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Sample records for automatic defibrillator implantation

  1. [Implanted automatic defibrillator after ventricular fibrillation treated with semi-automatic defibrillation].

    PubMed

    Ould-Ahmed, M; Bordier, E; Leenhardt, A; Frank, R; Michel, A

    1998-01-01

    We report two cases of out-of-hospital ventricular fibrillation treated without delay, with basic life support practiced by the witness, followed by a successful defibrillation by paramedics with a semi-automatic defibrillator. In the subsequent month, a cardioverter-defibrillator was implanted. In one patient, a ventricular tachycardia occurring 10 months later and a ventricular fibrillation 9 months later in the other respectively, were successfully reversed by the implanted defibrillator. These two cases illustrate the value of the "survival chain" concept (undelayed alert, basic life support by witness, early defibrillation by paramedics with a semi-automatic defibrillator, advanced life support by a physician) as well as the benefit of the implanted cardioverter-defibrillator. PMID:9750683

  2. Patient ECG recording control for an automatic implantable defibrillator

    NASA Technical Reports Server (NTRS)

    Fountain, Glen H. (Inventor); Lee, Jr., David G. (Inventor); Kitchin, David A. (Inventor)

    1986-01-01

    An implantable automatic defibrillator includes sensors which are placed on or near the patient's heart to detect electrical signals indicative of the physiology of the heart. The signals are digitally converted and stored into a FIFO region of a RAM by operation of a direct memory access (DMA) controller. The DMA controller operates transparently with respect to the microprocessor which is part of the defibrillator. The implantable defibrillator includes a telemetry communications circuit for sending data outbound from the defibrillator to an external device (either a patient controller or a physician's console or other) and a receiver for sensing at least an externally generated patient ECG recording command signal. The patient recording command signal is generated by the hand held patient controller. Upon detection of the patient ECG recording command, DMA copies the contents of the FIFO into a specific region of the RAM.

  3. Migration of an automatic implantable cardioverter-defibrillator patch causing massive hemothorax.

    PubMed Central

    Quigley, R L; Hamer, M E; Swiryn, S

    1996-01-01

    The automatic implantable cardioverter-defibrillator is composed of shocking electrodes (patches or coils), sensing electrodes, and a generator implanted in the abdominal wall. A number of complications with defibrillators have been reported, including migration of the various components. We describe a patient in whom one of the patches, originally sutured extrapericardially, migrated in the right hemithorax and eroded into the ipsilateral lung. The resultant massive hemothorax necessitated urgent thoracotomy, patch removal, and hematoma evacuation. A hybrid implantable cardioverter-defibrillator system was created as a replacement to minimize surgery while protecting the patient from sudden death. Images PMID:8680276

  4. Silicone Breast Implant and Automatic Implantable Cardioverter Defibrillator: Can They Coexist? A Case Report

    PubMed Central

    Arik, Zaretski

    2016-01-01

    Summary: We present a case of a silicone breast implant rupture after insertion of an automatic implantable cardioverter defibrillator (AICD). A 51-year-old woman presented to our plastic surgery clinic to exchange her silicone breast implants. The patient underwent cosmetic mastopexy and breast augmentation in 2008. Because of recurrent myocardial infarctions and chronic heart failure, she underwent an insertion of an AICD in 2014 in which the left breast implant was hit. In this report, we discuss the first case of an AICD insertion, disrupting a breast implant. This case report illustrates the rare but real possibility of breast implant rupture after even minor surgical manipulation of the breast area. PMID:27622117

  5. Automatic implantable cardioverter defibrillator pocket infection due to Providencia rettgeri: a case report

    PubMed Central

    De Benedetti, Maria Elena

    2009-01-01

    Coagulase-negative staphylococci and Staphylococcus aureus are the commonest pathogens involved in infections of pacemaker-defibrillator systems. Among causative Gram-negative bacteria, infections due to Klebsiella, Serratia, Pseudomonas, Acinetobacter and other species have been reported. We report herein a unique case of an automatic implantable cardioverter defibrillator infection due to Providencia rettgeri in a 65-year-old male who was admitted to our service with bacteremia and infection of the generator and subcutaneous array in a recently implanted device. PMID:19918391

  6. Automatic implantable cardioverter defibrillator pocket infection due to Providencia rettgeri: a case report.

    PubMed

    Marull, Jorge Manuel; De Benedetti, Maria Elena

    2009-01-01

    Coagulase-negative staphylococci and Staphylococcus aureus are the commonest pathogens involved in infections of pacemaker-defibrillator systems. Among causative Gram-negative bacteria, infections due to Klebsiella, Serratia, Pseudomonas, Acinetobacter and other species have been reported. We report herein a unique case of an automatic implantable cardioverter defibrillator infection due to Providencia rettgeri in a 65-year-old male who was admitted to our service with bacteremia and infection of the generator and subcutaneous array in a recently implanted device. PMID:19918391

  7. [Clinical development of the automatic implantable defibrillator over 35 years: A success story].

    PubMed

    Steinbeck, G

    2015-06-01

    After 12 years of development and experimental evaluation, the first automatic implantable cardioverter-defibrillator (ICD) was implanted in man on February 4, 1980. This overview describes the technical and functional developments over 35 years from a simple shock-box, weighing 292 g, to the sophisticated 80 g device of today, delivering graded therapy to sustained ventricular arrhythmias and biventricular stimulation to treat heart failure. Finally, a special tribute is given to Michel Mirowski, one of the inventors of the ICD, as scientist and physician dedicated to patient care. PMID:25990264

  8. Obstetric hemorrhage in a case of hypertrophic obstructive cardiomyopathy with automatic implantable cardioverter defibrillator: Anaesthesia and intensive care management

    PubMed Central

    Mishra, Sandeep Kumar; Bhat, Ravindra R.; Kavitha, Jayaram; Kundra, Pankaj; Parida, Satyen

    2016-01-01

    The physiological changes occurring during pregnancy and labor may reveal or exacerbate the symptoms of hypertrophic obstructive cardiomyopathy (HOCM). The addition of obstetric hemorrhage to this presents a unique challenge to the anesthesiologists and intensivists managing these patients in the operation theatres and the Intensive Care Units. Here we present a case of HOCM with automatic implantable cardioverter defibrillator in situ and postpartum hemorrhagic shock. PMID:26957702

  9. Bipolar Radiofrequency Neurotomy to Treat Neck and Back Pain in Patients with Automatic Implantable Cardioverter Defibrillator.

