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Knops RE, El-Chami MF, Marquie C, Nordbeck P, Quast AFBE, Tilz RR, Brouwer TF, Lambiase PD, Cassidy CJ, Boersma LVA, Burke MC, Pepplinkhuizen S, de Veld JA, de Weger A, Bracke FALE, Manyam H, Probst V, Betts TR, Bijsterveld NR, Defaye P, Demming T, Elders J, Field DC, Ghani A, Golovchiner G, de Jong JSSG, Lewis N, Marijon E, Martin CA, Miller MA, Shaik NA, van der Stuijt W, Kuschyk J, Olde Nordkamp LRA, Arya A, Borger van der Burg AE, Boveda S, van Doorn DJ, Glikson M, Kaiser L, Maass AH, van Woerkens LJPM, Zaidi A, Wilde AAM, Smeding L. Predictive value of the PRAETORIAN score for defibrillation test success in patients with subcutaneous ICD: A subanalysis of the PRAETORIAN-DFT trial. Heart Rhythm 2024; 21:836-844. [PMID: 38336193 DOI: 10.1016/j.hrthm.2024.02.005] [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: 12/19/2023] [Revised: 01/24/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The PRAETORIAN score estimates the risk of failure of subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy by using generator and lead positioning on bidirectional chest radiographs. The PRospective randomized compArative trial of subcutanEous implanTable cardiOverter-defibrillatoR ImplANtation with and without DeFibrillation Testing (PRAETORIAN-DFT) investigates whether PRAETORIAN score calculation is noninferior to defibrillation testing (DFT) with regard to first shock efficacy in spontaneous events. OBJECTIVE This prespecified subanalysis assessed the predictive value of the PRAETORIAN score for defibrillation success in induced ventricular arrhythmias. METHODS This multicenter investigator-initiated trial randomized 965 patients between DFT and PRAETORIAN score calculation after de novo S-ICD implantation. Successful DFT was defined as conversion of induced ventricular arrhythmia in <5 seconds from shock delivery within 2 attempts. Bidirectional chest radiographs were obtained after implantation. The predictive value of the PRAETORIAN score for DFT success was calculated for patients in the DFT arm. RESULTS In total, 482 patients were randomized to undergo DFT. Of these patients, 457 (95%) underwent DFT according to protocol, of whom 445 (97%) had successful DFT and 12 (3%) had failed DFT. A PRAETORIAN score of ≥90 had a positive predictive value of 25% for failed DFT, and a PRAETORIAN score of <90 had a negative predictive value of 99% for successful DFT. A PRAETORIAN score of ≥90 was the strongest independent predictor for failed DFT (odds ratio 33.77; confidence interval 6.13-279.95; P < .001). CONCLUSION A PRAETORIAN score of <90 serves as a reliable indicator for DFT success in patients with S-ICD, and a PRAETORIAN score of ≥90 is a strong predictor for DFT failure.
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Affiliation(s)
- Reinoud E Knops
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands.
