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Tang JE, Dodge RE, Guirguis F, Kumar N, Arango S, Holloway JO, Wernke C, Gorelik LA, Dimitrova GT, Savona SJ, Essandoh MK, Iyer MH. New Horizons in Nontransvenous Arrhythmia Management: Aurora Extravascular ICD. J Cardiothorac Vasc Anesth 2025; 39:1564-1570. [PMID: 40133098 DOI: 10.1053/j.jvca.2025.01.029] [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: 12/16/2024] [Accepted: 01/20/2025] [Indexed: 03/27/2025]
Abstract
Traditionally, transvenous implantable cardioverter-defibrillators (ICDs) have served as the cornerstone of sudden cardiac death treatment; however, transvenous implantable ICDs carry significant short- and long-term risks of complications associated with intravascular and intracardiac leads. Attempts to migrate from the transvenous components resulted in the development of the subcutaneous ICD, which successfully terminates life-threatening ventricular tachyarrhythmias. However, the subcutaneous ICD has limitations, including the need for higher defibrillation energy, a lack of bradycardic pacing, and a lack of antitachycardia pacing for terminating ventricular tachycardias. The Aurora Extravascular ICD (ICD, Medtronic, Minneapolis, MN) introduces a novel substernal lead placement and represents a notable advancement in the prevention of sudden cardiac death from ventricular tachyarrhythmias by integrating defibrillation therapy with short-term bradycardia and antitachycardia pacing capabilities without the need for transvenous leads. With the introduction of this novel device in clinical practice, anesthesiologists need to understand what makes the extravascular ICD system unique and how to manage it appropriately during the perioperative period.
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Affiliation(s)
- Jonathan E Tang
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH.
| | - Ryan E Dodge
- Department of Anesthesiology, Massachusetts General Hospital, Boston, MA
| | - Fady Guirguis
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Nicolas Kumar
- Department of Anesthesiology, Massachusetts General Hospital, Boston, MA
| | - Susana Arango
- Department of Anesthesiology, Massachusetts General Hospital, Boston, MA
| | - Jordan O Holloway
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Cassidy Wernke
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Leonid A Gorelik
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Galina T Dimitrova
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Salvatore J Savona
- Division of Cardiovascular Medicine, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael K Essandoh
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Manoj H Iyer
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
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Yokoshiki H, Watanabe M, Hamaguchi S, Tsutsui H, Shimizu A, Mitsuhashi T, Ishibashi K, Kabutoya T, Yoshiga Y, Kondo Y, Temma T, Takagi M, Tada H. Survival benefit of primary prevention implantable cardioverter-defibrillator/cardiac resynchronization therapy with a defibrillator: Analysis of the Japan cardiac device treatment registry and Japanese cardiac registry of heart failure in cardiology. J Arrhythm 2025; 41:e70084. [PMID: 40357355 PMCID: PMC12067054 DOI: 10.1002/joa3.70084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2025] [Revised: 04/06/2025] [Accepted: 04/28/2025] [Indexed: 05/15/2025] Open
Abstract
Background Evidence supporting the benefit from primary prevention implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy with a defibrillator (CRT-D) for heart failure with reduced ejection fraction (HFrEF) is scarce in real-world settings. Methods We analyzed propensity score matched cohorts of patients eligible for Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) from Japan cardiac device treatment registry (JCDTR) and Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). The former served as the defibrillator therapy group and the latter as the conventional therapy group. Results During an average follow-up of 24 months, death occurred in 35 of 285 patients (12%) with defibrillator therapy and 65 of 285 patients (23%) with conventional therapy. Adjusted hazard ratios of all-cause death, sudden death, heart failure death, and noncardiac death in defibrillator versus conventional therapy were 0.616 (95% confidence interval [CI]: 0.402-0.943, p = 0.026), 0.274 (95% CI: 0.103-0.731, p = 0.0097), 0.362 (95% CI: 0.172-0.764, p = 0.0077) and 1.45 (95% CI: 0.711-2.949, p = 0.31). After accounting for death without appropriate defibrillator therapy as a competing risk, the cumulative incidence of first appropriate defibrillator therapy in the defibrillator therapy group was nearly identical to that of all-cause death in the conventional therapy group. Subgroup analyses indicated a lack of defibrillator benefit in patients with hypertension (p = 0.01 for interaction). Conclusions Primary prevention ICD/CRT-D reduced the risk of all-cause mortality of patients with HFrEF eligible for SCD-HeFT compared to conventional therapy in the real-world cohort.
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Affiliation(s)
- Hisashi Yokoshiki
- Department of Cardiovascular MedicineSapporo City General HospitalSapporoJapan
| | - Masaya Watanabe
- Department of Cardiovascular MedicineHokko Memorial HospitalSapporoJapan
| | - Sanae Hamaguchi
- Department of Cardiovascular MedicineSapporo City General HospitalSapporoJapan
| | - Hiroyuki Tsutsui
- School of Medicine and Graduate SchoolInternational University of Health and WelfareOtawaraJapan
| | | | - Takeshi Mitsuhashi
- Department of Cardiovascular MedicineHoshi General HospitalKoriyamaJapan
| | - Kohei Ishibashi
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular Medicine, Department of MedicineJichi Medical University School of MedicineShimotsukeJapan
| | - Yasuhiro Yoshiga
- Division of Cardiology, Department of Medicine and Clinical ScienceYamaguchi University Graduate School of MedicineUbeJapan
| | - Yusuke Kondo
- Department of Cardiovascular MedicineChiba University Graduate School of MedicineChibaJapan
| | - Taro Temma
- Department of Cardiovascular MedicineHokkaido University HospitalSapporoJapan
| | - Masahiko Takagi
- Division of Cardiac ArrhythmiaKansai Medical University Medical CentreMoriguchiJapan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical SciencesUniversity of FukuiFukuiJapan
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Zhang JJ, Pogwizd SM, Fukuda K, Zimmermann WH, Fan C, Hare JM, Bolli R, Menasché P. Trials and tribulations of cell therapy for heart failure: an update on ongoing trials. Nat Rev Cardiol 2025; 22:372-385. [PMID: 39548233 DOI: 10.1038/s41569-024-01098-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2024] [Indexed: 11/17/2024]
Abstract
Heart failure (HF) remains a leading cause of mortality, responsible for 13% of all deaths worldwide. The prognosis for patients with HF is poor, with only a 50% survival rate within 5 years. A major challenge of ischaemia-driven HF is the loss of cardiomyocytes, compounded by the minimal regenerative capacity of the adult heart. To date, replacement of irreversibly damaged heart muscle can only be achieved by complete heart transplantation. In the past 20 years, cell therapy has emerged and evolved as a promising avenue for cardiac repair and regeneration. During this time, cell therapy for HF has encountered substantial barriers in both preclinical studies and clinical trials but the field continues to progress and evolve from lessons learned from such research. In this Review, we provide an overview of ongoing trials of cell-based and cell product-based therapies for the treatment of HF. Findings from these trials will facilitate the clinical translation of cardiac regenerative and reparative therapies not only by evaluating the safety and efficacy of specific cell-based therapeutics but also by establishing the feasibility of novel or underexplored treatment protocols such as repeated intravenous dosing, personalized patient selection based on pharmacogenomics, systemic versus intramural cell delivery, and epicardial engraftment of engineered tissue products.
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Affiliation(s)
- Jianyi Jay Zhang
- Department of Biomedical Engineering, School of Medicine, School of Engineering, The University of Alabama at Birmingham, Birmingham, AL, USA.
- Division of Cardiovascular Disease, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Steven M Pogwizd
- Division of Cardiovascular Disease, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Wolfram-Hubertus Zimmermann
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen - Georg-August-University, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Lower Saxony, Göttingen, Germany
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Göttingen, Germany
| | - Chengming Fan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Joshua M Hare
- Department of Medicine, Interdisciplinary Stem Cell Institute (ISCI), University of Miami, Miami, FL, USA
| | - Roberto Bolli
- Institute of Molecular Cardiology, University of Louisville, Louisville, KY, USA
| | - Philippe Menasché
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, Université de Paris, PARCC, INSERM, Paris, France
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Sanders DJ, Mazur A. Transvenous leads' last stand: Non-transvenous defibrillators and a leadless future. Trends Cardiovasc Med 2025:S1050-1738(25)00048-9. [PMID: 40204201 DOI: 10.1016/j.tcm.2025.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2025] [Accepted: 03/28/2025] [Indexed: 04/11/2025]
Affiliation(s)
- David J Sanders
- Division of Cardiology, Section of Electrophysiology, University of Illinois Chicago, Chicago, IL, 60607 USA
| | - Alexander Mazur
- Division of Cardiology, Section of Electrophysiology, Rush University Medical Center, Chicago, IL, 60612 USA.
