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Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:2324-2405. [PMID: 38727647 DOI: 10.1016/j.jacc.2024.02.014] [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] [Indexed: 05/20/2024]
Abstract
AIM The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy. METHODS A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.
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Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1239-e1311. [PMID: 38718139 DOI: 10.1161/cir.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
AIM The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy. METHODS A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Victor A Ferrari
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
- SCMR representative
| | | | - Sadiya S Khan
- ACC/AHA Joint Committee on Performance Measures representative
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Lampert R, Chung EH, Ackerman MJ, Arroyo AR, Darden D, Deo R, Dolan J, Etheridge SP, Gray BR, Harmon KG, James CA, Kim JH, Krahn AD, La Gerche A, Link MS, MacIntyre C, Mont L, Salerno JC, Shah MJ. 2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play. Heart Rhythm 2024:S1547-5271(24)02560-8. [PMID: 38763377 DOI: 10.1016/j.hrthm.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
Youth and adult participation in sports continues to increase, and athletes may be diagnosed with potentially arrhythmogenic cardiac conditions. This international multidisciplinary document is intended to guide electrophysiologists, sports cardiologists, and associated health care team members in the diagnosis, treatment, and management of arrhythmic conditions in the athlete with the goal of facilitating return to sport and avoiding the harm caused by restriction. Expert, disease-specific risk assessment in the context of athlete symptoms and diagnoses is emphasized throughout the document. After appropriate risk assessment, management of arrhythmias geared toward return to play when possible is addressed. Other topics include shared decision-making and emergency action planning. The goal of this document is to provide evidence-based recommendations impacting all areas in the care of athletes with arrhythmic conditions. Areas in need of further study are also discussed.
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Affiliation(s)
- Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut
| | - Eugene H Chung
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Rajat Deo
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joe Dolan
- Yale University School of Medicine, New Haven, Connecticut
| | | | - Belinda R Gray
- University of Sydney, Camperdown, New South Wales, Australia
| | | | | | | | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jack C Salerno
- University of Washington School of Medicine, Seattle, Washington
| | - Maully J Shah
- Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
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Peng G, Zei PC. Diagnosis and Management of Paroxysmal Supraventricular Tachycardia. JAMA 2024; 331:601-610. [PMID: 38497695 DOI: 10.1001/jama.2024.0076] [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: 03/19/2024]
Abstract
Importance Paroxysmal supraventricular tachycardia (PSVT), defined as tachyarrhythmias that originate from or conduct through the atria or atrioventricular node with abrupt onset, affects 168 to 332 per 100 000 individuals. Untreated PSVT is associated with adverse outcomes including high symptom burden and tachycardia-mediated cardiomyopathy. Observations Approximately 50% of patients with PSVT are aged 45 to 64 years and 67.5% are female. Most common symptoms include palpitations (86%), chest discomfort (47%), and dyspnea (38%). Patients may rarely develop tachycardia-mediated cardiomyopathy (1%) due to PSVT. Diagnosis is made on electrocardiogram during an arrhythmic event or using ambulatory monitoring. First-line acute therapy for hemodynamically stable patients includes vagal maneuvers such as the modified Valsalva maneuver (43% effective) and intravenous adenosine (91% effective). Emergent cardioversion is recommended for patients who are hemodynamically unstable. Catheter ablation is safe, highly effective, and recommended as first-line therapy to prevent recurrence of PSVT. Meta-analysis of observational studies shows single catheter ablation procedure success rates of 94.3% to 98.5%. Evidence is limited for the effectiveness of long-term pharmacotherapy to prevent PSVT. Nonetheless, guidelines recommend therapies including calcium channel blockers, β-blockers, and antiarrhythmic agents as management options. Conclusion and Relevance Paroxysmal SVT affects both adult and pediatric populations and is generally a benign condition. Catheter ablation is the most effective therapy to prevent recurrent PSVT. Pharmacotherapy is an important component of acute and long-term management of PSVT.
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Affiliation(s)
- Gary Peng
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul C Zei
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Margolis G, Hamuda N, Kobo O, Elbaz Greener G, Amir O, Homoud M, Madias C, Heist EK, Ruskin JN, Kazatsker M, Roguin A, Leshem E, Rozen G. Single- Versus Dual-Chamber Implantable Cardioverter-Defibrillator for Primary Prevention of Sudden Cardiac Death in the United States. J Am Heart Assoc 2023; 12:e029126. [PMID: 37522389 PMCID: PMC10492963 DOI: 10.1161/jaha.122.029126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/27/2023] [Indexed: 08/01/2023]
Abstract
Background Routine addition of an atrial lead during an implantable cardioverter-defibrillator (ICD) implantation for primary prevention of sudden cardiac death, in patients without pacing indications, was not shown beneficial in contemporary studies. We aimed to investigate the use and safety of single- versus dual-chamber ICD implantations in these patients. Methods and Results Using the National Inpatient Sample database, we identified patients with no pacing indications who underwent primary-prevention ICD implantation in the United States between 2015 and 2019. Sociodemographic and clinical characteristics, as well as in-hospital complications, were analyzed. Multivariable logistic regression was used to identify predictors of in-hospital complications. An estimated total of 15 940 patients, underwent ICD implantation for primary prevention of sudden cardiac death during the study period, 8860 (55.6%) received a dual-chamber ICD. The mean age was 64 years, and 66% were men. In-hospital complication rates in the dual-chamber ICD and single-chamber ICD group were 12.8% and 10.7%, respectively (P<0.001), driven by increased rates of pneumothorax/hemothorax (4.6% versus 3.4%; P<0.001) and lead dislodgement (3.6% versus 2.3%; P<0.001) in the dual-chamber ICD group. Multivariable analyses confirmed atrial lead addition as an independent predictor for "any complications" (odds ratio [OR], 1.1 [95% CI, 1.0-1.2]), for pneumo/hemothorax (odds ratio, 1.1 [95% CI, 1.0-1.4]), and for lead dislodgement (odds ratio, 1.3 [95% CI, 1.1-1.6]). Conclusions Despite lack of evidence for clinical benefit, dual-chamber ICDs are implanted for primary prevention of sudden cardiac death in a majority of patients who do not have pacing indication. This practice is associated with increased risk of periprocedural complications. Avoidance of routine implantation of atrial leads will likely improve safety outcomes.
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Affiliation(s)
- Gilad Margolis
- Division of Cardiovascular Medicine, Hillel Yaffe Medical CenterThe Ruth and Bruce Rappaport Faculty of MedicineTechnionHaifaIsrael
| | - Nashed Hamuda
- Division of Cardiovascular Medicine, Hillel Yaffe Medical CenterThe Ruth and Bruce Rappaport Faculty of MedicineTechnionHaifaIsrael
| | - Ofer Kobo
- Division of Cardiovascular Medicine, Hillel Yaffe Medical CenterThe Ruth and Bruce Rappaport Faculty of MedicineTechnionHaifaIsrael
| | - Gabby Elbaz Greener
- Department of Cardiology, Hadassah Medical CenterJerusalemIsrael
- Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
| | - Offer Amir
- Department of Cardiology, Hadassah Medical CenterJerusalemIsrael
- Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
| | - Munther Homoud
- Cardiovascular Center, Tufts Medical CenterTufts University School of MedicineBostonMAUSA
| | - Christopher Madias
- Cardiovascular Center, Tufts Medical CenterTufts University School of MedicineBostonMAUSA
| | - Edwin Kevin Heist
- Cardiac Arrhythmia Center, Massachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Jeremy N. Ruskin
- Cardiac Arrhythmia Center, Massachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Mark Kazatsker
- Division of Cardiovascular Medicine, Hillel Yaffe Medical CenterThe Ruth and Bruce Rappaport Faculty of MedicineTechnionHaifaIsrael
| | - Ariel Roguin
- Division of Cardiovascular Medicine, Hillel Yaffe Medical CenterThe Ruth and Bruce Rappaport Faculty of MedicineTechnionHaifaIsrael
| | - Eran Leshem
- Division of Cardiovascular Medicine, Hillel Yaffe Medical CenterThe Ruth and Bruce Rappaport Faculty of MedicineTechnionHaifaIsrael
| | - Guy Rozen
- Cardiovascular Center, Tufts Medical CenterTufts University School of MedicineBostonMAUSA
- Cardiac Arrhythmia Center, Massachusetts General HospitalHarvard Medical SchoolBostonMAUSA
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Patel D, Rao A, Friedman PA, Deshmukh AJ, Lande J, Murphy JA, Brown ML, Lexcen DR, Wilkoff BL. New atrial arrhythmia occurrence in single chamber implantable cardioverter defibrillator patients: A real-world investigation. J Cardiovasc Electrophysiol 2023; 34:438-444. [PMID: 36579406 PMCID: PMC10108104 DOI: 10.1111/jce.15790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION A current limitation of single chamber implantable cardioverter defibrillators (ICDs) is the lack of an atrial lead to reliably detect atrial fibrillation (AF) episodes. A novel ventricular based atrial fibrillation (VBAF) detection algorithm was created for single chamber ICDs to assess R-R variability for detection of AF. METHODS Patients implanted with Visia AF™ ICDs were prospectively enrolled in the Medtronic Product Surveillance Registry from December 15, 2015 to January 23, 2019 and followed with at least 30 days of monitoring with the algorithm. Time to device-detected daily burden of AF ≥ 6 min, ≥6 h, and ≥23 h were reported. Clinical actions after device-detected AF were recorded. RESULTS A total of 291 patients were enrolled with a mean follow-up of 22.5 ± 7.9 months. Of these, 212 (73%) had no prior history of AF at device implant. However, 38% of these individuals had AF detected with the VBAF algorithm with daily burden of ≥6 min within two years of implant. In these 80 patients with newly detected AF by their ICD, 23 (29%) had a confirmed clinical diagnosis of AF by their provider. Of patients with a clinical diagnosis of AF, nine (39%) were newly placed on anticoagulation, including five of five (100%) patients having a burden >23 h. CONCLUSIONS Continuous AF monitoring with the new VBAF algorithm permits early identification and actionable treatment for patients with undiagnosed AF that may improve patient outcomes.
