision making in other health care settings.
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Affiliation(s)
| | | | | | | | - Sam Sears
- East Carolina University, Department of Psychology, Greenville, NC
| | | | | | - Valentina Kutyifa
- University of Rochester Medical Center, School of Medicine and Dentistry
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Krzhizhanovskaya VV, Závodszky G, Lees MH, Dongarra JJ, Sloot PMA, Brissos S, Teixeira J. Early Signs of Critical Slowing Down in Heart Surface Electrograms of Ventricular Fibrillation Victims. LECTURE NOTES IN COMPUTER SCIENCE 2020. [PMCID: PMC7303708 DOI: 10.1007/978-3-030-50423-6_25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ventricular fibrillation (VF) is a dangerous type of cardiac arrhythmia which, without intervention, almost always results in sudden death. Implantable automatic defibrillators are among the most successful devices to prevent sudden death by automatically applying a shock to the heart when fibrillation occurs. However, the electric shock is very painful and could lead to dangerous situations when a patient is, for example, driving or biking. An early warning signal for VF could reduce the risk in such situations or, in the future, reduce the need for defibrillation altogether. Here, we test for the presence of critical slowing down (CSD), which has proven to be an early warning indicator for critical transitions in a range of different systems. CSD is characterized by a buildup of autocorrelation; we therefore study the residuals of heart surface electrocardiograms (ECGs) of patients that suffered VF to investigate if we can measure positive trends in autocorrelation. We consider several methods to extract these residuals from the original signals. For three out of four VF victims, we find a significant amount of positive autocorrelation trends in the residuals, which might be explained by CSD. We show that these positive trends may not be measurable from the original body surface ECGs, but only from certain areas around the heart surface. We argue that additional experimental studies involving heart surface ECG data of subjects that did not suffer VF are required to quantify the prediction accuracy of the promising results we get from the data of VF victims.
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42
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Ventricular Tachycardia Ablation. JACC Clin Electrophysiol 2019; 5:1363-1383. [DOI: 10.1016/j.jacep.2019.09.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 11/23/2022]
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43
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Shah PJ, Kapoor A. Pseudo inappropriate shock: A technical dilemma. Ann Card Anaesth 2019; 22:435-436. [PMID: 31621682 PMCID: PMC6813713 DOI: 10.4103/aca.aca_109_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
With liberal availability of high end cardiac implantable devices in recent era, we frequently encounter patients who are recipients of implantable cardioverter defibrillators (ICDs) in our routine clinical practice. Despite improvements in shock detecting algorithms by various manufacturers, incidence of inappropriate shock therapy remains high, it is cause of distress to physicians and patients. Here we present an interesting case of inappropriate shock in one of patient.
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Affiliation(s)
- Pujan J Shah
- Department of Cardiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Aditya Kapoor
- Department of Cardiology, SGPGIMS, Lucknow, Uttar Pradesh, India
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44
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Ali-Ahmed F, Matlock D, Zeitler EP, Thomas KL, Haines DE, Al-Khatib SM. Physicians' perceptions of shared decision-making for implantable cardioverter-defibrillators: Results of a physician survey. J Cardiovasc Electrophysiol 2019; 30:2420-2426. [PMID: 31515880 DOI: 10.1111/jce.14178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/26/2019] [Accepted: 08/31/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Centers for Medicare and Medicaid Services has mandated the use of shared decision-making (SDM) for implantable cardioverter-defibrillator (ICD) implantation. SDM tools help facilitate quality SDM by presenting patients with balanced evidence-based facts related to risk and benefits. Perceptions of ICD implantation may differ based on patients' sex and race. OBJECTIVE To determine if and how physicians are incorporating SDM in counseling patients about ICD and if they are aware of sex- and race-based differences in patients' perception of ICDs. METHODS This was a pilot study involving an online survey targeting attending physicians who implant ICDs. Physicians were randomly selected by a computer-based program; 350 surveys were sent. RESULTS Of the 124 (35%) respondents to the survey, 102 (84%) met the inclusion criteria, and of those, 99 (97%) were adult electrophysiologists. Most physicians (90, 88%) stated they engaged in SDM during the general consent process. Sixty-three (62%) physicians discuss end of life issues while obtaining general consent. Forty-four (43%) physicians said they use an existing SDM tool with the Colorado SDM tool being the most common (39, 89%). The majority of physicians were unaware of sex- and race-based differences in perceptions related to ICD implantation (sex 64, 63% and race 63, 62%). CONCLUSION A vast majority of physicians are engaging in SDM; however less than half are using a formal SDM tool, and a minority of physicians were aware of sex- and race-based differences in patients' perception of ICD implantation. Sex- and race-based tools might help address this gap.
