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Texas Heart Institute Journal 2011Electrical storm is an increasingly common and life-threatening syndrome that is defined by 3 or more sustained episodes of ventricular tachycardia, ventricular... (Review)
Review
Electrical storm is an increasingly common and life-threatening syndrome that is defined by 3 or more sustained episodes of ventricular tachycardia, ventricular fibrillation, or appropriate shocks from an implantable cardioverter-defibrillator within 24 hours. The clinical presentation can be dramatic. Electrical storm can manifest itself during acute myocardial infarction and in patients who have structural heart disease, an implantable cardioverter-defibrillator, or an inherited arrhythmic syndrome. The presence or absence of structural heart disease and the electrocardiographic morphology of the presenting arrhythmia can provide important diagnostic clues into the mechanism of electrical storm. Electrical storm typically has a poor outcome.The effective management of electrical storm requires an understanding of arrhythmia mechanisms, therapeutic options, device programming, and indications for radiofrequency catheter ablation. Initial management involves determining and correcting the underlying ischemia, electrolyte imbalances, or other causative factors. Amiodarone and β-blockers, especially propranolol, effectively resolve arrhythmias in most patients. Nonpharmacologic treatment, including radiofrequency ablation, can control electrical storm in drug-refractory patients. Patients who have implantable cardioverter-defibrillators can present with multiple shocks and may require drug therapy and device reprogramming. After the acute phase of electrical storm, the treatment focus should shift toward maximizing heart-failure therapy, performing revascularization, and preventing subsequent ventricular arrhythmias. Herein, we present an organized approach for effectively evaluating and managing electrical storm.
Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Catheter Ablation; Defibrillators, Implantable; Electric Countershock; Electrocardiography; Heart Conduction System; Humans; Recurrence; Treatment Outcome
PubMed: 21494516
DOI: No ID Found -
JACC. Clinical Electrophysiology Jul 2020
Topics: Death, Sudden, Cardiac; Defibrillators, Implantable; Electric Countershock; Humans; Subcutaneous Tissue
PubMed: 32703571
DOI: 10.1016/j.jacep.2020.04.014 -
European Heart Journal Mar 2022
Topics: COVID-19; Defibrillators, Implantable; Electric Countershock; Humans; Pandemics
PubMed: 34279020
DOI: 10.1093/eurheartj/ehab385 -
Circulation Journal : Official Journal... 2013There are few studies of pregnancy and delivery in patients with an implantable cardioverter-defibrillator (ICD). The purpose of this study was to investigate maternal...
BACKGROUND
There are few studies of pregnancy and delivery in patients with an implantable cardioverter-defibrillator (ICD). The purpose of this study was to investigate maternal and fetal outcome in these patients.
METHODS AND RESULTS
Six pregnant women with an ICD were retrospectively reviewed. All women underwent implantation of an ICD before pregnancy and delivered at the National Cerebral and Cardiovascular Center. The mean age at pregnancy and the mean follow-up period after ICD implantation were 28±3 years old and 5±3 years, respectively. There was no device-related complication during pregnancy. In 4 women, the number of tachyarrhythmias such as non-sustained ventricular tachycardia increased after the end of the second trimester of pregnancy and anti-arrhythmic medications were gradually increased. No patient received discharges or shocks from the ICD during pregnancy, however, and only one required anti-tachycardia pacing at 27 weeks' gestation. Mean gestational age at delivery was 37±2 weeks and all deliveries were by cesarean section, including 5 as emergency deliveries due to a fetal indication. After delivery, 2 mothers had reduced cardiac function and 1 received an ICD shock for the first time.
CONCLUSIONS
Pregnancy did not increase the risk of an ICD-related complication under appropriate management. Additional caution might be required in the postpartum period as well as during pregnancy and labor.