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Affiliation(s)
- Divyang Patel
- Division of Cardiology, Sentara Heart Hospital, Norfolk, Virginia, USA
| | - Archana Rao
- Institute of Cardiovascular Medicine and Science at Liverpool Heart and Chest Hospital Liverpool, Liverpool, UK
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeff Lande
- Medtronic Inc, Mounds View, Minnesota, USA
| | | | | | | | - Bruce L Wilkoff
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute Cleveland Clinic, Cleveland, Ohio, USA
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Gwag HB, Kim HR, Park SJ, Kim J, Chung TW, Choi JH, Kim JY, Park KM, On YK, Kim JS. The efficacy of single-lead implantable cardioverter-defibrillator with atrial sensing dipole to detect atrial fibrillation and to reduce inappropriate therapy according to atrial sensing ON or OFF: Rationale and design of the SMART-CONTROL study, a prospective multicenter randomized trial. Am Heart J 2022; 251:25-31. [PMID: 35568193 DOI: 10.1016/j.ahj.2022.05.008] [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] [Received: 10/07/2021] [Revised: 04/30/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Few studies have compared the efficacy of single-lead implantable cardioverter-defibrillator (ICD) with atrial sensing dipole (VDD-ICD) and conventional single-chamber ICD from the aspect of atrial fibrillation (AF) detection or inappropriate ICD therapy reduction. In the SMART-CONTROL trial (NCT03932604), we primarily aim to investigate whether the atrial sensing capability of VDD-ICD is useful in AF detection and inappropriate therapy reduction by randomly activating or deactivating the atrial sensing function. METHODS AND DESIGN This study was designed as a prospective, multicenter, open-label, randomized trial to enroll 640 patients with no history of clinical AF or rhythm control for AF within 1 year who were undergoing the implantation of VDD-ICD system. Patients are assigned randomly to atrial sensing "ON" or "OFF" group, with crossover allowed during follow-up. The coprimary outcomes are the incidence of AF detection and inappropriate ICD therapy over a 2-year follow-up period. The secondary outcomes include non-AF atrial tachyarrhythmia, ventricular tachyarrhythmia with or without ICD therapy, thromboembolic events, bleeding, heart failure hospitalization, mortality, a composite of adverse cardiovascular events, and long-term atrial sensing stability or variability. CONCLUSION We expect that this trial can evaluate the efficacy of a single-lead ICD system on various clinical outcomes including AF detection and inappropriate therapy reduction, and ultimately provide guidance to selection of ICD system.
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Affiliation(s)
- Hye Bin Gwag
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Hye Ree Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Juwon Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Wan Chung
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Hoon Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ju Youn Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - June Soo Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Pung X, Hong DZ, Ho TY, Shen X, Tan PT, Yeo C, Tan VH. The utilization of atrial sensing dipole in single lead implantable cardioverter defibrillator for detection of new‐onset atrial high‐rate episodes or subclinical atrial fibrillation: A systematic review and meta‐analysis. J Arrhythm 2022; 38:177-186. [PMID: 35387136 PMCID: PMC8977580 DOI: 10.1002/joa3.12675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/14/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Xuanming Pung
- Department of Cardiology Changi General Hospital Singapore City Singapore
| | - Daniel Zhihao Hong
- Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Tzyy Yeou Ho
- Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Xiayan Shen
- Department of Cardiology Changi General Hospital Singapore City Singapore
| | - Pei Ting Tan
- Health Services Research Changi General Hospital Singapore City Singapore
| | - Colin Yeo
- Department of Cardiology Changi General Hospital Singapore City Singapore
| | - Vern Hsen Tan
- Department of Cardiology Changi General Hospital Singapore City Singapore
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Francia P, Olivotto I, Lambiase PD, Autore C. Implantable cardioverter-defibrillators for hypertrophic cardiomyopathy: The Times They Are a-Changin'. Europace 2021; 24:1384-1394. [PMID: 34966939 DOI: 10.1093/europace/euab309] [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: 09/18/2021] [Accepted: 12/01/2021] [Indexed: 11/14/2022] Open
Abstract
The implantable cardioverter-defibrillator (ICD) is a life-saving therapy in patients with hypertrophic cardiomyopathy (HCM) at high risk of sudden cardiac death. The heterogeneity of clinical scenarios in HCM and the availability of ICDs with distinct characteristics emphasizes the need for selecting the right device for the right patient. There is growing awareness that unnecessarily complex devices can lead to short- and long-term complications without adding significant clinical benefits. Young patients have the greatest potential years of life gained from the ICD but are also most exposed to device-related complications. This increases the complexity of decision-making of ICD prescription in these often otherwise well patients in whom device selection should be tailored to preserve survival benefit without introducing morbidity. In the light of the multiple clinical phenotypes characterizing HCM, the present article offers evidence-based perspectives helpful in predicting the individual impact of the ICD and choosing the most appropriate device.
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Affiliation(s)
- Pietro Francia
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital. Dept of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Pier D Lambiase
- Institute of Cardiovascular Science, UCL Department of Cardiology, Barts Heart Centre, London, UK
| | - Camillo Autore
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
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Nicholls M. Keeping pace with one of Israel's leading cardiologists. Eur Heart J 2021; 43:360-361. [PMID: 34423372 DOI: 10.1093/eurheartj/ehab361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P, O'Gara PT, Beckman JA, Levine GN, Al-Khatib SM, Armbruster A, Birtcher KK, Ciggaroa J, Dixon DL, de Las Fuentes L, Deswal A, Fleisher LA, Gentile F, Goldberger ZD, Gorenek B, Haynes N, Hernandez AF, Hlatky MA, Joglar JA, Jones WS, Marine JE, Mark D, Palaniappan L, Piano MR, Tamis-Holland J, Wijeysundera DN, Woo YJ. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e23-e106. [PMID: 33926766 DOI: 10.1016/j.jtcvs.2021.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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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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13
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Ahmed I, Merchant FM, Curtis JP, Parzynski CS, Lampert R. Impact of insurance status on ICD implantation practice patterns: Insights from the NCDR ICD registry. Am Heart J 2021; 235:44-53. [PMID: 33503408 DOI: 10.1016/j.ahj.2021.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Whether insurance status influences practice patterns in implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) defibrillators, when indicated, is not known. METHODS AND RESULTS We analyzed the NCDR ICD Registry to evaluate associations of insurance status with guidelines-based receipt of CRT, as well as device-type, complication rates, and use of optimal medical therapy defined by guidelines. Among 798,028 patients with de novo ICD implants, we included only patients < 65 years (those older have Medicare) and excluded those admitted before 2006 (n=1,835) or with insurance coverage other than Medicare, Medicaid or private insurance (n=25,695) leaving 286,556 for analysis. Inverse probability of treatment weighting was used to control for imbalances between groups. Mean age was 53 years, 29% were female. Patients with private insurance and Medicare were more likely to receive CRT-D when indicated (79.6%, OR 1.19 95% CI 1.09-1.28, P <.001 and 78.5%, OR 1.11 95% CI 1.01-1.21 P = .03, respectively) compared to the uninsured (76.7%). The uninsured were also more likely than other groups to receive a single-chamber device. Complication rates did not differ. Uninsured patients were, however, more likely to receive optimal medical therapy, particularly in the subgroup receiving the implant for primary prevention. CONCLUSIONS In propensity-weighted analysis, uninsured patients are less likely to receive CRT when indicated but more likely to be receiving optimal medical therapy at discharge. Reasons for differences in device implantation practices based on insurance status require further study.