| | - Mikhael F El-Chami
- Division of Cardiology Section of Electrophysiology, Emory University, Atlanta, Georgia
| | | | - Peter Nordbeck
- Department of Internal Medicine I, University and University Hospital Würzburg, Würzburg, Germany
| | - Anne-Floor B E Quast
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Roland R Tilz
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tom F Brouwer
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Pier D Lambiase
- Office of the Director of Clinical Electrophysiology Research and Lead for Inherited Arrhythmia Specialist Services, University College London and Barts Heart Centre, London, United Kingdom
| | - Christopher J Cassidy
- Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Trust, Blackpool, United Kingdom
| | - Lucas V A Boersma
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands; Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Shari Pepplinkhuizen
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Jolien A de Veld
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Anouk de Weger
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Frank A L E Bracke
- Department of Electrophysiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Harish Manyam
- Department of Cardiology Erlanger Health System, University of Tennessee, Chattanooga, Tennessee
| | - Vincent Probst
- Service de Cardiologie, L'institut du thorax, CHU Nantes, Nantes, France
| | - Timothy R Betts
- Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Nick R Bijsterveld
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands; Department of Cardiology, Flevoziekenhuis, Almere, The Netherlands
| | - Pascal Defaye
- Service de Cardiologie, Centre hospitalier universitaire, Grenoble, France
| | - Thomas Demming
- Department of Internal Medicine III, Cardiology, Angiology, and Critical Care, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan Elders
- Department of Cardiology, Canisius Wilhelminahospital, Nijmegen, The Netherlands
| | - Duncan C Field
- Cardiology, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, United Kingdom
| | - Abdul Ghani
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | | | | | - Nigel Lewis
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Claire A Martin
- Department of Cardiology, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Marc A Miller
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
| | - Naushad A Shaik
- Department of Cardiac Electrophysiology, Advent Health Orlando, Orlando, Florida
| | - Willeke van der Stuijt
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Jürgen Kuschyk
- First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany; First Department of Medicine-Cardiology, University Medical Center Mannheim, and the German Center for Cardiovascular Research Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Louise R A Olde Nordkamp
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Anita Arya
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | | | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | - Dirk J van Doorn
- Department of Cardiology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Lukas Kaiser
- Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Alexander H Maass
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Amir Zaidi
- Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Arthur A M Wilde
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Lonneke Smeding
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart Failure & Arrhythmias, Amsterdam, The Netherlands
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Vidal Margenat A, Zedan A, Schubert S, Gopani S, Hariharan R. Patients with a high defibrillation threshold: Approaches to management. Pacing Clin Electrophysiol 2024; 47:222-232. [PMID: 38291870 DOI: 10.1111/pace.14936] [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: 10/06/2023] [Revised: 12/30/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
Implantable cardioverter-defibrillators (ICDs) have revolutionized the prognosis for patients at elevated risk of ventricular tachyarrhythmias. For safety, defibrillation should be effective with a minimum of 10 J below the device's maximum energy. While modern ICDs rarely deliver ineffective shocks in primary prevention, the surge in managing severe heart failure patients has led to an increased number of patients with high defibrillation thresholds (DFTs). This article elucidates the potential causes of high DFT, including clinical factors, lead and device placement, the presence of a Left Ventricular Assist Device (LVAD), prolonged ventricular arrhythmias, shock vectors, waveform tilt, medications, and manufacturer-specific options. We also detail management strategies, highlighting alternative shock coil placements, practical recommendations, and case studies from our institution. Our management algorithm suggests addressing preventable causes, re-evaluating coil positions, considering non-invasive system modifications, upgrading to a higher-capacity device, and adding extra coil(s).
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Affiliation(s)
| | - Ahmed Zedan
- EP Heart, University of Texas, Houston, Texas, USA
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Aggarwal K, Boyapati SP, Valecha J, Noor A, Kanwal F, Jain R, Kanagala SG. Arrhythmias and Hypertrophic Cardiomyopathy: Unravelling the Connection. Curr Cardiol Rev 2024; 20:39-48. [PMID: 38279754 PMCID: PMC11327833 DOI: 10.2174/011573403x279223231227111737] [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: 08/26/2023] [Revised: 11/15/2023] [Accepted: 11/30/2023] [Indexed: 01/28/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) results from gene mutations affecting cardiac sarcomeres and is inherited in an autosomal dominant manner. With a prevalence of 1:200-1:500 in the general population, HCM is characterised by a hypertrophied and non-dilated left ventricle with predominant involvement of the interventricular septum. The myocardium's structural and intracellular factors, combined with triggers such as physical exertion, autonomic dysfunction, and ischemia, can lead to reentry events, and atrial and ventricular arrhythmias, including atrial fibrillation (AF) which is common among HCM patients. To manage the increased risk of mortality arising from congestive heart failure and thromboembolism, in patients with AF long-term anticoagulation and antiarrhythmic drugs are employed. HCM patients may also encounter supraventricular and ventricular arrhythmias, such as nonsustained ventricular tachycardia and ventricular premature beats, which can potentially lead to sudden cardiac death and necessitate treatment with implanted defibrillators. Physicians must comprehensively analyse clinical, anatomical, hemodynamic, rhythmic, functional, and genetic characteristics to identify HCM patients at high risk of sudden death. This article aims to discuss the pathophysiology of arrhythmia in HCM and clinical recommendations for various ventricular and atrial fibrillation including catheter ablation and implantable cardioverter-defibrillator (ICD).
