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Magisetty R, Park SM. New Era of Electroceuticals: Clinically Driven Smart Implantable Electronic Devices Moving towards Precision Therapy. MICROMACHINES 2022; 13:161. [PMID: 35208286 PMCID: PMC8876842 DOI: 10.3390/mi13020161] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022]
Abstract
In the name of electroceuticals, bioelectronic devices have transformed and become essential for dealing with all physiological responses. This significant advancement is attributable to its interdisciplinary nature from engineering and sciences and also the progress in micro and nanotechnologies. Undoubtedly, in the future, bioelectronics would lead in such a way that diagnosing and treating patients' diseases is more efficient. In this context, we have reviewed the current advancement of implantable medical electronics (electroceuticals) with their immense potential advantages. Specifically, the article discusses pacemakers, neural stimulation, artificial retinae, and vagus nerve stimulation, their micro/nanoscale features, and material aspects as value addition. Over the past years, most researchers have only focused on the electroceuticals metamorphically transforming from a concept to a device stage to positively impact the therapeutic outcomes. Herein, the article discusses the smart implants' development challenges and opportunities, electromagnetic field effects, and their potential consequences, which will be useful for developing a reliable and qualified smart electroceutical implant for targeted clinical use. Finally, this review article highlights the importance of wirelessly supplying the necessary power and wirelessly triggering functional electronic circuits with ultra-low power consumption and multi-functional advantages such as monitoring and treating the disease in real-time.
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Affiliation(s)
- RaviPrakash Magisetty
- Department of Convergence IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Korea;
| | - Sung-Min Park
- Department of Convergence IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Korea;
- Department of Electrical Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Korea
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Korea
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Shao Y, Cheng Y, Shah RU, Weir CR, Bray BE, Zeng-Treitler Q. Shedding Light on the Black Box: Explaining Deep Neural Network Prediction of Clinical Outcomes. J Med Syst 2021; 45:5. [PMID: 33404886 PMCID: PMC7983057 DOI: 10.1007/s10916-020-01701-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 12/16/2020] [Indexed: 12/27/2022]
Abstract
Deep neural network models are emerging as an important method in healthcare delivery, following the recent success in other domains such as image recognition. Due to the multiple non-linear inner transformations, deep neural networks are viewed by many as black boxes. For practical use, deep learning models require explanations that are intuitive to clinicians. In this study, we developed a deep neural network model to predict outcomes following major cardiovascular procedures, using temporal image representation of past medical history as input. We created a novel explanation for the prediction of the model by defining impact scores that associate clinical observations with the outcome. For comparison, a logistic regression model was fitted to the same dataset. We compared the impact scores and log odds ratios by calculating three types of correlations, which provided a partial validation of the impact scores. The deep neural network model achieved an area under the receiver operating characteristics curve (AUC) of 0.787, compared to 0.746 for the logistic regression model. Moderate correlations were found between the impact scores and the log odds ratios. Impact scores generated by the explanation algorithm has the potential to shed light on the "black box" deep neural network model and could facilitate its adoption by clinicians.
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Affiliation(s)
- Yijun Shao
- Biomedical Informatics Center, George Washington University, Washington, DC, USA.
- Washington DC VA Medical Center, Washington, DC, USA.
| | - Yan Cheng
- Biomedical Informatics Center, George Washington University, Washington, DC, USA
- Washington DC VA Medical Center, Washington, DC, USA
| | - Rashmee U Shah
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Bruce E Bray
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Qing Zeng-Treitler
- Biomedical Informatics Center, George Washington University, Washington, DC, USA
- Washington DC VA Medical Center, Washington, DC, USA
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Bhatia M, Safavi-Naeini P, Razavi M, Collard CD, Tolpin DA, Anton JM. Anesthetic Management of Laser Lead Extraction for Cardiovascular Implantable Electronic Devices. Semin Cardiothorac Vasc Anesth 2017; 21:302-311. [DOI: 10.1177/1089253217728581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiovascular implantable electronic devices (CIEDs) play a significant role in the modern management of cardiovascular disease. CIEDs include implantable pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices. These devices improve the quality of life of their recipients and help reduce the incidence of sudden cardiac death. Traditionally, CIEDs have been reliant on the use of transvenous endocardial leads to directly connect with the heart. Over time, these endovascular leads may become endothelialized rendering removal extremely difficult. As the indications for CIEDs expands and with the continuing evolution of these devices, the number of patients requiring explantation for device recall, malfunction, and infection continues to increase. In this manuscript, we review the most common CIEDs, the indications and process of lead removal/device explantation, potential complications associated with the procedure and the anesthetic management of these patients.
