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Kardiologia Polska Sep 2020
Topics: Child; Defibrillators, Implantable; Electric Countershock; Electrocardiography; Heart Defects, Congenital; Humans; Young Adult
PubMed: 32988178
DOI: 10.33963/KP.15620 -
Journal of Internal Medicine Mar 2018Out-of-hospital cardiac arrest (OHCA) is a major health problem that affects approximately four hundred and thousand patients annually in the United States alone. It is... (Review)
Review
Out-of-hospital cardiac arrest (OHCA) is a major health problem that affects approximately four hundred and thousand patients annually in the United States alone. It is a major challenge for the emergency medical system as decreased survival rates are directly proportional to the time delay from collapse to defibrillation. Historically, defibrillation has only been performed by physicians and in-hospital. With the development of automated external defibrillators (AEDs), rapid defibrillation by nonmedical professionals and subsequently by trained or untrained lay bystanders has become possible. Much hope has been put to the concept of Public Access Defibrillation with a massive dissemination of public available AEDs throughout most Western countries. Accordingly, current guidelines recommend that AEDs should be deployed in places with a high likelihood of OHCA. Despite these efforts, AED use is in most settings anecdotal with little effect on overall OHCA survival. The major reasons for low use of public AEDs are that most OHCAs take place outside high incidence sites of cardiac arrest and that most OHCAs take place in residential settings, currently defined as not suitable for Public Access Defibrillation. However, the use of new technology for identification and recruitment of lay bystanders and nearby AEDs to the scene of the cardiac arrest as well as new methods for strategic AED placement redefines and challenges the current concept and definitions of Public Access Defibrillation. Existing evidence of Public Access Defibrillation and knowledge gaps and future directions to improve outcomes for OHCA are discussed. In addition, a new definition of the different levels of Public Access Defibrillation is offered as well as new strategies for increasing AED use in the society.
Topics: Cardiopulmonary Resuscitation; Defibrillators; Electric Countershock; Humans; Out-of-Hospital Cardiac Arrest; Population Surveillance; Registries
PubMed: 29331055
DOI: 10.1111/joim.12730 -
Trends in Cardiovascular Medicine Aug 2016With increasing indications and access to cardiac implantable electronic devices (CIEDs) worldwide, the number of patients needing CIED follow-up continues to rise. In... (Review)
Review
With increasing indications and access to cardiac implantable electronic devices (CIEDs) worldwide, the number of patients needing CIED follow-up continues to rise. In parallel, the technology available for managing these devices has advanced considerably. In this setting, remote monitoring (RM) has emerged as a complement to routine in-office care. Rigorous studies, randomized and otherwise, have demonstrated advantages to patient with CIED management systems, which incorporates RM resulting in authoritative guidelines from relevant professional societies recommending RM for all eligible patients. In addition to clinical benefits, CIED management programs that include RM have been shown to be cost effective and associated with high patient satisfaction. Finally, RM programs hold promise for the future of CIED research in light of the massive data collected through RM databases converging with unprecedented computational capability. This review outlines the available data associated with clinical outcomes in patients managed with RM with an emphasis on randomized trials; the impact of RM on patient satisfaction, cost-effectiveness, and healthcare utilization; and possible future directions for the use of RM in clinical practice and research.
Topics: Cardiac Pacing, Artificial; Cardiac Resynchronization Therapy; Cardiac Resynchronization Therapy Devices; Defibrillators, Implantable; Electric Countershock; Heart Diseases; Humans; Pacemaker, Artificial; Patient Participation; Physician's Role; Practice Guidelines as Topic; Predictive Value of Tests; Prosthesis Design; Prosthesis Failure; Remote Sensing Technology; Risk Factors; Signal Processing, Computer-Assisted; Telemetry; Treatment Outcome
PubMed: 27134007
DOI: 10.1016/j.tcm.2016.03.012 -
Cardiology Journal 2013
Topics: Arrhythmias, Cardiac; Cardiac Resynchronization Therapy; Cardiac Resynchronization Therapy Devices; Clinical Trials as Topic; Death, Sudden, Cardiac; Defibrillators, Implantable; Electric Countershock; Humans; Prosthesis Design; Prosthesis Failure; Treatment Outcome
PubMed: 23788293
DOI: 10.5603/CJ.2013.0064 -
Journal of the American College of... Feb 2023
Topics: Humans; Out-of-Hospital Cardiac Arrest; Electric Countershock; Cardiopulmonary Resuscitation; Emergency Medical Services; Defibrillators
PubMed: 36792283
DOI: 10.1016/j.jacc.2022.11.048 -
Heart Rhythm Jan 2020The 2015 HRS/EHRA/APHRS/SOLAECE Expert Consensus Statement on Optimal Implantable Cardioverter-Defibrillator Programming and Testing provided guidance on bradycardia... (Review)
Review
