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Fujito T, Nagahara D, Tsuzuki T, Kamiyama N, Mochizuki A, Miura T. High defibrillation threshold with right-sided ICD implantation was resolved by a dual coil lead via persistent left superior vena cava. J Cardiol Cases 2022; 25:262-265. [PMID: 35582083 PMCID: PMC9091524 DOI: 10.1016/j.jccase.2021.10.012] [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: 06/01/2021] [Revised: 09/30/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) can be problematic when device implantation is scheduled from the left side because of the technical difficulty in delivering leads. Right-sided implantation is an alternative method, but there is a risk of a high defibrillation threshold (DFT). Transvenous implantation of an implantable cardioverter defibrillator (ICD) was scheduled for a 54-year-old man with idiopathic dilated cardiomyopathy and monomorphic non-sustained ventricular tachycardia, but computed tomography revealed the presence of a PLSVC. Right-sided ICD implantation was performed first; however, an ICD shock at 35 J failed to terminate the induced ventricular fibrillation (VF). Re-implantation via the PLSVC by a left subclavian approach with a dual coil lead was performed next. The dual coil right ventricular lead was successfully implanted via the PLSVC, and the induced VF was terminated by a single shock at 25 J. In the present case, the proximal coil was located in the coronary sinus (CS) and it enabled an antero-posterior defibrillation vector across the left ventricle. In addition to the re-location of the ICD generator from the right side to the left side, the new positioning of the proximal coil inside the CS is likely to have contributed to the great improvement of the DFT. .
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Affiliation(s)
- Takefumi Fujito
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Daigo Nagahara
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Taro Tsuzuki
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoyuki Kamiyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Mochizuki
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
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Otsuki S, Aiba T, Tahara Y, Nakajima K, Kataoka N, Kamakura T, Wada M, Ishibashi K, Yamagata K, Inoue Y, Miyamoto K, Nagase S, Noda T, Izumi C, Noguchi T, Nishimura K, Yonemoto N, Nonogi H, Nagao K, Ikeda T, Sato N, Tsutsui H, Yasuda S, Kusano K. Intra-day change in occurrence of out-of-hospital ventricular fibrillation in Japan: The JCS-ReSS study. Int J Cardiol 2020; 318:54-60. [PMID: 32569698 DOI: 10.1016/j.ijcard.2020.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/17/2020] [Accepted: 06/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Real-world evidence of out-of-hospital ventricular fibrillation (VF), especially regarding intra-day change, remains unclear. We aimed to investigate that age- and gender-dependent difference of intra-day change of VF occurrence. METHOD We enrolled 71,692 patients (males: 56,419 [78.7%], females: 15,273 [21.3%]) in whom cardiac VF had been documented from the 2005-2015 All-Japan Utstein Registry data. Subjects were divided into four groups: group-I (<18 years old), group-II (18-39), group-III (40-69), and group-IV (≥70). Among four groups in each of male and female, we compared the intra-day change of VF occurrence, and evaluated the risk factors of the unfavorable neurologic outcomes at 1 month after VF. RESULTS Regardless of age, the incidence of VF was significantly greater in male than in female subjects. In male subjects, VF in group-I, III and IV occurred higher at daytime, however, group-II had no intra-day difference because group-II had a higher VF events at midnight~ early morning compared with other aged groups (Poisson regression analysis, p = .03). While in female, each group showed similar intra-day pattern of VF occurrence. Logistic regression analysis revealed that some of the clinical parameters such as time periods from call receipt to first shock and the presence of bystander cardiopulmonary resuscitation were important for risk of 30-day neurologically unfavorable outcomes. CONCLUSIONS The intra-day change of VF occurrence was age-dependently different in males but not in females, suggesting age- and gender-dependent differences in underlying cardiac diseases. These might affect the significant difference in unfavorable neurologic outcome.