    PubMed

    Bautista, Alexander; Dadabayev, Alisher; Rosenquist, Ellen; Cheng, Jianguo

    2016-03-01

    We report 2 cases of successful treatment of neck and back pain with bipolar radiofrequency ablation (RFA) of the cervical and lumbar facet joints in patients with an automatic implantable cardioverter defibrillator (AICD).Two patients with complex cardiac histories and AICD devices were treated with bipolar RFA of the facet joints. One presented with axial neck pain and the other with axial back pain. The histories and physical examinations were consistent with facetogenic pain. Diagnostic medial branch block resulted in more than 70% pain relief lasting for several days, allowing patients to perform routine daily activities without significant pain. However, we were concerned about the use of conventional RFA of the medial branches of nerves for the fear of interference with the function of AICD by the RF currents and energy. We took advantage of the localized and limited current of bipolar RFA to perform this procedure for the cervical or lumbar facet joints avoiding any interference with the function of AICD. The procedures provided long-term pain relief to the patients, and marked improvement in their functional status without any evident complications related to the function of their AICD.This case report describes the safe and successful completion of bipolar RFA of the medial branch nerves to treat cervical and lumbar facetogenic pain in patients with AICD. This modality of treatment may be considered in patients with AICD. We are finding it to be increasingly common that patients who present with chronic neck and back pain have AICDs in place. PMID:27008309

  10. MedlinePlus: Pacemakers and Implantable Defibrillators

    MedlinePlus

    ... CA, 10/30/13 Statistics and Research Elderly Benefit from Using Implantable Defibrillators (American Heart Association) Many People with Implantable Defibrillators Can Participate in Vigorous Sports (American Heart Association) Clinical Trials ClinicalTrials.gov: Defibrillators, ...

  11. ANTIARRHYTHMICS VERSUS IMPLANTABLE DEFIBRILLATORS (AVID)

    EPA Science Inventory

    Evaluates whether use of an implantable cardiac defibrillator (ICD) results in reduction in total mortality, when compared with conventional pharmacological therapy, in patients resuscitated from sudden cardiac death who are otherwise at very high risk of mortality from arrhythmi...

  12. Automatic Supporting System for Regionalization of Ventricular Tachycardia Exit Site in Implantable Defibrillators

    PubMed Central

    Sanromán-Junquera, Margarita; Mora-Jiménez, Inmaculada; Almendral, Jesús; García-Alberola, Arcadio; Rojo-Álvarez, José Luis

    2015-01-01

    Electrograms stored in Implantable Cardioverter Defibrillators (ICD-EGM) have been proven to convey useful information for roughly determining the anatomical location of the Left Ventricular Tachycardia exit site (LVTES). Our aim here was to evaluate the possibilities from a machine learning system intended to provide an estimation of the LVTES anatomical region with the use of ICD-EGM in the situation where 12-lead electrocardiogram of ventricular tachycardia are not available. Several machine learning techniques were specifically designed and benchmarked, both from classification (such as Neural Networks (NN), and Support Vector Machines (SVM)) and regression (Kernel Ridge Regression) problem statements. Classifiers were evaluated by using accuracy rates for LVTES identification in a controlled number of anatomical regions, and the regression approach quality was studied in terms of the spatial resolution. We analyzed the ICD-EGM of 23 patients (18±10 EGM per patient) during left ventricular pacing and simultaneous recording of the spatial coordinates of the pacing electrode with a navigation system. Several feature sets extracted from ICD-EGM (consisting of times and voltages) were shown to convey more discriminative information than the raw waveform. Among classifiers, the SVM performed slightly better than NN. In accordance with previous clinical works, the average spatial resolution for the LVTES was about 3 cm, as in our system, which allows it to support the faster determination of the LVTES in ablation procedures. The proposed approach also provides with a framework suitable for driving the design of improved performance future systems. PMID:25910170

  13. Elderly Benefit from Using Implantable Defibrillators

    MedlinePlus

    ... org Learn More Elderly benefit from using implantable defibrillators June 17, 2013 Categories: Heart News Study Highlights: Older people may benefit from implantable cardioverter defibrillators (ICDs) as much as younger people. Overall health, ...

  14. How Does an Implantable Cardioverter Defibrillator Work?

    MedlinePlus

    ... on Twitter. How Does an Implantable Cardioverter Defibrillator Work? An implantable cardioverter defibrillator (ICD) has wires with ... tune the programming of your ICD so it works better to correct irregular heartbeats. The type of ...

  15. [Implantable cardioverter defibrillator: an update].

    PubMed

    le Heuzey, Jean-Yves; Aliot, Etienne

    2007-01-01

    Automatic implantable cardioverter defibrillator is now a well established therapy to prevent sudden cardiac death. In secondary prevention (patients with a previous cardiac arrest) defibrillator can be considered as a class I indication, if there is no transient or reversible cause. The level of proof is A. in primary prevention the defibrillator is indicated in coronary artery disease patients with or without symptoms of mild to moderate heart failure (NYHA II or III), an ejection fraction lower than 30 %, measured at least one month after a myocardial infarction and 3 months after a revascularisation, surgery or angioplasty (level of proof B). It is also indicated in symptomatic spontaneous sustained ventricular tachycardias with underlying heart disease (level of proof B), in patients with spontaneous sustained ventricular tachycardia, poorly tolerated, without underlying heart disease for which pharmacological treatment or ablation can not be performed or failed (level of proof B). Finally it is also indicated in patients with syncope of unknown cause with sustained ventricular tachycardia or inducible ventricular fibrillation, with an underlying heart disease (level of proof B). The guidelines proposed by the different societies have also proposed class IIa recommendations which are the following: coronary artery disease patients with left ventricular dysfunction (ejection fraction between 31 or 35 %) measured at least one month after a myocardial infarction and 3 months after a revascularisation with an inducible ventricular arrhythmia. It can be also indicated in idiopathic dilated cardiomyopathies with an ejection fraction lower than 30% and NYHA class II or III. It can be also indicated in familial or inherited conditions with a high risk of sudden cardiac death by ventricular fibrillation without any other efficient known treatment and finally in heart failure patients remaining symptomatic, in class III or IV NYHA, with an optimal medical therapy, an

  16. Predictors of severe tricuspid regurgitation in patients with permanent pacemaker or automatic implantable cardioverter-defibrillator leads.