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Affiliation(s)
- Meena Bhatia
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Pereira FTM, Rocha EA, Monteiro MDPM, Lima NDA, Rodrigues Sobrinho CRM, Pires Neto RDJ. Clinical Course After Cardioverter-Defibrillator Implantation: Chagasic Versus Ischemic Patients. Arq Bras Cardiol 2016; 107:99-100. [PMID: 27411097 PMCID: PMC5074062 DOI: 10.5935/abc.20160101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 03/07/2016] [Indexed: 11/20/2022] Open
Abstract
Background: The outcome of Chagas disease patients after receiving implantable
cardioverter defibrillator (ICD) is still controversial. Objective: To compare clinical outcomes after ICD implantation in patients with chronic
Chagas cardiomyopathy (CCC) and ischemic heart disease (IHD). Methods: Prospective study of a population of 153 patients receiving ICD (65 with CCC
and 88 with IHD). The devices were implanted between 2003 and 2011. Survival
rates and event-free survival were compared. Results: The groups were similar regarding sex, functional class and ejection
fraction. Ischemic patients were, on average, 10 years older than CCC
patients (p < 0.05). Patients with CCC had lower schooling and monthly
income than IHD patients (p < 0.05). The number of appropriate therapies
was 2.07 higher in CCC patients, who had a greater incidence of appropriate
shock (p < 0.05). Annual mortality rate and electrical storm incidence
were similar in both groups. There was no sudden death in CCC patients, and
only one in IHD patients. Neither survival time (p = 0.720) nor event-free
survival (p = 0.143) significantly differed between the groups. Conclusion: CCC doubles the risk of receiving appropriate therapies as compared to IHD,
showing the greater complexity of arrhythmias in Chagas patients.
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Affiliation(s)
| | - Eduardo Arrais Rocha
- Setor de Cardiologia, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | | | - Neiberg de Alcantara Lima
- Setor de Cardiologia, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, CE, Brazil
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Pacemakers and implantable cardioverter defibrillators, unknown to chest radiography: Review, complications and systematic reading. Eur J Radiol 2015; 84:499-508. [DOI: 10.1016/j.ejrad.2014.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/03/2014] [Accepted: 12/06/2014] [Indexed: 11/21/2022]
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Ranolazine preserves and improves left ventricular ejection fraction and autonomic measures when added to guideline-driven therapy in chronic heart failure. Heart Int 2014; 9:66-73. [PMID: 27004101 PMCID: PMC4774941 DOI: 10.5301/heartint.5000219] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2014] [Indexed: 11/20/2022] Open
Abstract
Background Ranolazine (RAN) reduces cardiac sodium channel 1.5’s late sodium current in congestive heart failure (CHF), reducing myocardial calcium overload, potentially improving left ventricular (LV) function. RAN blocks neuronal sodium channel 1.7, potentially altering parasympathetic and sympathetic (P&S) activity. The effects of RAN on LV ejection fraction (LVEF) and P&S function in CHF were studied. Methods Matched CHF patients were given open-label RAN (1000 mg po-bid) added to guideline-driven therapy (RANCHF, 41 systolic, 13 diastolic) or no adjuvant therapy (control, NORANCHF, 43 systolic, 12 diastolic). Echocardiographic LVEF and P&S measures were obtained at baseline and follow-up (mean 23.7 months). Results LVEF increased in 70% of RANCHF patients, an average of 11.3 units. Mean LVEF remained unchanged in NORANCHF patients. P&S measures indicated cardiovascular autonomic neuropathy (P≤0.1 bpm2) in 20% of NORANCHF patients at baseline and in 29% at follow-up (increasing in both groups). At baseline, 28% of patients had high sympathovagal balance (SB), RAN normalized SB over 50% of these; in contrast, the NORANCHF group had a 20% increase in patients with high SB. Conclusions RAN preserves or improves LVEF and decreases high SB in CHF.
