1
|
Lambiase PD, Maclean E. Review of the National Institute for Health and Care Excellence guidelines on the management of atrial and ventricular arrhythmias. Heart 2024; 110:313-322. [PMID: 37487695 DOI: 10.1136/heartjnl-2022-322122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/03/2023] [Indexed: 07/26/2023] Open
Abstract
The National Institute for Health and Care Excellence (NICE) guidelines present a synopsis of extensive internal evidence and technology reviews, with a particular focus on clinical efficacy and cost-effectiveness within the NHS in England. This approach has delivered a novel perspective on arrhythmia management, with important distinctions from other policymakers' recommendations. For example, when compared with the European Society of Cardiology (ESC) and the American Heart Association (AHA)/Heart Rhythm Society (HRS)/American College of Cardiology (ACC) guidelines on atrial fibrillation (AF), NICE advocates unique strategies regarding arrhythmia detection, stroke and bleeding risk stratification, and rhythm control (NICE CG 196). Likewise, for patients at risk of sudden cardiac death, NICE TA314 not only recommends device therapy based on New York Heart Association class and ECG findings, but also incorporates quality-adjusted life year data from analysis of key randomised controlled trials.This review examines the NICE guidelines, together with those from the AHA/HRS/ACC and ESC, on the management of AF and ventricular arrhythmias and highlights the key common features and discrepancies between these important documents.
Collapse
Affiliation(s)
- Pier D Lambiase
- Cardiac Electrophysiology, St Bartholomew's Hospital, London, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Edd Maclean
- Cardiac Electrophysiology, St Bartholomew's Hospital, London, UK
- Queen Mary University of London, William Harvey Research Institute, London, UK
| |
Collapse
|
2
|
Al-Aidarous S, Protonotarios A, Elliott PM, Lambiase PD. Management of arrhythmogenic right ventricular cardiomyopathy. Heart 2024; 110:156-162. [PMID: 37433658 DOI: 10.1136/heartjnl-2023-322612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disease characterised by fibrofatty replacement of the ventricular myocardium due to specific mutations, leading to ventricular arrhythmias and sudden cardiac death. Treating this condition can be challenging due to progressive fibrosis, phenotypic variations and small patient cohorts limiting the feasibility of conducting meaningful clinical trials. Although widely used, the evidence base for anti-arrhythmic drugs is limited. Beta-blockers are theoretically sound, yet their efficacy in reducing arrhythmic risk is not robust. Additionally, the impact of sotalol and amiodarone is inconsistent with studies reporting contradictory results. Emerging evidence suggests that combining flecainide and bisoprolol may be efficacious.Radiofrequency ablation has shown some potential in disrupting ventricular tachycardia circuits, with combined endo and epicardial ablation yielding better results which could be considered at the index procedure. In addition, stereotactic radiotherapy may be a future option that can decrease arrhythmias beyond simple scar formation by altering levels of Nav1.5 channels, Connexin 43 and Wnt signalling, potentially modifying myocardial fibrosis.Future therapies, such as adenoviruses and GSk3b modulation, are still in early-stage research. While implantable cardioverter-defibrillator implantation is a key intervention for reducing arrhythmic death, the risks of inappropriate shocks and device complications must be carefully considered.