    PubMed

    Najib, Mohammad Q; Vittala, Satya S; Challa, Suresh; Raizada, Amol; Tondato, Fernando J; Lee, Howard R; Chaliki, Hari P

    2013-01-01

    Patients with permanent pacemaker or automatic implantable cardioverter-defibrillator (AICD) leads have an increased prevalence of tricuspid regurgitation. However, the roles of cardiac rhythm and lead-placement duration in the development of severe tricuspid regurgitation are unclear. We reviewed echocardiographic data on 26 consecutive patients who had severe tricuspid regurgitation after permanent pacemaker or AICD placement; before treatment, they had no organic tricuspid valve disease, pulmonary hypertension, left ventricular dysfunction, or severe tricuspid regurgitation. We compared the results to those of 26 control subjects who had these same devices but no more than mild tricuspid regurgitation. The patients and control subjects were similar in age (mean, 81 ±6 vs 81 ±8 yr; P = 0.83), sex (male, 42% vs 46%; P = 0.78), and left ventricular ejection fraction (0.60 ±0.06 vs 0.58 ± 0.05; P = 0.4). The patients had a higher prevalence of atrial fibrillation (92% vs 65%; P=0.01) and longer median duration of pacemaker or AICD lead placement (49.5 vs 5 mo; P < 0.001). After adjusting for age, sex, and right ventricular systolic pressure by multivariate logistic regression analysis, we found that atrial fibrillation (odds ratio=6.4; P = 0.03) and duration of lead placement (odds ratio=1.5/yr; P = 0.001) were independently associated with severe tricuspid regurgitation. Out study shows that atrial fibrillation and longer durations of lead placement might increase the risk of severe tricuspid regurgitation in patients with permanent pacemakers or AICDs. PMID:24391312

  17. Predictors of Severe Tricuspid Regurgitation in Patients with Permanent Pacemaker or Automatic Implantable Cardioverter-Defibrillator Leads

    PubMed Central

    Najib, Mohammad Q.; Vittala, Satya S.; Challa, Suresh; Raizada, Amol; Tondato, Fernando J.; Lee, Howard R.; Chaliki, Hari P.

    2013-01-01

    Patients with permanent pacemaker or automatic implantable cardioverter-defibrillator (AICD) leads have an increased prevalence of tricuspid regurgitation. However, the roles of cardiac rhythm and lead-placement duration in the development of severe tricuspid regurgitation are unclear. We reviewed echocardiographic data on 26 consecutive patients who had severe tricuspid regurgitation after permanent pacemaker or AICD placement; before treatment, they had no organic tricuspid valve disease, pulmonary hypertension, left ventricular dysfunction, or severe tricuspid regurgitation. We compared the results to those of 26 control subjects who had these same devices but no more than mild tricuspid regurgitation. The patients and control subjects were similar in age (mean, 81 ±6 vs 81 ±8 yr; P = 0.83), sex (male, 42% vs 46%; P = 0.78), and left ventricular ejection fraction (0.60 ±0.06 vs 0.58 ± 0.05; P = 0.4). The patients had a higher prevalence of atrial fibrillation (92% vs 65%; P=0.01) and longer median duration of pacemaker or AICD lead placement (49.5 vs 5 mo; P < 0.001). After adjusting for age, sex, and right ventricular systolic pressure by multivariate logistic regression analysis, we found that atrial fibrillation (odds ratio=6.4; P = 0.03) and duration of lead placement (odds ratio=1.5/yr; P = 0.001) were independently associated with severe tricuspid regurgitation. Out study shows that atrial fibrillation and longer durations of lead placement might increase the risk of severe tricuspid regurgitation in patients with permanent pacemakers or AICDs. PMID:24391312

  18. Athletes with Implantable Cardioverter Defibrillators.

    PubMed

    Ponamgi, Shiva P; DeSimone, Christopher V; Ackerman, Michael J

    2015-07-01

    Athletes with an implantable cardioverter defibrillator (ICD) represent a diverse group of individuals who may be at an increased risk of sudden cardiac death when engaging in vigorous physical activity. Therefore, they are excluded by the current guidelines from participating in most competitive sports except those classified as low intensity, such as bowling and golf. The lack of substantial data on the natural history of the cardiac diseases affecting these athletes as well as the unknown efficacy of ICDs in terminating life-threatening arrhythmias occurring during intense exercise has resulted in the restrictive nature of these now decade old guidelines. PMID:26100423

  19. Automatic Implantable Cardiac Defibrillator

    MedlinePlus Videos and Cool Tools

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  20. Pacemakers and implantable cardioverter defibrillators.

    PubMed

    Allen, M

    2006-09-01

    An increasing number of patients are now treated cardiac pacemakers and implantable cardioverter defibrillators and the technology of these is constantly changing. It is vital to have a good understanding of how they function and what the real risks are. Understanding how the device should work when functioning normally, and the possible effects of electromagnetic interference, is paramount to their safe management in the peri-operative period. Knowing when a device should be disabled or reprogrammed requires careful consideration. Information from the patient's pacemaker clinic should be sought whenever possible and can be invaluable. In addition, the Medicines Healthcare products Regulatory Agency have published the first set of UK guidelines on the management of implantable devices in the presence of surgical diathermy and this will undoubtedly provide a firm foundation on which anaesthetists can base much of their practice. PMID:16922756

  1. Implantation of additional defibrillation lead into the coronary sinus: an effective method of decreasing defibrillation threshold.

    PubMed

    Wilczek, Rajmund; Swiątkowski, Maciej; Czepiel, Aleksandra; Sterliński, Maciej; Makowska, Ewa; Kułakowski, Piotr

    2011-01-01

    We report a case of successful implantation of an additional defibrillation lead into the coronary sinus due to high defibrillation threshold (DFT) in a seriously ill patient with a history of extensive myocardial infarction referred for implantable cardioverter- defibrillator implantation after an episode of unstable ventricular tachycardia. All previous attempts to reduce DFT, including subcutaneous electrode implantation, had been unsuccessful. PMID:22219117

  2. Pacemakers and Implantable Defibrillators - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Multiple Languages → All Health Topics → Pacemakers and Implantable Defibrillators URL of this page: https://medlineplus.gov/languages/ ... List of All Topics All Pacemakers and Implantable Defibrillators - Multiple Languages To use the sharing features on ...

  3. The Subcutaneous Implantable Cardioverter Defibrillator.

    PubMed

    Mangels, Daniel; Frishman, William H

    2016-01-01

    The subcutaneous implantable cardioverter defibrillator (S-ICD) is a subcutaneous alternative to conventional transvenous ICD (TV-ICD) systems, which have previously been shown to treat life-threatening ventricular tachyarrhythmias in cardiac disease patients. A review of the literature reveals that S-ICDs have similar shock efficacy rates for both induced and spontaneous ventricular tachyarrhythmias when compared with TV-ICDs. Furthermore, S-ICDs seem to have a higher specificity for withholding therapy when supraventricular tachycardia is present compared with TV-ICDs. The advantages of the S-ICD system are numerous: fewer vascular complications including thrombosis and hemothorax, avoidance of fluoroscopy, and an easier means of lead replacement. These advantages make the S-ICD system most suitable for younger patients who may require replacements in later life, those with abnormal venous anatomy, and individuals prone to infection and/or central vein thrombosis. However, S-ICDs are not without their complications and are associated with a higher incidence of inappropriate shocks secondary to T wave oversensing. S-ICDs also lack antitachycardia pacing, making them a suboptimal device in patients with recurrent monomorphic ventricular tachycardia who would otherwise benefit from the antitachycardia pacing offered in TV-ICDs. Lastly, the limited number of long-term randomized, head-to-head studies involving direct comparison with TV-ICDs poses a challenge in the implementation of the S-ICD. PMID:26807549

  4. Athletes with Implantable Cardioverter Defibrillators

    PubMed Central

    Ponamgi, Shiva P.; DeSimone, Christopher V.; Ackerman, Michael J.