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Trohman RG. Temporary left ventricular resynchronization therapy in cardiogenic shock: A new pacing paradigm to fight an old foe? Heart Rhythm 2013; 10:53-4. [DOI: 10.1016/j.hrthm.2012.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Indexed: 10/27/2022]
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Abstract
OBJECTIVE The purpose of this article is to review the normal and abnormal radiographic appearances of cardiac pacemaker and implantable cardioverter defibrillator systems. CONCLUSION Chest radiographs showing pacemakers and implantable cardioverter defibrillators contain identifying and clinically relevant information, such as MRI compatibility and possible malfunction. Accurate and timely reporting of these features provides important information that can improve patient care.
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Matlock DD, Peterson PN, Wang Y, Curtis JP, Reynolds MR, Varosy PD, Masoudi FA. Variation in use of dual-chamber implantable cardioverter-defibrillators: results from the national cardiovascular data registry. ACTA ACUST UNITED AC 2012; 172:634-41; discussion 641. [PMID: 22529229 DOI: 10.1001/archinternmed.2012.394] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Among patients without an indication for a pacemaker, current evidence is inconclusive whether a dual-chamber implantable cardioverter-defibrillator (ICD) is superior to a single-chamber ICD. The current use of dual-chamber ICDs is not well characterized. METHODS We conducted a cross-sectional study exploring hospital-level variation in the use of dual-chamber ICDs across the United States. Patients receiving a primary prevention ICD from 2006 through 2009 without a documented indication for a pacemaker were included. Multivariate hierarchical logistic regression was used to explore patient, health care provider, and physician factors related to the use of a dual-chamber device. RESULTS Dual-chamber devices were implanted in 58% of the 87,115 patients without a pacing indication among 1293 hospitals, with hospital rates ranging from 0% in 33 centers to 100% in 109 centers. In multivariate analysis, geographic region was a strong independent predictor of dual-chamber device use, ranging from 36.4% in New England (reference region) to 66.4% in the Pacific region (odds ratio [OR], 5.25; 95% CI, 3.35-8.21). Hospital clustering was assessed using a median OR which was 3.96, meaning that 2 identical patients at different hospitals would have nearly a 4-fold difference in their chance of receiving a dual-chamber ICD. CONCLUSIONS Use of dual-chamber ICDs for the primary prevention of sudden cardiac death among patients without an indication for permanent pacing varies markedly at the hospital level in the United States. This is a clear example of how practice can vary independent of patient factors.
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Affiliation(s)
- Dan D Matlock
- Department of Medicine, University of Colorado Denver School of Medicine, Aurora, 80045, USA.
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MEHRA MANDEEPR, ALBERT NANCYM, CURTIS ANNEB, GHEORGHIADE MIHAI, HEYWOOD JTHOMAS, LIU YANG, O’CONNOR CHRISTOPHERM, REYNOLDS DWIGHT, WALSH MARYNORINE, YANCY CLYDEW, FONAROW GREGGC. Factors Associated with Improvement in Guideline-Based Use of ICDs in Eligible Heart Failure Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:135-45. [DOI: 10.1111/j.1540-8159.2011.03279.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Indications for implantable cardioverter-defibrillator placement in ischemic cardiomyopathy and after myocardial infarction. Curr Heart Fail Rep 2011; 8:252-9. [PMID: 21769565 DOI: 10.1007/s11897-011-0069-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Dramatic reductions in the rate of sudden cardiac death due to use of implantable cardioverter-defibrillators (ICDs) have been well-established in several large randomized clinical trials including patients with left ventricular dysfunction after myocardial infarction. This article reviews the literature regarding ICD utilization in the postinfarction population, with a strong emphasis on recent clinical trials. The most current indications for, and timing of, ICD implantation postinfarction also are summarized.