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Affiliation(s)
- Sou Otsuki
- National Cerebral and Cardiovascular Center, Suita, Japan; Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Takeshi Aiba
- National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Yoshio Tahara
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Naoya Kataoka
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Mitsuru Wada
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | | | - Yuko Inoue
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koji Miyamoto
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Nagase
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Noda
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chisato Izumi
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | | | | | | | | | | | | | - Satoshi Yasuda
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kengo Kusano
- National Cerebral and Cardiovascular Center, Suita, Japan
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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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Rudic B, Tülümen E, Fastenrath F, Akin I, Borggrefe M, Kuschyk J. Defibrillation failure in patients undergoing replacement of subcutaneous defibrillator pulse generator. Heart Rhythm 2020; 17:455-459. [DOI: 10.1016/j.hrthm.2019.10.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Indexed: 11/30/2022]
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Left axillary active can positioning markedly reduces defibrillation threshold of a transvenous defibrillator failing to defibrillate at maximum output. HeartRhythm Case Rep 2018; 5:36-39. [PMID: 30693203 PMCID: PMC6342727 DOI: 10.1016/j.hrcr.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Watanabe M, Yokoshiki H, Mitsuyama H, Mizukami K, Tenma T, Kamada R, Takahashi M, Matsui Y, Anzai T. Long-term reliability of the defibrillator lead inserted by the extrathoracic subclavian puncture. J Arrhythm 2018; 34:541-547. [PMID: 30327700 PMCID: PMC6174403 DOI: 10.1002/joa3.12107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/02/2018] [Accepted: 07/14/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND As the transvenous defibrillator lead is fragile and its failure may cause a life-threatening event, reliable insertion techniques are required. While the extrathoracic puncture has been introduced to avoid subclavian crush syndrome, the reports on the long-term defibrillator lead survival using this approach, especially the comparison with the cephalic cutdown (CD), remain scarce. We aimed to evaluate the long-term survival of the transvenous defibrillator lead inserted by the extrathoracic subclavian puncture (ESCP) compared with CD. METHODS Between 1998 and 2011, 324 consecutive patients who underwent an implantable cardioverter-defibrillator (ICD) implantation in Hokkaido University Hospital were included. ICD leads were inserted by CD from 1998 to 2003 and by contrast venography-guided ESCP thereafter. Lead failure was defined as a nonphysiologic high-rate oversensing with abnormal lead impedance or highly elevated sensing and pacing threshold. RESULTS Of 324 patients, CD was used in 37 (11%) and ESCP in 287 patients (89%). During the median follow-up of 6.2 years (IQR:3.2-8.3), 7 leads (2 in CD and 5 leads in ESCP group) failed. All patients with lead failure in ESCP group were implanted with either SJM Riata (n = 1) or Medtronic Fidelis lead (n = 4). Five-year lead survival was 93.8% (CI95%:77.3-98.4%) in CD compared with 99.1% (CI95%:96.6-99.8%) in ESCP group (P = 0.903). Univariate Cox regression analysis showed that the use of Fidelis or Riata lead was the strong predictor of the ICD lead failure (HR 13.8, CI95%:2.9-96.5; P = 0.001). CONCLUSIONS Contrast venography-guided extrathoracic puncture ensures the reliable long-term survival in the transvenous defibrillator leads.