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2020; 76:3022-3055. [PMID: 33229115 DOI: 10.1016/j.jacc.2020.08.044] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM This executive summary of the hypertrophic cardiomyopathy clinical practice guideline provides recommendations and algorithms for clinicians to diagnose and manage hypertrophic cardiomyopathy in adult and pediatric patients as well as supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from January 1, 2010, to April 30, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. STRUCTURE Many recommendations from the earlier hypertrophic cardiomyopathy guidelines have been updated with new evidence or a better understanding of earlier evidence. This summary operationalizes the recommendations from the full guideline and presents a combination of diagnostic work-up, genetic and family screening, risk stratification approaches, lifestyle modifications, surgical and catheter interventions, and medications that constitute components of guideline directed medical therapy. For both guideline-directed medical therapy and other recommended drug treatment regimens, the reader is advised to follow dosing, contraindications and drug-drug interactions based on product insert materials.
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15
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2020; 142:e533-e557. [PMID: 33215938 DOI: 10.1161/cir.0000000000000938] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aim This executive summary of the hypertrophic cardiomyopathy clinical practice guideline provides recommendations and algorithms for clinicians to diagnose and manage hypertrophic cardiomyopathy in adult and pediatric patients as well as supporting documentation to encourage their use. Methods A comprehensive literature search was conducted from January 1, 2010, to April 30, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Structure Many recommendations from the earlier hypertrophic cardiomyopathy guidelines have been updated with new evidence or a better understanding of earlier evidence. This summary operationalizes the recommendations from the full guideline and presents a combination of diagnostic work-up, genetic and family screening, risk stratification approaches, lifestyle modifications, surgical and catheter interventions, and medications that constitute components of guideline directed medical therapy. For both guideline-directed medical therapy and other recommended drug treatment regimens, the reader is advised to follow dosing, contraindications and drug-drug interactions based on product insert materials.
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Affiliation(s)
| | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
- HFSA Representative
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16
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2020; 76:e159-e240. [PMID: 33229116 DOI: 10.1016/j.jacc.2020.08.045] [Citation(s) in RCA: 352] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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17
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Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy. Circulation 2020; 142:e558-e631. [DOI: 10.1161/cir.0000000000000937] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
- HFSA Representative
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18
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Ahsan S, Tousoulis D, Papageorgiou N. Implantable cardioverter-defibrillators: The shock "Paradox". Hellenic J Cardiol 2020; 61:428-429. [PMID: 33321183 DOI: 10.1016/j.hjc.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Syed Ahsan
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Dimitris Tousoulis
- 1(st) Cardiology Department, Athens University Medical School, Hipporkation Hospital, Athens, Greece
| | - Nikolaos Papageorgiou
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
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19
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Burger AL, Schmidinger H, Ristl R, Pezawas T. Appropriate and inappropriate therapy in patients with single- or multi-chamber implantable cardioverter-defibrillators. Hellenic J Cardiol 2020; 61:421-427. [DOI: 10.1016/j.hjc.2020.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/28/2020] [Accepted: 03/14/2020] [Indexed: 11/28/2022] Open
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20
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Over- and undersensing-pitfalls of arrhythmia detection with implantable devices and wearables. Herzschrittmacherther Elektrophysiol 2020; 31:273-287. [PMID: 32767089 PMCID: PMC7412442 DOI: 10.1007/s00399-020-00710-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 01/30/2023]
Abstract
Cardiac implantable electronic devices (CIEDs) are a cornerstone of arrhythmia and heart failure detection as well as management. In recent years new kinds of devices have emerged which can be used subcutaneously or worn on the skin. In particular for large-scale arrhythmia monitoring, small, unobtrusive gadgets seem positioned to upend paradigms and care delivery. However, the performance of CIEDs and wearables is only as good as their sensing and detection capacities. Whether for pacing, defibrillation or diagnostic monitoring, the device must be able to process and filter the sensed signal to reduce noise and to exclude irrelevant physiological signals. The demands on sensing and detection quality will differ depending on how the information is applied. With a pacemaker or implantable cardioverter/defibrillator, withheld or erroneous therapy can have severe consequences and accurate and reliable detection of cardiac function is crucial. Monitoring devices are usually used in risk assessment and management, with greater tolerance for isolated artefacts or lower quality of readings. This review discusses sensing and detection and the performance to date by CIEDs as well as subcutaneous and wearable devices.
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21
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Barbhaiya CR, Niazi O, Bostrom J, Patil S, Jankelson L, Bernstein S, Park D, Holmes D, Aizer A, Chinitz LA. Early ICD lead failure in defibrillator systems with multiple leads via cephalic access. J Cardiovasc Electrophysiol 2020; 31:1462-1469. [DOI: 10.1111/jce.14523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Chirag R. Barbhaiya
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Osama Niazi
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Jack Bostrom
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Sachi Patil
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - David Park
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Larry A. Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
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22
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Watanabe A, Fujimura O. Repeated misclassifications of tachycardia by an implantable cardiac defibrillator. Indian Pacing Electrophysiol J 2020; 20:35-38. [PMID: 31843557 PMCID: PMC6994405 DOI: 10.1016/j.ipej.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 12/01/2022] Open
Abstract
This case describes repeated misclassifications of SVT due to AV node reentry as VT by an ICD. This case illustrates the limitations of SVT-VT discrimination algorithm. Careful analysis of the stored tracings is of critical importance to reach the correct diagnosis.
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Affiliation(s)
- Atsuyuki Watanabe
- Department of Cardiovascular Medicine, Okayama University, Okayama, Japan; UCLA Cardiac Arrhythmia Center, Los Angeles, CA, USA.
| | - Osamu Fujimura
- Department of Cardiovascular Medicine, Okayama University, Okayama, Japan; UCLA Cardiac Arrhythmia Center, Los Angeles, CA, USA
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23
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The efficacy of the Linox Smart DX ICD lead from a single center experience. Indian Pacing Electrophysiol J 2019; 20:137-140. [PMID: 31862483 PMCID: PMC7384368 DOI: 10.1016/j.ipej.2019.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/15/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose The Biotronik LinoxSmart DX implanted cardioverter defibrillator (ICD) lead is a novel VDD lead with the advantage of integrated atrial sensing dipole combined with a special augmentation and filtering mechanisms. We sought to determine the efficacy of the Biotronik LinoxSmart DX ICD lead. Methods Non-randomized consecutive patients implanted with Biotronik LinoxSmart DX lead at Sheba Medical Center were included in this study. Electrical parameters and arrhythmic events were recorded during follow up of one year. Results Seventy-three patients (69 males (94.5%), mean age 61 ± 12 years) were included. All patients were successfully implanted with a Biotronic VR-T DX device and LinoxSmart DX ICD lead (DX-17 in 37% and DX-15 in 63% patients). Mean P wave amplitude at time of implantation was 3.66 ± 2.9 mV and improved significantly throughout the follow-up (5.29 ± 4.39 mV, p = 0.009). Appropriate atrial sensing (defined as P wave amplitude of ≥0.8 mV) rate of 100% at implantation significantly decreased to 89% (p = 0.015) at 12 months. Three out of 67 (4.5%) patients without a known history of atrial fibrillation had documented new onset paroxysmal atrial fibrillation. Appropriate shocks occurred in 4 (5.5%) patients. One patient with atrial sensing less than 0.4 mV had inappropriate shock. Conclusions Among patients implanted with the Biotronik LinoxSmart DX ICD lead in our single center, appropriate atrial sensing rate decreased over 12 months. Larger studies are needed to evaluate the reliability of long term appropriate atrial sensing.
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24
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Thomas G, Choi DY, Doppalapudi H, Richards M, Iwai S, Daoud EG, Houmsse M, Kanagasundram AN, Mainigi SK, Lubitz SA, Cheung JW. Subclinical atrial fibrillation detection with a floating atrial sensing dipole in single lead implantable cardioverter-defibrillator systems: Results of the SENSE trial. J Cardiovasc Electrophysiol 2019; 30:1994-2001. [PMID: 31328298 PMCID: PMC6852241 DOI: 10.1111/jce.14081] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/07/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Subclinical atrial fibrillation (AF), in the form of cardiac implantable device-detected atrial high rate episodes (AHREs), has been associated with increased thromboembolism. An implantable cardioverter-defibrillator (ICD) lead with a floating atrial dipole may permit a single lead (DX) ICD system to detect AHREs. We sought to assess the utility of the DX ICD system for subclinical AF detection in patients, with a prospective multicenter, cohort-controlled trial. METHODS AND RESULTS One hundred fifty patients without prior history of AF (age 59 ± 13 years; 108 [72%] male) were enrolled into the DX cohort and implanted with a Biotronik DX ICD system at eight centers. Age-, sex-, and left ventricular ejection fraction-matched single- and dual-chamber ICD cohorts were derived from a Cornell database and from the IMPACT trial, respectively. The primary endpoint were AHRE detection at 12 months. During median 12 months follow-up, AHREs were detected in 19 (13%) patients in the DX, 8 (5.3%) in the single-chamber, and 19 (13%) in the dual-chamber cohorts. The rate of AHRE detection was significantly higher in the DX cohort compared to the single-chamber cohort (P = .026), but not significantly different compared to the dual-chamber cohort. There were no inappropriate ICD therapies in the DX cohort. At 12 months, only 3.0% of patients in the DX cohort had sensed atrial amplitudes less than 1.0 mV. CONCLUSION Use of a DX ICD lead allows subclinical AF detection with a single lead DX system that is superior to that of a conventional single-chamber ICD system.