The 2015 HRS/EHRA/APHRS/SOLAECE Expert Consensus Statement on Optimal Implantable Cardioverter-Defibrillator Programming and Testing provided guidance on bradycardia programming, tachycardia detection, tachycardia therapy, and defibrillation testing for implantable cardioverter-defibrillator (ICD) patient treatment. The 32 recommendations represented the consensus opinion of the writing group, graded by Class of Recommendation and Level of Evidence. In addition, Appendix B provided manufacturer-specific translations of these recommendations into clinical practice consistent with the recommendations within the parent document. In some instances, programming guided by quality evidence gained from studies performed in devices from some manufacturers was translated such that this programming was approximated in another manufacturer's ICD programming settings. The authors found that the data, although not formally tested, were strong, consistent, and generalizable beyond the specific manufacturer and model of ICD. As expected, because these recommendations represented strategic choices to balance risks, there have been reports in which adverse outcomes were documented with ICDs programmed to Appendix B recommendations. The recommendations have been reviewed and updated to minimize such adverse events. Notably, patients who do not receive unnecessary ICD therapy are not aware of being spared potential harm, whereas patients in whom their ICD failed to treat life-threatening arrhythmias have their event recorded in detail. The revised recommendations employ the principle that the randomized trials and large registry data should guide programming more than anecdotal evidence. These recommendations should not replace the opinion of the treating physician who has considered the patient's clinical status and desired outcome via a shared clinical decision-making process.
Topics: Arrhythmias, Cardiac; Cardiology; Consensus; Defibrillators, Implantable; Electric Countershock; Humans; Retrospective Studies; Societies, Medical
PubMed: 31103461
DOI: 10.1016/j.hrthm.2019.02.034 -
Texas Heart Institute Journal 2012Since the implantable cardioverter-defibrillator was first used clinically in 1980, several large randomized controlled trials have shown that therapy with this device... (Review)
Review
Since the implantable cardioverter-defibrillator was first used clinically in 1980, several large randomized controlled trials have shown that therapy with this device can be beneficial in various patient populations. Evidence suggests that this therapy is useful in the secondary prevention of sudden cardiac death among patients who have survived arrhythmic events. Several trials have also shown the usefulness of implantable cardioverter-defibrillator therapy in the primary prevention of sudden cardiac death in patients with coronary artery disease and nonischemic cardiomyopathy. Other data support the use of this device for various infiltrative and inherited conditions. When used with cardiac resynchronization therapy, implantable cardioverter-defibrillators have improved survival rates and quality of life in patients with severe heart failure. Further research is needed to examine the potential benefits of implantable cardioverter-defibrillators in elderly, female, and hemodialysis-dependent patients, and to determine the optimal waiting period for implantation after myocardial infarction, coronary revascularization, and initial heart-failure diagnosis.
Topics: Cardiac Resynchronization Therapy; Death, Sudden, Cardiac; Defibrillators, Implantable; Electric Countershock; Equipment Design; Heart Diseases; Humans; Patient Selection; Primary Prevention; Risk Assessment; Risk Factors; Secondary Prevention; Treatment Outcome
PubMed: 22719141
DOI: No ID Found -
Heart Rhythm Dec 2021To date, only a few comparisons between subcutaneous implantable cardioverter-defibrillator (S-ICD) patients undergoing and those not undergoing defibrillation testing... (Clinical Trial)
Clinical Trial Observational Study
BACKGROUND
To date, only a few comparisons between subcutaneous implantable cardioverter-defibrillator (S-ICD) patients undergoing and those not undergoing defibrillation testing (DT) at implantation (DT+ vs DT-) have been reported.
OBJECTIVE
The purpose of this study was to compare long-term clinical outcomes of 2 propensity-matched cohorts of DT+ and DT- patients.
METHODS
Among consecutive S-ICD patients implanted across 17 centers from January 2015 to October 2020, DT- patients were 1:1 propensity-matched for baseline characteristics with DT+ patients. The primary outcome was a composite of ineffective shocks and cardiovascular mortality. Appropriate and inappropriate shock rates were deemed secondary outcomes.
RESULTS
Among 1290 patients, a total of 566 propensity-matched patients (283 DT+; 283 DT-) served as study population. Over median follow-up of 25.3 months, no significant differences in primary outcome event rates were found (10 DT+ vs 14 DT-; P = .404) as well as for ineffective shocks (5 DT- vs 3 DT+; P = .725). At multivariable Cox regression analysis, DT performance was associated with a reduction of neither the primary combined outcome nor ineffective shocks at follow-up. A high PRAETORIAN score was positively associated with both the primary outcome (hazard ratio 3.976; confidence interval 1.339-11.802; P = .013) and ineffective shocks alone at follow-up (hazard ratio 19.030; confidence interval 4.752-76.203; P = .003).