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Affiliation(s)
- Masaya Watanabe
- Department of Cardiovascular MedicineHokkaido University Graduate School of MedicineSapporoJapan
| | - Hisashi Yokoshiki
- Department of Cardiovascular MedicineHokkaido University Graduate School of MedicineSapporoJapan
- Department of Cardiovascular MedicineSapporo City General HospitalSapporoJapan
| | - Hirofumi Mitsuyama
- Department of Cardiovascular MedicineHokkaido University Graduate School of MedicineSapporoJapan
| | - Kazuya Mizukami
- Department of Cardiovascular MedicineHokkaido University Graduate School of MedicineSapporoJapan
| | - Taro Tenma
- Department of Cardiovascular MedicineHokkaido University Graduate School of MedicineSapporoJapan
| | - Rui Kamada
- Department of Cardiovascular MedicineHokkaido University Graduate School of MedicineSapporoJapan
| | - Masayuki Takahashi
- Department of Cardiovascular MedicineHokkaido University Graduate School of MedicineSapporoJapan
| | - Yoshiro Matsui
- Department of Cardiovascular SurgeryHokkaido University Graduate School of MedicineSapporoJapan
| | - Toshihisa Anzai
- Department of Cardiovascular MedicineHokkaido University Graduate School of MedicineSapporoJapan
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Do K, Chang P, Konecny T, Carlson SK, Tun H, Huntsinger M, Doshi RN. Predictors of Elevated Defibrillation Threshold with the Subcutaneous Implantable Cardioverter-defibrillator. J Innov Card Rhythm Manag 2017; 8:2920-2929. [PMID: 32494435 PMCID: PMC7252865 DOI: 10.19102/icrm.2017.081203] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/07/2017] [Indexed: 11/06/2022] Open
Abstract
There are limited data regarding defibrillation thresholds (DFTs) for the subcutaneous implantable cardioverter-defibrillator (S-ICD), and factors associated with elevated DFTs remain incompletely understood. The objective of this study was to determine the factors associated with elevated DFTs in patients undergoing S-ICD implantation. A retrospective cross-sectional analysis of all patients undergoing S-ICD implantation at our institution between 2013 and 2016 who underwent step-down DFT testing was performed. Factors associated with a higher DFT were analyzed. In total, 56 patients (mean age: 49.3 ± 13.1 years, mean left ventricular ejection rate: 31.1% ± 13.7%) underwent S-ICD implantation in the study period. Full DFT testing was performed in 31 of the 56 patients (55%), with an average DFT of 46.4 joules (J) ± 25.9 J found among this cohort. The DFT was > 65 J in five of the 31 patients (16%). A high DFT was associated with increased body mass index (BMI) (37.7 kg/m2 versus 29.4 kg/m2; p = 0.02) and either increased septal or posterior wall thickness (1.5 cm versus 1.0 cm; p = 0.0003 and 1.4 cm versus 1.1 cm; p= 0.003, respectively). Patients with high DFTs also had higher failed shock impedance values (138 Ω versus 71 Ω; p = 0.005). Renal failure did not appear to affect DFT (51.4 J versus 51.7 J; p = 0.99). BMI, body surface area (BSA), and septal and posterior left ventricular wall thickness predicted elevated DFT on univariate analysis, although findings were not significant with multivariate analysis due to the small sample size. Thus, elevated S-ICD DFT appears to be associated with increased BMI, BSA, and septal or posterior wall thickness. In contrast, dialysis-dependent renal failure is not associated with elevated DFT. Further investigation is necessary in order to better characterize and predict which patients are at-risk for high DFTs.
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Affiliation(s)
- Khuyen Do
- Keck USC Medical Center and LAC-USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Philip Chang
- Keck USC Medical Center and LAC-USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Tomas Konecny
- Keck USC Medical Center and LAC-USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Steven K Carlson
- Keck USC Medical Center and LAC-USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Han Tun
- Keck USC Medical Center and LAC-USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Mary Huntsinger
- Keck USC Medical Center and LAC-USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Rahul N Doshi
- Keck USC Medical Center and LAC-USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
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Yokoshiki H, Shimizu A, Mitsuhashi T, Furushima H, Sekiguchi Y, Manaka T, Nishii N, Ueyama T, Morita N, Okamura H, Nitta T, Hirao K, Okumura K. Survival and Heart Failure Hospitalization in Patients With Cardiac Resynchronization Therapy With or Without a Defibrillator for Primary Prevention in Japan - Analysis of the Japan Cardiac Device Treatment Registry Database. Circ J 2017. [PMID: 28626201 DOI: 10.1253/circj.cj-17-0234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Randomized control trials comparing the effectiveness of cardiac resynchronization therapy devices, with (CRT-D) or without (CRT-P) a defibrillator, are scarce in heart failure patients with no prior sustained ventricular tachyarrhythmias.Methods and Results:The Japan Cardiac Device Treatment Registry (JCDTR) has data for 2714 CRT-D and 555 CRT-P recipients for primary prevention with an implantation date between January 2011 and August 2015. Of these patients, follow-up data were available for 717. Over the mean follow-up period of 21 months, Kaplan-Meier curves of survival free of combined events for all-cause death or heart failure hospitalization (whichever came first) diverged between the CRT-D (n=620) and CRT-P (n=97) groups with a rate of 22% vs. 42%, respectively, at 24 months (P=0.0011). However, this apparent benefit of CRT-D over CRT-P was no longer significant after adjustment for covariates. With regard to mortality, including heart failure death or sudden cardiac death, there was no significant difference between the 2 groups. CONCLUSIONS In patients without sustained ventricular tachyarrhythmias enrolled in the JCDTR, there was no significant difference in mortality between the CRT-D and CRT-P groups, despite a lower trend in CRT-D recipients. This study was limited by large clinical and demographic differences between the 2 groups.