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Goldenberg I, Ezekowitz J, Albert C, Alexis JD, Anderson L, Behr ER, Daubert J, Di Palo KE, Ellenbogen KA, Dzikowicz DJ, Hsich E, Huang DT, Januzzi JL, Kutyifa V, Lala A, Onwuanyi A, Piña IL, Sandhu RK, Sears S, Sroubek J, Strawderman R, Zareba W, Butler J. Reassessing the need for primary prevention implantable cardioverter-defibrillators in contemporary patients with heart failure. Heart Rhythm 2025; 22:1040-1051. [PMID: 39918486 DOI: 10.1016/j.hrthm.2024.10.078] [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: 08/20/2024] [Revised: 09/27/2024] [Accepted: 10/13/2024] [Indexed: 04/01/2025]
Abstract
The main function of the implantable cardioverter-defibrillator (ICD) is to protect against sudden cardiac death (SCD) due to ventricular tachyarrhythmia (VTA). Current guidelines provide a recommendation to implant a prophylactic ICD for the primary prevention of SCD in individuals having heart failure with reduced ejection fraction (HFrEF) who never experienced a previous sustained VTA. However, these recommendations are based on clinical trials conducted more than 20 years ago and may not be applicable to contemporary patients with HFrEF who have a lower arrhythmic risk as a result of advances in heart failure medical therapies. Thus, there is an unmet need for more appropriate selection of contemporary patients with HFrEF for a primary prevention ICD. In this article, we review data underlying the current clinical equipoise on the need for routine implantation of a primary prevention ICD in patients with HFrEF and the rationale for conducting clinical trials that aim to reassess the role of the ICD in this population.
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Affiliation(s)
- Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York.
| | - Justin Ezekowitz
- The Canadian VIGOUR Centre at the University of Alberta, Edmonton, Alberta, Canada
| | - Christine Albert
- Department of Cardiology Cedars-Sinai Medical Center, Los Angeles, California
| | - Jeffrey D Alexis
- Division of Cardiology, Department of Medicine, University of Rochester, Rochester, New York
| | - Lisa Anderson
- Cardiovascular and Genomics Research Institute, St. George's, University of London, London, United Kingdom; Cardiology, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, Department of Cardiology, Mayo Clinic Healthcare, London, United Kingdom
| | - Elijah R Behr
- Cardiovascular and Genomics Research Institute, St. George's, University of London, London, United Kingdom; Cardiology, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, Department of Cardiology, Mayo Clinic Healthcare, London, United Kingdom
| | | | | | - Kenneth A Ellenbogen
- Department of Cardiology, Virginia Commonwealth University Health, Richmond, Virginia
| | - Dillon J Dzikowicz
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York
| | - Eileen Hsich
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - David T Huang
- Division of Cardiology, Department of Medicine, University of Rochester, Rochester, New York
| | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School, Baim Institute for Clinical Research, Boston, Massachusetts
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York
| | - Anuradha Lala
- Department of Cardiology, Mount Sinai Medical Center, New York, New York
| | - Anekwe Onwuanyi
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia
| | - Ileana L Piña
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Roopinder K Sandhu
- Department of Cardiology, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Sears
- Department of Cardiology and Department of Psychology, East Carolina University, Greenville, North Carolina
| | - Jakub Sroubek
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Robert Strawderman
- Department of Biostatistics, University of Rochester, Rochester, New York
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York
| | - Javed Butler
- Baylor Scott and White Research Institute and HealthCare, Dallas, Texas.
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Zipes DP. Cardiac defibrillation in humans. Heart Rhythm 2025; 22:600-601. [PMID: 40023518 DOI: 10.1016/j.hrthm.2024.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 08/19/2024] [Indexed: 03/04/2025]
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Gangadharan A, Peigh G, Arif M, Baman J, Patil K, Chicos A, Kim SS, Lin AC, Pfenniger A, Passman RS, Knight BP, Verma N. Rates of and Indications for Subcutaneous ICD Extraction: A Multihospital Healthcare System Analysis. J Cardiovasc Electrophysiol 2025; 36:168-176. [PMID: 39523771 PMCID: PMC11726997 DOI: 10.1111/jce.16493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 09/12/2024] [Accepted: 10/28/2024] [Indexed: 11/16/2024]
Abstract
INTRODUCTION The subcutaneous implantable cardioverter defibrillator (S-ICD) is an alternative to a transvenous ICD in patients who meet the criteria for ICD implantation without concurrent need for cardiac pacing. The objective of this study is to examine the rates of and indications for S-ICD removal and extraction. METHODS A retrospective analysis of all patients who underwent S-ICD implantation between 2010 and 2022 at a single multihospital healthcare system was performed. The primary endpoint was S-ICD removal or extraction. Patient and device characteristics were abstracted from the electronic medical record. Univariate and multivariate analyses were completed to determine factors associated with S-ICD extraction. RESULTS A total of 372 patients (69.5% male; 48.6 ± 14.4 years old) underwent S-ICD implantation during the study period. There were 22 (5.9%) patients (81.8% male; 52.1 ± 13.2 years old) who underwent S-ICD extraction over a median follow-up period of 4.4 [2.0-6.5] years. The median length of time between implantation and extraction was 39.6 [8.3-64.6] months. The most common indications for S-ICD extraction were the need for bradycardia pacing (frequency among extractions, 18.2%), infection (22.7%), and inappropriate shocks due to oversensing (22.7%). A smoking history and higher body mass index were independently associated with S-ICD extraction. CONCLUSIONS The overall rate of S-ICD extraction over 4.4 [2.0-6.5] years was 5.9%, with the most common indications for extraction being the need for bradycardia pacing, infection, and inappropriate shocks due to oversensing. A smoking history and high body mass index are associated with increased rates of S-ICD extraction. With appropriate patient selection for the S-ICD, the need to remove the device after implantation is low.
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Affiliation(s)
- Arati Gangadharan
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Graham Peigh
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Mariam Arif
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Jayson Baman
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Kaustubha Patil
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Alexandru Chicos
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Susan S. Kim
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Albert C. Lin
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Anna Pfenniger
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Rod S. Passman
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Bradley P. Knight
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Nishant Verma
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
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Tang JE, Guirguis F, Iyer MH, Essandoh MK, Gorelik LA. Modular Cardiac Rhythm Management: Tailoring Nontransvenous Arrhythmic Treatment. J Cardiothorac Vasc Anesth 2025; 39:20-23. [PMID: 39489668 DOI: 10.1053/j.jvca.2024.09.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 09/25/2024] [Indexed: 11/05/2024]
Affiliation(s)
- Jonathan E Tang
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH.
| | - Fady Guirguis
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Manoj H Iyer
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael K Essandoh
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Leonid A Gorelik
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
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9
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Yao-Cheng Ho C, Stiles MK. Lead Management: Device Programming and Defibrillation Threshold Testing. Card Electrophysiol Clin 2024; 16:347-357. [PMID: 39461826 DOI: 10.1016/j.ccep.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2024]
Abstract
Implantable cardioverter-defibrillators (ICDs) reduce sudden cardiac death (SCD) and improve survival in patients with a history of life-threatening arrhythmia or sudden cardiac arrest, and in select populations at high risk of SCD due to ventricular arrhythmias. However, patients with ICDs may receive inappropriate or unnecessary shocks, which have been associated with pro-arrhythmia, psychological sequelae, poor quality of life, and increased mortality. The benefits and risks of ICD therapy are therefore directly impacted on by physician operative and programming decisions. This article aims to provide a detailed review of transvenous ICD programming as guided by clinical trials.
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Affiliation(s)
- Charles Yao-Cheng Ho
- Department of Cardiology, Waikato Hospital, 183 Pembroke Street, Hamilton 3204, New Zealand.
| | - Martin K Stiles
- Department of Cardiology, Waikato Hospital, 183 Pembroke Street, Hamilton 3204, New Zealand; Waikato Clinical School, University of Auckland, Waikato Hospital, 183 Pembroke Street, Hamilton 3204, New Zealand
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10
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Singu S, Dearing BD, Robichaux RP, Buckley RS. The Plumber Versus Electrician Dilemma: To Bypass or to Defibrillate? Cureus 2024; 16:e58543. [PMID: 38957826 PMCID: PMC11218923 DOI: 10.7759/cureus.58543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 07/04/2024] Open
Abstract
We present a unique case of an 80-year-old male who presented to our emergency department following cardiac defibrillation when he was found to be in polymorphic ventricular tachycardia (VT) after a syncopal event while at cardiac rehabilitation. He had known coronary artery disease and had a four-vessel coronary artery bypass graft (CABG) 20 years prior to presentation. He underwent left heart catheterization (LHC) two months prior to the syncopal event for worsening shortness of breath and the decision at that time was to proceed with medical management and intervene with redo-CABG if shortness of breath did not improve or progressively worsened. While admitted under our care after the polymorphic VT event, we faced the dilemma of whether to proceed with redo-CABG first since cardiac ischemia is a common cause of polymorphic VT or whether to insert an implantable cardioverter-defibrillator (ICD) before proceeding with redo-CABG. We present the current literature that addresses ICD implantation for secondary prevention and our approach to this complicated case.