Collapse
Affiliation(s)
- Sayed Al-Aidarous
- Institute of Cardiovascular Science, University College London, London, UK
| | - Alexandros Protonotarios
- Institute of Cardiovascular Science, University College London, London, UK
- St Bartholomew's Hospital, London, UK
| | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, London, UK
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiology, Saint Bartholomew's Hospital, Barts Heart Centre, London, UK
| |
Collapse
|
3
|
Hnatkova K, Andršová I, Novotný T, Vanderberk B, Sprenkeler D, Junttila J, Reichlin T, Schlögl S, Vos MA, Friede T, Bauer A, Huikuri HV, Willems R, Schmidt G, Sticherling C, Zabel M, Malik M. QRS complex and T wave planarity for the efficacy prediction of automatic implantable defibrillators. Heart 2024; 110:178-187. [PMID: 37714697 PMCID: PMC10850677 DOI: 10.1136/heartjnl-2023-322878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/19/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE To test the hypothesis that in recipients of primary prophylactic implantable cardioverter-defibrillators (ICDs), the non-planarity of ECG vector loops predicts (a) deaths despite ICD protection and (b) appropriate ICD shocks. METHODS Digital pre-implant ECGs were collected in 1948 ICD recipients: 21.4% females, median age 65 years, 61.5% ischaemic heart disease (IHD). QRS and T wave three-dimensional loops were constructed using singular value decomposition that allowed to measure the vector loop planarity. The non-planarity, that is, the twist of the three-dimensional loops out of a single plane, was related to all-cause mortality (n=294; 15.3% females; 68.7% IHD) and appropriate ICD shocks (n=162; 10.5% females; 87.7% IHD) during 5-year follow-up after device implantation. Using multivariable Cox regression, the predictive power of QRS and T wave non-planarity was compared with that of age, heart rate, left ventricular ejection fraction, QRS duration, spatial QRS-T angle, QTc interval and T-peak to T-end interval. RESULTS QRS non-planarity was significantly (p<0.001) associated with follow-up deaths despite ICD protection with HR of 1.339 (95% CI 1.165 to 1.540) but was only univariably associated with appropriate ICD shocks. Non-planarity of the T wave loop was the only ECG-derived index significantly (p<0.001) associated with appropriate ICD shocks with multivariable Cox regression HR of 1.364 (1.180 to 1.576) but was not associated with follow-up mortality. CONCLUSIONS The analysed data suggest that QRS and T wave non-planarity might offer distinction between patients who are at greater risk of death despite ICD protection and those who are likely to use the defibrillator protection.
Collapse
Affiliation(s)
- Katerina Hnatkova
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Irena Andršová
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czech Republic
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czech Republic
| | - Bert Vanderberk
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - David Sprenkeler
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Juhani Junttila
- MRC Oulu, University Central Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Simon Schlögl
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Gottingen, Germany
- German Center of Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tim Friede
- German Center of Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Axel Bauer
- University Hospital for Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Heikki V Huikuri
- University Central Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Rik Willems
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
- Division of Clinical Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Georg Schmidt
- Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | | | - Markus Zabel
- German Center of Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- Cardiology and Pneumology, Heart Center, University Hospital Göttingen, Göttingen, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czech Republic
| |
Collapse
|
4
|
Muller SA, Te Riele ASJM. Implantable cardioverter-defibrillator shocks during long-term follow-up in arrhythmogenic right ventricular cardiomyopathy. Heart 2023:heartjnl-2022-322138. [PMID: 36977546 DOI: 10.1136/heartjnl-2022-322138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Affiliation(s)
- Steven A Muller
- Cardiology, UMC Utrecht, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Anneline S J M Te Riele
- Cardiology, UMC Utrecht, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| |
Collapse
|
5
|
