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Journal of the American College of... Oct 2023
Topics: Humans; Out-of-Hospital Cardiac Arrest; Cardiopulmonary Resuscitation; Electric Countershock; Emergency Medical Services
PubMed: 37879783
DOI: 10.1016/j.jacc.2023.09.798 -
CJEM Jan 2024
Topics: Humans; Electric Countershock; Defibrillators; Out-of-Hospital Cardiac Arrest
PubMed: 38194062
DOI: 10.1007/s43678-023-00633-9 -
Europace : European Pacing,... Dec 2023Single-connector (DF4) defibrillator leads have become the predominantly implanted transvenous implantable cardioverter-defibrillator lead. However, data on their... (Review)
Review
AIMS
Single-connector (DF4) defibrillator leads have become the predominantly implanted transvenous implantable cardioverter-defibrillator lead. However, data on their long-term performance are derived predominantly from manufacturer product performance reports.
METHODS AND RESULTS
We reviewed medical records in 5289 patients with DF4 leads between 2011 and 2023 to determine the frequency of lead-related abnormalities. We defined malfunction as any single or combination of electrical abnormalities requiring revision including a sudden increase (≥2×) in stimulation threshold, a discrete jump in high-voltage impedance, or sensing of non-physiologic intervals or noise. We documented time to failure, predictors of failure, and management strategies. Mean follow-up after implant was 4.15 ± 3.6 years (median = 3.63), with 37% of leads followed for >5 years. A total of 80 (1.5%) leads demonstrated electrical abnormalities requiring revision with an average time to failure of 4 ± 2.8 years (median = 3.5). Of the leads that malfunctioned, 62/80 (78%) were extracted and replaced with a new lead and in the other 18 cases, malfunctioned DF4 leads were abandoned, and a new lead implanted. In multivariable models, younger age at implant (OR 1.03 per year; P < 0.001) and the presence of Abbott/St. Jude leads increased the risk of malfunction.
CONCLUSION
DF4 defibrillator leads demonstrate excellent longevity with >98.3% of leads followed for at least 5 years still functioning normally. Younger age at implant and lead manufacturer are associated with an increased risk of DF4 lead malfunction. The differences in lead survival between manufacturers require further investigation.
Topics: Humans; Defibrillators, Implantable; Equipment Failure; Retrospective Studies
PubMed: 38000900
DOI: 10.1093/europace/euad347 -
Current Cardiology Reports Oct 2023Describe disparities in diagnosis and management between men and women with advanced heart failure (HF). Our goal is to identify barriers and suggest solutions. (Review)
Review
PURPOSE OF REVIEW
Describe disparities in diagnosis and management between men and women with advanced heart failure (HF). Our goal is to identify barriers and suggest solutions.
RECENT FINDINGS
Women with advanced HF are less likely to undergo diagnostic testing and procedures (i.e., revascularization, implantable cardioverter defibrillators, cardiac resynchronization therapy, mechanical circulatory support, and orthotopic heart transplantation). Disparities related to gender create less favorable outcomes for women with advanced HF. The issues arise from access to care, paucity of knowledge, enrollment in clinical trials, and eligibility for advanced therapies. In this review, we propose a call to action to level the playing field in order to improve survival in women with advanced HF.
Topics: Male; Humans; Female; Heart Failure; Heart Transplantation; Defibrillators, Implantable; Cardiac Resynchronization Therapy; Heart-Assist Devices; Treatment Outcome
PubMed: 37698818
DOI: 10.1007/s11886-023-01946-y -
The American Journal of Cardiology Aug 2023High-risk athletes with implanted cardioverter-defibrillators who are competing in intense sports represent a controversial issue in cardiovascular medicine. Such...
High-risk athletes with implanted cardioverter-defibrillators who are competing in intense sports represent a controversial issue in cardiovascular medicine. Such devices have the capability to protect patients with a variety of cardiovascular diseases from sudden death and have aborted potentially lethal events during competitive sports but they can also lead to adverse clinical consequences for athletes with implants and other participants. In conclusion, clinicians and athletes should consider the data presented here in making prudent and informed recommendations regarding the eligibility of this patient group with implanted cardioverter-defibrillators for intense competitive sports.
Topics: Humans; Defibrillators, Implantable; Death, Sudden, Cardiac; Sports; Athletes; Electric Countershock
PubMed: 37393157
DOI: 10.1016/j.amjcard.2023.05.050 -
Cardiac Electrophysiology Clinics Dec 2023Pediatric patients with congenital heart disease present unique challenges when it comes to cardiac implantable electronic devices. Pacing strategy is often determined... (Review)
Review
Pediatric patients with congenital heart disease present unique challenges when it comes to cardiac implantable electronic devices. Pacing strategy is often determined by patient size/weight and operator experience. Anatomic considerations, including residual shunts, anatomic obstructions and barriers, and abnormalities in the native conduction system, will affect the type of CIED implanted. Given the young age of patients, it is important to have an "eye on the future" when making pacemaker/defibrillator decisions, as one can expect several generator changes, lead revisions, and potential lead extractions during their lifetime.