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Affiliation(s)
- Sravani Singu
- Internal Medicine, Thomas Hospital, Infirmary Health, Fairhope, USA
| | - Brian D Dearing
- Clinical and Interventional Cardiology, Cardiology Associates, Fairhope, USA
| | | | - Ralph S Buckley
- Clinical and Non-Invasive Cardiology, Cardiology Associates, Fairhope, USA
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11
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Block M, Klein HU. [History of the implantable cardioverter-defibrillator in Germany]. Herzschrittmacherther Elektrophysiol 2024; 35:55-67. [PMID: 38421401 PMCID: PMC10923992 DOI: 10.1007/s00399-024-01001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
The implantable cardioverter-defibrillator (ICD) was a breakthrough in the prevention of sudden cardiac death. After years of technical development in the USA, Michel Mirowski succeeded in proving reliable automatic defibrillation of ventricular tachyarrhythmias through initial human implantations in 1980, despite many obstacles. Nearly 4 years later, the first patients received ICDs at multiple centers in Germany. Subsequently, outside the USA, Germany became the country with highest implantation rates. The absolute number of implantations remained small as long as implantations required epicardial defibrillation electrodes and therefore thoracotomy by cardiac surgeons. Pacemaker-like implantation using a transvenous defibrillation electrode with a pectoral ICD became feasible in the early 1990s pushing implantation rates to the next level. Technical advancements were accompanied by clinical research in Germany, and often, the first-in-human studies were conducted in Germany. In 1991, the first guidelines for indications were established in the USA and Germany. Several randomized studies on indications were published between 1996 and 2009, mostly led by American teams with German participation, but also under German leadership (CASH, CAT, DINAMIT, IRIS). The DANISH study in 2016 questioned the results of these long-standing studies. Instead of providing ICDs to patients using a broad indication, future efforts aim to identify patients who, despite optimal medical therapy, cardiac resynchronization therapy (CRT), and/or catheter ablation, need protection against sudden cardiac death. Risk scores incorporating myocardial scars in magnetic resonance imaging (MRI) and genetic information are expected to contribute to more individualized and effective indications.
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Beggs SAS, Wright GA, Gardner RS. Primary prevention implantable cardioverter defibrillators for patients with heart failure. Heart 2023; 110:65-73. [PMID: 37463731 DOI: 10.1136/heartjnl-2022-321728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Affiliation(s)
- Simon A S Beggs
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gary A Wright
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Clydebank, UK
| | - Roy S Gardner
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Clydebank, UK
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Sahu P, Acharya S, Totade M. Evolution of Pacemakers and Implantable Cardioverter Defibrillators (ICDs) in Cardiology. Cureus 2023; 15:e46389. [PMID: 37927638 PMCID: PMC10620620 DOI: 10.7759/cureus.46389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Pacemakers and implantable cardioverter defibrillators (ICDs) have revolutionized cardiology by providing life-saving interventions for patients with cardiac rhythm disturbances. Pacing the heart is an effective treatment for people suffering from bradycardia caused by sinus node dysfunction or atrioventricular (AV) block, and electronic pacing has saved countless lives since its introduction into clinical practice. AV synchronization is the typical cycle of atrial depolarization and contraction followed by ventricular depolarization and contraction. The continuation of this cycle leads to appropriate ventricular filling and cardiac output. By contrast, the failure of the cycle results in AV asynchrony, which may result in heart failure. Cardiac resynchronization treatment (CRT) involves using customized pacemakers with or without implantable cardioverter defibrillators and tries to resynchronize the failing heart by enhancing myocardial contraction without increasing energy consumption. This review delves into the extensive journey of pacemakers and ICDs in the field of cardiology. It highlights the transformative impact of these devices on patient care and quality of life, emphasizing technological advancements, clinical applications, and prospects. This comprehensive review aims to provide insights into the dynamic landscape of cardiac rhythm management.
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Affiliation(s)
- Palash Sahu
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
| | - Manisha Totade
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, IND
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Pan J, Ng SM, Neubauer S, Rider OJ. Phenotyping heart failure by cardiac magnetic resonance imaging of cardiac macro- and microscopic structure: state of the art review. Eur Heart J Cardiovasc Imaging 2023; 24:1302-1317. [PMID: 37267310 PMCID: PMC10531211 DOI: 10.1093/ehjci/jead124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/04/2023] Open
Abstract
Heart failure demographics have evolved in past decades with the development of improved diagnostics, therapies, and prevention. Cardiac magnetic resonance (CMR) has developed in a similar timeframe to become the gold-standard non-invasive imaging modality for characterizing diseases causing heart failure. CMR techniques to assess cardiac morphology and function have progressed since their first use in the 1980s. Increasingly efficient acquisition protocols generate high spatial and temporal resolution images in less time. This has enabled new methods of characterizing cardiac systolic and diastolic function such as strain analysis, exercise real-time cine imaging and four-dimensional flow. A key strength of CMR is its ability to non-invasively interrogate the myocardial tissue composition. Gadolinium contrast agents revolutionized non-invasive cardiac imaging with the late gadolinium enhancement technique. Further advances enabled quantitative parametric mapping to increase sensitivity at detecting diffuse pathology. Novel methods such as diffusion tensor imaging and artificial intelligence-enhanced image generation are on the horizon. Magnetic resonance spectroscopy (MRS) provides a window into the molecular environment of the myocardium. Phosphorus (31P) spectroscopy can inform the status of cardiac energetics in health and disease. Proton (1H) spectroscopy complements this by measuring creatine and intramyocardial lipids. Hyperpolarized carbon (13C) spectroscopy is a novel method that could further our understanding of dynamic cardiac metabolism. CMR of other organs such as the lungs may add further depth into phenotypes of heart failure. The vast capabilities of CMR should be deployed and interpreted in context of current heart failure challenges.
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Affiliation(s)
- Jiliu Pan
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Sher May Ng
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Oliver J Rider
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
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15
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Pay L, Yumurtaş AÇ, Tezen O, Çetin T, Eren S, Çinier G, Hayıroğlu Mİ, Tekkeşin Aİ. Efficiency of MVP ECG Risk Score for Prediction of Long-Term Atrial Fibrillation in Patients With ICD for Heart Failure With Reduced Ejection Fraction. Korean Circ J 2023; 53:621-631. [PMID: 37525494 PMCID: PMC10475693 DOI: 10.4070/kcj.2022.0353] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/03/2023] [Accepted: 05/09/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The morphology-voltage-P-wave duration (MVP) electrocardiography (ECG) risk score is a newly defined scoring system that has recently been used for atrial fibrillation (AF) prediction. The aim of this study was to evaluate the ability of the MVP ECG risk score to predict AF in patients with an implantable cardioverter defibrillator (ICD) and heart failure with reduced ejection fraction in long-term follow-up. METHODS The study used a single-center, and retrospective design. The study included 328 patients who underwent ICD implantation in our hospital between January 2010 and April 2021, diagnosed with heart failure. The patients were divided into low, intermediate and high-risk categories according to the MVP ECG risk scores. The long-term development of atrial fibrillation was compared among these 3 groups. RESULTS The low-risk group included 191 patients, the intermediate-risk group 114 patients, and the high-risk group 23 patients. The long-term AF development rate was 12.0% in the low-risk group, 21.9% in the intermediate risk group, and 78.3% in the high-risk group. Patients in the high-risk group were found to have 5.2 times higher rates of long-term AF occurrence compared to low-risk group. CONCLUSIONS The MVP ECG risk score, which is an inexpensive, simple and easily accessible tool, was found to be a significant predictor of the development of AF in the long-term follow-up of patients with an ICD with heart failure with reduced ejection fraction. This risk score may be used to identify patients who require close follow-up for development and management of AF.
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Affiliation(s)
- Levent Pay
- Department of Cardiac, Ardahan State Hospital, Ardahan, Turkey.
| | - Ahmet Çağdaş Yumurtaş
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training Hospital, İstanbul, Turkey
| | - Ozan Tezen
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training Hospital, İstanbul, Turkey
| | - Tuğba Çetin
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training Hospital, İstanbul, Turkey
| | - Semih Eren
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training Hospital, İstanbul, Turkey
| | - Göksel Çinier
- Department of Cardiac Electrophysiology, Başakşehir Çam ve Sakura City Hospital, Istanbul, Turkey
| | - Mert İlker Hayıroğlu
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training Hospital, İstanbul, Turkey
| | - Ahmet İlker Tekkeşin
- Department of Cardiac Electrophysiology, Başakşehir Çam ve Sakura City Hospital, Istanbul, Turkey
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16
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Bressi E, Ellenbogen KA, Kron J. Novel Intercostal Extravascular ICD Lead Compatible With Standard Pulse Generators: Another Step Forward in ICD Evolution? Circ Arrhythm Electrophysiol 2023; 16:433-436. [PMID: 37485681 DOI: 10.1161/circep.123.012256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Affiliation(s)
- Edoardo Bressi
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond (E.B., K.A.E., J.K.)
- Department of Cardiovascular Sciences, Policlinico Casilino of Rome, Italy (E.B.)
| | - Kenneth A Ellenbogen
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond (E.B., K.A.E., J.K.)
| | - Jordana Kron
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond (E.B., K.A.E., J.K.)