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12
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Ma H, Tang Q, Yang Q, Bi X, Li H, Ge L, Lin K, Xu D, Du X, Lu J, An J, Jin L, Jerecic R, Li K, Li D. Contrast-enhanced whole-heart coronary MRA at 3.0T for the evaluation of cardiac venous anatomy. Int J Cardiovasc Imaging 2010; 27:1003-9. [PMID: 21120611 PMCID: PMC3182318 DOI: 10.1007/s10554-010-9757-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 11/19/2010] [Indexed: 11/03/2022]
Abstract
This study was designed to evaluate the value of contrast-enhanced whole-heart coronary MRA (CMRA) at 3.0T in depicting the cardiac venous anatomy. In cardiac resynchronization therapy (CRT), left ventricular (LV) pacing is achieved by positioning the LV lead in one of the tributaries of the coronary sinus (CS). Pre-implantation knowledge of the venous anatomy may help determine whether transvenous LV lead placement for CRT is feasible. Images of 51 subjects undergoing contrast-enhanced whole-heart CMRA at 3.0T were retrospectively analyzed. Data acquisition was performed using electrocardiography-triggered, navigator-gated, inversion-recovery prepared, segmented gradient-echo sequence. A 32-element cardiac coil was used for data acquisition. The visibility of the cardiac veins was graded visually using a 4-point scale (1: poor–4: excellent). The paired Student t test was used to evaluate differences in diameters of the ostium of the CS in anteroposterior and superoinferior direction. The cardiac veins were finally evaluated in 48 subjects with three anatomic variations. The diameter of the CS ostium in the superoinferior direction (1.13 ± 0.26 cm) was larger than in the anteroposterior direction (0.82 ± 0.19 cm) (P < 0.05). The mean visibility score of CS, posterior interventricular vein, posterior vein of the left ventricle, left marginal vein, and anterior interventricular vein was 4.0 ± 0.0, 3.4 ± 0.5, 3.4 ± 0.5, 3.0 ± 0.8, and 3.3 ± 0.5, respectively. In conclusion, contrast-enhanced whole-heart CMRA at 3.0T can depict the normal and variant cardiac venous anatomy.
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Affiliation(s)
- Heng Ma
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45, Chang-Chun Street, 100053 Xuanwu District, Beijing, China
| | - Qing Tang
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45, Chang-Chun Street, 100053 Xuanwu District, Beijing, China
| | - Xiaoming Bi
- Cardiovascular MR R&D, Siemens Healthcare, Chicago, IL USA
| | - Han Li
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lan Ge
- Department of Radiology, Northwestern University, Suite 1600, 737 N. Michigan Ave., Chicago, IL 60611 USA
| | - Kai Lin
- Department of Radiology, Northwestern University, Suite 1600, 737 N. Michigan Ave., Chicago, IL 60611 USA
| | - Dong Xu
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiangying Du
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45, Chang-Chun Street, 100053 Xuanwu District, Beijing, China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45, Chang-Chun Street, 100053 Xuanwu District, Beijing, China
| | - Jing An
- Siemens Healthcare, MR Collaboration NE Asia, Siemens Mindit Magnetic Resonance, Shenzhen, China
| | - Lixin Jin
- Siemens Healthcare, MR Collaboration NE Asia, Siemens Limited China, Shanghai, China
| | - Renate Jerecic
- Siemens Healthcare, MR Collaboration NE Asia, Siemens Limited China, Shanghai, China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45, Chang-Chun Street, 100053 Xuanwu District, Beijing, China
| | - Debiao Li
- Department of Radiology, Northwestern University, Suite 1600, 737 N. Michigan Ave., Chicago, IL 60611 USA
- Cedars-Sinai Medical Center and UCLA, Los Angeles, CA USA
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Affiliation(s)
- Daniel B. Kramer
- From the CardioVascular Institute, Beth Israel Deaconess Medical Center; and Harvard Medical School, Boston, Mass
| | - Mark E. Josephson
- From the CardioVascular Institute, Beth Israel Deaconess Medical Center; and Harvard Medical School, Boston, Mass
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Heywood JT, Fonarow GC, Yancy CW, Albert NM, Curtis AB, Gheorghiade M, Inge PJ, McBride ML, Mehra MR, O'Connor CM, Reynolds D, Walsh MN. Comparison of medical therapy dosing in outpatients cared for in cardiology practices with heart failure and reduced ejection fraction with and without device therapy: report from IMPROVE HF. Circ Heart Fail 2010; 3:596-605. [PMID: 20634483 DOI: 10.1161/circheartfailure.109.912683] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few data exist to characterize the delivery of evidence-based medical therapy for outpatients with heart failure who have received implantable cardioverter-defibrillators or cardiac resynchronization therapy (CRT) for systolic dysfunction. METHODS AND RESULTS IMPROVE HF is a prospective study characterizing the management of 15 381 outpatients with systolic heart failure (left ventricular ejection fraction ≤35%) enrolled from 167 US cardiology practices. Data were abstracted for dose, type, and daily frequency for angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and aldosterone antagonists. Target doses for each medication class were based on current guidelines. Patients with devices (implantable cardioverter-defibrillators, CRT with defibrillators, or CRT with pacemakers) more frequently received evidence-based medical therapy than did those without such devices, although treatment at or above target doses was low for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (implantable cardioverter-defibrillators 32.6%, CRT with pacemaker 30.7%, CRT with defibrillator 32.0%, no device 34.6%) and β-blockers (20.2%, 17.4%, 20.4%, and 15.3%, respectively). Fewer patients received aldosterone antagonists, although when used, doses were more frequently within the target dosing range (70.1%, 72.1%, 72.7%, and 76.5%, respectively). Multivariable models showed that use of CRT with defibrillators and CRT with pacemakers was significantly associated with delivery of β-blockers at or above target doses, but no device therapies were associated with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or aldosterone antagonist dosing. CONCLUSIONS Patients treated with heart failure devices received evidence-based medical therapy at similar or greater frequency than did those without such devices. Patients with CRT with defibrillator or CRT with pacemaker devices were more likely to be treated with target doses of β-blockers than were patients not treated with device therapy. Doses of evidenced-based therapies remain significantly lower in clinical practice than in clinical trials. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00303979.