Topics: Adult; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cesarean Section; Defibrillators, Implantable; Electric Countershock; Emergencies; Female; Gestational Age; Humans; Live Birth; Postpartum Period; Pregnancy; Pregnancy Complications, Cardiovascular; Prosthesis Design; Prosthesis Failure; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome
PubMed: 23291990
DOI: 10.1253/circj.cj-12-1275 -
Clinical Research in Cardiology :... Nov 2022Sudden cardiac death (SCD) is the most frequent cause of cardiovascular death in industrialized nations. Patients with cardiomyopathy are at increased risk for SCD and... (Review)
Review
Sudden cardiac death (SCD) is the most frequent cause of cardiovascular death in industrialized nations. Patients with cardiomyopathy are at increased risk for SCD and may benefit from an implantable cardioverter-defibrillator (ICD). The risk of SCD is highest in the first months after myocardial infarction or first diagnosis of severe non-ischemic cardiomyopathy. On the other hand, left ventricular function may improve in a subset of patients to such an extent that an ICD might no longer be needed. To offer protection from a transient risk of SCD, the wearable cardioverter-defibrillator (WCD) is available. Results of the first randomized clinical trial investigating the role of the WCD after myocardial infarction were recently published. This review is intended to provide insight into data from the VEST trial, and to put these into perspective with studies and clinical experience. As a non-invasive, temporary therapy, the WCD may offer advantages over early ICD implantation. However, recent data demonstrate that patient compliance and education play a crucial role in this new concept of preventing SCD.
Topics: Humans; Death, Sudden, Cardiac; Electric Countershock; Defibrillators, Implantable; Cardiomyopathies; Myocardial Infarction; Wearable Electronic Devices; Defibrillators; Randomized Controlled Trials as Topic
PubMed: 35305126
DOI: 10.1007/s00392-022-02003-4 -
Medicina (Kaunas, Lithuania) 2005Defibrillation and cardioversion are techniques in which a short electric impulse is administered to the heart in order to restore its normal rhythm. During... (Review)
Review
Defibrillation and cardioversion are techniques in which a short electric impulse is administered to the heart in order to restore its normal rhythm. During cardioversion electric impulse is synchronized to the QRS on electrocardiogram. During defibrillation electric current passes through the heart in any phase of electric heart cycle. This mode of treatment is rather new - Lown et al. started to use it in a clinical practice in 1962. During defibrillation or cardioversion electric current goes from negative to positive electrode of defibrillator and passes the heart on its way. This induces transmembrane potential in myocardium cells and results in synchronic depolarization of all myocardium. The pathophysiology of defibrillation is explained by critical mass hypothesis as well as the upper limit of vulnerability hypothesis. The success of defibrillation depends on many factors, such as the location and size of electrodes, the type of defibrillator, the morphology of electric impulse, transthoracic impedance, the type and duration of arrhythmia. This procedure can be performed only on unconscious patient. The possible complications of the procedure can be disturbances in heart rhythm and conduction, the changes in arterial blood pressure, the damage to the myocardium, embolia, pulmonary edema and others. This article describes the mechanism of action of defibrillation and cardioversion, indications for this procedure, the technique and methods of defibrillation and cardioversion, the factors, responsible for the efficacy of the procedure and possible complications of defibrillation.
Topics: Defibrillators; Defibrillators, Implantable; Electric Countershock; Electric Impedance; Electrocardiography; Electrodes; Heart; Humans; Membrane Potentials
PubMed: 16272838
DOI: No ID Found -
Clinical Cardiology Sep 2015Chagas disease results from infection by the protozoan parasite Trypanosoma cruzi and is endemic in Latin America. T cruzi is most commonly transmitted through the feces... (Review)
Review
Chagas disease results from infection by the protozoan parasite Trypanosoma cruzi and is endemic in Latin America. T cruzi is most commonly transmitted through the feces of an infected triatomine, but can also be congenital, via contaminated blood transfusion or through direct oral contact. In the acute phase, the disease can cause cardiac derangements such as myocarditis, conduction system abnormalities, and/or pericarditis. If left untreated, the disease advances to the chronic phase. Up to one-half of these patients will develop a cardiomyopathy, which can lead to cardiac failure and/or ventricular arrhythmias, both of which are major causes of mortality. Diagnosis is confirmed by serologic testing for specific immunoglobulin G antibodies. Initial treatment consists of the antiparasitic agents benznidazole and nifurtimox. The treatment of Chagas cardiac disease comprises standard medical therapy for heart failure and amiodarone for ventricular arrhythmias, with consideration for implantable cardioverter-defibrillator. Chagas disease causes the highest infectious burden of any parasitic disease in the Western Hemisphere, and increased awareness of this disease is essential to improve diagnosis, enhance management, and reduce spread.