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17
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Thompson AE, Christie M, Lentz L. Substernal Extravascular Implantable Cardioverter-Defibrillator System Infections in Large Animals. Int Heart J 2023; 64:724-731. [PMID: 37460324 DOI: 10.1536/ihj.22-553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
The extravascular implantable cardioverter-defibrillator (EV ICD) with lead implantation in the substernal space may provide clinical advantages over transvenous and subcutaneous systems. This is the first reported examination of substernal infection in large animals implanted with the EV ICD system.The system was implanted in 13 large animals (canine, porcine, and ovine). The porcine were co-implanted with a transvenous cardiac resynchronization therapy with defibrillator (CRT-D) system. Infection was promoted through a cadence of immunosuppressive monitors and study interventions. The animals were monitored for clinical presentation of infection over 12-18 weeks, and cultures were collected to confirm infection. Treatment was bifurcated: 1) some infections were treated only with antibiotics ( "antibiotics only" ), whereas 2) some infections were treated with system removal and antibiotics ( "antibiotics + explant" ). Histopathology was conducted at the study closure.Five infections were confirmed over the course of the study, four of which involved infection of the EV ICD system and one infection of only the concomitantly implanted transvenous CRT-D system without EV ICD-related infection. Among the four EV ICD infections, two of two infections treated with antibiotics only did not resolve whereas two of two infections treated with antibiotics + explant resolved, as shown by histology. The transvenous CRT-D system infection progressed to septicemia and endocarditis, requiring early study discontinuation. No EV ICD-related infection progressed to blood stream infection, and the sternal bone did not become infected when infection was present in the substernal tissues.The study findings suggest that EV ICD-related infections are treatable with system removal and antibiotic therapy.
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18
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Maron BJ, Estes NAM, Rowin EJ, Maron MS, Reynolds MR. Development of the Implantable Cardioverter-Defibrillator: JACC Historical Breakthroughs in Perspective. J Am Coll Cardiol 2023; 82:353-373. [PMID: 37468191 DOI: 10.1016/j.jacc.2023.04.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 07/21/2023]
Abstract
Implantable cardioverter-defibrillators (ICDs) represent transformational technology, arguably the most significant advance in cardiovascular medicine in 50 years. The vision and determination of pioneers Mirowski and Mower was fundamental to this monumental achievement, working with limited resources and confronted by skepticism/criticism from medical establishment. The inventors were followed >35 years in which a multitude of innovative clinical scientists and engineers introduced technological advances leading to the sophisticated devices in practice today. A pivotal patient experiment with automated termination of ventricular fibrillation (1980) led to U.S. Food and Drug Administration approval. Transvenous lead systems converted ICDs from thoracotomy-based secondary prevention to primary prevention of sudden death devices in countless patients worldwide. ICD acceptance was solidified by prospective randomized controlled trials showing reduced mortality superior to antiarrhythmic drugs. ICDs eventually expanded from coronary disease to inherited arrhythmia conditions (eg, hypertrophic cardiomyopathy). The ICD breakthrough story demonstrates how significant progress is possible in medicine against all odds, given fearless imagination to pursue novel ideas that conflict with accepted wisdom.
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Affiliation(s)
- Barry J Maron
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
| | - N A Mark Estes
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ethan J Rowin
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Martin S Maron
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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19
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Magnusson PM, Morell KR, Lazo J, Listig A, Pergolizzi JV. The Sex Data Gap Within Implantable Cardioverter Defibrillator (ICD) Studies: A Retrospective Study of Literature From 1980 Until 2022. Cureus 2023; 15:e42139. [PMID: 37602048 PMCID: PMC10438180 DOI: 10.7759/cureus.42139] [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: 10/31/2022] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Implantable cardioverter defibrillators (ICDs) are a form of cardiac therapy used to prevent death in patients at risk for sudden heart failure. Using 100 articles from the introduction of ICDs until now, a retrospective literature review was conducted. These studies were analyzed for sex disparity over the past 40 years. The difference in the number of male participants to female participants was statistically significant for both the earlier and later study groups (p = 0.0014 and p = 0.0004 respectively), indicating a significant and consistently lower number of females in ICD research over time. This review shows no significant difference in the sex disparity since the implementation of ICDs. Unfortunately, due to a gap in the literature, the reason for this disparity between the sexes in ICD literature can only be speculated. This disparity may be partly due to a lack of incentive and encouragement for women to participate in research.
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Affiliation(s)
- Peter M Magnusson
- Center for Research and Development (CFUG), Uppsala University, Gävle, SWE
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20
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Huybrechts WLH, Bergonti M, Saenen JB, Miljoen H, Van Leuven O, Van Assche L, Van Herck P, Wittock A, De Cleen D, Sarkozy A, Heidbüchel H. Left Bundle Branch Area Defibrillator (LBBAD): A First-in-Human Feasibility Study. JACC Clin Electrophysiol 2023; 9:620-627. [PMID: 37225308 DOI: 10.1016/j.jacep.2023.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Left bundle branch area (LBBA) pacing is a promising pacing technique. LBBA implantable cardioverter-defibrillator (ICD) lead implantation reduces the number of leads in patients with both pacing and ICD indications, reducing cost and potentially increasing safety. LBBA positioning of ICD leads has not previously been described. OBJECTIVES The goal of this study was to evaluate the safety and feasibility of implanting an LBBA ICD lead. METHODS This prospective, single-center, feasibility study was conducted in patients with an ICD indication. LBBA ICD lead implantation was attempted. Acute pacing parameters and paced electrocardiography data were collected, and defibrillation testing was performed. RESULTS LBBA defibrillator (LBBAD) implantation was attempted in 5 patients (mean age 57 ± 16.5 years; 20% female) and achieved in 3 (60%). Mean procedural and fluoroscopy duration were 170.0 ± 17.3 minutes and 28.8 ± 16.1 minutes, respectively. Left bundle capture was achieved in 2 patients (66%) and left septal capture in 1 patient. LBBA pacing exhibited a mean QRS duration and V6 R-wave peak time of 121.3 ± 8.3 milliseconds and 86.1 ± 10.0 milliseconds. In all 3 patients, defibrillation testing was successful with mean time to adequate shock delivery of 8.6 ± 2.6 seconds. Acute LBBA pacing threshold and R-wave amplitudes were 0.80 ± 0.60 V at 0.4 milliseconds and 7.0 ± 2.7 mV. No LBBA lead-related complications occurred. CONCLUSIONS This first-in-human evaluation showed the feasibility of LBBAD implantation in a small cohort of patients. With current tools, implantation remains complex and time-consuming. Considering the feasibility reported and the potential benefits, further technological development in this field is warranted with evaluation of long-term safety and performance.
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Affiliation(s)
- Wim L H Huybrechts
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium; Department GENCOR-Heart Rhythm Disorders, University of Antwerp, Antwerp, Belgium.
| | - Marco Bergonti
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium. https://twitter.com/Mbergonti
| | - Johan B Saenen
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium; Department GENCOR-Heart Rhythm Disorders, University of Antwerp, Antwerp, Belgium
| | - Hielko Miljoen
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium; Department GENCOR-Heart Rhythm Disorders, University of Antwerp, Antwerp, Belgium
| | | | | | - Paul Van Herck
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Anouk Wittock
- Department of Anesthesiology, University Hospital Antwerp, Edegem, Belgium
| | | | - Andrea Sarkozy
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium; Department GENCOR-Heart Rhythm Disorders, University of Antwerp, Antwerp, Belgium
| | - Hein Heidbüchel
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium; Department GENCOR-Heart Rhythm Disorders, University of Antwerp, Antwerp, Belgium
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21
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Maron MS, Rowin E, Spirito P, Maron BJ. Differing strategies for sudden death prevention in hypertrophic cardiomyopathy. Heart 2023; 109:589-594. [PMID: 36270782 PMCID: PMC10086464 DOI: 10.1136/heartjnl-2020-316693] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/01/2022] [Indexed: 11/04/2022] Open
Abstract
Sudden death (SD) has traditionally been the most visible and feared complication of hypertrophic cardiomyopathy (HCM). Substantial progress in reducing the occurrence of these catastrophic events represents a new paradigm in disease management. Prevention of SD in HCM has resulted from introduction of primary prevention ICDs that reliably terminate life-threatening ventricular tachyarrhythmias, as well as a matured risk stratification algorithm capable of reliably identifying those patients at highest risk. This initiative has been a major determinant of reducing HCM-related mortality to a low rate of 0.5%/year. In such a heterogeneous heart disease as HCM, no perfect risk stratification strategy is possible, and available approaches differ in terms of sensitivity and specificity for identifying patients with SD risk. Major cardiovascular societies, American Heart Association/American College of Cardiology in the USA and European Society of Cardiology in Europe have promoted different risk stratification guidelines creating the potential for judging SD risk in a given HCM patient differently based on commitment to a particular societal guideline or country of residence. In this review, we provide a critical but balanced assessment of these two divergent SD prevention strategies with regard to their respective strengths and weaknesses, as a guide to clinicians directly engaged in this important management issue.