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Affiliation(s)
| | | | | | - Amna Noor
- Services Hospital Center, Lahore, Pakistan
| | - Fnu Kanwal
- Chandka Medical College, Larkana, Sindh, Pakistan
| | - Rohit Jain
- Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
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Kumar KR, Mandleywala SN, Madias C, Weinstock J, Rowin EJ, Maron BJ, Maron MS, Link MS. Single Coil Implantable Cardioverter Defibrillator Leads in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2020; 125:1896-1900. [PMID: 32305220 DOI: 10.1016/j.amjcard.2020.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 12/21/2022]
Abstract
Patients with hypertrophic cardiomyopathy (HC) may require higher energies to terminate ventricular fibrillation (VF); thus, dual coil defibrillation leads are often implanted. However, single coil leads may be preferred in young patients. All patients with HCM implanted with a transvenous ICD from years 2000 to 2014 were included. Of 249 patients, 223 underwent VF testing including 150 with a dual coil lead and 73 a single coil. Patients tested with dual coil compared with single coil had lower successful VF energies (15.7 ± 6.1 joule to 20.2 ± 7.9 joule (p <0.0001)). Adequate safety margin for defibrillation was noted in 97.3% of patients. Notably, 6 (4 with single coil leads) had inadequate safety margins (defined as ≥10 joule). Three of these 6 patients required replacement of a single coil lead with a dual coil lead. The remaining 3 underwent waveform tilt alteration, higher energy ICD, or removal of the can from the shock vector. There were no clinical or implant predictors of inadequate safety margins. In follow-up of 16 ± 30 months (range 0 to 170), there were 24 arrhythmias including 13 VF, all successfully terminated. In conclusion, in HC patients undergoing ICD implantation, single coil leads can provide adequate safety margins. In conclusion, defibrillation testing should be considered in all HC patients undergoing ICD implantation, and should be performed in those undergoing implantation with a single coil lead.
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Kim SS, Park HW, Jeong HK, Lee KH, Yoon NS, Cho JG. Defibrillation threshold testing during implantable cardioverter defibrillator implantation: 5-year follow-up. J Interv Card Electrophysiol 2020; 60:485-491. [PMID: 32399866 DOI: 10.1007/s10840-020-00733-x] [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: 12/23/2019] [Accepted: 03/16/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Defibrillation threshold (DFT) testing is a routine practice in some Asian countries for patients receiving an implantable cardioverter defibrillator (ICD). However, there are few long-term data about the necessity of intraoperative DFT testing in an Asian population. We investigated the safety of DFT testing and the long-term clinical outcomes in Asian patients undergoing ICD implantation. METHODS All patients undergoing de novo transvenous ICD implantation were randomized to undergo periprocedural DFT testing. The study included 67 patients (50 males; 51.5 ± 16.9 years) who underwent ICD implantation with (n = 33) or without (n = 34) intraoperative DFT testing between March 2012 and February 2014. We compared first-shock success, composite safety end points (the sum of complications recorded at 30 days), arrhythmic death, and all-cause mortality. RESULTS The baseline clinical characteristics and the procedural-related adverse event rate (3.0% with DFT vs. 0% with non-DFT, p = 0.214) did not differ between groups. The programmed output of the first shock was lower in the DFT testing group (22.9 ± 4.4 J vs. 25.3 ± 5.4 J, p = 0.007). However, there were no significant differences between groups for all-cause mortality (12.1% vs. 17.6%, p = 0.526) or first-shock success rate for ventricular arrhythmia (100% vs. 88.2%, p = 0.471). CONCLUSIONS There were no between-group differences in periprocedural safety, complications, and long-term clinical outcomes. Our results suggest that DFT testing in Asian patients allows reduction of the programmed output of the first shock, but does not affect long-term clinical outcomes.