Vuorinen AM, Lehmonen L, Karvonen J, Holmström M, Kivistö S, Kaasalainen T. Reducing cardiac implantable electronic device-induced artefacts in cardiac magnetic resonance imaging. Eur Radiol 2023; 33:1229-1242. [PMID: 36029346 PMCID: PMC9889467 DOI: 10.1007/s00330-022-09059-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/17/2022] [Accepted: 07/24/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Cardiac implantable electronic device (CIED)-induced metal artefacts possibly significantly diminish the diagnostic value of magnetic resonance imaging (MRI), particularly cardiac MR (CMR). Right-sided generator implantation, wideband late-gadolinium enhancement (LGE) technique and raising the ipsilateral arm to the generator during CMR scanning may reduce the CIED-induced image artefacts. We assessed the impact of generator location and the arm-raised imaging position on the CIED-induced artefacts in CMR. METHODS We included all clinically indicated CMRs performed on patients with normal cardiac anatomy and a permanent CIED with endocardial pacing leads between November 2011 and October 2019 in our institution (n = 171). We analysed cine and LGE sequences using the American Heart Association 17-segment model for the presence of artefacts. RESULTS Right-sided generator implantation and arm-raised imaging associated with a significantly increased number of artefact-free segments. In patients with a right-sided pacemaker, the median percentage of artefact-free segments in short-axis balanced steady-state free precession LGE was 93.8% (IQR 9.4%, n = 53) compared with 78.1% (IQR 20.3%, n = 58) for left-sided pacemaker (p < 0.001). In patients with a left-sided implantable cardioverter-defibrillator, the median percentage of artefact-free segments reached 87.5% (IQR 6.3%, n = 9) using arm-raised imaging, which fell to 62.5% (IQR 34.4%, n = 9) using arm-down imaging in spoiled gradient echo short-axis cine (p = 0.02). CONCLUSIONS Arm-raised imaging represents a straightforward method to reduce CMR artefacts in patients with left-sided generators and can be used alongside other image quality improvement methods. Right-sided generator implantation could be considered in CIED patients requiring subsequent CMR imaging to ensure sufficient image quality. KEY POINTS • Cardiac implantable electronic device (CIED)-induced metal artefacts may significantly diminish the diagnostic value of an MRI, particularly in cardiac MRIs. • Raising the ipsilateral arm relative to the CIED generator is a cost-free, straightforward method to significantly reduce CIED-induced artefacts on cardiac MRIs in patients with a left-sided generator. • Right-sided generator implantation reduces artefacts compared with left-sided implantation and could be considered in CIED patients requiring subsequent cardiac MRIs to ensure adequate image quality in the future.
Collapse
Affiliation(s)
- Aino-Maija Vuorinen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| | - Lauri Lehmonen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| | - Jarkko Karvonen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| | - Miia Holmström
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| | - Sari Kivistö
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| | - Touko Kaasalainen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| |
Collapse
|
6
|
Sanders KH, Chousou PA, Carver K, Pugh PJ, Degens H, Azzawi M. Benefits of support groups for patients living with implantable cardioverter defibrillators: a mixed-methods systematic review and meta-analysis. Open Heart 2022; 9:openhrt-2022-002021. [PMID: 36252993 PMCID: PMC9577922 DOI: 10.1136/openhrt-2022-002021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patients with implantable cardioverter defibrillators (ICD) experience anxiety, depression and reduced quality of life (QoL). OBJECTIVES This mixed-methods systematic review evaluates whether ICD support groups have a beneficial effect on mental well-being. METHODS Literature searches were carried out in MEDLINE, Embase, CINAHL, PsycINFO and Web of Science. Eligible studies investigated patient-led support groups for ICD patients aged 18 years or older, using any quantitative or qualitative design. The Mixed-Methods Assessment Tool was used to assess quality. Meta-analysis of measures of mental well-being was conducted. Thematic synthesis was used to generate analytic themes from the qualitative data. The data were integrated and presented using the Pillar Integration Process. RESULTS Ten studies were included in this review. All studies bar one were non-randomised or had a qualitative design and patients had self-selected to attend a support group. Five contributed to the quantitative data synthesis and seven to the qualitative synthesis. Meta-analysis of anxiety and QoL measures showed no significant impact of support groups on mental well-being, but qualitative data showed that patients perceived benefit from attendance through sharing experiences and acceptance of life with an ICD. DISCUSSION ICD support group attendance improved the patients' perceived well-being. Attendees value the opportunity to share their experiences which helps to accept their new life with an ICD. Future research could consider outcomes such as patient acceptance and the role of healthcare professionals at support groups.