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Affiliation(s)
- George Thomas
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Daniel Y Choi
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Harish Doppalapudi
- Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Sei Iwai
- Division of Cardiology, Westchester Medical Center, Valhalla, New York
| | - Emile G Daoud
- Division of Cardiovascular Medicine, The Ohio State University Medical Center, Columbus, Ohio
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, The Ohio State University Medical Center, Columbus, Ohio
| | | | - Sumeet K Mainigi
- Department of Cardiology and Electrophysiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Steven A Lubitz
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jim W Cheung
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
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25
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Safak E, Eckardt L, Jung W, Ince H, Senges J, Hochadel M, Perings C, Spitzer S, Brachmann J, Seidl K, Hink HU, D'Ancona G. Determinants of inappropriate implantable cardioverter-defibrillator shocks: the German Device Registry perspective. J Interv Card Electrophysiol 2019; 56:71-77. [PMID: 31375974 DOI: 10.1007/s10840-019-00600-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/16/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the present study, we have focused upon rates and clinical determinants of inappropriate shock (IS) after implantable cardioverter-defibrillator (ICD). METHODS Data were collected prospectively in the German Device II Registry. RESULTS A total of 783 patients were included. Three sub-groups were identified: non-shock (NS) included 725 patients (92.6%), IS 24 (3.1%), and appropriate shock (AS) 34 (4.3%). IS patients were younger (AS 68 (58-77); IS 59 (51-68); NS 66 (56-75) years; p = 0.03), had been mainly referred for primary prophylaxis (AS 42.4%; IS 70.8%; NS 67.3%; p = 0.01), had a higher resting heart rate (AS 70 (63-80); IS 80 (71-98); NS 70 (60-81) BPM; p = 0.003), had more often atrial fibrillation (AF) (AS 14.7%; IS 45.8%; NS 18.8%; p = 0.006), and shorter QRS duration (AS 100 (90-120); IS 95 (90-100); NS 120 (98-150) msec.; p = 0.001). VVI-ICD was more common in IS (AS 64.7%; IS 83.3%; NS 49.8%; p = 0.002). At a follow-up of 18.2 months (75% IQR 13.6-22.4), no deaths were observed in the IS group, one (2.9%) in the AS, and 36 (4.9%) in the NS (p = 0.9). At logistic regression, VVI-ICD implantation was the strongest IS independent determinant (OR 5.0; 95% CI 1.6-15.9; p = 0.004) together with age < 70 years (OR 4.6; CI 1.4-14.7; p = 0.009), AF at time of ICD implantation (OR 3.5; CI 1.3-9.1; p = 0.01), and resting heart rate > 70/min (OR 2.8; CI 1.0-7.3; p = 0.03). CONCLUSION In a contemporary setting, some specific conditions such as VVI-ICD, younger age, and faster resting heart rates remain important IS determinants after ICD implantation.
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Affiliation(s)
- Erdal Safak
- Vivantes Klinikum Am Urban, Diffenbach strasse, Berlin, Germany.,Rostock University Medical Center, Rostock, Germany
| | - Lars Eckardt
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Münster, Germany
| | - Werner Jung
- Klinik für Innere Medizin III Kardiologie, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
| | - Hüseyin Ince
- Vivantes Klinikum Am Urban, Diffenbach strasse, Berlin, Germany.,Rostock University Medical Center, Rostock, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | | | - Stefan Spitzer
- Praxisklinik Herz und Gefäße Dresden and Institute of Medical Technology, Brandenburg University of Technology Cottbus, Cottbus, Germany
| | | | | | | | - Giuseppe D'Ancona
- Vivantes Klinikum Am Urban, Diffenbach strasse, Berlin, Germany. .,Rostock University Medical Center, Rostock, Germany.
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26
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Zeitler EP, Sanders GD, Singh K, Greenfield RA, Gillis AM, Wilkoff BL, Piccini JP, Al-Khatib SM. Single vs. dual chamber implantable cardioverter-defibrillators or programming of implantable cardioverter-defibrillators in patients without a bradycardia pacing indication: systematic review and meta-analysis. Europace 2019; 20:1621-1629. [PMID: 30137296 DOI: 10.1093/europace/euy183] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/23/2018] [Indexed: 11/13/2022] Open
Abstract
Aims Implantable cardioverter-defibrillators (ICDs) are key in the prevention of sudden cardiac death, but outcomes may vary by type of device or programming [single chamber (SC) vs. dual chamber (DC)] in patients without a bradycardia pacing indication. We sought to meta-analyse patient outcomes of randomized trials of SC vs. DC devices or programming. Methods and results We searched PubMed, Embase, Scopus, Web of Science, and Cochrane trials databases for relevant studies excluding those published before 2000, involving children, or not available in English. Endpoints included mortality, inappropriate ICD therapies, and implant complications. Endpoints with at least three reporting studies were meta-analysed. We identified eight studies meeting inclusion criteria representing 2087 patients with 16.1 months mean follow-up. Mean age was 62.7 years (SD 1.92); in six studies reporting sex, most patients were male (85%). Comparing patients with a SC or DC ICD or programming, we found similar rates of mortality [odds ratio (OR) 0.95, 95% confidence interval (CI) 0.54-1.68; P = 0.86] and inappropriate therapies (OR 1.46, 95% CI 0.97-2.19; P = 0.07) in five and six studies, respectively. In three studies of SC vs. DC ICDs (but not programming) rates of pneumothorax and lead dislodgement were not different (OR 2.12, 95% CI 0.18-24.72; P = 0.55 and OR 0.87, 95% CI 0.32-2.47; P = 0.83, respectively). Conclusion In this meta-analysis of randomized controlled trials comparing SC vs. DC ICD device or programming, there was no significant difference in inappropriate therapies, mortality, pneumothorax, or lead dislodgement. Future studies should compare these devices over longer follow-up and in specific patient populations.
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Affiliation(s)
- Emily P Zeitler
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | | | - Kavisha Singh
- Department of Medicine, University of Texas Southwestern, Dallas, TX, USA
| | | | - Anne M Gillis
- Department of Medicine, Libin Cardiovascular Institute, University of Calgary, Alberta, CA, USA
| | - Bruce L Wilkoff
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Jonathan P Piccini
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Sana M Al-Khatib
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
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27
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Fleeman BE, Aleong RG. Optimal Strategies to Reduce Inappropriate Implantable Cardioverter-defibrillator Shocks. J Innov Card Rhythm Manag 2019; 10:3623-3632. [PMID: 32477727 PMCID: PMC7252710 DOI: 10.19102/icrm.2019.100403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/31/2018] [Indexed: 11/10/2022] Open
Abstract
Since the widespread implementation of implantable cardioverter-defibrillators (ICDs), their effectiveness in various situations has become well-established. However, despite many advances in both the technology and its utilization, inappropriate therapy remains a risk. Here, we review ICD shocks, their effect on outcomes, and current methods to reduce inappropriate therapy, finding overall that inappropriate ICD shocks are common and associated with adverse outcomes. However, strategies do exist to minimize inappropriate shock rates including device selection and programming, medication, catheter ablation, and remote monitoring. Overall, ICDs are useful in reducing the risk of sudden cardiac death, but many patients with an ICD will receive an inappropriate shock. Understanding strategies to prevent inappropriate shocks is crucial to improving the care of patients with ICDs.
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28
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Aguiar Rosa S, Silva Cunha P, Lousinha A, Valente B, Delgado AS, Pimenta R, Brás M, Coutinho Cruz M, Portugal G, Viveiros Monteiro A, Oliveira M, Cruz Ferreira R. Importance of monitoring zones in the detection of arrhythmias in patients with implantable cardioverter-defibrillators under remote monitoring. Rev Port Cardiol 2019; 38:11-16. [PMID: 30686652 DOI: 10.1016/j.repc.2018.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/18/2018] [Accepted: 05/13/2018] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Implantable cardioverter-defibrillator (ICD) monitoring zones (MZ) provide passive features that do not interfere with the functioning of active treatment zones. However, it is not known for certain whether programming an MZ affects arrhythmia detection by the ICD. The aim of the present study is to assess the clinical relevance of MZ in a population of patients with ICDs. METHODS In this retrospective analysis of patients with ICDs, with or without cardiac resynchronization therapy, for primary prevention under remote monitoring, the MZ was analyzed and recorded arrhythmias were assessed in detail. RESULTS A total of 221 patients were studied (77% men; age 64±12 years). Mean ejection fraction was 30±12%. The mean follow-up was 63±35 months. One hundred and seventy-four MZ events were documented in 139 patients (62.9%): 74 of non-sustained ventricular tachycardia (NSVT), 42 of supraventricular tachycardia, 44 of atrial fibrillation/atrial flutter, and five cases of noise. Among the 137 patients who presented with arrhythmias in the MZ (excluding two cases with noise detection only), 22 (16.1%) received appropriate shocks and/or antitachycardia pacing (ATP), while of the other 84 patients, 15.5% received appropriate ICD treatment (p=NS). In patients who presented with NSVT in the MZ, 15 (20.5%) received appropriate shocks and/or ATP. In accordance with the MZ findings, physicians decided to change outpatient medication in 41.7% of all patients in whom arrhythmic events were reported. CONCLUSION Ventricular and supraventricular arrhythmias are common findings in the MZ of ICD patients. Programming an MZ is valuable in the diagnosis of arrhythmias and may be a useful tool in clinical practice.