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Affiliation(s)
- Sung Soo Kim
- Cardiovascular Division, Chosun University Hospital, 365, Pilmun daero, Dong-gu, Gwangju, South Korea
| | - Hyung Wook Park
- Department of Cardiovascular Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, South Korea.
| | - Hyung Ki Jeong
- Department of Cardiovascular Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Ki Hong Lee
- Department of Cardiovascular Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Nam Sik Yoon
- Department of Cardiovascular Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Jeong Gwan Cho
- Department of Cardiovascular Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju, 61469, South Korea
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6
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Vamos M, Healey JS, Wang J, Connolly SJ, Mabo P, Van Erven L, Kautzner J, Glikson M, Neuzner J, O'Hara G, Vinolas X, Gadler F, Hohnloser SH. Implantable cardioverter–defibrillator therapy in hypertrophic cardiomyopathy: A SIMPLE substudy. Heart Rhythm 2018; 15:386-392. [DOI: 10.1016/j.hrthm.2017.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 11/29/2022]
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7
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FRANCIA PIETRO, ADDUCI CARMEN, SEMPRINI LORENZO, PALANO FRANCESCA, SANTINI DARIA, MUSUMECI BEATRICE, SANTOLAMAZZA CATERINA, VOLPE MASSIMO, AUTORE CAMILLO. Prognostic Implications of Defibrillation Threshold Testing in Patients With Hypertrophic Cardiomyopathy. J Cardiovasc Electrophysiol 2016; 28:103-108. [DOI: 10.1111/jce.13121] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/03/2016] [Accepted: 10/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- PIETRO FRANCIA
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
| | - CARMEN ADDUCI
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
| | - LORENZO SEMPRINI
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
| | - FRANCESCA PALANO
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
| | - DARIA SANTINI
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
| | - BEATRICE MUSUMECI
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
| | - CATERINA SANTOLAMAZZA
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
| | - MASSIMO VOLPE
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
- IRCCS Neuromed; Pozzilli (IS); Italy
| | - CAMILLO AUTORE
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital; Sapienza University; Rome Italy
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Okamura H, Friedman PA, Inoue Y, Noda T, Aiba T, Yasuda S, Ogawa H, Kamakura S, Kusano K, Espinosa RE. Single-Coil Defibrillator Leads Yield Satisfactory Defibrillation Safety Margin in Hypertrophic Cardiomyopathy. Circ J 2016; 80:2199-203. [DOI: 10.1253/circj.cj-16-0428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Okamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Division of Cardiovascular Diseases, Mayo Clinic
| | | | - Yuko Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shiro Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Kanda T, Masuda M, Sunaga A, Fujita M, Iida O, Okamoto S, Ishihara T, Nanto K, Shiraki T, Sera F, Uematsu M. Fabry cardiomyopathy presenting with a high defibrillation threshold: A short case report. J Arrhythm 2015; 31:170-1. [DOI: 10.1016/j.joa.2014.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 09/29/2014] [Accepted: 10/15/2014] [Indexed: 11/29/2022] Open
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Mizukami K, Yokoshiki H, Mitsuyama H, Watanabe M, Tenma T, Matsui Y, Tsutsui H. Predictors of high defibrillation threshold in patients with implantable cardioverter-defibillator using a transvenous dual-coil lead. Circ J 2014; 79:77-84. [PMID: 25391259 DOI: 10.1253/circj.cj-14-0860] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Defibrillation testing (DT) is considered a standard procedure during implantable cardioverter-defibrillator (ICD) implantation. However, little is known about the factors that are significantly related to patients with high defibrillation threshold (DFT) using the present triad system. METHODS AND RESULTS We examined 286 consecutive patients who underwent ICD implantation with a transvenous dual-coil lead and DT from December 2000 to December 2011. We defined patients who required 25 J or more by the implanted device as the high DFT group, and those who required less than 25 J as the normal DFT group. For each patient, assessment parameters included underlying disease, comorbidities, NYHA functional class, drugs, and echocardiographic measures. The high DFT group consisted of 12 patients (4.2%). Multivariate analysis identified 3 independent predictors for high DFT: atrial fibrillation (odds ratio (OR) 4.85, 95% confidence interval (CI) 1.24-22.33, P=0.023), hypertension (OR 4.01, 95% CI 1.08-15.96, P=0.039), thickness of interventricular septum (IVS) >12 mm (OR 4.82, 95% CI 1.17-20.31, P=0.030). CONCLUSIONS Atrial fibrillation, hypertension and IVS hypertrophy were significantly associated with high DFT. Identification of such patients could help to lower the risk of complications with DT.