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Affiliation(s)
- Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Akihiko Shimizu
- Faculty of Health Sciences, Yamaguchi Graduate School of Medicine
| | - Takeshi Mitsuhashi
- Cardiovascular Medicine, Jichi Medical University Saitama Medical Center
| | | | - Yukio Sekiguchi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | | | - Nobuhiro Nishii
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Takeshi Ueyama
- Division of Cardiology, Department of Medicine and Clinical Sciences, Yamaguchi Graduate School of Medicine
| | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | - Hideo Okamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University
| | - Ken Okumura
- Cardiovascular Center, Saiseikai Kumamoto Hospital
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Kodani T, Mine T, Kishima H, Masuyama T. The Effects of Shock from Defibrillation Threshold Testing on Cardiac Systolic and Diastolic Function. Pacing Clin Electrophysiol 2016; 39:999-1005. [PMID: 27380898 DOI: 10.1111/pace.12915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 05/15/2016] [Accepted: 06/17/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inappropriate implantable cardioverter defibrillator (ICD) shocks are associated with increased overall mortality. However, it remains unclear whether shocks from defibrillation threshold (DFT) testing directly impair cardiac function. METHODS DFT testing was performed in 34 patients who underwent ICD/cardiac resynchronization therapy with a defibrillator implantation/generator exchange. Heart rate and cardiac function, including left ventricular (LV) systolic pressure, LV end-diastolic pressure, peak positive and negative dp/dt ( + dp/dt and -dp/dt, respectively) of LV pressure, and the tau index, were assessed with a Mikro-Cath™ diagnostic pressure catheter (CD Leycom, Zoetermeer, the Netherlands). These parameters were measured before and 1 minute, 3 minutes, 5 minutes, 10 minutes, and 15 minutes after DFT testing. RESULTS Peak positive dp/dt increased over baseline at each interval (976 ± 229 mm Hg/s vs 1,039 ± 258, 1,049 ± 245, 1,042 ± 247, 1,037 ± 259, and 1,034 ± 254 mm Hg/s, respectively; P < 0.01). Furthermore, peak negative dp/dt (-1,140 ± 397 mm Hg/s vs -1,185 ± 447, 1,193 ± 435, -1,195 ± 434, -1,189 ± 449, and -1,186 ± 459 mm Hg/s, respectively; P < 0.01) and the tau index (65.1 ± 18.5 vs 62.5 ± 16.8*, 62.4 ± 15.9(**) , 63.0 ± 16.8*, and 62.8 ± 18.7*, respectively; *P < 0.05, (**) P < 0.01) decreased compared to those at baseline at each interval. CONCLUSION Shock after DFT testing improved LV systolic and diastolic function immediately, especially in patients with preserved LV ejection fraction.