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Affiliation(s)
| | | | - Ana Lousinha
- Cardiology Department, Santa Marta Hospital, Lisbon, Portugal
| | - Bruno Valente
- Cardiology Department, Santa Marta Hospital, Lisbon, Portugal
| | | | - Ricardo Pimenta
- Cardiology Department, Santa Marta Hospital, Lisbon, Portugal
| | - Manuel Brás
- Cardiology Department, Santa Marta Hospital, Lisbon, Portugal
| | | | | | | | - Mário Oliveira
- Cardiology Department, Santa Marta Hospital, Lisbon, Portugal
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29
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Zungsontiporn N, Loguidice M, Daniels J. Important Parameters for Implantable Cardioverter Defibrillator Selection. Card Electrophysiol Clin 2019; 10:145-152. [PMID: 29428136 DOI: 10.1016/j.ccep.2017.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The efficacy of implantable cardioverter defibrillators in reducing the risk of sudden cardiac death has been well established by several clinical trials. Several factors relating to device characteristics, patient attributes, and comorbidities should be considered when selecting the appropriate implantable cardioverter defibrillators for each patient. This review examines some of these issues.
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Affiliation(s)
- Nath Zungsontiporn
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Michael Loguidice
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - James Daniels
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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30
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Aguiar Rosa S, Silva Cunha P, Lousinha A, Valente B, Delgado AS, Pimenta R, Brás M, Coutinho Cruz M, Portugal G, Viveiros Monteiro A, Oliveira M, Cruz Ferreira R. Importance of monitoring zones in the detection of arrhythmias in patients with implantable cardioverter-defibrillators under remote monitoring. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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31
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Single-brand dual-chamber discriminators to prevent inappropriate shocks in patients implanted with prophylactic implantable cardioverter defibrillators: a propensity-weighted comparison of single- and dual-chamber devices. J Interv Card Electrophysiol 2018; 54:267-275. [PMID: 30523511 DOI: 10.1007/s10840-018-0494-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Comparisons of the efficacy of dual- vs. single-chamber implantable cardioverter defibrillators (ICDs) in preventing inappropriate shocks have had contradictory results. We investigated whether dual-chamber devices have a lower risk of inappropriate shocks and the specific role of supraventricular tachycardia (SVT) discriminators. METHODS All heart failure (HF) patients without an indication for pacing and implanted with a prophylactic ICD were recruited from the nationwide multicenter UMBRELLA registry. Arrhythmic events were collected by remote monitoring and reviewed by a committee of experts. RESULTS Among 782 patients, single-chamber ICDs were implanted in 537 (68.7%) and dual-chamber devices in 245 (31.3%). During a mean follow-up of 52.2 ± 24.5 months, 109 inappropriate shocks were delivered in 49 patients (6.2%). In the propensity-score-matched analysis, dual-chamber ICDs were related to lower rates of inappropriate shocks as compared to single-chamber devices (0.9% vs. 11.8%, p = < 0.001, log-rank test). In multivariable Cox proportional analysis, independent predictors of inappropriate shock were history of atrial fibrillation (hazard ratio (HR) = 2.78, CI 1.37-5.64, p = 0.004), chronic kidney disease (HR = 6.15, CI 2.82-13.53, p < 0.001), and non-ischemic cardiomyopathy (HR = 2.84, CI 1.54-5.23, p = 0.001). Among ICD settings, PR logic was the only discriminator independently related to a reduced risk of inappropriate shocks (HR = 0.18, CI 0.06-0.48, p = 0.001), along with an SVT limit enabled over 200 bpm (HR = 0.24, CI 0.11-0.51, p < 0.001). CONCLUSIONS In this nationwide cohort of primary prevention ICD-only patients, dual-chamber devices were related to lower risk of inappropriate shocks compared to single-chamber ICDs. Besides, PR logic and SVT limit > 200 bpm emerged as protective factors.
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Lebedeva VK, Klitcenko OA, Lebedev DS, Lyubimtseva TA. Ventricular tachycardia prediction in patients with implantable cardioverter-defibrillators for primary prevention of sudden cardiac death. Indian Pacing Electrophysiol J 2018; 19:57-62. [PMID: 30485792 PMCID: PMC6451020 DOI: 10.1016/j.ipej.2018.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/24/2018] [Accepted: 11/25/2018] [Indexed: 11/03/2022] Open
Abstract
Clinical data analysis of 83 patients with implantable cardioverter-defibrillators (ICDs) for sudden cardiac death (SCD) primary prevention has been done. We revealed 5 parameters associated with the detection of life-threatening ventricular arrhythmias. These parameters formed the basis for constructing a logistic regression model. The model makes it possible to obtain the probability of occurrence of a specific event depending on the severity of the predictive parameters and the degree of its influence (risk of true ventricular arrhythmias detection). Estimating the potential risk of the life-threatening arrhythmias, individual programming options are required in implantable cardioverter-defibrillators (ICDs) to reduce the amount of unnecessary electrotherapy, as well as more accurate monitoring of the patient's drug therapy.
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Affiliation(s)
- Viktoria K Lebedeva
- Arrhythmology Department, National Almazov Medical Research Centre, 2 Akkuratova St., St. Petersburg, 197341, Russian Federation
| | - Olga A Klitcenko
- North-Western State Medical University Named After I.I Mechnikov., 41 Kirochnaya St., St. Petersburg, 191015, Russian Federation
| | - Dmitry S Lebedev
- Arrhythmology Department, National Almazov Medical Research Centre, 2 Akkuratova St., St. Petersburg, 197341, Russian Federation
| | - Tamara A Lyubimtseva
- Arrhythmology Department, National Almazov Medical Research Centre, 2 Akkuratova St., St. Petersburg, 197341, Russian Federation.
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Krause U, Müller MJ, Wilberg Y, Pietzka M, Backhoff D, Ruschewski W, Paul T. Transvenous and non-transvenous implantable cardioverter-defibrillators in children, adolescents, and adults with congenital heart disease: who is at risk for appropriate and inappropriate shocks? Europace 2018; 21:106-113. [DOI: 10.1093/europace/euy219] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/13/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
| | - Matthias J Müller
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
| | - Yannic Wilberg
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
| | - Matthias Pietzka
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
| | - David Backhoff
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
| | - Wolfgang Ruschewski
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August-University Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
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Cost Saving Potential of an Early Detection of Atrial Fibrillation in Patients after ICD Implantation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3417643. [PMID: 30186856 PMCID: PMC6112263 DOI: 10.1155/2018/3417643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 06/28/2018] [Accepted: 07/11/2018] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation (AF) is a relevant comorbidity in recipients of implantable cardioverter-defibrillators (ICD). Latest generation single-chamber ICD allow the additional sensing of atrial tachyarrhythmias and, therefore, contribute to the early detection and treatment of AF, potentially preventing AF-related stroke. The present study aimed to measure the impact on patient-related costs of this new ICD compared to conventional ICD. A Markov model was developed to simulate the long-term incidence of stroke in patients treated with a single-chamber ICD with or without atrial sensing capabilities. The median annual cost per patient and its difference, the number of strokes avoided, and the cost per stroke avoided were estimated. During a 9-year horizon, the costs for the ICD and stroke treatment were €570 per patient-year for an ICD with atrial sensing capabilities and €491 per patient-year for a conventional ICD. Per 1,000 patients, 4.6 strokes per year are assumed to be avoided by the new device. Higher CHA2DS2-VASc scores are associated with higher numbers of avoided strokes and larger potential for cost savings. Apart from clinical advantages, the use of ICD with atrial sensing capabilities may reduce the incidence of stroke and, in high-risk patients, may also contribute to reduce overall health care costs.