Collapse
Affiliation(s)
- Katie H Sanders
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK,Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Panagiota Anna Chousou
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Kathryn Carver
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter J Pugh
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hans Degens
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK,Lithuanian Sports University, Kaunas, Lithuania
| | - May Azzawi
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
7
|
Brown G, Conway S, Ahmad M, Adegbie D, Patel N, Myneni V, Alradhawi M, Kumar N, Obaid DR, Pimenta D, Bray JJH. Role of artificial intelligence in defibrillators: a narrative review. Open Heart 2022; 9:openhrt-2022-001976. [PMID: 35790317 PMCID: PMC9258481 DOI: 10.1136/openhrt-2022-001976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/17/2022] [Indexed: 02/01/2023] Open
Abstract
Automated external defibrillators (AEDs) and implantable cardioverter defibrillators (ICDs) are used to treat life-threatening arrhythmias. AEDs and ICDs use shock advice algorithms to classify ECG tracings as shockable or non-shockable rhythms in clinical practice. Machine learning algorithms have recently been assessed for shock decision classification with increasing accuracy. Outside of rhythm classification alone, they have been evaluated in diagnosis of causes of cardiac arrest, prediction of success of defibrillation and rhythm classification without the need to interrupt cardiopulmonary resuscitation. This review explores the many applications of machine learning in AEDs and ICDs. While these technologies are exciting areas of research, there remain limitations to their widespread use including high processing power, cost and the ‘black-box’ phenomenon.
Collapse
Affiliation(s)
- Grace Brown
- Cardiology Department, Royal Free Hospital, London, UK
| | - Samuel Conway
- Cardiology Department, Royal Free Hospital, London, UK
| | - Mahmood Ahmad
- Medical Sciences, University College London, London, UK
| | - Divine Adegbie
- Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | - Nishil Patel
- Cardiology Department, North Middlesex University Hospital, London, UK
| | | | | | - Niraj Kumar
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiology Department, Barts Health NHS Trust, London, UK
| | - Daniel R Obaid
- Institute of Life Sciences, Swansea University, Swansea, UK
| | - Dominic Pimenta
- Cardiology Department, Richmond Research Institute, London, UK
| | - Jonathan J H Bray
- Cardiff University College of Biomedical and Life Sciences, Cardiff, UK
| |
Collapse
|
8
|
Maille B, Bodin A, Bisson A, Herbert J, Pierre B, Clementy N, Klein V, Franceschi F, Deharo JC, Fauchier L. Predicting outcome after cardiac resynchronisation therapy defibrillator implantation: the CRT-D Futility score. Heart 2022; 108:1186-1193. [PMID: 35410895 DOI: 10.1136/heartjnl-2021-320532] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Risk-benefit for cardiac resynchronisation therapy (CRT) defibrillator (CRT-D) over CRT pacemaker remains a matter of debate. We aimed to identify patients with a poor outcome within 1 year of CRT-D implantation, and to develop a CRT-D Futility score. METHODS Based on an administrative hospital-discharge database, all consecutive patients treated with prophylactic CRT-D implantation in France (2010-2019) were included. A prediction model was derived and validated for 1-year all-cause death after CRT-D implantation (considered as futility) by using split-sample validation. RESULTS Among 23 029 patients (mean age 68±10 years; 4873 (21.2%) women), 7016 deaths were recorded (yearly incidence rate 7.2%), of which 1604 (22.8%) occurred within 1 year of CRT-D implantation. In the derivation cohort (n=11 514), the final logistic regression model included-as main predictors of futility-older age, diabetes, mitral regurgitation, aortic stenosis, history of hospitalisation with heart failure, history of pulmonary oedema, atrial fibrillation, renal disease, liver disease, undernutrition and anaemia. Area under the curve for the CRT-D Futility score was 0.716 (95% CI: 0.698 to 0.734) in the derivation cohort and 0.692 (0.673 to 0.710) in the validation cohort. The Hosmer-Lemeshow test had a p-value of 0.57 suggesting accurate calibration. The CRT-D Futility score outperformed the Goldenberg and EAARN scores for identifying futility. Based on the CRT-D Futility score, 15.9% of these patients were categorised at high risk (predicted futility of 16.6%). CONCLUSIONS The CRT-D Futility score, established from a large nationwide cohort of patients treated with CRT-D, may be a relevant tool for optimising healthcare decision-making.