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Affiliation(s)
- J Thomas Heywood
- Division of Cardiology, Scripps Clinic Torrey Pines, La Jolla, Calif 92037, USA.
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Knackstedt C, Schimpf T, Napp A, Wessling B, Rothe C, Mischke K, Schnakenberg U, Schauerte P. Super-selective electrical stimulation of the left ventricle via a miniaturized magnetized stimulation wire: proof of concept study. BIOMED ENG-BIOMED TE 2010; 55:285-90. [DOI: 10.1515/bmt.2010.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mehra MR, Yancy CW, Albert NM, Curtis AB, Stough WG, Gheorghiade M, Heywood JT, McBride ML, O'Connor CM, Reynolds D, Walsh MN, Fonarow GC. Evidence of clinical practice heterogeneity in the use of implantable cardioverter-defibrillators in heart failure and post–myocardial infarction left ventricular dysfunction: Findings from IMPROVE HF. Heart Rhythm 2009; 6:1727-34. [DOI: 10.1016/j.hrthm.2009.08.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 08/17/2009] [Indexed: 12/01/2022]
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The Heart Failure Clinic: A Consensus Statement of the Heart Failure Society of America. J Card Fail 2008; 14:801-15. [DOI: 10.1016/j.cardfail.2008.10.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 10/03/2008] [Accepted: 10/06/2008] [Indexed: 12/31/2022]
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Imaging of the coronary venous system in patients with congestive heart failure: comparison of 16 slice MSCT and retrograde coronary sinus venography. Int J Cardiovasc Imaging 2008; 24:783-91. [DOI: 10.1007/s10554-008-9333-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 06/16/2008] [Indexed: 11/25/2022]
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Knackstedt C, Mühlenbruch G, Mischke K, Bruners P, Schimpf T, Frechen D, Schummers G, Mahnken AH, Günther RW, Kelm M, Schauerte P. Imaging of the Coronary Venous System: Validation of Three-Dimensional Rotational Venous Angiography Against Dual-Source Computed Tomography. Cardiovasc Intervent Radiol 2008; 31:1150-8. [DOI: 10.1007/s00270-008-9352-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 04/02/2008] [Accepted: 04/10/2008] [Indexed: 11/29/2022]
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Frankenstein L, Zugck C, Nelles M, Schellberg D, Remppis A, Katus H. Primary ICD-therapy in patients with advanced heart failure: selection strategies and future trials. Clin Res Cardiol 2008; 97:594-600. [PMID: 18347765 DOI: 10.1007/s00392-008-0656-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 02/19/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND For allocation of primary ICD-therapy, a possible lower limit of inclusion criteria--defining overly advanced heart failure--is less well investigated. Also, a multi-variable approach to stratification beyond ejection fraction (LVEF) appears warranted. We examined whether adding a selection limit of peak VO(2) <or= 14 ml/kg/min to LVEF <or= 20% improves stratification. Furthermore, we sought to provide current survival data and a size-estimate for prospective trials based on real-life data for this high risk cohort. METHODS In our prospective clinical registry 1,926 patients with systolic CHF were recruited consecutively since 1994. Of these patients, 292 met the selection criteria described above. The mean age was 57.6 +/- 9.5 years, 83% were male, 37% had ischemic cardiomyopathy and 28% received primary ICD-therapy. All cause mortality was considered as end point. RESULTS Median follow-up was 45 (18-86) months. ICD was not a significant predictor of outcome either for the entire population, or grouped according to aetiology of CHF. Still, 3-year mortality was 15% (ICD-patients) Vs. 28% (non-ICD-patients); P = 0.05; under combination medical therapy. Inversely, in ICD-patients medical combination therapy conveyed a significant survival benefit (P < 0.001). Consequently, the number-needed-to-treat was eight under combination therapy and the size estimate amounts to 300 patients for a prospective trial in this cohort. CONCLUSION A cut-off of LVEF <or= 20% and pVO(2) <or= 14 ml/kg/min could identify patients that do not draw a significant survival benefit from adjunct primary ICD-therapy. Our results indicate the need for a specific randomized trial in this cohort. The according mortality data and a size estimate are provided.