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Affiliation(s)
- Takeshi Kodani
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takanao Mine
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Hideyuki Kishima
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Ishigaki D, Kutsuzawa D, Arimoto T, Iwayama T, Hashimoto N, Kumagai Y, Nishiyama S, Takahashi H, Shishido T, Miyamoto T, Nitobe J, Fukui A, Watanabe T, Kubota I. The association between defibrillation shock energy and acute cardiac damage in patients with implantable cardioverter defibrillators. J Arrhythm 2016; 32:481-485. [PMID: 27920833 PMCID: PMC5129114 DOI: 10.1016/j.joa.2016.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/12/2016] [Accepted: 03/31/2016] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The aim of this study was to establish a minimally invasive defibrillation testing (DT) protocol for patients with implantable cardioverter defibrillators (ICDs). METHODS Two different energy DTs were performed, immediately after (15 J-DT) and 7 days after (≤10 J-DT) device implantation, in 20 consecutive ICD implantation patients. Cardiac-troponin T (c-TNT) and heart-type fatty acid binding protein (H-FABP) levels were measured before implantation, 2 h after implantation, and 1 day after each DT. For an additional 122 patients with ICD, we retrospectively analyzed 203 DTs immediately and 7 days after device implantation. RESULTS Serum c-TNT levels were significantly elevated 2 h after 15 J-DT [0.008 (0.004-0.019) vs. 0.053 (0.037-0.068) ng/mL, p<0.001], but not ≤10 J-DT [0.007 (0.004-0.018) ng/mL]. Similarly, serum H-FABP levels were significantly elevated 2 h after 15 J-DT (2.9±1.5 vs. 6.4±3.4 ng/mL, p<0.001), but not ≤10 J-DT (2.7±1.5 ng/mL). The changes in c-TNT and H-FABP levels between baseline and 2 h after DT were significantly greater for 15 J-DT compared with ≤10 J-DT [c-TnT: 0.039 (0.029-0.060) vs. 0 (0-0.003) ng/mL, p<0.001; H-FABP: 3.6±2.8 vs. -0.16±1.1 ng/mL, p<0.001]. The success rates of the initial shocks delivered for ventricular fibrillation were no different between ≤10 J-DT (85% [78/92]) and ≥15 J-DT (92% [103/111]). CONCLUSIONS Elevated levels of myocardial damage markers such as c-TNT and H-FABP were not found after ≤10 J-DT. In addition, an acceptable success rate was confirmed in ≤10 J-DT.
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Affiliation(s)
- Daisuke Ishigaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Daisuke Kutsuzawa
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Takanori Arimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Tadateru Iwayama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Naoaki Hashimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Yu Kumagai
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Satoshi Nishiyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Hiroki Takahashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Tetsuro Shishido
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Takuya Miyamoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Joji Nitobe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Akio Fukui
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Isao Kubota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
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Noro M, Zhu X, Enomoto Y, Oikawa Y, Tatsunami H, Ishii R, Toyoda Y, Asami M, Sahara N, Takagi T, Narabayashi Y, Hashimoto H, Ito N, Kujime S, Sakai T, Nakamura K, Sakata T, Abe H, Sugi K. Decreased Defibrillation Threshold and Minimized Myocardial Damage With Left Axilla Implantable Cardioverter Defibrillator Implantation. Circ J 2016; 80:878-86. [PMID: 26888267 DOI: 10.1253/circj.cj-15-1258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To reduce myocardial damage caused by implantable cardioverter defibrillator (ICD) shock, the left axilla was studied as an alternative pulse generator implantation site, and compared with the traditional implantation site, the left anterior chest. METHODS AND RESULTS Computer simulation was used to study the defibrillation conduction pattern and estimate the simulated defibrillation threshold (DFT) and myocardial damage when pulse generators were placed in the left axilla and left anterior chest, respectively; pulse generators were also newly implanted in the left axilla (n=30) and anterior chest (n=40) to compare the corresponding DFT. On simulation, when ICD generators were implanted in the left axilla, compared with the left anterior chest, the whole heart may be defibrillated with a lower defibrillation energy (left axilla 6.4 J vs. left anterior chest 12.0 J) and thus the proportion of cardiac myocardial damage may be reduced (2.1 vs. 4.2%). Clinically, ventricular fibrillation was successfully terminated with a defibrillation output ≤5 J in 86.7% (26/30) of the left axillary group, and in 27.5% (11/40) of the left anterior group (P<0.001). CONCLUSIONS Clinically and theoretically, the left axilla was shown to be an improved ICD implantation site that may reduce DFT and lessen myocardial damage due to shock. Lower DFT also facilitates less myocardial damage, as a result of the lower shock required.