    2015-01-01

    Summary Athletes with an implantable cardioverter defibrillator (ICD) represent a diverse group of individuals who may be at an increased risk of sudden cardiac death (SCD) when engaging in vigorous physical activity. Therefore, they are excluded by the current guidelines from participating in most competitive sports except those classified as low intensity, such as bowling and golf. The lack of substantial data on the natural history of the cardiac diseases affecting these athletes, as well as the unknown efficacy of implanted ICDs in terminating life-threatening arrhythmias occurring during intense exercise, have resulted in the restrictive nature of these now decade old guidelines. Recently, there is emerging data, derived from a few retrospective studies and a large prospective registry that demonstrates the relative safety of high-risk athletes participating in competitive sports and challenges the prohibitive nature of these guidelines. Nevertheless, the safe participation of all athletes with an ICD in competitive sports continues to be contemplated. The increased number of inappropriate shocks, damage to the ICD/pacemaker system, and the questionable efficacy of the delivered shock in the setting of vigorous physical activity are some of the main challenges faced by these athletes who choose to continue participation in competitive sports. The fear of SCD and ICD shocks faced by these athletes is also associated with a negative psychological burden and affects their quality of life, as does restricting them from all competitive sports. Therefore, shared decision making is necessary between the clinician and athlete after carefully analyzing the risks and benefits associated with competitive sports participation. PMID:26100423

  5. Indications for an implantable cardioverter defibrillator (ICD).

    PubMed

    Aizawa, Yoshifusa; Chinushi, Masaomi; Washizuka, Takashi

    2004-05-01

    Since the first clinical use of implantable defibrillator in human, the technology and the function of implantable cardioverter-defibrillator (ICD) have been much improved and now, ICD can be implanted within the chest wall. ICD is the most reliable therapy to prevent sudden cardiac death (SCD) in patients with documented VT/VF and the efficacy is most clear in patients with depressed heart function. It is now extended as a tool of the primary prevention of SCD in high risk patients after myocardial infarction. However, such beneficial effect is not applicable to DCM though patients might have depressed heart function. ICD is not free from procedure- or device-related problems which need to be resolved. From unknown causes, VT/VF might recur in an incessant form and an emergency admission is needed. Therefore, even during ICD therapy, patients often require antiarrhythmic drugs or catheter ablation. PMID:15206546

  6. Reliability systems for implantable cardiac defibrillator batteries

    NASA Astrophysics Data System (ADS)

    Takeuchi, Esther S.

    The reliability of the power sources used in implantable cardiac defibrillators is critical due to the life-saving nature of the device. Achieving a high reliability power source depends on several systems functioning together. Appropriate cell design is the first step in assuring a reliable product. Qualification of critical components and of the cells using those components is done prior to their designation as implantable grade. Product consistency is assured by control of manufacturing practices and verified by sampling plans using both accelerated and real-time testing. Results to date show that lithium/silver vanadium oxide cells used for implantable cardiac defibrillators have a calculated maximum random failure rate of 0.005% per test month.

  7. Advances in implantable cardioverter defibrillator therapy.

    PubMed

    Rickard, John; Wilkoff, Bruce L

    2016-03-01

    Since the first implant in 1980, implantable cardioverter defibrillator (ICD) technology has progressed rapidly. Modern ICD's have hundreds of programmable options with the general goal of preventing inappropriate shocks and providing shocks for truly life threatening symptomatic ventricular arrhythmias. New studies on ICD programming have shown the benefits of prolonged detection intervals in reaching this goal. Anti-tachycardia pacing (ATP) therapy has become an important adjunct to defibrillator shocks. Remote monitoring technologies have surfaced which have been shown to identify arrhythmias and problems with the device in an expedient fashion. The subcutaneous ICD offers the advantage of avoiding intravascular leads and their inherent risks. Lastly, the current understanding of the effects of MRI in ICD patients has advanced creating new opportunities to provide MRI safely to such patients. PMID:26653411

  8. Cardiomyopathy and the use of implanted cardio-defibrillators in children.

    PubMed

    Kaminer, S J; Pickoff, A S; Dunnigan, A; Sterba, R; Wolff, G S

    1990-05-01

    Children and adults with cardiomyopathy and ventricular dysrhythmias have a uniformly poor prognosis, despite medical therapy. The use of automatic implantable cardio-defibrillators in adult patients with medically resistant ventricular dysrhythmias has resulted in a positive impact on survival. Because of its size and former lack of programmability, the device has been used rarely in children. Four patients with cardiomyopathy, in whom refractory ventricular dysrhythmias were managed with automatic implantable cardio-defibrillators, are presented. Two of these children are the youngest and smallest known in whom the device has been used; one of them received the first programmable model. The use of the automatic implantable cardio-defibrillator may enhance survival in selected young patients. PMID:1693196

  9. Defibrillation testing at the time of implantable cardioverter defibrillator implantation: results of the European Heart Rhythm Association survey.

    PubMed

    Morgan, John M; Marinskis, Germanas

    2011-04-01

    This survey assesses the current practices of testing defibrillation function at the time of the first implanted cardioverter defibrillator placement. Responses have been collected from 57 European heart rhythm management centres. The results of the survey show an extraordinary inconsistency in the approaches to defibrillation testing (19.3% of responders report no testing at the time of implantation). A policy statement on this topic would help to improve patient care and unify the procedure according to evidence based data. PMID:21447521

  10. Utilization of implantable defibrillators in Africa.

    PubMed

    Millar, R N Scott; Mayosi, B M

    2003-01-01

    Sub-Saharan Africa is dominated by diseases of poverty. HIV/AIDS affects 28.5 out of a total of 600 million in the region. South Africa is the only country in sub-Saharan Africa in which implantable cardiovertor defibrillators (ICDs) are implanted (0.8/million in 2001). Only 3 of the 35 new ICDs were implanted in state-funded public hospitals. The pacemaker implantation rate for South Africa was 41/million in 2001. Approximately 20% of the population consume 56% of the health care expenditure, mainly funded by Medical Insurance. A tax-funded state health care system serves the rest of the population, but is concentrated on improving sanitation and primary health care. Diversion of funds from academic tertiary hospitals has reduced specialised services, particularly cardiology and cardiac surgery, and has resulted in an exodus of skilled personnel to the private sector. In the rest of sub-Saharan Africa, tertiary health care is mainly privately funded. Cardiology and cardiac surgery is not widely available. Many countries are crippled by debt and chronic local conflicts. Only one state hospital (Groote Schuur, Cape Town) provides an electrophysiology (EP) service including catheter ablation and ICD implantation, and training in EP, by two electrophysiologists. EP services are available privately in 3 centres. No EP service exists in the rest of sub-Saharan Africa. PMID:12766510