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Affiliation(s)
- Fatima Ali-Ahmed
- Duke Clinical Research Institute, Durham, North Carolina.,Division of Cardiology, Beaumont Health, Michigan
| | - Daniel Matlock
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Emily P Zeitler
- Division of Cardiology, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Dartmouth, Lebanon, New Hampshire
| | - Kevin L Thomas
- Duke Clinical Research Institute, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | | | - Sana M Al-Khatib
- Duke Clinical Research Institute, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina
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45
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Hammash M, McEvedy SM, Wright J, Cameron J, Miller J, Ski CF, Thompson DR, Biddle MJ, Wimsatt A, Schrader M, Smith RV, Chung ML, Moser DK. Perceived control and quality of life among recipients of implantable cardioverter defibrillator. Aust Crit Care 2019; 32:383-390. [DOI: 10.1016/j.aucc.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/28/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022] Open
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46
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Chang TY, Lin CY, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Chen SA. Role of catheter ablation in patients with ischemic ventricular tachycardia: From basic to clinical practice. J Chin Med Assoc 2019; 82:609-615. [PMID: 31305344 DOI: 10.1097/jcma.0000000000000137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Catheter ablation provides a therapeutic option for decreasing episodes of ventricular tachycardia in patients with coronary artery disease. Clinical studies show improvement with catheter ablation in reducing arrhythmia recurrence and therapy from implantable defibrillators, but not in decreasing mortality. Ablation can be an important tool for patients with electrical storm. Overall, complication rates of catheter ablation are acceptable, but recurrence rates are still significant. Advances in mapping and ablation technologies could be expected to improve the success rates and reduce the mortality.
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Affiliation(s)
- Ting-Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chin-Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
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Jha MK, Qamar A, Vaduganathan M, Charney DS, Murrough JW. Screening and Management of Depression in Patients With Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 73:1827-1845. [PMID: 30975301 PMCID: PMC7871437 DOI: 10.1016/j.jacc.2019.01.041] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 12/11/2022]
Abstract
Depression is a common problem in patients with cardiovascular disease (CVD) and is associated with increased mortality, excess disability, greater health care expenditures, and reduced quality of life. Depression is present in 1 of 5 patients with coronary artery disease, peripheral artery disease, and heart failure. Depression complicates the optimal management of CVD by worsening cardiovascular risk factors and decreasing adherence to healthy lifestyles and evidence-based medical therapies. As such, standardized screening pathways for depression in patients with CVD offer the potential for early identification and optimal management of depression to improve health outcomes. Unfortunately, the burden of depression in patients with CVD is under-recognized; as a result, screening and management strategies targeting depression have been poorly implemented in patients with CVD. In this review, the authors discuss a practical approach for the screening and management of depression in patients with CVD.
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Affiliation(s)
- Manish K Jha
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, and Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arman Qamar
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts. https://twitter.com/AqamarMD
| | - Muthiah Vaduganathan
- Heart & Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. https://twitter.com/mvaduganathan
| | - Dennis S Charney
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, and Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Office of the Dean, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James W Murrough
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, and Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York.
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Coutinho Cruz M, Viveiros Monteiro A, Portugal G, Laranjo S, Lousinha A, Valente B, Osório P, Silva Cunha P, de Sousa L, Oliveira JA, Agapito A, Martins Oliveira M, Pinto F, Cruz Ferreira R. Long-term follow-up of adult patients with congenital heart disease and an implantable cardioverter defibrillator. CONGENIT HEART DIS 2019; 14:525-533. [PMID: 30889316 DOI: 10.1111/chd.12767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/28/2018] [Accepted: 02/24/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sudden cardiac death is common in the adult congenital heart disease (ACHD) population. Knowledge and experience about the use of implantable cardioverter defibrillators (ICD) in ACHD patients is very limited. We aimed to characterize a cohort of patients with ACHD and ICDs. DESIGN Thirty consecutive ACHD patients submitted to an ICD implantation in a single tertiary center were evaluated. Data on baseline clinical features, heart defect, indication for ICD, type of device, appropriate therapies, ICD-related complication, and mortality during follow-up were collected. RESULTS Of the 30 patients, 56.7% received appropriate therapies due to ventricular tachycardia (VT) or ventricular fibrillation (VF). The rate of inappropriate therapies and device-related complications was 33.3%. Secondary prevention and primary prevention patients with class I indications for ICD had more appropriate therapies than complication, but this relationship was reversed for patients with class II indications. Remote monitoring played an important role in diagnosing new atrial arrhythmias before scheduled visits in 46.2% of patients, leading to a change in medication. VT/VF episodes were associated with a composite of death, cardiac transplantation, and hospital admission (OR 13.0; 95% CI: 2.1-81.5). CONCLUSION ICDs are not only useful in preventing SCD, but also have a major role in diagnosing atrial tachyarrhythmias ahead of scheduled visits. Although improvements in ICD technology might reduce complications and inappropriate therapies, adequate selection of candidates for primary prevention still remains difficult because of the lack of clear indications.