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Affiliation(s)
- Lutz Frankenstein
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.
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Cesario DA, Turner JW, Dec GW. Biventricular pacing and defibrillator use in chronic heart failure. Cardiol Clin 2008; 25:595-603; vii. [PMID: 18063163 DOI: 10.1016/j.ccl.2007.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Since the 1970s when the implantable cardioverter defibrillator (ICD) was developed, multiple clinical trials have documented survival benefits in certain high-risk subsets of heart failure patients. Over the past decade, cardiac resynchronization therapy (CRT) emerged as an important therapy in carefully selected patients with ongoing symptoms despite optimized pharmacological therapy. ICDs should be considered first-line therapy for survivors of life-threatening ventricular arrhythmic events. Subsets of patients with both ischemic and nonischemic dilated cardiomyopathy appear to have a survival benefit from primary ICD therapy. CRT has resulted in substantial symptomatic improvement and survival benefits in a subgroup of chronic heart failure patients. CRT should be considered in heart failure patients undergoing ICD implantation who have evidence of ventricular dyssynchrony.
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Affiliation(s)
- David A Cesario
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Hemminger EJ, Girsky MJ, Budoff MJ. Applications of computed tomography in clinical cardiac electrophysiology. J Cardiovasc Comput Tomogr 2007; 1:131-42. [DOI: 10.1016/j.jcct.2007.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Revised: 08/09/2007] [Accepted: 09/12/2007] [Indexed: 11/25/2022]
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23
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Mischke K, Knackstedt C, Mühlenbruch G, Schimpf T, Neef P, Zarse M, Plisiene J, Stanzel S, Eickholt C, Fache K, Frechen D, Spüntrup E, Hanrath P, Kelm M, Schauerte P. Imaging of the coronary venous system: Retrograde coronary sinus angiography versus venous phase coronary angiograms. Int J Cardiol 2007; 119:339-43. [PMID: 17064793 DOI: 10.1016/j.ijcard.2006.07.148] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Accepted: 07/29/2006] [Indexed: 12/14/2022]
Abstract
BACKGROUND Left ventricular lead implantation for cardiac resynchronization therapy (CRT) usually requires a pre- or intraprocedural occlusion contrast venography of the coronary sinus (CS) in order to identify tributaries to the lateral wall. As many patients undergo a preprocedural coronary angiogram, we investigated the diagnostic accuracy of venous phase imaging of the CS in patients prior to CRT implantation. The aim of this study was to assess the quality of venous phase coronary sinus angiography. METHODS In 24 CRT patients retrograde occlusion venography and venous phase coronary sinus angiography obtained during coronary angiography were compared with respect to image quality, vessel diameters and the ability to identify a coronary sinus side branch suitable for left ventricular lead placement. RESULTS Suitable target vessels for left ventricular lead implantation were identified in all patients irrespective of the method (retrograde occlusion venography or venous phase coronary sinus angiography). There was a high concordance in vessel diameters between venous phase and retrograde angiography. Visibility was superior in retrograde venography. CONCLUSIONS In heart failure patients who are scheduled for coronary angiograms venous phase coronary sinus angiography is a time-saving and easy to perform alternative imaging modality. Radiation exposure and the amount of contrast medium needed is reduced as compared to coronary sinus occlusion angiography. The information obtained thereby may be used to plan subsequent CRT implantation without the need for retrograde coronary sinus angiography.