Collapse
Affiliation(s)
- Baptiste Maille
- Cardiology, Assistance Publique Hopitaux de Marseille, Marseille, France .,C2VN, Aix-Marseille University, Marseille, France
| | - Alexandre Bodin
- Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Arnaud Bisson
- Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Julien Herbert
- Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Bertrand Pierre
- Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Nicolas Clementy
- Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Victor Klein
- Cardiology, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Frédéric Franceschi
- Cardiology, Assistance Publique Hopitaux de Marseille, Marseille, France.,C2VN, Aix-Marseille University, Marseille, France
| | - Jean-Claude Deharo
- Cardiology, Assistance Publique Hopitaux de Marseille, Marseille, France.,C2VN, Aix-Marseille University, Marseille, France
| | - Laurent Fauchier
- Cardiology, Trousseau University Hospital, Tours, France.,François Rabelais University, Tours, France
| |
Collapse
|
9
|
Nazari N, Sayah S, Safavi N, Hekmat M, Emkanjoo Z. Sex Difference in Clinical Outcome of Patients With Implantable Cardioverter-defibrillator. Res Cardiovasc Med 2013; 2:46-9. [PMID: 25478489 PMCID: PMC4253752 DOI: 10.5812/cardiovascmed.5027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 06/12/2012] [Accepted: 06/21/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Indications for the use of the Implantable Cardioverter-Defibrillator (ICD) have been greatly expanded in recent years, but the influence of sex on the efficacy of the ICD in eligible patients has still been remained unknown. OBJECTIVES The aim of this study was to determine the impact of sex on the effectiveness of the ICD intervention for mortality and appropriate events. MATERIALS AND METHODS This retrospective study was conducted on the outcome of the ICD therapy in 443 patients, including 341 men with a mean age of 55 ± 16 years and 102 women with a mean age of 54 ± 17 years, in our center between April 2001 and February 2007. Sex-specific cumulative probabilities of outcomes concerning mortality and appropriate ICD intervention were evaluated for the patients. RESULTS Among the 443 patients, enrolled in this study, the women and men had a mean left ventricular ejection fraction of 35 ± 14.8% and 30 ± 13.5%, respectively (P = 0.03). Ischemic heart disease was more frequent in the men than the women (P = 0.0001).The average follow-up period was 3 years. Test for an interaction between sex and the ICD treatment regarding total mortality was not significant (23 men and 6 women). Additionally, there was no significant difference in appropriate events between the women and men (129 men and 33 women). CONCLUSIONS While women were significantly less likely than the men to receive the ICD therapy, no conclusive evidence could be found for the impact of sex factor on the effectiveness of the ICD intervention with respect to mortality and appropriate events.
Collapse
Affiliation(s)
- Neshat Nazari
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Neshat Nazari, Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-Asr Ave, Niayesh Blvd, Tehran, IR Iran.Tel.: +98-2122007745, Fax: +98-2122007745, E-mail:
| | - Sima Sayah
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Nasrin Safavi
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mostafa Hekmat
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Zahra Emkanjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| |
Collapse
|
10
|
Kim JB, Joung B, Lee MH, Kim SS. Use of a tunneling technique to achieve a lower defibrillation threshold during implantable cardioverter defibrillator implantation via the right subclavian vein. J Korean Med Sci 2010; 25:1526-8. [PMID: 20890438 PMCID: PMC2946667 DOI: 10.3346/jkms.2010.25.10.1526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 12/21/2009] [Indexed: 12/02/2022] Open
Abstract
A 56-yr-old man with aborted sudden cardiac death underwent implantable cardioverter defibrillator (ICD) implantation. While the ICD was being implanted, a left subclavian venogram failed to visualize the left subclavian vein, which was attributed to likely prolonged indwelling of the left subclavian sheath for venous access. Accordingly, the right subclavian vein was punctured and the ICD lead was diverted from the right side area to the active Can in the left pectoral area by tunneling over the sternum for high defibrillation threshold. The approach used in this case may be considered in patients who had difficult left subclavicular venous access and it may be prudent to save the left subclavian vein for ICD implantation in patients with fatal tachyarrhythmia.
Collapse
Affiliation(s)
- Jin-Bae Kim
- Cardiology Division, Departmet of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Soon Kim
- Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|