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Nguyen E, Weeda ER, Kohn CG, D'Souza BA, Russo AM, Noreika S, Coleman CI. Wearable Cardioverter-defibrillators for the Prevention of Sudden Cardiac Death: A Meta-analysis. J Innov Card Rhythm Manag 2018; 9:3151-3162. [PMID: 32477809 PMCID: PMC7252786 DOI: 10.19102/icrm.2018.090506] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/13/2018] [Indexed: 01/24/2023] Open
Abstract
Wearable cardioverter-defibrillators (WCDs) protect patients from sudden cardiac death (SCD) by detecting and treating life-threatening ventricular tachycardia/fibrillation (VT/VF). Recently, two large studies evaluating WCDs were published. However, the results of older and newer studies have yet to be systematically summarized. The objective of the current study was to conduct a meta-analysis assessing the use and effectiveness of WCDs. We searched MEDLINE and Scopus (January 1998–July 2017) as well as the gray literature. We included registry/observational studies that (1) evaluated adult patients using WCDs; (2) provided data on one or more outcomes of interest; and (3) were full-text studies published in English. We calculated pooled incidence and/or rate [with 95% confidence intervals (CIs)] estimates from nonoverlapping populations using a random-effects meta-analysis model. Statistical heterogeneity was assessed via the I2 statistic. We identified 11 studies (19,882 patients) with nonoverlapping populations/endpoints; seven of them evaluated WCD use across various indications, while the remaining studies restricted their focus to a single indication. Most of the studies were retrospective (82%) and multicenter (64%) in nature, with 45% using manufacturers’ registry data. The median duration of WCD use was three or more months in nine (82%) studies, and daily wear time ranged from a mean/median of 17 hours to 24 hours per day across included studies. Seven (64%) studies reported a mean/median daily wear time of more than 20 hours. This meta-analysis showed that the incidences of all-cause and SCD-related mortality among WCD patients were 1.4% (95% CI: 0.7%–2.4%) and 0.2% (95% CI: 0.1%–0.3%), respectively. VT/VF occurred in 2.6% (95% CI: 1.8%–3.5%) of patients. Across patients, 1.7% (95% CI: 1.4%–2.0%) received appropriate WCD treatment, corresponding to a rate of 9.1 patients/100 person-years (95% CI: 6.2–11.9 patients/100 person-years). Successful VT/VF termination following appropriate treatment occurred in 95.5% of patients (95% CI: 92.0%–98.0%) and the incidence of inappropriate treatment was infrequent (0.9%; 95% CI: 0.5%–1.4%). A moderate-to-high degree of statistical heterogeneity was observed in pooled analyses of mortality, VT/VF occurrence, and appropriate/inappropriate treatment (I2 ≥ 41% for all). In conclusion, WCDs appear to be successful in terms of terminating VT/VF in patients with an elevated risk of SCD and are appropriate for use while long-term risk management strategies are being identified.
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Affiliation(s)
- Elaine Nguyen
- Department of Pharmacy Practice, Idaho State University College of Pharmacy, Meridian, ID, USA
| | - Erin R Weeda
- Department of Pharmacy Practice, The Medical University of South Carolina, Charleston, SC, USA
| | - Christine G Kohn
- Department of Pharmacy Practice, University of Connecticut, Storrs, CT, USA
| | | | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Stacey Noreika
- Department of Pharmacy Practice, University of Connecticut, Storrs, CT, USA
| | - Craig I Coleman
- Department of Pharmacy Practice, University of Connecticut, Storrs, CT, USA
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Safak E, D´Ancona G, Kaplan H, Caglayan E, Kische S, Öner A, Ince H, Ortak J. New generation cardioverter-defibrillator lead with a floating atrial sensing dipole: Long-term performance. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:128-135. [DOI: 10.1111/pace.13256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 11/08/2017] [Accepted: 12/03/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Erdal Safak
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
| | - Giuseppe D´Ancona
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
| | - Hilmi Kaplan
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
| | - Evren Caglayan
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
| | - Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
| | - Alper Öner
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
| | - Jasmin Ortak
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
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Auricchio A, Hudnall JH, Schloss EJ, Sterns LD, Kurita T, Meijer A, Fagan DH, Rogers T. Inappropriate shocks in single-chamber and subcutaneous implantable cardioverter-defibrillators: a systematic review and meta-analysis. Europace 2017; 19:1973-1980. [PMID: 28340005 PMCID: PMC5834016 DOI: 10.1093/europace/euw415] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/25/2016] [Accepted: 12/18/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS Single-chamber (VR-ICD) and subcutaneous (S-ICD) implantable cardioverter-defibrillators are effective to protect patients against sudden death but expose them to higher risk of inappropriate shock (IS). We sought to quantify the annual rate and influencing factors of ISs in VR- and S-ICDs from the literature. METHODS AND RESULTS PubMed, Embase, and Cochrane Library were searched for full text articles with IS rates. Poisson distribution estimated proportion of patients with ISs; rates were annualized based on follow-up duration. Random effects meta-analysis accounted for study-to-study variation. Out of 3264 articles, 16 qualified for the meta-analysis. Across studies, 6.4% [95% confidence interval (CI) 5.1-7.9%] of patients received an IS per year. Meta-regression analyses demonstrated that IS rates were lower in more recent studies [rate ratio (RR) per year: 0.93, 95% CI: 0.87-0.98; P = 0.01] and trended lower in studies with longer follow-up (RR per year: 0.78, 95% CI: 0.60-1.01; P = 0.06). Use of S-ICDs (RR: 1.81, 95% CI: 0.86-3.81; P = 0.12) and ventricular tachycardia zone programmed on (RR: 1.13, 95% CI: 0.65-1.97; P = 0.66) were not associated with a significantly increased change in risk. The IS rate observed in one of the more recent studies was significantly lower than predicted after accounting for covariates (RR: 0.29, 95% CI: 0.14-0.60; P < 0.001). CONCLUSIONS A comprehensive review of the literature shows that 6.4% of patients with ICDs experienced their first IS annually. One of the 16 studies was better than predicted with the lowest reported rate (1.9%) and could not be explained by timing of the study or other covariates.
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Affiliation(s)
- Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete, 48, CH-6900 Lugano, Switzerland
| | | | - Edward J Schloss
- The Christ Hospital/The Ohio Heart & Vascular Center, Cincinnati, OH, USA
| | | | - Takashi Kurita
- Division of Cardiology, Kinki University School of Medicine, Osaka, Japan
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Peterson PN, Greenlee RT, Go AS, Magid DJ, Cassidy-Bushrow A, Garcia-Montilla R, Glenn KA, Gurwitz JH, Hammill SC, Hayes J, Kadish A, Reynolds K, Sharma P, Smith DH, Varosy PD, Vidaillet H, Zeng CX, Normand SLT, Masoudi FA. Comparison of Inappropriate Shocks and Other Health Outcomes Between Single- and Dual-Chamber Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death: Results From the Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter-Defibrillators. J Am Heart Assoc 2017; 6:JAHA.117.006937. [PMID: 29122811 PMCID: PMC5721776 DOI: 10.1161/jaha.117.006937] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In US clinical practice, many patients who undergo placement of an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death receive dual-chamber devices. The superiority of dual-chamber over single-chamber devices in reducing the risk of inappropriate ICD shocks in clinical practice has not been established. The objective of this study was to compare risk of adverse outcomes, including inappropriate shocks, between single- and dual-chamber ICDs for primary prevention. METHODS AND RESULTS We identified patients receiving a single- or dual-chamber ICD for primary prevention who did not have an indication for pacing from 15 hospitals within 7 integrated health delivery systems in the Longitudinal Study of Implantable Cardioverter-Defibrillators from 2006 to 2009. The primary outcome was time to first inappropriate shock. ICD shocks were adjudicated for appropriateness. Other outcomes included all-cause hospitalization, heart failure hospitalization, and death. Patient, clinician, and hospital-level factors were accounted for using propensity score weighting methods. Among 1042 patients without pacing indications, 54.0% (n=563) received a single-chamber device and 46.0% (n=479) received a dual-chamber device. In a propensity-weighted analysis, device type was not significantly associated with inappropriate shock (hazard ratio, 0.91; 95% confidence interval, 0.59-1.38 [P=0.65]), all-cause hospitalization (hazard ratio, 1.03; 95% confidence interval, 0.87-1.21 [P=0.76]), heart failure hospitalization (hazard ratio, 0.93; 95% confidence interval, 0.72-1.21 [P=0.59]), or death (hazard ratio, 1.19; 95% confidence interval, 0.93-1.53 [P=0.17]). CONCLUSIONS Among patients who received an ICD for primary prevention without indications for pacing, dual-chamber devices were not associated with lower risk of inappropriate shock or differences in hospitalization or death compared with single-chamber devices. This study does not justify the use of dual-chamber devices to minimize inappropriate shocks.