CONCLUSION
In 2 cohorts of strictly propensity-matched patients, DT performance was not associated with significant differences in cardiovascular mortality and ineffective shocks. The PRAETORIAN score is capable of correctly identifying a large percentage of patients at risk for ineffective shock conversion in both cohorts.
Topics: Comparative Effectiveness Research; Death, Sudden, Cardiac; Defibrillators, Implantable; Electric Countershock; Equipment Failure; Equipment Failure Analysis; Europe; Female; Humans; Male; Materials Testing; Middle Aged; Propensity Score; Risk Assessment; Tachycardia, Ventricular
PubMed: 34214647
DOI: 10.1016/j.hrthm.2021.06.1201 -
International Journal of Environmental... Jun 2021The aim of the study was to assess the factors that influence the occurrence of concerns and their intensification after the implantation of a cardioverter defibrillator. (Observational Study)
Observational Study
BACKGROUND AND OBJECTIVES
The aim of the study was to assess the factors that influence the occurrence of concerns and their intensification after the implantation of a cardioverter defibrillator.
MATERIALS AND METHODS
This was a prospective and observational study including 158 patients. The study was conducted in two stages: stage I before implantable cardioverter defibrillator (ICD) implantation and stage II follow-up visit six months after ICD implantation. Standardized questionnaires were used in both stages.
RESULTS
Age and female gender were significantly correlated with the occurrence and intensity of concerns. Patients who had a device implanted for secondary prevention also experienced higher levels of concern. Additionally, a multiple regression model using the stepwise input method was performed. The model was statistically significant and explained 42% of the observed variance in the dependent variable ( = 0.0001, R = 0.4215). The analysis showed that age ( = 0.0036), insomnia ( = 0.0276), anxiety ( = 0.0000) and negative emotions ( = 0.0374) were important predictors of the dependent variable and enabled higher levels of the number of concerns to be predicted.
CONCLUSIONS
There is a relationship between the severity of the concerns related to an implanted ICD and age, gender, anxiety, negative emotions and insomnia. Indications for ICD implantation may be associated with increased concerns about ICD.
Topics: Anxiety; Defibrillators, Implantable; Electric Countershock; Female; Humans; Prospective Studies; Surveys and Questionnaires
PubMed: 34198777
DOI: 10.3390/ijerph18116095 -
Journal of Cardiovascular... May 2022A wearable cardioverter defibrillator (WCD) is indicated in appropriate patients to reduce the risk for sudden cardiac death. Challenges for patients wearing a WCD have...
INTRODUCTION
A wearable cardioverter defibrillator (WCD) is indicated in appropriate patients to reduce the risk for sudden cardiac death. Challenges for patients wearing a WCD have been frequent false shock alarms primarily due to electrocardiogram noise and wear discomfort. The objective of this study was to test a contemporary WCD designed for reduced false shock alarms and improved comfort.
METHODS
One hundred and thirty patients with left ventricular ejection fraction ≤40% and an active implantable cardioverter defibrillator (ICD) were fitted with the ASSURE WCD (Kestra Medical Technologies) and followed for 30 days. WCD detection was enabled and shock alarm markers recorded, but shocks and shock alarms were disabled. All WCD episodes and ICD ventricular tachycardia/ventricular fibrillation (VT/VF) episodes were adjudicated. The primary endpoint was the false-positive shock alarm rate with a performance goal of 1 every 3.4 days (0.29 per patient-day).
RESULTS
Of 163 WCD episodes, 4 were VT/VF and 159 non-VT/VF (121 rhythms with noise, 32 uncertain with noise, 6 atrial flutter without noise). Only three false-positive shock alarm markers were recorded; one false-positive shock alarm every 1333 patient-days (0.00075 per patient-day, 95% confidence interval: 0.00015-0.00361; p < .001). No ICD recorded VT/VF episodes meeting WCD detection criteria (≥170 bpm for ≥20 s) were missed by the WCD during 3501 patient-days of use. Median wear was 31.0 days (interquartile range [IQR] 2.0) and median daily use 23.0 h (IQR 1.7). Adverse events were mostly mild: skin irritation (19.4%) and musculoskeletal discomfort (8.5%).
CONCLUSION
The ASSURE WCD demonstrated a low false-positive shock alarm rate, low patient-reported discomfort, and no serious adverse events.
Topics: Arrhythmias, Cardiac; Death, Sudden, Cardiac; Defibrillators; Defibrillators, Implantable; Electric Countershock; Electrocardiography; Humans; Stroke Volume; Ventricular Fibrillation; Ventricular Function, Left; Wearable Electronic Devices
PubMed: 35174572
DOI: 10.1111/jce.15417