  11. Contact dermatitis after implantable cardiac defibrillator implantation for ventricular tachycardia

    PubMed Central

    Dogan, Pinar; Inci, Sinan; Kuyumcu, Mevlut Serdar; Kus, Ozgur

    2016-01-01

    Summary Pacemaker contact sensitivity is a rare condition. Less than 30 reports of pacemaker skin reactions have been described. We report a 57-year-old woman who underwent an implantable cardiac defibrillator (ICD) implantation for ventricular tachycardia. A skin patch test was positive on almost all components of the pacemaker system. She was treated with topical corticosteroids and skin lesions resolved within 2 weeks. Because of widespread use of various devices, we will see this more often and therefore it is important to recognize this problem and its effective management. PMID:26989652

  12. What Are the Risks of Having an Implantable Cardioverter Defibrillator?

    MedlinePlus

    ... from the NHLBI on Twitter. What Are the Risks of Having an Implantable Cardioverter Defibrillator? Unnecessary Electrical ... prescribe medicine so unnecessary pulses occur less often. Risks Related to Surgery Although rare, some ICD risks ...

  13. Implantable Cardiac Defibrillator Lead Failure and Management.

    PubMed

    Swerdlow, Charles D; Kalahasty, Gautham; Ellenbogen, Kenneth A

    2016-03-22

    The implantable-cardioverter defibrillator (ICD) lead is the most vulnerable component of the ICD system. Despite advanced engineering design, sophisticated manufacturing techniques, and extensive bench, pre-clinical, and clinical testing, lead failure (LF) remains the Achilles' heel of the ICD system. ICD LF has a broad range of adverse outcomes, ranging from intermittent inappropriate pacing to proarrhythmia leading to patient mortality. ICD LF is often considered in the context of design or construction defects, but is more appropriately considered in the context of the finite service life of a mechanical component placed in chemically stressful environment and subjected to continuous mechanical stresses. This clinical review summarizes LF mechanisms, assessment, and differential diagnosis of LF, including lead diagnostics, recent prominent lead recalls, and management of LF and functioning, but recalled leads. Despite recent advances in lead technology, physicians will likely continue to need to understand how to manage patients with transvenous ICD leads. PMID:26988958

  14. Pacemakers and implantable cardioverter defibrillators--general and anesthetic considerations.

    PubMed

    Rapsang, Amy G; Bhattacharyya, Prithwis

    2014-01-01

    A pacemaking system consists of an impulse generator and lead or leads to carry the electrical impulse to the patient's heart. Pacemaker and implantable cardioverter defibrillator codes were made to describe the type of pacemaker or implantable cardioverter defibrillator implanted. Indications for pacing and implantable cardioverter defibrillator implantation were given by the American College of Cardiologists. Certain pacemakers have magnet-operated reed switches incorporated; however, magnet application can have serious adverse effects; hence, devices should be considered programmable unless known otherwise. When a device patient undergoes any procedure (with or without anesthesia), special precautions have to be observed including a focused history/physical examination, interrogation of pacemaker before and after the procedure, emergency drugs/temporary pacing and defibrillation, reprogramming of pacemaker and disabling certain pacemaker functions if required, monitoring of electrolyte and metabolic disturbance and avoiding certain drugs and equipments that can interfere with pacemaker function. If unanticipated device interactions are found, consider discontinuation of the procedure until the source of interference can be eliminated or managed and all corrective measures should be taken to ensure proper pacemaker function should be done. Post procedure, the cardiac rate and rhythm should be monitored continuously and emergency drugs and equipments should be kept ready and consultation with a cardiologist or a pacemaker-implantable cardioverter defibrillator service may be necessary. PMID:24907883

  15. The first cardioverter defibrillator implanted in Central Africa

    PubMed Central

    Cabral, Tantchou Tchoumi Jacques; Budzee, Appolonia; Butera, Gianfranco

    2016-01-01

    Sudden cardiac deaths, which account for approximately 350 000 deaths each year, is a major health care problem. Antiarrhythmic drugs have not been reliable in preventing sudden cardiac death. Although β-blockers, angiotensin-converting enzyme inhibitors, and revascularization play a role in prevention of sudden cardiac death, the development and subsequent refinement of the implantable cardioverter-defibrillator has made the most important contribution to its management. We report the first documented implantation of a cardioverter defibrillator in central, eastern and western Africa. PMID:27279942

  16. Bilateral Subclavian Vein Occlusion in a SAPHO Syndrome Patient Who Needed an Implantable Cardioverter Defibrillator.

    PubMed

    Ishizuka, Masato; Yamamoto, Yuko; Yamada, Shintaro; Maemura, Sonoko; Nakata, Ryo; Motozawa, Yoshihiro; Yamamoto, Keisuke; Takizawa, Masataka; Uozumi, Hiroki; Ikenouchi, Hiroshi

    2016-05-25

    A 79-year-old Asian man was hospitalized because of progressive exertional dyspnea with decreasing left ventricular ejection fraction and frequent non-sustained ventricular tachycardia. Pre-procedure venography for implantable cardioverter defibrillator (ICD) implantation showed occlusion of the bilateral subclavian veins. In consideration of subcutaneous humps in the sterno-clavicular area and palmoplantar pustulosis, we diagnosed him as having synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome and speculated that it induced peri-osteal chronic inflammation in the sterno-clavicular area, resulting in occlusion of the adjacent bilateral subclavian veins. An automatic external defibrillator (AED) was installed in the patient's house and total subcutaneous ICD was considered. Venous thrombosis in SAPHO syndrome is not frequent but has been reported. To the best of our knowledge, this is the first case of bilateral subclavian vein occlusion in a SAPHO syndrome patient who needs ICD implantation. PMID:27181039

  17. When to consider an implantable cardioverter defibrillator following myocardial infarction?

    PubMed

    Szwejkowski, Benjamin R; Wright, Gary A; Connelly, Derek T; Gardner, Roy S

    2015-12-01

    After reading this article the reader should be familiar with: Current guidelines for implantable cardioverter defibrillator (ICD) use post myocardial infarction (MI) and ischaemic cardiomyopathy. Primary prevention ICD guidelines. Secondary prevention ICD guidelines. Non-sustained ventricular tachycardia in patients post MI and the use of ICDs. Programming ICDs. PMID:26526420