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MESH Headings
- Humans
- Risk Assessment
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/epidemiology
- Defibrillators, Implantable/adverse effects
- Tachycardia, Ventricular/etiology
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- Risk Factors
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Affiliation(s)
- Martin S Maron
- Hypertrophic Cardiomyopathy Center, Lahey Medical Center, Burlington, Massachusetts, USA
| | - Ethan Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Medical Center, Burlington, Massachusetts, USA
| | - Paolo Spirito
- Divisione di Cardiologia, Ospedali Galliera, Genoa, Italy
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Lahey Medical Center, Burlington, Massachusetts, USA
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22
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Mehdinejadshani M, Fallah H, Kamali F, Alizadeh-Diz A, Eslami M, Golabchi A, Taherpour M, Shahabi J, Mollazadeh R, Madadi S, Azhari A, Sodagar A, Eftekharzadeh M, Oraii S, Fazelifar A, Kazemisaeed A, Ghorbanisharif A, Dalili M, Khorgami M, Heidari-Bakavoli A, Jorat M, Nikoo H, Kheirkhah J, Saravi M, Khodaparast M, Mirzaali M, Emkanjoo Z, Mirmasoumi M, Sadeghian S, Mokhtari M, Hedayati-Goudarzi M, Haghjoo M. Clinical outcomes of subcutaneous implantable cardiac defibrillator implantation - Iran SICD registry. Pacing Clin Electrophysiol 2023; 46:273-278. [PMID: 36751953 DOI: 10.1111/pace.14668] [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: 12/11/2022] [Revised: 12/29/2022] [Accepted: 01/15/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND The subcutaneous implantable-defibrillator (S-ICD) is a relatively new alternative to the transvenous ICD system to minimize intravascular lead-related complications. This paper presents outcome of SICD implantation in patients enrolled in Iran S-ICD registry. METHODS Between October 2015 and June 2022, this prospective multicenter national registry included 223 patients with a standard indication for an ICD, who neither required bradycardia pacing nor needed cardiac resynchronization to evaluate the early post-implant complications and long-term follow-up results of the S-ICD system. RESULTS The mean age of the patients was 45 ± 17 years. The majority (79.4%) were male. Ischemic cardiomyopathy (39.5%) was the most common underlying disorder among patients selected for S-ICD implant. Most study patients (68.6%) had ICD for primary prevention of sudden cardiac death. Seven patients (3.1%) were found to have suboptimal lead positions. Six patients (2.7%) developed a pocket hematoma; all were managed medically. During a mean follow-up of 2 years, the appropriate therapy was recorded in 13% of the patients and inappropriate ICD intervention mainly due to supraventricular tachycardia in 8.9%. Pocket infection was observed in four patients (1.8%) and five patients (2.2%) died mainly due to heart failure. CONCLUSION S-ICDs were effective at detecting and treating both induced and spontaneous ventricular arrhythmias. Major clinical complications were rare.
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Affiliation(s)
- Mahdiye Mehdinejadshani
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Fallah
- Department of Cardiology, Faculty of Medicine, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Farzad Kamali
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfath Alizadeh-Diz
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Eslami
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Allahyar Golabchi
- The Advocate Center for Clinical Research, Ayatollah Yasrebi Hospital, Kashan, Iran
| | | | - Javad Shahabi
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Mollazadeh
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Shabnam Madadi
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Azhari
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | | | - Amirfarjam Fazelifar
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Kazemisaeed
- Cardiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Dalili
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadrafie Khorgami
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireaza Heidari-Bakavoli
- Department of Cardiovascular Disease, Faculty of Medcine, Mashhad University of Medical Sciences, Mashahd, Iran
| | | | - Hossein Nikoo
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jalal Kheirkhah
- Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehrdad Saravi
- Department of Cardiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Morteza Khodaparast
- Zavareh Atherosclerosis Research Center, Baqyitallah University of Medical Sciences, Tehran, Iran
| | - Mansour Mirzaali
- Shafa Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zahra Emkanjoo
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Saeed Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Meisam Mokhtari
- Cardiac Electrophysiology Department, Shahid Chamran Cardiovascular Medical and Research Center, Isfahan University of Medical Science, Isfahan, Iran
| | | | - Majid Haghjoo
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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23
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Yang Y, Birgersdotter-Green U. The subcutaneous implantable cardioverter-defibrillator should be reserved for niche indications. Heart Rhythm O2 2022; 3:597-601. [PMID: 36340490 PMCID: PMC9626898 DOI: 10.1016/j.hroo.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Ulrika Birgersdotter-Green
- Address reprint requests and correspondence: Dr Ulrika Birgersdotter-Green, 9452 Medical Center Dr, MC 7411, La Jolla, CA 92037.
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24
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Phogat V, Byrnes S, Chaudhuri D. Acute ST-Segment Elevation Myocardial Infarction as a Rare Postoperative Complication of Biventricular Implantable Cardioverter-Defibrillator Placement. JACC Case Rep 2022; 4:1195-1199. [PMID: 36213888 PMCID: PMC9537089 DOI: 10.1016/j.jaccas.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/08/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022]
Abstract
We present a rare case of an 84-year-old woman who suffered an acute ST-segment elevation myocardial infarction as a postoperative complication of biventricular implantable cardioverter-defibrillator placement, caused by the left ventricular lead impinging onto the second obtuse marginal artery. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Vishal Phogat
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
- Address for correspondence: Dr Vishal Phogat, Department of Medicine, SUNY Upstate University Hospital, Room 5138, 750 East Adams Street, Syracuse, New York 13210, USA. DrVishalPhogat
| | - Sean Byrnes
- Department of Cardiology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Debanik Chaudhuri
- Department of Cardiology, SUNY Upstate Medical University, Syracuse, New York, USA
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25
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Cannom DS, Zareba W. In Memoriam: Morton Mower, MD, January 31, 1933–April 25, 2022. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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De Filippo P, Malanchini G, Ferrari P. Implantable cardioverted defibrillators: 40 years of history and beyond. Expert Rev Cardiovasc Ther 2022; 20:593-596. [PMID: 35799448 DOI: 10.1080/14779072.2022.2098116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Paolo De Filippo
- Cardiac Electrophysiology and Pacing Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giovanni Malanchini
- Cardiac Electrophysiology and Pacing Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paola Ferrari
- Cardiac Electrophysiology and Pacing Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
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27
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Klein HU. A Hero behind the curtain in memoriam of Dr. Morton M. Mower. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Helmut U Klein
- Clinical Cardiovascular Research Center, University of Rochester Medical Center , Rochester, NY 14620 , USA
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Boriani G, Vitolo M, Leyva F. Implantable cardioverter defibrillators for primary prevention of sudden cardiac death: what are the barriers to implementation in the "real world"? Eur J Heart Fail 2022; 24:1223-1226. [PMID: 35717601 DOI: 10.1002/ejhf.2581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/16/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Francisco Leyva
- Aston Medical School, Aston University, Birmingham, United Kingdom
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29
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Haydock P, Camm AJ. History and evolution of pacing and devices. BRITISH HEART JOURNAL 2022; 108:794-799. [PMID: 35459730 DOI: 10.1136/heartjnl-2021-320149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/23/2022] [Indexed: 12/11/2022]
Abstract
Cardiac implanted electronic devices are commonplace in the modern practice of cardiology. This article reviews the history of the development of these technologies, with particular reference to the role played by UK physicians and members of the British Cardiovascular Society. Key breakthroughs in the treatment of heart block, ventricular arrhythmia and heart failure are presented in their historical and contemporary context so that the reader might look back on the incredible progress and achievements of the last 100 years and also look forward to what may be achieved in the coming decades.
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Affiliation(s)
- Paul Haydock
- Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A John Camm
- Cardiology, St George's University of London, London, UK
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30
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Ursaru AM, Petris AO, Costache II, Nicolae A, Crisan A, Tesloianu ND. Implantable Cardioverter Defibrillator in Primary and Secondary Prevention of SCD-What We Still Don't Know. J Cardiovasc Dev Dis 2022; 9:120. [PMID: 35448096 PMCID: PMC9028370 DOI: 10.3390/jcdd9040120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 12/07/2022] Open
Abstract
Implantable cardioverter defibrillators (ICDs) are the cornerstone of primary and secondary prevention of sudden cardiac death (SCD) all around the globe. In almost 40 years of technological advances and multiple clinical trials, there has been a continuous increase in the implantation rate. The purpose of this review is to highlight the grey areas related to actual ICD recommendations, focusing specifically on the primary prevention of SCD. We will discuss the still-existing controversies strongly reflected in the differences between the international guidelines regarding ICD indication class in non-ischemic cardiomyopathy, and also address the question of early implantation after myocardial infarction in the absence of clear protocols for patients at high risk of life-threatening arrhythmias. Correlating the insufficient data in the literature for 40-day waiting times with the increased risk of SCD in the first month after myocardial infarction, we review the pros and cons of early ICD implantation.
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Affiliation(s)
- Andreea Maria Ursaru
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
| | - Antoniu Octavian Petris
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
- Department of Cardiology, “Grigore. T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Irina Iuliana Costache
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
- Department of Cardiology, “Grigore. T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Ana Nicolae
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
| | - Adrian Crisan
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
| | - Nicolae Dan Tesloianu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
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Abstract
INTRODUCTION The subcutaneous implantable cardioverter defibrillator (S-ICD) is currently in its third generation and has been adopted in guidelines and in mainstream clinical practice. Considerable improvements have been made since the introduction of this device over a decade ago. AREAS COVERED A literature search was undertaken in Pubmed on articles relating to the S-ICD. EXPERT OPINION The therapy has been proven to be safe and effective and is a valuable option in selected patients. Nevertheless, there remain many shortcomings of the S-ICD which are discussed in this review, and which hopefully will be addressed by future generations of the device.