Topics: Antiparasitic Agents; Cardiovascular Agents; Chagas Cardiomyopathy; Defibrillators, Implantable; Electric Countershock; Humans; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 25993972
DOI: 10.1002/clc.22421 -
European Journal of Heart Failure Sep 2015
Topics: Cardiac Resynchronization Therapy; Cardiomyopathies; Defibrillators, Implantable; Early Medical Intervention; Electric Countershock; Female; Humans; Male; Stroke Volume; Ventricular Function, Left
PubMed: 26289768
DOI: 10.1002/ejhf.336 -
Journal of the American Heart... Apr 2021Background One third of primary prevention implantable cardioverter-defibrillator patients receive appropriate therapy, but all remain at risk of defibrillator... (Observational Study)
Observational Study
Background One third of primary prevention implantable cardioverter-defibrillator patients receive appropriate therapy, but all remain at risk of defibrillator complications. Information on these complications in contemporary cohorts is limited. This study assessed complications and their risk factors after defibrillator implantation in a Dutch nationwide prospective registry cohort and forecasts the potential reduction in complications under distinct scenarios of updated indication criteria. Methods and Results Complications in a prospective multicenter registry cohort of 1442 primary implantable cardioverter-defibrillator implant patients were classified as major or minor. The potential for reducing complications was derived from a newly developed prediction model of appropriate therapy to identify patients with a low probability of benefitting from the implantable cardioverter-defibrillator. During a follow-up of 2.2 years (interquartile range, 2.0-2.6 years), 228 complications occurred in 195 patients (13.6%), with 113 patients (7.8%) experiencing at least one major complication. Most common ones were lead related (n=93) and infection (n=18). Minor complications occurred in 6.8% of patients, with lead-related (n=47) and pocket-related (n=40) complications as the most prevailing ones. A surgical reintervention or additional hospitalization was required in 53% or 61% of complications, respectively. Complications were strongly associated with device type. Application of stricter implant indication results in a comparable proportional reduction of (major) complications. Conclusions One in 13 patients experiences at least one major implantable cardioverter-defibrillator-related complication, and many patients undergo a surgical reintervention. Complications are related to defibrillator implantations, and these should be discussed with the patient. Stricter implant indication criteria and careful selection of device type implanted may have significant clinical and financial benefits.
Topics: Aged; Death, Sudden, Cardiac; Defibrillators, Implantable; Electric Countershock; Equipment Failure Analysis; Female; Humans; Male; Needs Assessment; Netherlands; Patient Selection; Postoperative Complications; Prosthesis Implantation; Registries; Reoperation; Risk Assessment; Risk Factors
PubMed: 33787324
DOI: 10.1161/JAHA.120.018063 -
Resuscitation May 2020For out-of-hospital cardiac arrest (OHCA) in residential areas, a dispatcher driven alert-system using text messages (TM-system) directing local rescuers (TM-responders)...
BACKGROUND
For out-of-hospital cardiac arrest (OHCA) in residential areas, a dispatcher driven alert-system using text messages (TM-system) directing local rescuers (TM-responders) to OHCA patients was implemented and the desired density of automated external defibrillators (AEDs) or TM-responders investigated.
METHODS
We included OHCA cases with the TM-system activated in residential areas between 2010-2017. For each case, densities/km of activated AEDs and TM-responders within a 1000 m circle were calculated. Time intervals between 112-call and first defibrillation were calculated.
RESULTS
In total, 813 patients (45%) had a shockable initial rhythm. In 17% a TM-system AED delivered the first shock. With increasing AED density, the median time to shock decreased from 10:59 to 08:17 min. (p < 0.001) and shocks <6 min increased from 6% to 12% (p = 0.024). Increasing density of TM-responders was associated with a decrease in median time to shock from 10:59 to 08:20 min. (p < 0.001) and increase of shocks <6 min from 6% to 13% (p = 0.005). Increasing density of AEDs and TM-responders resulted in a decline of ambulance first defibrillation by 19% (p = 0.016) and 22% (p = 0.001), respectively. First responder AED defibrillation did not change significantly. Densities of >2 AEDs/km did not result in further decrease of time to first shock but >10 TM-responders/km resulted in more defibrillations <6 min.
CONCLUSION
With increasing AED and TM-responder density within a TM-system, time to defibrillation in residential areas decreased. AED and TM-responders only competed with ambulances, not with first responders. The recommended density of AEDs and TM-responders for earliest defibrillation is 2 AEDs/km and >10 TM-responders/km.
Topics: Cardiopulmonary Resuscitation; Defibrillators; Electric Countershock; Emergency Medical Services; Emergency Responders; Humans; Out-of-Hospital Cardiac Arrest; Text Messaging
PubMed: 32045663
DOI: 10.1016/j.resuscitation.2020.01.031