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Affiliation(s)
- Karl Mischke
- Department of Cardiology, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
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24
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Abstract
The past 25 years have seen the implantable cardioverter defibrillator emerge as the treatment of choice for ventricular arrhythmias with reduction in size but increased therapeutic options. Understanding the complex mechanisms of ventricular arrhythmias and defibrillation in normal and diseased hearts has been the focus of many research teams including that of John Uther at the Westmead Hospital Department of Cardiology. Marked improvements in capacitor and battery technologies, arrhythmia discrimination, pacing algorithms, shock waveforms and monitoring capabilities enable wider use and patient acceptance. Emergence of cardiac resynchronisation therapy and the implantable defibrillator for treatment of chronic heart failure is not only giving quality of life and extended survival for heart failure patients but has also cast new light on the evolution of heart failure.
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Affiliation(s)
- Loraine K Holley
- Department of Medical and Molecular Biosciences, University of Technology, Sydney, PO Box 123, Broadway, NSW 2007, Australia.
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25
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Arora R, Frisch DR, Kadish AH. The Role of Implantable Cardioverter-Defibrillators in Primary and Secondary Prevention of Sudden Cardiac Death. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50027-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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26
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Affiliation(s)
- M W H Behan
- Cardiothoracic Department at Guy's and St Thomas' NHS Trust, London SE1 7EH
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27
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Gheorghiade M, Sopko G, De Luca L, Velazquez EJ, Parker JD, Binkley PF, Sadowski Z, Golba KS, Prior DL, Rouleau JL, Bonow RO. Navigating the crossroads of coronary artery disease and heart failure. Circulation 2006; 114:1202-13. [PMID: 16966596 DOI: 10.1161/circulationaha.106.623199] [Citation(s) in RCA: 264] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
MESH Headings
- Cardiac Output, Low/epidemiology
- Cardiac Output, Low/etiology
- Cardiac Output, Low/physiopathology
- Cardiac Output, Low/therapy
- Coronary Artery Disease/complications
- Coronary Artery Disease/epidemiology
- Coronary Artery Disease/physiopathology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/pathology
- Death, Sudden, Cardiac/prevention & control
- Electrophysiology
- Humans
- Incidence
- Myocardial Ischemia/etiology
- Myocardial Ischemia/physiopathology
- Myocardial Ischemia/prevention & control
- Myocardial Ischemia/therapy
- Prognosis
- Systole/physiology
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Affiliation(s)
- Mihai Gheorghiade
- Northwestern University Feinberg School of Medicine, Galter 10-240, 201 E Huron St, Chicago, IL 60611, USA
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28
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29
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Swedberg K, Cleland J, Dargie H, Drexler H, Follath F, Komajda M, Smiseth O, Tavazzi L. The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology: Guidelines for the Diagnosis and Treatment of Chronic Heart Failure: reply. Eur Heart J 2005. [DOI: 10.1093/eurheartj/ehi551] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Karl Swedberg
- Department of Medicine
Sahlgrenska University Hospital/Östra
Goteborg SE 416 85
Sweden
Tel: +46 31 3434000
Fax: +46 31 258933
E-mail address:
| | - John Cleland
- Academic Cardiology Unit
University of Hull—Castle Hill Hospital
Castle Road
Kingston upon Hull
East Yorkshire HU16 5JQ
UK
| | - Henry Dargie
- Cardiac Research
Level 4 Western Infirmary
Dumbarton Road
Glasgow G11 6NT
Scotland
UK
| | - Helmut Drexler
- Abt. Kardiologie u. Angiologie
Zentrum Innere Medizin
Med. Hochschule Hannover (MHH)
Carl-Neubergstrasse 1
DE-30625 Hannover
Germany
| | - Ferenc Follath
- Department of Internal Medicine
University Hospital
Ramistrasse 100
CH-8091 Zurich
Switzerland
| | - Michel Komajda
- Département de Cardiologie
CHU Pitié-Salpêtrière
47, blvd de l'Hôpital
75651 Paris
France
| | - Otto Smiseth
- Department of Cardiology
Rikshospitalet, University Hospital
Pilestredet 32
NO-0027 Oslo
Norway
| | - Luigi Tavazzi
- Divisione di Cardiologia
Policlinico San Matteo, IRCCS
Piazzale Golgi 2
IT-27100 Pavia
Italy
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