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Affiliation(s)
- Axel Friedli
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
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32
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Chahine M, Fontaine JM, Boutjdir M. Racial Disparities in Ion Channelopathies and Inherited Cardiovascular Diseases Associated With Sudden Cardiac Death. J Am Heart Assoc 2022; 11:e023446. [PMID: 35243873 PMCID: PMC9075281 DOI: 10.1161/jaha.121.023446] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/11/2021] [Indexed: 12/19/2022]
Abstract
Cardiovascular disease (CVD) continues to be the most common cause of death worldwide, and cardiac arrhythmias account for approximately one half of these deaths. The morbidity and mortality from CVD have been reduced significantly over the past few decades; however, disparities in racial or ethnic populations still exist. This review is based on available literature to date and focuses on known cardiac channelopathies and other inherited disorders associated with sudden cardiac death in African American/Black subjects and the role of epigenetics in phenotypic manifestations of CVD, and illustrates existing disparities in treatment and outcomes. The review also highlights the knowledge gaps that limit understanding of the manifestation of phenotypic abnormalities across racial or ethnic groups and discusses disparities associated with device underuse in the management of patients at risk for sudden cardiac death. We discuss factors related to reports in the United States, that the overall mortality attributed to CVD and the number of out-of-hospital cardiac arrests are higher among African American/Black subjects when compared with other racial or ethnic groups. African American/Black subjects are disproportionally affected by CVD, including cardiac arrhythmias and sudden cardiac death, thus highlighting a major concern in this population that remains underrepresented in clinical trials with limited genetic testing and device underuse. The proposed solutions include (1) early identification of genetic variants, which is crucial in tailoring a preventive management strategy; (2) inclusion of diverse racial or ethnic groups in clinical trials; (3) compliance with guideline-directed medical treatment and referral to cardiovascular subspecialists; and (4) training and mentoring of underrepresented junior faculty in cardiovascular health disparities research.
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Affiliation(s)
- Mohamed Chahine
- Department of MedicineFaculty of MedicineUniversité LavalQuebec CityQCCanada
- CERVO Brain Research CenterQuebec CityQCCanada
| | - John M. Fontaine
- University of Pittsburgh Medical CenterWilliamsportPA
- University of Central Florida School of Medicine Affiliate–West Florida HospitalPensacolaFL
| | - Mohamed Boutjdir
- Cardiovascular Research ProgramVeterans Administration New York Harbor Healthcare SystemNew YorkNY
- Department of Medicine, Cell Biology and PharmacologyState University of New York Downstate Medical CenterNew YorkNY
- Department of MedicineNew York University School of MedicineNew YorkNY
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33
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Panchangam S, Monahan KM, Helm RH. Anti-tachycardia Pacing: Mechanism, History and Contemporary Implementation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022. [DOI: 10.1007/s11936-022-00959-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Awuah DO, Hussain MS, Ponnapalli A, Deliwala SS, Seedahmed EM, Bachuwa G. Refractory familial hypokalaemic periodic paralysis leading to cardiovascular compromise. BMJ Case Rep 2022; 15:e246674. [PMID: 35131788 PMCID: PMC8823031 DOI: 10.1136/bcr-2021-246674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/03/2022] Open
Abstract
Familial hypokalaemic periodic paralysis (FHPP) is a rare neuromuscular disorder that is classified under periodic paralysis (PP), which is characterised by episodes of muscle weakness. Common triggers include intense exercise, fasting or consumption of carbohydrate-rich meals. Hypokalaemic PP has an incidence of 1 in 100 000; despite the temporal association, cardiac manifestations are exceedingly rare. We present a case of FHPP, a channelopathy presenting with severe refractory hypokalaemia. The challenges with our patient were maintaining potassium levels within normal ranges and initiating a close follow-up plan. Due to the lack of clinical guidance in our case, many aspects of care, including surveillance, medications and genetic testing, remain unaddressed. Medical management includes aggressive correction with supplements, potassium-sparing diuretics and carbonic anhydrase inhibitors. Severe cases of dysrhythmias, especially ventricular fibrillation, require electrophysiology evaluation and possible implantation of a defibrillator to prevent sudden cardiac death.
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Affiliation(s)
- Dominic O Awuah
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | | | | | | | | | - Ghassan Bachuwa
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
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35
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Philippon F, Domain G, Sarrazin JF, Nault I, O’Hara G, Champagne J, Steinberg C. Evolution of Devices to Prevent Sudden Cardiac Death: Contemporary Clinical Impacts. Can J Cardiol 2022; 38:515-525. [DOI: 10.1016/j.cjca.2022.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 12/12/2022] Open
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Lee HJ, Kim J, Chang SA, Kim YJ, Kim HK, Lee SC. Major Clinical Issues in Hypertrophic Cardiomyopathy. Korean Circ J 2022; 52:563-575. [PMID: 35929051 PMCID: PMC9353251 DOI: 10.4070/kcj.2022.0159] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022] Open
Abstract
By actively implementing contemporary management strategies in hypertrophic cardiomyopathy, morbidity and mortality can be substantially reduced. In this review, we discuss the pathophysiology and management of the major clinical issues in hypertrophic cardiomyopathy, including sudden cardiac death, atrial fibrillation and thromboembolism, dynamic left ventricular outflow tract obstruction, and heart failure progression. Although echocardiography and cardiac magnetic resonance imaging currently play an essential and complementary role in the management of hypertrophic cardiomyopathy, further studies are needed to establish how developing techniques such as myocardial deformation and late gadolinium enhancement can provide better risk stratification and guide treatment. Hypertrophic cardiomyopathy (HCM) is one of the most common inheritable cardiomyopathies. Contemporary management strategies, including the advent of implantable cardioverter-defibrillators and effective anticoagulation, have substantially improved the clinical course of HCM patients; however, the disease burden of HCM is still high in Korea. Sudden cardiac death (SCD), atrial fibrillation and thromboembolic risk, dynamic left ventricular outflow tract (LVOT) obstruction, and heart failure (HF) progression remain important issues in HCM. SCD in HCM can be effectively prevented with implantable cardioverter-defibrillators. However, appropriate patient selection is important for primary prevention, and the 5-year SCD risk score and the presence of major SCD risk factors should be considered. Anticoagulation should be initiated in all HCM patients with atrial fibrillation regardless of the CHA2DS2-VASc score, and non-vitamin K antagonist oral anticoagulants are the first option. Symptomatic dynamic LVOT obstruction is first treated medically with negative inotropes, and if symptoms persist, septal reduction therapy is considered. The recently approved myosin inhibitor mavacamten is promising. HF in HCM is usually related to diastolic dysfunction, while about 5% of HCM patients show reduced left ventricular ejection fraction <50%, also referred to as “end-stage” HCM. Myocardial fibrosis plays an important role in the progression to advanced HF in patients with HCM. Patients who do not respond to guideline-directed medical therapy can be considered for heart transplantation. The development of imaging techniques, such as myocardial deformation on echocardiography and late gadolinium enhancement on cardiac magnetic resonance, can provide better risk evaluation and decision-making for management strategies in HCM.