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Affiliation(s)
- Pamela N Peterson
- Denver Health Medical Center, Denver, CO .,University of Colorado Denver Anschutz Medical Campus, Aurora, CO.,Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
| | - Robert T Greenlee
- Marshfield Clinic Research Foundation, Marshfield, WI.,Marshfield Clinic, Marshfield, WI
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,University of California San Francisco, San Francisco, CA.,Stanford University School of Medicine, Palo Alto, CA
| | - David J Magid
- University of Colorado Denver Anschutz Medical Campus, Aurora, CO.,Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
| | | | | | - Karen A Glenn
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
| | | | | | - John Hayes
- Marshfield Clinic Research Foundation, Marshfield, WI
| | | | - Kristi Reynolds
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, CA
| | - Param Sharma
- Marshfield Clinic Research Foundation, Marshfield, WI
| | - David H Smith
- Kaiser Permanente Northwest Center for Health Research, Portland, OR
| | - Paul D Varosy
- University of Colorado Denver Anschutz Medical Campus, Aurora, CO.,Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.,Eastern Colorado VA Health Care System, Denver, CO
| | | | - Chan X Zeng
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
| | | | - Frederick A Masoudi
- University of Colorado Denver Anschutz Medical Campus, Aurora, CO.,Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
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Abstract
PURPOSE OF REVIEW Medical devices have become an integral part of comprehensive heart failure management. Not all heart failure patients, however, accrue benefit from every new device, and even with extensive practice guidelines, this remains an evolving field. RECENT FINDINGS The addition of implantable devices, like internal cardioverter defibrillators (ICDs), and novel pacing technologies, including cardiac resynchronization therapy (CRT), have helped to compliment goal-directed medical therapy and positively impact prognosis in multiple high-quality clinical trials. This review attempts to summarize the rapidly evolving literature with respect to existing device guidelines for routine implantable devices as well as some available and future technologies that are not yet a part of routine guidelines. ICD, CRT, and other implantable devices continue to save lives, decrease hospitalizations, and evolve the management of patients with heart failure beyond the capabilities of optimal guideline-directed medical therapy alone.
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Affiliation(s)
- Brett G Angel
- Division of Cardiology, Hahnemann University Hospital, Drexel University College of Medicine, 245 North 15th Street, Suite 6122, Philadelphia, PA, 19102, USA.
| | - Heath Saltzman
- Division of Cardiology, Hahnemann University Hospital, Drexel University College of Medicine, 245 North 15th Street, Suite 6122, Philadelphia, PA, 19102, USA
| | - Luke S Kusmirek
- Division of Cardiology, Hahnemann University Hospital, Drexel University College of Medicine, 245 North 15th Street, Suite 6122, Philadelphia, PA, 19102, USA
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Chia PL, Foo D. Overview of implantable cardioverter defibrillator and cardiac resynchronisation therapy in heart failure management. Singapore Med J 2017; 57:354-9. [PMID: 27440409 DOI: 10.11622/smedj.2016117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Clinical trials have established the benefits of implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) in the treatment of heart failure patients. As adjuncts to guideline-directed medical therapy, ICDs confer mortality benefits from sudden cardiac arrest, while CRT reduces mortality, hospitalisation rates and improves functional capacity. This review discusses the use of ICDs and CRT devices in heart failure management, outlining the evidence supporting their use, indications and contraindications.
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Affiliation(s)
- Pow-Li Chia
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - David Foo
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
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Tao S, Ashikaga H, Ciuffo LA, Yoneyama K, Lima JA, Frank TF, Weiss RG, Tomaselli GF, Wu KC. Impaired left atrial function predicts inappropriate shocks in primary prevention implantable cardioverter-defibrillator candidates. J Cardiovasc Electrophysiol 2017; 28:796-805. [PMID: 28429529 PMCID: PMC5528170 DOI: 10.1111/jce.13234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/04/2017] [Accepted: 04/12/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Inappropriate implantable cardioverter-defibrillator (ICD) shocks, commonly caused by atrial fibrillation (AF), are associated with an increased mortality. Because impaired left atrial (LA) function predicts development of AF, we hypothesized that impaired LA function predicts inappropriate shocks beyond a history of AF. METHODS AND RESULTS We prospectively analyzed the association between LA function and incident inappropriate shocks in primary prevention ICD candidates. In the Prospective Observational Study of ICD (PROSE-ICD), we assessed LA function using tissue-tracking cardiac magnetic resonance (CMR) prior to ICD implantation. A total of 162 patients (113 males, age 56 ± 15 years) were included. During the mean follow-up of 4.0 ± 2.9 years, 26 patients (16%) experienced inappropriate shocks due to AF (n = 19; 73%), supraventricular tachycardia (n = 5; 19%), and abnormal sensing (n = 2; 8%). In univariable analyses, inappropriate shocks were associated with AF history prior to ICD implantation, age below 70 years, QRS duration less than 120 milliseconds, larger LA minimum volume, lower LA stroke volume, lower LA emptying fraction, impaired LA maximum and preatrial contraction strains (Smax and SpreA ), and impaired LA strain rate during left ventricular systole and atrial contraction (SRs and SRa ). In multivariable analysis, impaired Smax (hazard ratio [HR]: 0.96, P = 0.044), SpreA (HR: 0.94, P = 0.030), and SRa (HR: 0.25, P < 0.001) were independently associated with inappropriate shocks. The receiver-operating characteristics curve showed that SRa improved the predictive value beyond the patient demographics including AF history (P = 0.033). CONCLUSION Impaired LA function assessed by tissue-tracking CMR is an independent predictor of inappropriate shocks in primary prevention ICD candidates beyond AF history.
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Affiliation(s)
- Susumu Tao
- Division of Cardiology; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, United States
| | - Hiroshi Ashikaga
- Division of Cardiology; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, United States
- Department of Biomedical Engineering; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, United States
| | - Luisa A. Ciuffo
- Division of Cardiology; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, United States
| | - Kihei Yoneyama
- Division of Cardiology; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, United States
| | - Joao A.C. Lima
- Division of Cardiology; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, United States
| | - Terry F. Frank
- Division of Cardiology; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, United States
| | - Robert G. Weiss
- Division of Cardiology; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, United States
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, United States
| | - Gordon F. Tomaselli
- Division of Cardiology; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, United States
| | - Katherine C. Wu
- Division of Cardiology; Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, United States
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Weisman D, Beinart R, Erez A, Koren-Morag N, Goldenberg I, Eldar M, Glikson M, Luria D. Effect of supplemented intake of omega-3 fatty acids on arrhythmias in patients with ICD: fish oil therapy may reduce ventricular arrhythmia. J Interv Card Electrophysiol 2017; 49:255-261. [DOI: 10.1007/s10840-017-0267-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
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Mizukami K, Yokoshiki H, Mitsuyama H, Watanabe M, Tenma T, Kamada R, Takahashi M, Sasaki R, Maeno M, Tsutsui H. Influence of myopotential interference on the Wavelet discrimination algorithm in implantable cardioverter-defibrillator. J Arrhythm 2017; 33:214-219. [PMID: 28607617 PMCID: PMC5459332 DOI: 10.1016/j.joa.2016.08.005] [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: 06/23/2016] [Revised: 08/01/2016] [Accepted: 08/26/2016] [Indexed: 11/06/2022] Open
Abstract
Background Wavelet is a morphology-based algorithm for detecting ventricular tachycardia. The electrogram (EGM) source of the Wavelet algorithm is nominally programmed with the Can-RV coil configuration, which records a far-field ventricular potential. Therefore, it may be influenced by myopotential interference. Methods We performed a retrospective review of 40 outpatients who had an implantable cardioverter-defibrillator (ICD) with the Wavelet algorithm. The percent-match score of the Wavelet algorithm was measured during the isometric chest press by pressing the palms together. We classified patients with percent-match scores below 70% due to myopotential interference as positive morphology change, and those with 70% or more as negative morphology change. Stored episodes of tachycardia were evaluated during the follow-up. Results The number of patients in the positive morphology change group was 22 (55%). Amplitude of the Can-RV coil EGM was lower in the positive morphology change group compared to that in the negative group (3.9±1.3 mV vs. 7.4±1.6 mV, P=0.0015). The cut-off value of the Can-RV coil EGM was 5 mV (area under curve, 0.89). Inappropriate detections caused by myopotential interference occurred in two patients (5%) during a mean follow-up period of 49 months, and one of them received an inappropriate ICD shock. These patients had exhibited positive morphology change. Conclusions The Wavelet algorithm is influenced by myopotential interference when the Can-RV coil EGM is less than 5 mV.