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Affiliation(s)
- Kazuya Mizukami
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt H, McKenna WJ, Mogensen J, Nihoyannopoulos P, Nistri S, Pieper PG, Pieske B, Rapezzi C, Rutten FH, Tillmanns C, Watkins H. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 2014; 35:2733-79. [PMID: 25173338 DOI: 10.1093/eurheartj/ehu284] [Citation(s) in RCA: 2890] [Impact Index Per Article: 289.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
MESH Headings
- Ablation Techniques/methods
- Adult
- Angina Pectoris/etiology
- Arrhythmias, Cardiac/etiology
- Cardiac Imaging Techniques/methods
- Cardiac Pacing, Artificial/methods
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/etiology
- Cardiomyopathy, Hypertrophic/therapy
- Child
- Clinical Laboratory Techniques/methods
- Death, Sudden, Cardiac/prevention & control
- Delivery of Health Care
- Diagnosis, Differential
- Electrocardiography/methods
- Female
- Genetic Counseling/methods
- Genetic Testing/methods
- Heart Failure/etiology
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Medical History Taking/methods
- Pedigree
- Physical Examination/methods
- Preconception Care/methods
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prenatal Care/methods
- Risk Factors
- Sports Medicine
- Syncope/etiology
- Thoracic Surgical Procedures/methods
- Ventricular Outflow Obstruction/etiology
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12
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Zhang L, Mmagu O, Liu L, Li D, Fan Y, Baranchuk A, Kowey PR. Hypertrophic cardiomyopathy: Can the noninvasive diagnostic testing identify high risk patients? World J Cardiol 2014; 6:764-770. [PMID: 25228955 PMCID: PMC4163705 DOI: 10.4330/wjc.v6.i8.764] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/25/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death (SCD) in the young, particularly among athletes. Identifying high risk individuals is very important for SCD prevention. The purpose of this review is to stress that noninvasive diagnostic testing is important for risk assessment. Extreme left ventricular hypertrophy and documented ventricular tachycardia and fibrillation increase the risk of SCD. Fragmented QRS and T wave inversion in multiple leads are more common in high risk patients. Cardiac magnetic resonance imaging provides complete visualization of the left ventricular chamber, allowing precise localization of the distribution of hypertrophy and measurement of wall thickness and cardiac mass. Moreover, with late gadolinium enhancement, patchy myocardial fibrosis within the area of hypertrophy can be detected, which is also helpful in risk stratification. Genetic testing is encouraged in all cases, especially in those with a family history of HCM and SCD.
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13
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How to Manage a High Defibrillation Threshold in ICD Patients: and Does it Really Matter? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:497-505. [DOI: 10.1007/s11936-013-0244-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Impact of QRS Duration and Morphology on the Risk of Sudden Cardiac Death in Asymptomatic Patients With Aortic Stenosis. J Am Coll Cardiol 2012; 59:1142-9. [DOI: 10.1016/j.jacc.2011.12.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 11/29/2011] [Accepted: 12/07/2011] [Indexed: 11/23/2022]
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Quin EM, Cuoco FA, Forcina MS, Coker JB, Yoe RH, Spencer WH, Fernandes VL, Nielsen CD, Sturdivant JL, Leman RB, Wharton JM, Gold MR. Defibrillation thresholds in hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 2010; 22:569-72. [PMID: 21091965 DOI: 10.1111/j.1540-8167.2010.01943.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Defibrillation threshold (DFT) testing is performed in part to ensure an adequate safety margin for the termination of spontaneous ventricular arrhythmias. Left ventricular mass is a predictor of high DFTs, so patients with hypertrophic cardiomyopathy (HCM) are often considered to be at risk for increased defibrillation energy requirements. However, there are little prospective data addressing this issue. OBJECTIVE To assess DFTs in patients with HCM and evaluate the clinical predictors of elevated DFTs. METHODS Eighty-nine consecutive patients with HCM and 600 control patients with ischemic or nonischemic cardiomyopathy underwent a uniform modified step-down DFT testing protocol. DFT was compared between the control and HCM populations. Predictors of elevated DFT were evaluated in the HCM group. RESULTS There was no difference in DFT between HCM and control groups (10.4 ± 5.8 J vs 11.2 ± 5.6 J, respectively). Among patients with HCM, clinical parameters such as left ventricular ejection fraction, interventricular septal thickness, left ventricular mass, and QRS duration were not predictive of an elevated DFT. Only 3 patients (3.4%) with HCM had a DFT >20 J. CONCLUSION Patients with HCM do not have elevated DFTs as compared to more typical populations undergoing implantable cardioverter-defibrillator implant; high-energy devices or complex lead systems are not needed routinely in this population.