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Affiliation(s)
- Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ayoub K, Richardson T. High Defibrillation Threshold: Brace For Impact. J Cardiovasc Electrophysiol 2021; 33:241-243. [PMID: 34911152 DOI: 10.1111/jce.15327] [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: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
Sudden cardiac death (SCD) constitutes a major public health problem and accounts for approximately 50% of all cardiovascular deaths This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Karam Ayoub
- Division of Cardiac Electrophysiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Travis Richardson
- Division of Cardiac Electrophysiology, Vanderbilt University Medical Center, Nashville, TN, USA
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38
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Carlozzi NE, Choi SW, Wu Z, Miner JA, Lyden AK, Graves C, Wang J, Sen S. An App-Based Just-in-Time Adaptive Self-management Intervention for Care Partners (CareQOL): Protocol for a Pilot Trial. JMIR Res Protoc 2021; 10:e32842. [PMID: 34889775 PMCID: PMC8704108 DOI: 10.2196/32842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Care partners (ie, informal family caregivers) of individuals with health problems face considerable physical and emotional stress, often with a substantial negative impact on the health-related quality of life (HRQOL) of both care partners and care recipients. Given that these individuals are often overwhelmed by their caregiving responsibilities, low-burden self-management interventions are needed to support care partners to ensure better patient outcomes. OBJECTIVE The primary objective of this study is to describe an intensive data collection protocol that involves the delivery of a personalized just-in-time adaptive intervention that incorporates passive mobile sensor data feedback (sleep and activity data from a Fitbit [Fitbit LLC]) and real time self-reporting of HRQOL via a study-specific app called CareQOL (University of Michigan) to provide personalized feedback via app alerts. METHODS Participants from 3 diverse care partner groups will be enrolled (care partners of persons with spinal cord injury, care partners of persons with Huntington disease, and care partners of persons with hematopoietic cell transplantation). Participants will be randomized to either a control group, where they will wear the Fitbit and provide daily reports of HRQOL over a 3-month (ie, 90 days) period (without personalized feedback), or the just-in-time adaptive intervention group, where they will wear the Fitbit, provide daily reports of HRQOL, and receive personalized push notifications for 3 months. At the end of the study, participants will complete a feasibility and acceptability questionnaire, and metrics regarding adherence and attrition will be calculated. RESULTS This trial opened for recruitment in November 2020. Data collection was completed in June 2021, and the primary results are expected to be published in 2022. CONCLUSIONS This trial will determine the feasibility and acceptability of an intensive app-based intervention in 3 distinct care partner groups: care partners for persons with a chronic condition that was caused by a traumatic event (ie, spinal cord injury); care partners for persons with a progressive, fatal neurodegenerative disease (ie, Huntington disease); and care partners for persons with episodic cancer conditions that require intense, prolonged inpatient and outpatient treatment (persons with hematopoietic cell transplantation). TRIAL REGISTRATION ClinicalTrials.gov NCT04556591; https://clinicaltrials.gov/ct2/show/NCT04556591. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/32842.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Zhenke Wu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Angela K Lyden
- Clinical Trials Support Office, University of Michigan, Ann Arbor, MI, United States
| | - Christopher Graves
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Jitao Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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Delle Donna P, Petrovic L, Nasir U, Ahmed A, Suero-Abreu GA. Phantom Shocks Associated With a Wearable Cardioverter Defibrillator. J Med Cases 2021; 12:49-53. [PMID: 34434428 PMCID: PMC8383611 DOI: 10.14740/jmc3606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/07/2020] [Indexed: 11/11/2022] Open
Abstract
Wearable cardioverter defibrillators (WCDs) are external devices capable of continuous cardiac rhythm monitoring as well as automatic detection and defibrillation of potentially life-threatening arrhythmias such as ventricular tachycardia (VT) and ventricular fibrillation (VF). They are an alternative approach for patients when an implantable cardioverter defibrillator (ICD) is not appropriate. Although treatment with ICD is considered highly effective for the primary and secondary prevention of sudden cardiac death (SCD) in high-risk patients susceptible to VT and VF, patients may still experience psychological difficulties such as fear of shock, avoidance of normal behaviors and reduced quality of life. One of these phenomena is phantom shock (PS), which is defined as a perception of having received a shock with no evidence of recorded defibrillation upon device interrogation. While PS has been reported in the ICD literature, to the best of our knowledge, we present the first known case of WCD-related PS. We also present a review of the current literature to explore the prevalence of PS, the factors associated with its pathogenesis and interventional studies aimed at reducing its occurrence. We highlight this case because PS is considered a phenomenon that few recognize, which should be discriminated from real device shocks before clinicians initiate treatment, device reprogramming or device discontinuation. We describe the psychosocial factors associated with PS to emphasize the importance of managing any associated psychiatric disorders and psychosocial factors both before and after initiation of device treatment.
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Affiliation(s)
- Paul Delle Donna
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Luka Petrovic
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Umair Nasir
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ahmed Ahmed
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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41
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Narducci M, Scacciavillani R, Pinnacchio G, Bencardino G, Perna F, Comerci G, Campisi M, Ceccarelli I, Pavone C, Spera F, Bisignani A, Crea F, Pelargonio G. The potential impact of acute coronary syndromes on automatic sensing system in Subcutaneous-ICDs. IJC HEART & VASCULATURE 2021; 35:100841. [PMID: 34345651 PMCID: PMC8319739 DOI: 10.1016/j.ijcha.2021.100841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Subcutaneous-ICD (S-ICD) is emerging as a suitable option for most ICD candidates, however some open issues regarding the sensing algorithm still remain. OBJECTIVES We aimed to examine the performance of the S-ICD sensing algorithm in patients hospitalized for ST elevation myocardial infarction (STEMI), non ST elevation acute coronary syndrome (NSTE-ACS) or chronic coronary syndrome (CCS), before and after revascularization. METHODS We performed a S-ICD automated screening on 75 patients, 21 hospitalized for STEMI, 23 for NSTE-ACS and 31 for CCS, before and after percutaneous revascularization, regardless their eligibility to ICD implantation. RESULTS Patients did not differ in clinical, electrocardiographic and echocardiographic parameters. Rates of screening pass were significantly lower in STEMI patients compared to NSTE-ACS and CCS (5% vs 56.7% vs 81% respectively, p < .0001). The viability of the primary vector was lower in STEMI patients compared to NSTE-ACS and CCS (33% vs 56% vs 71%, p .027 respectively). After revascularization, there were no more significant differences between groups. Pairing subjects at baseline and after revascularization, STEMI subjects percentages of screening success were respectively 5% and 81% (p < .001) and the rates of primary vector viability were 33% and 81% (p .002). STEMI was the only independent predictor of screening failure at multivariate logistic regression analysis (odds ratio 10.68 confidence interval 2.77-41.38, p = .001). CONCLUSION The performance of the S-ICD and possible malfunction detections in the context of an acute ischemic event deserve further evaluation. Adequate patient selection and the development of dynamic device programming are warranted.
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Affiliation(s)
- M.L. Narducci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - R. Scacciavillani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - G. Pinnacchio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - G. Bencardino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - F. Perna
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - G. Comerci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - M. Campisi
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - I. Ceccarelli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - C. Pavone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - F. Spera
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - A. Bisignani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
| | - F. Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - G. Pelargonio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Roma, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
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42
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Gebran A, Refaat MM. Long-term evaluation of a novel extravascular implantable cardioverter defibrillator. J Cardiovasc Electrophysiol 2021; 32:2379-2380. [PMID: 34314084 DOI: 10.1111/jce.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Anthony Gebran
- Division of Trauma Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marwan M Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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43
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Pike A, Dobbin-Williams K, Swab M. Experiences of adults living with an implantable cardioverter defibrillator for cardiovascular disease: a systematic review of qualitative evidence. JBI Evid Synth 2021; 18:2231-2301. [PMID: 32813405 DOI: 10.11124/jbisrir-d-19-00239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The objective of this review was to synthesize the best available qualitative evidence on the everyday life experiences of adults living with an implantable cardioverter defibrillator for cardiovascular disease. INTRODUCTION Cardiovascular disease is a rising concern worldwide. The efficacy of the implantable cardioverter defibrillator as a successful treatment for cardiovascular disease has been well documented. Research suggests that living with an implantable cardioverter defibrillator is complex and can cause substantial psychosocial distress that can manifest itself at various intervals over time. The first step to developing evidence-based recommendations related to the management of implantable cardioverter defibrillator-related distress is a critical appraisal and synthesis of relevant literature to gain a more comprehensive understanding of this phenomenon. INCLUSION CRITERIA The participants of interest were adults 18 years or older who had an implantable cardioverter defibrillator for the management of cardiovascular disease (e.g. ischemic heart disease, angina, cardiomyopathy, myocardial infarction, congenital defect, arrhythmias, heart failure). The phenomenon of interest was the everyday life experience of adults living with an implantable cardioverter defibrillator. The review considered all qualitative research related to the phenomenon of interest. METHODS Key databases searched were PubMed, CINAHL, PsycINFO, Embase, International Bibliography of the Social Sciences, Sociological Abstracts, OpenGrey, MedNar, ProQuest Dissertations and Theses Global, Google, and Google Scholar. Published and unpublished papers and articles from 1990 to July 2018 were included in the search. The JBI approach to critical appraisal, study selection, data extraction, and synthesis for qualitative research was used throughout the review. RESULTS Twenty-seven papers were included in the review that yielded 143 findings and 13 categories. The methodological quality of the 27 included studies was moderate to strong. Based on ConQual scores, confidence in the synthesized findings was moderate. From this, three synthesized findings were extracted: i) living under the shadow of uncertainty, ii) orchestrating a new normal, and iii) crafting a positive vision for the future. CONCLUSIONS Evidence suggests that while implantable cardioverter defibrillator recipients do experience psychosocial distress, they gradually positively embrace the device as part of their everyday norm. Recommendations for practice and education point to the further development of best practice guidelines for implantable cardioverter defibrillator management, continuing education programs for health care providers, and strategies to support implantable cardioverter defibrillator recipients and their families to cope with the device. Research that examines onset, level, and duration of implantable cardioverter defibrillator psychosocial distress is needed to target specific interventions reflective of this population's needs. While findings suggest the experiences of women living with an implantable cardioverter defibrillator are similar to men, the low number of women in included studies limits the strength of this conclusion.
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Affiliation(s)
- April Pike
- Memorial University of Newfoundland, Faculty of Nursing, St. John's, NL, Canada.,Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada
| | - Karen Dobbin-Williams
- Memorial University of Newfoundland, Faculty of Nursing, St. John's, NL, Canada.,Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada
| | - Michelle Swab
- Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada.,Memorial University of Newfoundland, Health Sciences Library, St. John's, NL, Canada
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Clementy N, Bodin A, Bisson A, Teixeira-Gomes AP, Roger S, Angoulvant D, Labas V, Babuty D. The Defibrillation Conundrum: New Insights into the Mechanisms of Shock-Related Myocardial Injury Sustained from a Life-Saving Therapy. Int J Mol Sci 2021; 22:5003. [PMID: 34066832 PMCID: PMC8125879 DOI: 10.3390/ijms22095003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
Implantable cardiac defibrillators (ICDs) are recommended to prevent the risk of sudden cardiac death. However, shocks are associated with an increased mortality with a dose response effect, and a strategy of reducing electrical therapy burden improves the prognosis of implanted patients. We review the mechanisms of defibrillation and its consequences, including cell damage, metabolic remodeling, calcium metabolism anomalies, and inflammatory and pro-fibrotic remodeling. Electrical shocks do save lives, but also promote myocardial stunning, heart failure, and pro-arrhythmic effects as seen in electrical storms. Limiting unnecessary implantations and therapies and proposing new methods of defibrillation in the future are recommended.