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Affiliation(s)
- Madalena Coutinho Cruz
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - André Viveiros Monteiro
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Guilherme Portugal
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Sérgio Laranjo
- Pediatric Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Lousinha
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Bruno Valente
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Paulo Osório
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Pedro Silva Cunha
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Lídia de Sousa
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - José Alberto Oliveira
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Agapito
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Mário Martins Oliveira
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Fátima Pinto
- Pediatric Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rui Cruz Ferreira
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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49
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Ayan M, Habash F, Alqam B, Gheith Z, Cross M, Vallurupalli S, Paydak H. A comparison of anti-arrhythmic efficacy of carvedilol vs metoprolol succinate in patients with implantable cardioverter-defibrillators. Clin Cardiol 2019; 42:299-304. [PMID: 30592068 PMCID: PMC6712318 DOI: 10.1002/clc.23144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/16/2018] [Accepted: 12/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effects of carvedilol and metoprolol succinate on appropriate and inappropriate implantable cardioverter defibrillator (ICD) therapy in patients with heart failure with reduced ejection fraction (HFrEF) are not fully understood. HYPOTHESIS The hypothesis of our study is possible carvedilol superiority over metoprolol in patients with ICD. METHODS All patients with ICD registered to a single device clinic between 1/2012 and 6/2017 (n = 569) were identified. Patients with systolic heart failure (left ventricular ejection fraction ≤40%) treated with carvedilol vs metoprolol succinate were compared. Primary endpoint was difference in survival free of appropriate device therapy (shock or anti‐tachycardia pacing, ATP). Secondary endpoints were freedom from inappropriate therapy (shock or ATP) and all cause death. RESULTS A total of 225 patients were included in the analysis with median follow up of 57 months (IQR 33.7‐90). The 2 groups were comparable in the baseline characteristics. Carvedilol was superior to metoprolol succinate in improving survival free of appropriate ICD therapy (HR 0.42; 95% CI 0.24‐0.72, P = 0.01). This difference was driven by reduction in survival free of appropriate shocks (HR 0.30; 95% CI 0.15‐0.63, P = −0.01) while there was no significant difference in appropriate ATP (HR 0.55; 95% CI 0.28‐1.1, P = 0.12). There was no significant difference in time to inappropriate shocks (HR 1.02; 95% CI 0.19‐5.6, P = 0.97), inappropriate ATP (HR 0.93, OR 0.24‐3.5, p value 0.9) or all cause death (HR 0.8; 95% CI 0.42‐1.5, P = 0.52). CONCLUSIONS This study suggests that carvedilol use was associated with improved survival free of appropriate ICD therapy compared to metoprolol succinate in patients with HFrEF.
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Affiliation(s)
- Mohamed Ayan
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Fuad Habash
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Bilal Alqam
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Zaid Gheith
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Michael Cross
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Srikanth Vallurupalli
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Hakan Paydak
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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50
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Strachan PH, Carroll SL, de Laat S, Schwartz L, Arthur HM. Patients’ Perspectives on End-Of-Life Issues and Implantable Cardioverter Defibrillators. J Palliat Care 2018. [DOI: 10.1177/082585971102700103] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increasing numbers of cardiovascular patients are receiving implantable cardioverter defibrillators (ICDs) for primary prevention of sudden cardiac death (SCD). This report examines patients’ perspectives on related end-of-life issues. Using a grounded theory approach, audiotaped, semi-structured interviews were undertaken with 30 participants from two ICD referral centres in southwestern Ontario (24 who accepted an ICD and 6 who declined). Interview transcripts, verification with interviewees, researcher memos, published literature, and participant demographics were analyzed using NVivo7. Most participants were male, had comorbidities and an ejection fraction of less than 30 percent, and ranged in age from 26 to 87. Consensus was reached by three research team members on three main themes: quality versus quantity of life, preferred mode of death, and the technical realities of the ICD. The ICD was considered in relation to both quantity and quality of life. Most participants focused on the prevention of SCD, not the implications of the ICD for death by any other cause. Participants advocated for incorporating the ICD into advance care planning. Our findings have implications for the development of advance care plans and education of health professionals.
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Affiliation(s)
- Patricia H. Strachan
- PH Strachan (corresponding author): McMaster University, School of Nursing, HSC 2J20D, 1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5
| | | | - Sonya de Laat
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Schwartz
- School of Nursing, McMaster University, Hamilton, Ontario, Canada, and Heart and Stroke Foundation of Ontario, Ottawa, Ontario, Canada
| | - Heather M. Arthur
- School of Nursing, McMaster University, Hamilton, Ontario, Canada, and Heart and Stroke Foundation of Ontario, Ottawa, Ontario, Canada
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