  18. Runaway implantable defibrillator--a rare complication of radiation therapy.

    PubMed

    Nemec, Jan

    2007-05-01

    A case of a patient with runaway implantable cardioverter defibrillator (ICD) due to radiation therapy of a lung cancer is reported. This manifested as poorly tolerated wide complex tachycardia due to inappropriate rapid ventricular pacing, The event terminated with polymorphic VT, which inhibited pacing and ceased spontaneously before ICD discharge. The likely cause was corruption of device random access memory by ionizing radiation. PMID:17461884

  19. Implantable cardioverter defibrillator infection due to Mycobacterium mageritense.

    PubMed

    Fukunaga, Masato; Goya, Masahiko; Ogawa, Midori; Fukuda, Kazumasa; Taniguchi, Hatsumi; Ando, Kenji; Iwabuchi, Masashi; Miyazaki, Hiroaki

    2016-03-01

    Rapidly growing non-tuberculous mycobacteria (RGM) are usually detected in blood cultures after 4-5 days of incubation, so it is important to differentiate RGM from contamination of commensal organisms on human skin. We report an unusual case of Mycobacterium mageritense bacteremia and infection of an implantable cardioverter defibrillator originally misidentified as Corynebacterium spp. or Nocardia spp. in gram-stained smears. 16S rRNA gene sequencing had utility in the definitive identification of isolates. We should be aware that RGM infection may exist in repeated implantable device infections. PMID:26719132

  20. [Implantable cardioverter-defibrillator at the end of life].

    PubMed

    Pfeiffer, D; Hagendorff, A; Kühne, C; Reinhardt, S; Klein, N

    2015-06-01

    Brady- and tachyarrhythmias at the end of life are common observations. Implantable cardioverter-defibrillators answer with antibrady and antitachycardia pacing, which will not be associated with any complaints of the dying patient. In contrast, defibrillation and cardioversion shocks are extremely painful. Therefore shocks should be inactivated at the end of life. Family doctors, internists, emergency physicians and paramedics are unable to inactivate shocks. Deactivation of shocks at the end of life is not comparable to euthanasia or assisted suicide, but allow the patient to die at the end of an uncurable endstage disease. Deactivation of shocks should be discussed with the patient before initial implantation of the devices. The precise moment of the inactivation at the end of life should be discussed with patients and relatives. There is no common recommendation for the time schedule of this decision; therefore it should be based on the individual situation of the patient. Emergency health care physicians need magnets and sufficient information to inactivate defibrillators. The wishes of the patient have priority in the decision process and should be written in the patient's advance directive, which must be available in the final situation. However the physician must not necessarily follow every wish of the patient. As long as the laws in the European Union are not uniform, German recommendations are needed. PMID:26001358

  1. Antiarrhythmic Drug Therapy to Avoid Implantable Cardioverter Defibrillator Shocks

    PubMed Central

    Abboud, Jaber

    2016-01-01

    Implantable cardioverter defibrillators (ICDs) are effective in the prevention of arrhythmic sudden cardiac death. Many patients receiving an ICD are affected by heart failure and are at risk of ventricular arrhythmias, which may lead to appropriate shocks. On the other hand, in this population the incidence of atrial fibrillation, giving rise to inappropriate ICD shocks, is high. Accordingly, ICD discharges occur frequently and many patients with an ICD will need concomitant antiarrhythmic drug therapy to avoid or reduce the frequency of shocks. Therapeutic agents such as β-blockers, class I or class III antiarrhythmic drugs effectively suppress arrhythmias, but may have side-effects. Some drugs could eventually influence the function of ICDs by altering defibrillation or pacing threshold. Few prospective randomised trials are available, but current data suggest that amiodarone is most effective for prevention of appropriate or inappropriate ICD shocks. This review article summarises current knowledge regarding the antiarrhythmic management of patients with ICDs.

  2. Antiarrhythmic Drug Therapy to Avoid Implantable Cardioverter Defibrillator Shocks.

    PubMed

    Abboud, Jaber; R Ehrlich, Joachim

    2016-08-01

    Implantable cardioverter defibrillators (ICDs) are effective in the prevention of arrhythmic sudden cardiac death. Many patients receiving an ICD are affected by heart failure and are at risk of ventricular arrhythmias, which may lead to appropriate shocks. On the other hand, in this population the incidence of atrial fibrillation, giving rise to inappropriate ICD shocks, is high. Accordingly, ICD discharges occur frequently and many patients with an ICD will need concomitant antiarrhythmic drug therapy to avoid or reduce the frequency of shocks. Therapeutic agents such as β-blockers, class I or class III antiarrhythmic drugs effectively suppress arrhythmias, but may have side-effects. Some drugs could eventually influence the function of ICDs by altering defibrillation or pacing threshold. Few prospective randomised trials are available, but current data suggest that amiodarone is most effective for prevention of appropriate or inappropriate ICD shocks. This review article summarises current knowledge regarding the antiarrhythmic management of patients with ICDs. PMID:27617090

  3. Submuscular versus subcutaneous pectoral implantation of cardioverter-defibrillators: effect on high voltage pathway impedance and defibrillation efficacy.

    PubMed

    Iskos, D; Lock, K; Lurie, K G; Fahy, G J; Petersen-Stejskal, S; Benditt, D G

    1998-03-01

    Implantable cardioverter-defibrillator (ICD) pulse generators are now routinely positioned in a pectoral location, either submuscularly (under the pectoralis muscles) or subcutaneously (over the pectoralis muscles). Furthermore, in current ICDs, the generator shield usually participates in the defibrillation energy pathway ("hot can"). Consequently, the precise generator location could affect defibrillation system efficacy. To assess this issue, we compared high voltage pathway impedance and defibrillation threshold (DFT) in 20 patients undergoing submuscular and 46 patients undergoing subcutaneous pectoral implantation of an Angeion Sentinel ICD and an AngeFlex dual-coil defibrillation lead. Measurements were performed at time of ICD implant, pre-hospital discharge, and 1, 3 and/or 6 months later. Following induction of ventricular fibrillation, 569 biphasic waveform shocks were delivered between the generator shield and either the distal defibrillation coil (RV/can configuration) or both proximal and distal coils (RV/SVC/can configuration). Impedance differences between submuscular and subcutaneous implants were approximately 3-4 Ohms (p value of 0.132 to < 0.001 depending on time of follow-up and lead configuration). A significant increase in impedance over time was noted independent of implant location and lead configuration. The DFT at implant or pre-discharge was assessed in 27 individuals, and was 9.9 +/- 3.8 J in 8 patients in the submuscular group, and 7.4 +/- 3.3 J in 19 patients in the subcutaneous group (p = 0.057). In conclusion, anatomic location of a "hot can" ICD generator (submuscular versus subcutaneous) influences impedance to defibrillation current, but the impact is of small magnitude and does not appear to result in clinically important differences in DFT. PMID:9869996