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Affiliation(s)
- Nicolas Clementy
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Alexandre Bodin
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
| | - Arnaud Bisson
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Ana-Paula Teixeira-Gomes
- Plate-forme de Chirurgie et d’Imagerie pour la Recherche et l’Enseignement (CIRE), INRA, Université de Tours, CHU de Tours, 37380 Nouzilly, France; (A.-P.T.-G.); (V.L.)
| | - Sebastien Roger
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Denis Angoulvant
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Valérie Labas
- Plate-forme de Chirurgie et d’Imagerie pour la Recherche et l’Enseignement (CIRE), INRA, Université de Tours, CHU de Tours, 37380 Nouzilly, France; (A.-P.T.-G.); (V.L.)
| | - Dominique Babuty
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
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Device-related infection in de novo transvenous implantable cardioverter-defibrillator Medicare patients. Heart Rhythm 2021; 18:1301-1309. [PMID: 33887452 DOI: 10.1016/j.hrthm.2021.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cardiac device infection is a serious complication of implantable cardioverter-defibrillator (ICD) placement and requires complete device removal with accompanying antimicrobial therapy for durable cure. Recent guidelines have highlighted the need to better identify patients at high risk of infection to assist in device selection. OBJECTIVE To estimate the prevalence of infection in de novo transvenous (TV) ICD implants and assess factors associated with infection risk in a Medicare population. METHODS A retrospective cohort study was conducted using 100% Medicare administrative and claims data to identify patients who underwent de novo TV-ICD implantation (July 2016-December 2017). Infection within 720 days of implantation was identified using ICD-10 codes. Baseline factors associated with infection were identified by univariable logistic regression analysis of all variables of interest, including conditions in Charlson and Elixhauser comorbidity indices, followed by stepwise selection criteria with a P ≤ .25 for inclusion in a multivariable model and a backwards, stepwise elimination process with P ≤ .1 to remain in the model. A time-to-event analysis was also conducted. RESULTS Among 26,742 patients with de novo TV-ICD, 519 (1.9%) developed an infection within 720 days post implant. While more than half (54%) of infections occurred during the first 90 days, 16% of infections occurred after 365 days. Multivariable analysis revealed several significant predictors of infection: age <70 years, renal disease with dialysis, and complicated diabetes mellitus. CONCLUSION The rate of de novo TV-ICD infection was 1.9%, and identified risk factors associated with infection may be useful in device selection.
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Abstract
The treatment of drug-refractory chronic ventricular tachycardia (VT) has undergone a revolution over the last 50 years. We now have automatic implantable cardioverter defibrillator therapy with pace-terminating capabilities, and catheter ablation of VT has refined mapping and improved methods of lesion generation. Between 1980 and 1993, Houston Methodist Hospital became a leader in the diagnosis and surgical ablation of VT and other arrhythmias. This is a brief account of that period and some of the experiences and lessons that have led to significant advances used today.
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Affiliation(s)
- Gerald M Lawrie
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
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Khalsa SS, Clausen AN, Shahabi L, Sorg J, Gonzalez SE, Naliboff B, Shivkumar K, Ajijola OA. Cardiac sympathetic denervation and mental health. Auton Neurosci 2021; 232:102787. [PMID: 33631539 DOI: 10.1016/j.autneu.2021.102787] [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: 03/06/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bilateral cardiac sympathetic denervation (BCSD) is a surgical treatment for refractory ventricular arrhythmias. Although the procedure has shown efficacy at reducing cardiac arrhythmias, its impact on mental health is unknown. In the current study we examined associations between the BCSD procedure and mental health. METHODS 10 ventricular arrhythmia patients undergoing BCSD completed assessments of anxiety, depression, and posttraumatic stress symptoms at pre- and post-BCSD time points. Wilcoxon signed rank and Mann-Whitney U tests were used to examine differences in mental health symptoms in the pre- and post-BSCD states. Point biserial correlations were used to explore associations between BCSD response and mental health symptoms. RESULTS A significant reduction of anxiety symptoms was observed from pre- to post-BCSD. At the post-BCSD assessment, participants who successfully responded to the BCSD procedure exhibited lower anxiety symptoms compared to non-responders. However, no significant relationships were identified for depressive or PTSD symptoms. CONCLUSION The BCSD procedure is associated with reduced anxiety shortly after successful treatment for refractory ventricular arrhythmias in a small sample. Longitudinal surveillance of mental health symptoms after BCSD may be warranted to monitor the impact of this procedure on mental health.
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Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, United States of America; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States of America.
| | - Ashley N Clausen
- Department of Behavioral Health, Kansas City VA Medical Center, Kansas City, MO, United States of America; Department of Psychiatry and Behavioral Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Leila Shahabi
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Julie Sorg
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Sarah E Gonzalez
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Bruce Naliboff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Oppenheimer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Kalyanam Shivkumar
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Olujimi A Ajijola
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
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Evolution of risk stratification and sudden death prevention in hypertrophic cardiomyopathy: Twenty years with the implantable cardioverter-defibrillator. Heart Rhythm 2021; 18:1012-1023. [PMID: 33508516 DOI: 10.1016/j.hrthm.2021.01.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 11/21/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a relatively common inherited myocardial disorder, once regarded as largely untreatable with ominous prognosis and most visibly as a common cause of sudden death (SD) in the young. Over the last several years, HCM has been transformed into a contemporary treatable disease with management options that significantly alter clinical course. With the use of implantable cardioverter-defibrillators (ICDs) in the HCM patient population, a new paradigm has emerged, with primary prevention device therapy reliably terminating potentially lethal ventricular tachyarrhythmias (3%-4% per year) and being largely responsible for a >10-fold decrease in disease-related mortality (to 0.5% per year), independent of age. An evidenced-based and guideline directed clinical risk stratification algorithm has evolved, including variables identified with cardiac magnetic resonance. One or more risk markers judged major and relevant within a patient's clinical profile can be considered sufficient to recommend a primary prevention implant (associated with a measure of physician judgment and shared decision-making). ICD decisions using the prospective individual risk marker strategy have been associated with 95% sensitivity for identifying patients who subsequently experienced appropriate ICD therapy, (albeit often delayed substantially for >5 or >10 years after implant), but without heart failure deterioration or HCM death following device intervention. A rigid mathematically derived statistical risk model proposed by the European Society of Cardiology is associated with low sensitivity (ie, 33%) for predicting SD events. Introduction of prophylactically inserted ICDs to HCM 20 years ago has significantly altered the clinical course and landscape of this disease. SD prevention has reduced HCM mortality significantly, making preservation of life and the potential for normal longevity a reality for most patients.
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Coughlin LN, Nahum-Shani I, Philyaw-Kotov ML, Bonar EE, Rabbi M, Klasnja P, Murphy S, Walton MA. Developing an Adaptive Mobile Intervention to Address Risky Substance Use Among Adolescents and Emerging Adults: Usability Study. JMIR Mhealth Uhealth 2021; 9:e24424. [PMID: 33448931 PMCID: PMC7846447 DOI: 10.2196/24424] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/11/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Substance use among adolescents and emerging adults continues to be an important public health problem associated with morbidity and mortality. Mobile health (mHealth) provides a promising approach to deliver just-in-time adaptive interventions (JITAIs) to prevent escalation of use and substance use-related consequences. OBJECTIVE This pilot study aims to describe the iterative development and initial feasibility and acceptability testing of an mHealth smartphone app, called MiSARA, designed to reduce escalation in substance use. METHODS We used social media advertisements to recruit youth (n=39; aged 16-24 years, who screened positive for past-month binge drinking or recreational cannabis use) with a waiver of parental consent. Participants used the MiSARA app for 30 days, with feasibility and acceptability data reported at a 1-month follow-up. We present descriptive data regarding behavior changes over time. RESULTS The results show that most participants (31/39, 79%) somewhat liked the app at least, with most (29/39, 74%) rating MiSARA as 3 or more stars (out of 5). Almost all participants were comfortable with self-reporting sensitive information within the app (36/39, 92%); however, most participants also desired more interactivity (27/39, 69%). In addition, participants' substance use declined over time, and those reporting using the app more often reported less substance use at the 1-month follow-up than those who reported using the app less often. CONCLUSIONS The findings suggest that the MiSARA app is a promising platform for JITAI delivery, with future trials needed to optimize the timing and dose of messages and determine efficacy.
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Affiliation(s)
- Lara N Coughlin
- Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Inbal Nahum-Shani
- Institute of Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Meredith L Philyaw-Kotov
- Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, MI, United States
| | - Erin E Bonar
- Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Mashfiqui Rabbi
- Department of Statistics, Harvard University, Cambridge, MA, United States
| | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Susan Murphy
- Department of Statistics, Harvard University, Cambridge, MA, United States
- Computer Science, Harvard John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, United States
| | - Maureen A Walton
- Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
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Affiliation(s)
- Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (S.M.A.-K.)
| | - Fred M Kusumoto
- Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, FL (F.M.K.)
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