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Affiliation(s)
- Ernest M Quin
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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16
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Perrine SA, Nayak R, Bharadwaj AS, McKelvey G, Mohamad T, Jacob S. Effect of substance abuse on defibrillation threshold in patients with implantable cardioverter-defibrillator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:193-9. [PMID: 20946279 DOI: 10.1111/j.1540-8159.2010.02907.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of recreational drugs has been observed to have deleterious effects on the heart. The aim of our study was to evaluate the effect of substance abuse on the defibrillation threshold (DFT) in patients with implantable cardioverter-defibrillators (ICDs). METHODS A retrospective analysis was conducted on patients who had undergone ICD placement at a tertiary university medical center in Detroit, Michigan. Subjects were identified based on self-reported drug use and placed into one of the three groups: controls, cocaine, and other illicit drugs. Due to a disparity in race among groups, the main analysis on DFT value was conducted on African-American patients only. Furthermore, exploratory analyses were conducted to investigate the effects of marijuana use and race on DFT values. RESULTS A history of cocaine use (n = 17) significantly increases DFT among African Americans (17.3 ± 8 Joule [J] vs 12.5 ± 5 J in cases vs controls, P < 0.05), while previous use of marijuana does not significantly influence DFT. African-American patients with a history of illicit drug use had indications for ICD implantation at an earlier age and that within the control (nondrug using) group; African Americans (n = 73) had higher DFT compared to Caucasians (n = 32), (14.5 ± 0.5 J vs 9.7 ± 0.6 J, P < 0.05). CONCLUSIONS A history of cocaine use in African Americans with ICD is a risk factor for high DFT and race itself (being African American) may be a risk for high DFT. Use of high-energy ICDs and other DFT lowering techniques may be considered for patients who have used or continue to use cocaine or in whom DFT testing cannot be performed at the time of implantation.
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Affiliation(s)
- Shane A Perrine
- Department of Psychiatry and Behavioral Neurosciences, Division of Cardiology/Electrophysiology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
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17
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Tod während der Versorgung mit einem implantierbaren Kardioverter-/Defibrillator-System. Rechtsmedizin (Berl) 2010. [DOI: 10.1007/s00194-010-0680-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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ROBERTS BRETTD, HOOD ROBERTE, SABA MAGDIM, DICKFELD TIMMM, SALIARIS ANASTASIOSP, SHOROFSKY STEPHENR. Defibrillation Threshold Testing in Patients with Hypertrophic Cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1342-6. [DOI: 10.1111/j.1540-8159.2010.02843.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Puntmann VO, Yap YG, McKenna W, Camm AJ. Significance of Maximal and Regional Left Ventricular Wall Thickness in Association With Arrhythmic Events in Patients With Hypertrophic Cardiomyopathy. Circ J 2010; 74:531-7. [DOI: 10.1253/circj.cj-09-0723] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Yee Guan Yap
- St George's, University of London, Cranmer Terrace
| | | | - A. John Camm
- St George's, University of London, Cranmer Terrace
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Kawata H, Noda T, Kurita T, Yamagata K, Yamada Y, Okamura H, Satomi K, Shimizu W, Suyama K, Aihara N, Isobe M, Kamakura S. Clinical Effect of Implantable Cardioverter Defibrillator Replacements - When Should You Resume Driving After an Implantable Cardioverter Defibrillator Replacement? -. Circ J 2010; 74:2301-7. [DOI: 10.1253/circj.cj-10-0316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiro Kawata
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Takashi Noda
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takashi Kurita
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kenichiro Yamagata
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yuko Yamada
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hideo Okamura
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kazuhiro Satomi
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Wataru Shimizu
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kazuhiro Suyama
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Naohiko Aihara
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Shiro Kamakura
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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