Topics: Humans; Child; Defibrillators, Implantable; Pacemaker, Artificial; Heart Defects, Congenital; Electrodes, Implanted; Device Removal
PubMed: 37865521
DOI: 10.1016/j.ccep.2023.06.003 -
Biotechnology and Bioengineering Mar 2024This review covers currently available cardiac implantable electronic devices (CIEDs) as well as updated progress in real-time monitoring techniques for CIEDs. A... (Review)
Review
This review covers currently available cardiac implantable electronic devices (CIEDs) as well as updated progress in real-time monitoring techniques for CIEDs. A variety of implantable and wearable devices that can diagnose and monitor patients with cardiovascular diseases are summarized, and various working mechanisms and principles of monitoring techniques for Telehealth and mHealth are discussed. In addition, future research directions are presented based on the rapidly evolving research landscape including Artificial Intelligence (AI).
Topics: Humans; Pacemaker, Artificial; Defibrillators, Implantable; Cardiovascular Diseases; Artificial Intelligence; Telemedicine
PubMed: 38151894
DOI: 10.1002/bit.28637 -
Journal of Cardiothoracic and Vascular... Sep 2023Heightened sympathetic input to the myocardium potentiates cardiac electrical instability and may herald an electrical storm. An electrical storm is characterized by 3... (Review)
Review
Heightened sympathetic input to the myocardium potentiates cardiac electrical instability and may herald an electrical storm. An electrical storm is characterized by 3 or more episodes of ventricular tachycardia, ventricular fibrillation, or appropriate internal cardiac defibrillator shocks within 24 hours. Management of electrical storms is resource-intensive and inevitably requires careful coordination between multiple subspecialties. Anesthesiologists have an important role in acute, subacute, and long-term management. Identifying the phase of an electrical storm and understanding the characteristics of each morphology may help the anesthesiologist anticipate the management approach. In the acute phase, management of an electrical storm is aimed at providing advanced cardiac life support and identifying reversible causes. After initial stabilization, subacute management focuses on dampening the sympathetic surge with sedation, thoracic epidural, or stellate ganglion blockade. Definitive long-term management with surgical sympathectomy or catheter ablation also may be warranted. Our objective is to provide an overview of electrical storms and the anesthesiologist's role in management.
Topics: Humans; Ventricular Fibrillation; Arrhythmias, Cardiac; Tachycardia, Ventricular; Defibrillators, Implantable; Heart; Catheter Ablation; Treatment Outcome
PubMed: 37296026
DOI: 10.1053/j.jvca.2023.05.029 -
The Nursing Clinics of North America Sep 2023Although the concepts of pacing have been around for more than half a century, technological advances in cardiac implantable electronic devices (CIEDs) have changed the... (Review)
Review
Although the concepts of pacing have been around for more than half a century, technological advances in cardiac implantable electronic devices (CIEDs) have changed the landscape for patients in need of pacing support or sudden death prevention. Nurses encounter patients with CIEDs in all aspects of the health care setting. Because exciting CIED therapies are on the horizon, nurses must stay up-to-date to promote optimal outcomes for CIED patients. This essential guide provides nurses with a comprehensive overview of the principles of pacing and implantable cardioverter defibrillators (ICDs), as well as innovative technologies such as leadless cardiac pacemakers and subcutaneous ICDs.
Topics: Humans; Pacemaker, Artificial; Defibrillators, Implantable; Nurses
PubMed: 37536789
DOI: 10.1016/j.cnur.2023.05.007 -
Cardiology in the Young Sep 2023Sudden cardiac arrest is an uncommon event with high morbidity and mortality. There are improved outcomes with early access to an automated external defibrillator and...
Sudden cardiac arrest is an uncommon event with high morbidity and mortality. There are improved outcomes with early access to an automated external defibrillator and cardiopulmonary resuscitation. We assessed the availability of automated external defibrillators and emergency cardiac arrest plans in schools. A cross-sectional electronic survey was conducted to determine the status of emergency cardiac arrest plans and automated external defibrillator presence. Most schools (88%) had access to an automated external defibrillator; however, trained staff and maintenance plans were highly variable. Automated external defibrillator availability did not differ by racial/ethnic or socio-economic composition; however, there was a relationship between number of automated external defibrillators and student population (p = 0.0030). The majority of schools either did not have (28%) or did not know if they had (36%) an emergency cardiac arrest plan. Even without state legislation, automated external defibrillators were largely available in schools. However, there remains a paucity of emergency cardiac arrest plans and automated external defibrillator maintenance plans.
Topics: Humans; Cross-Sectional Studies; Heart Arrest; Death, Sudden, Cardiac; Cardiopulmonary Resuscitation; Schools; Defibrillators
PubMed: 36047061
DOI: 10.1017/S1047951122002815