  4. Patient perceptions of implantable cardioverter-defibrillator deactivation discussions: A qualitative study

    PubMed Central

    MacIver, Jane; Tibbles, Alana; Billia, Filio; Ross, Heather

    2016-01-01

    Background: There is a class I recommendation for implantable cardioverter-defibrillator deactivation discussions to occur between physicians and heart failure patients. Few studies have reported the patient’s perspective on the timing of implantable cardioverter-defibrillator deactivation discussions. Aim: To determine patient awareness, preferences and timing of implantable cardioverter-defibrillator deactivation discussions. Design: Grounded theory was used to collect and analyze interview data from 25 heart failure patients with an implantable cardioverter-defibrillator. Setting and participants: Patients with an implantable cardioverter-defibrillator, from the Heart Function Clinic at University Health Network (Toronto, Canada). Results: The sample (n = 25) was predominately male (76%) with an average age of 62 years. Patients identified three stages where they felt implantable cardioverter-defibrillator deactivation should be discussed: (1) prior to implantation, (2) with any significant deterioration but while they were of sound mind to engage in and communicate their preferences and (3) at end of life, where patients wished further review of their previously established preferences and decisions about implantable cardioverter-defibrillator deactivation. Most patients (n = 17, 68%) said they would consider deactivation, six (24%) were undecided and two (8%) were adamant they would never turn it off. Conclusion: The patient preferences identified in this study support the need to include information on implantable cardioverter-defibrillator deactivation at implant, with change in clinical status and within broader discussions about end-of-life treatment preferences. Using this process to help patients determine and communicate their implantable cardioverter-defibrillator deactivation preferences may reduce the number of patients experiencing distressing implantable cardioverter-defibrillator shocks at end of life. PMID:27110361

  5. [Implantable cardioverter/defibrillator: long-term stability of the defibrillation threshold with a unipolar electrode configuration (active-can")].

    PubMed

    Knuefermann, P; Wolpert, C; Spehl, S; Korte, T; Manz, M; Lüderitz, B; Jung, W

    2000-09-01

    The majority of cardioverter/defibrillator (ICD) implantations are currently performed with a non-thoracotomy approach. From November 1993 to January 1995, 46 patients underwent implantation of a PCD 7219C with an "active-can" lead configuration at our institution. While the chronic stability of the defibrillation threshold (DFT) for an epicardial lead system is well established, the results are still inconsistent for non-thoracotomy lead systems. Accordingly, the aim of the present study was to compare the acute and chronic defibrillation thresholds of the ICDs implanted with an "active-can" lead system in order to assess the chronic stability of these systems. The defibrillation energy requirements were measured at implant, prior to hospital discharge, three, six and twelve months after implantation of the defibrillator. The patient group consisted of 8 females and 38 males with a mean age of 57.2 years. The mean left ventricular ejection fraction was 43.8%. The most frequent underlying heart disease was coronary artery disease in 31 of 46 patients. Eight patients had idiopathic dilated cardiomyopathy. In 39 of 46 patients, the defibrillation threshold could be successfully determined at all 4 time points after implantation. The mean defibrillation energy requirement at the time of implantation was 9.2 +/- 5.9 Joules (J). The subsequent mean energy requirements were 7.6 +/- 4.8 J at pre-hospital discharge, 8.6 +/- 5.7 J at the 3 month, 8.1 +/- 6.0 J at the 6 month and 8.6 +/- 5.8 J at the 12 month follow-up visits. The mean defibrillation threshold was lowest at the time of prehospital discharge, significantly lower than at the time of initial implantation (p = 0.021). However, at all later time points up to one year, there was no significant difference in the DFT as compared with the time of initial implantation. Comparing the DFT at the time of implantation and the DFT at all other time points, there were no significant differences (9.23 vs. 8.56 J, p = 0

  6. [Hypersensitivity reactions to implantable cardiac pacemakers and defibrillators].

    PubMed

    Kreft, B

    2016-05-01

    Nowadays, for modern electrotherapy of cardiac arrhythmias different pacemaker systems are used. Antibradycardia pacing systems (e. g. single-chamber, two-chamber, three-chamber systems, frequency-adapted pacemaker) can be distinguished from antitachycardia pacing systems like implantable or portable cardioverter defibrillators and combined antibradycardia/antitachycardia systems. Cutaneous reactions overlying a pacemaker or defibrillator are often termed "pacemaker dermatitis". In terms of the differential diagnostic workup, these cutaneous reactions can have various causes. After exclusion of infection by analyzing clinical and laboratory-chemical results, "pressure dermatitis" or the often clinically asymptomatic "reticular telangiectatic erythema" (synonym "postimplantation erythema") must be considered. Histological examination of the affected skin can contribute to the diagnosis. In case of suspected contact hypersensitivity to implant material, allergological exploration should be realized. In addition to patch testing with commercially available contact allergens, product-related material metal alloy discs are often available from the pacemaker manufacturer for epicutaneous testing. Due to the lack of additional benefit compared to standardized patch testing, a clear recommendation for such metal alloy discs cannot be given. In selected cases of suspected hypersensitivity reaction, sensitization can eventually be analyzed by the lymphocyte transformation test. Positive reactions must always be critically interpreted taking into consideration the corresponding clinical signs. Depending on the cause, cutaneous reactions are occasionally self-limiting. In many cases, however, removal of the pacemaker is inevitable. PMID:26943358

  7. Adjuvant antiarrhythmic therapy in patients with implantable cardioverter defibrillators.

    PubMed

    Bunch, T Jared; Anderson, Jeffrey L

    2014-04-01

    The risk of sudden cardiac death from ventricular fibrillation or ventricular tachycardia in patients with cardiomyopathy related to structural heart disease has been favorably impacted by the wide adaptation of implantable cardioverter defibrillators (ICDs) for both primary and secondary prevention. Unfortunately, after ICD implantation both appropriate and inappropriate ICD therapies are common. ICD shocks in particular can have significant effects on quality of life and disease-related morbidity and mortality. While not indicated for primary prevention of ICD therapies, beta-blockers and antiarrhythmic drugs are a cornerstone for secondary prevention of them. This review will summarize our current understanding of adjuvant antiarrhythmic drug therapy in ICD patients. The review will also discuss the roles of nonantiarrhythmic drug approaches that are used in isolation and in combination with antiarrhythmic drugs to reduce subsequent risk of ICD shocks. PMID:24288157

  8. Deactivation of Pacemakers and Implantable Cardioverter-Defibrillators

    PubMed Central

    Kramer, Daniel B.; Mitchell, Susan L.; Brock, Dan W.