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Affiliation(s)
- Mahito Noro
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
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12
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Noro M, Zhu X, Enomoto Y, Asami M, Ishii R, Toyoda Y, Sahara N, Takagi T, Narabayasi Y, Hashimoto H, Ito N, Kujime S, Oikawa Y, Tatsunami H, Sakai T, Nakamura K, Sakata T, Sugi K. Efficacy and Myocardial Injury With Subcutaneous Implantable Cardioverter Defibrillators – Computer Simulation of Defibrillation Shock Conduction –. Circ J 2016; 80:85-92. [DOI: 10.1253/circj.cj-15-0883] [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)
- Mahito Noro
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Xin Zhu
- Biomedical Information Technology Lab, University of Aizu
| | - Yoshinari Enomoto
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Masako Asami
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Rina Ishii
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Yasutake Toyoda
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Naohiko Sahara
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Takahito Takagi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Yuriko Narabayasi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hikari Hashimoto
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Naoshi Ito
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Shingo Kujime
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | | | | | - Tsuyoshi Sakai
- Division of Cardiovascular Medicine, Saiseikai Yokohama Eastern Hospital
| | - Keijirou Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Takao Sakata
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Kaoru Sugi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
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13
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Bertomeu-González V, Moreno-Arribas J, Castillo-Castillo J, Martínez-Ferrer J, Viñolas X, Rodríguez A, Díaz-Infante E, Fernández-Lozano I, Alzueta J, Fontenla A. Etiology and Programming Effects on Shock Efficacy in ICD Recipients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:73-80. [PMID: 26450114 DOI: 10.1111/pace.12765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/20/2015] [Accepted: 09/24/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND We sought to assess the efficacy of high-energy shocks to restore rhythm and predictors of success in patients with sustained ventricular arrhythmias and implantable cardioverter defibrillator (ICD). METHODS AND RESULTS Data from 162 patients included in the UMBRELLA study that experienced one or more episodes of ventricular tachycardia (VT) for which ICD shocks of at least 30 Joules were delivered (appropriate high-energy shocks) were analyzed. In total, 456 ventricular arrhythmia episodes were registered. Forty four episodes (9.6%) from 39 patients (24%) had at least one ineffective high-energy shock delivered. Hypertrophic cardiomyopathy was more frequent among patients with unsuccessful shocks (10.3% vs 2.4%). Patients with ineffective shocks had higher proportion of sustained monomorphic ventricular arrhythmias (86.4%; the other 13.6% were sustained polymorphic and ventricular fibrillation [VF]) compared with patients with all their shocks effective (62.9%, P = 0.02). No statistical differences were found between groups in time from detection to the high-energy shock delivery, in tachycardia cycle length, or in antitachycardia pacing, but patients with ineffective high-energy shocks had higher proportion of previously ineffective low-energy shock (9.1% vs 0.5%, P = 0.01). CONCLUSION We found a substantial rate of ineffective high-energy shocks for the treatment of VT or VF in patients with ICD. High-energy shock efficacy seems to be reduced by hypertrophic cardiomyopathy and by the administration of previous low-energy shocks.
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Affiliation(s)
| | - José Moreno-Arribas
- Hospital Universitario de San Juan, Universidad Miguel Hernandez, Alicante, Spain
| | | | | | | | - Aníbal Rodríguez
- Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | | | - Javier Alzueta
- Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
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