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Affiliation(s)
- Kazuya Mizukami
- Department of Cardiovascular Medicine, National Hospital Organization Hokkaido Medical Center, Yamanote 5-7-1-1, Nishi-ku, Sapporo 063-0005, Japan
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Hirofumi Mitsuyama
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Masaya Watanabe
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Taro Tenma
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Rui Kamada
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Masayuki Takahashi
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Ryo Sasaki
- Division of Medical Engineering Center, Hokkaido University Hospital, Japan
| | - Motoki Maeno
- Division of Medical Engineering Center, Hokkaido University Hospital, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
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Defaye P, Boveda S, Klug D, Beganton F, Piot O, Narayanan K, Périer MC, Gras D, Fauchier L, Bordachar P, Algalarrondo V, Babuty D, Deharo JC, Leclercq C, Marijon E, Sadoul N. Dual- vs. single-chamber defibrillators for primary prevention of sudden cardiac death: long-term follow-up of the Défibrillateur Automatique Implantable—Prévention Primaire registry. Europace 2017; 19:1478-1484. [DOI: 10.1093/europace/euw230] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/27/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - Frankie Beganton
- Paris Cardiovascular Research Center, Inserm U970, Paris, France
| | - Olivier Piot
- Centre Cardiologique du Nord, Saint Denis, France
| | - Kumar Narayanan
- Paris Cardiovascular Research Center, Inserm U970, Paris, France
| | | | - Daniel Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | | | | | | | | | | | | | - Eloi Marijon
- Paris Cardiovascular Research Center, Inserm U970, Paris, France
- European Georges Pompidou Hospital, Paris, France
- Paris Descartes University, Paris, France
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Abstract
Optimal programming of implantable cardioverter defibrillators (ICDs) is essential to appropriately treat ventricular tachyarrhythmias and to avoid unnecessary and inappropriate shocks. There have been a series of large clinical trials evaluating tailored programming of ICDs. We reviewed the clinical trials evaluating ICD therapies and detection, and the consensus statement on ICD programming. In doing so, we found that prolonged ICD detection times, higher rate cutoffs, and antitachycardia pacing (ATP) programming decreases inappropriate and painful therapies in a primary prevention population. The use of supraventricular tachyarrhythmia discriminators can also decrease inappropriate shocks. Tailored ICD programming using the knowledge gained from recent ICD trials can decrease inappropriate and unnecessary ICD therapies and decrease mortality.
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Hwang KW, Nam GB, Han J, Kim YG, Choi HO, Kim J, Choi KJ, Kim YH. Incidence of Atrial Tachyarrhythmias in Patients With Early Repolarization Syndrome. Int Heart J 2017; 58:43-49. [PMID: 28077816 DOI: 10.1536/ihj.16-104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Atrial tachyarrhythmias (ATAs) occur in a significant proportion of Brugada syndrome (BrS) patients and are often an important cause of inappropriate shocks. The aim of this retrospective study was to evaluate the incidence of ATAs and ATA-induced inappropriate shocks in early repolarization syndrome (ERS) patients as compared to BrS patients.We analyzed data from 20 consecutive patients who were diagnosed with ERS and compared them with patients diagnosed with BrS (n = 31). Clinical and ICD interrogation data were collected and analyzed for all events with ICD shocks.Three patients had a history of atrial fibrillation (AF) prior to ICD implantation. One patient had AV reentrant tachycardia and was successfully ablated before ICD implantation. ATAs were newly diagnosed in 4 patients with no prior history of AF. There were no significant differences in gender, age, or left atrial diameter between ATA development. Four (20%) of 20 consecutive patients received inappropriate ICD shocks for ATAs. One suffered from repeat inappropriate shocks triggered by paroxysmal AF and received catheter ablation for AF.ATAs were not infrequent in patients with ERS and seemed to be related to inappropriate ICD therapy. Careful ICD programming is required to reduce ATA-related inappropriate ICD shock in patients with ERS.
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Affiliation(s)
- Ki Won Hwang
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University of Medicine
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Implantable cardioverter-defibrillator implantation for primary and secondary prevention: indications and outcomes. Cardiol Young 2017; 27:S126-S131. [PMID: 28084973 DOI: 10.1017/s1047951116002365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Implantable cardioverter-defibrillators effectively reduce the rate of sudden cardiac death in children. Significant efforts have been made to better characterise the indications for their placement, and over the past two decades there has been a shift in their use from secondary to primary prevention. Primary prevention includes placement in patients thought to be at high risk of sudden cardiac death before the patient experiences any event. Secondary prevention includes placement after a high-risk event including sustained ventricular tachycardia or resuscitated cardiac arrest. Although liberal device implantation may be appealing even in patients having marginal indications, studies have shown high rates of adverse effects including inappropriate device discharges and the need for re-intervention because of hardware malfunction. The indications for placement of an implantable cardioverter-defibrillator, whether for primary or secondary prevention of sudden cardiac death, vary based on cardiac pathology. This review will assist the provider in understanding the risks and benefits of device implantation in order to enhance the shared decision-making capacity of patients, families, and providers.
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48
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The wearable defibrillator. Curr Opin Cardiol 2017; 32:39-46. [DOI: 10.1097/hco.0000000000000345] [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: 11/26/2022]
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49
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Wieneke H, Svendsen JH, Lande J, Spencker S, Martinez JG, Strohmer B, Toivonen L, Le Marec H, Garcia-Fernandez FJ, Corrado D, Huertas-Vazquez A, Uy-Evanado A, Rusinaru C, Reinier K, Foldesi C, Hulak W, Chugh SS, Siffert W. Polymorphisms in the GNAS Gene as Predictors of Ventricular Tachyarrhythmias and Sudden Cardiac Death: Results From the DISCOVERY Trial and Oregon Sudden Unexpected Death Study. J Am Heart Assoc 2016; 5:JAHA.116.003905. [PMID: 27895044 PMCID: PMC5210425 DOI: 10.1161/jaha.116.003905] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Population‐based studies suggest that genetic factors contribute to sudden cardiac death (SCD). Methods and Results In the first part of the present study (Diagnostic Data Influence on Disease Management and Relation of Genetic Polymorphisms to Ventricular Tachy‐arrhythmia in ICD Patients [DISCOVERY] trial) Cox regression was done to determine if 7 single‐nucleotide polymorphisms (SNPs) in 3 genes coding G‐protein subunits (GNB3, GNAQ, GNAS) were associated with ventricular tachyarrhythmia (VT) in 1145 patients receiving an implantable cardioverter‐defibrillator (ICD). In the second part of the study, SNPs significantly associated with VT were further investigated in 1335 subjects from the Oregon SUDS, a community‐based study analyzing causes of SCD. In the DISCOVERY trial, genotypes of 2 SNPs in the GNAS gene were nominally significant in the prospective screening and significantly associated with VT when viewed as recessive traits in post hoc analyses (TT vs CC/CT in c.393C>T: HR 1.42 [CI 1.11‐1.80], P=0.005; TT vs CC/CT in c.2273C>T: HR 1.57 [CI 1.18‐2.09], P=0.002). TT genotype in either SNP was associated with a HR of 1.58 (CI 1.26‐1.99) (P=0.0001). In the Oregon SUDS cohort significant evidence for association with SCD was observed for GNAS c.393C>T under the additive (P=0.039, OR=1.21 [CI 1.05‐1.45]) and recessive (P=0.01, OR=1.52 [CI 1.10‐2.13]) genetic models. Conclusions GNAS harbors 2 SNPs that were associated with an increased risk for VT in ICD patients, of which 1 was successfully replicated in a community‐based population of SCD cases. To the best of our knowledge, this is the first example of a gene variant identified by ICD VT monitoring as a surrogate parameter for SCD and also confirmed in the general population. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00478933.
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Affiliation(s)
- Heinrich Wieneke
- Department of Cardiology, Contilia Heart and Vessel Centre, St. Marien-Hospital Mülheim, Mülheim, Germany
| | | | | | - Sebastian Spencker
- Department of Cardiology, DRK Kliniken Berlin I Köpenick, Berlin, Germany
| | | | - Bernhard Strohmer
- Department of Cardiology, Salzburger Landeskliniken, Paracelsus Private Medical University, Salzburg, Austria
| | - Lauri Toivonen
- Department of Cardiovascular Research, Meilahden Sairaala, Helsinki, Finland
| | - Hervé Le Marec
- Department of Cardiology and Vascular Medicine, Hospital Guillaume et René Laennec, Nantes, France
| | | | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, Medical School, University of Padua, Padua, Italy
| | | | | | | | | | - Csaba Foldesi
- Gottsegen National Institute of Cardiology, Budapest, Hungary
| | - Wieslaw Hulak
- Samodzielny Publiczny Szpital Wojewódzki Gorzowie Wielkopolski, Gorzow, Poland
| | | | - Winfried Siffert
- Institute of Pharmacogenetics, University Hospital Essen, Essen, Germany
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Abstract
The use of implantable cardioverter defibrillators (ICD) has favorably impacted the prevention and treatment of sudden cardiac death (SCD) associated with ventricular arrhythmias. However, there are situations where an ICD cannot be immediately implanted, even though the patient is at high risk for SCD. The wearable cardioverter defibrillator (WCD) is a unique technology that can bridge this gap for patients. The WCD has been demonstrated to terminate ventricular tachycardia/fibrillation if worn and used correctly. With proper training, it is relatively easy to put on, maintain, and use. Most patients are compliant and are able to consistently wear the device. The WCD negates the infection risk or procedural complications associated with insertion and possible extraction of leads, as with an ICD. In terms of primary prevention of ventricular tachycardia/fibrillation in patients with a left ventricular ejection fraction ≤35%, prospective, randomized studies evaluating the survival of patients utilizing the WCD will need to be performed before evidenced-based criteria for its use can be established. On the basis of current data, WCD use for those awaiting heart transplant, for those with ICD indications status post-ICD explant, and for high-risk SCD patients with possible reversible cardiomyopathy appears to be a reasonable approach on the basis of current data.
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