    2013-01-01

    Cardiac implantable electrical devices (CIEDs), including pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs), are the most effective treatment for life-threatening arrhythmias. Patients or their surrogates may request device deactivation to avoid prolongation of the dying process or in other settings, such as after device-related complications or with changes in their health care goals. Despite published guidelines outlining theoretical and practical aspects of this common clinical scenario, significant uncertainty remains for both patients and health care providers regarding the ethical and legal status of CIED deactivation. This review outlines the ethical and legal principles supporting CIED deactivation at patients’ request, centered upon patient autonomy and authority over their own medical treatment. The empirical literature describing stakeholder views and experiences surrounding CIED deactivation is described, along with lessons for future research and practice guidance surrounding the care of patients with CIEDs. PMID:23217433

  9. Quality of Life Effects of Automatic External Defibrillators in the Home: Results from the Home Automatic External Defibrillator Trial (HAT)

    PubMed Central

    Mark, Daniel B.; Anstrom, Kevin J.; McNulty, Steven E.; Flaker, Greg C.; Tonkin, Andrew M.; Smith, Warren M.; Toff, William D.; Dorian, Paul; Clapp-Channing, Nancy E.; Anderson, Jill; Johnson, George; Schron, Eleanor B.; Poole, Jeanne E.; Lee, Kerry L.; Bardy, Gust H.

    2010-01-01

    Background Public access automatic external defibrillators (AEDs) can save lives, but most deaths from out-of-hospital sudden cardiac arrest occur at home. The Home Automatic External Defibrillator Trial (HAT) found no survival advantage for adding a home AED to cardiopulmonary resuscitation (CPR) training for 7001 patients with a prior anterior wall myocardial infarction. Quality of life (QOL) outcomes for both the patient and spouse/companion were secondary endpoints. Methods A subset of 1007 study patients and their spouse/companions was randomly selected for ascertainment of QOL by structured interview at baseline and 12 and 24 months following enrollment. The primary QOL measures were the Medical Outcomes Study 36-Item Short-Form (SF-36) psychological well-being (reflecting anxiety and depression) and vitality (reflecting energy and fatigue) subscales. Results For patients and spouse/companions, the psychological well-being and vitality scales did not differ significantly between those randomly assigned an AED plus CPR training and controls who received CPR training only. None of the other QOL measures collected showed a clinically and statistically significant difference between treatment groups. Patients in the AED group were more likely to report being extremely or quite a bit reassured by their treatment assignment. Spouse/companions in the AED group reported being less often nervous about the possibility of using AED/CPR treatment than those in the CPR group. Conclusions Adding access to a home AED to CPR training did not affect quality of life either for patients with a prior anterior myocardial infarction or their spouse/companion but did provide more reassurance to the patients without increasing anxiety for spouse/companions. PMID:20362722

  10. Cost-effectiveness of implantable cardioverter defibrillator therapy.

    PubMed

    Morgan, John M

    2002-01-01

    Cost-efficacy assessment of implantable cardioverter defibrillator (ICD) therapy has proved contentious and may have limited uptake of ICD therapy, particularly in Europe. Published modeling assessments are too inaccurate to determine clinical practice, and assessments based on clinical studies are incomplete (from the cost-efficacy viewpoint). Although ICD therapy seems certain to be most cost-effective in patients who are likely to have good longevity if their risk of sudden cardiac death is countered, the benefit of ICD therapy is not necessarily limited to such groups. Physicians and health economists need to develop a better understanding of how to assess high-technology therapy costs so that uptake of such therapy is appropriately expedited with due regard to ethical and cost constraints. PMID:11843460

  11. The Significance of Shocks in Implantable Cardioverter Defibrillator Recipients

    PubMed Central

    Li, Anthony; Kaura, Amit; Sunderland, Nicholas; Dhillon, Paramdeep S

    2016-01-01

    Large-scale implantable cardioverter defibrillator (ICD) trials have unequivocally shown a reduction in mortality in appropriately selected patients with heart failure and depressed left ventricular function. However, there is a strong association between shocks and increased mortality in ICD recipients. It is unclear if shocks are merely a marker of a more severe cardiovascular disease or directly contribute to the increase in mortality. The aim of this review is to examine the relationship between ICD shocks and mortality, and explore possible mechanisms. Data examining the effect of shocks in the absence of spontaneous arrhythmias as well as studies of non-shock therapy and strategies to reduce shocks are analysed to try and disentangle the shocks versus substrate debate.

  12. The Significance of Shocks in Implantable Cardioverter Defibrillator Recipients.

    PubMed

    Li, Anthony; Kaura, Amit; Sunderland, Nicholas; Dhillon, Paramdeep S; Scott, Paul A

    2016-08-01

    Large-scale implantable cardioverter defibrillator (ICD) trials have unequivocally shown a reduction in mortality in appropriately selected patients with heart failure and depressed left ventricular function. However, there is a strong association between shocks and increased mortality in ICD recipients. It is unclear if shocks are merely a marker of a more severe cardiovascular disease or directly contribute to the increase in mortality. The aim of this review is to examine the relationship between ICD shocks and mortality, and explore possible mechanisms. Data examining the effect of shocks in the absence of spontaneous arrhythmias as well as studies of non-shock therapy and strategies to reduce shocks are analysed to try and disentangle the shocks versus substrate debate. PMID:27617089

  13. Generator and Lead-Related Complications of Implantable Cardioverter Defibrillators

    PubMed Central

    Yaminisharif, Ahmad; Soofizadeh, Nader; Shafiee, Akbar; Kazemisaeid, Ali; Jalali, Arash; Vasheghani-Farahani, Ali

    2014-01-01

    Background: Increase in the number of patients treated with Implantable Cardioverter Defibrillator (ICD) requests more attention regarding its complications. Objectives: This study aimed to assess the generator- and lead-related complications at implantation and during follow-up in the patients who were treated with ICD for primary and secondary prevention reasons. Methods: We retrospectively reviewed 255 consecutive patients who underwent transvenous ICD implantation for the first time in a 7-year period and were followed-up for 3 years at Tehran Heart Center. The personal and clinical data of the patients as well as specific data on the ICD implantation were retrieved. The frequency of each of the complications was reported and the study variables were compared between the patients with and without complications using Student’s t-test and chi-square test where appropriate. P values less than 0.05 were considered as statistically significant. Results: Out of a total of 525 implanted leads and 255 implanted devices in 255 patients (mean age = 62.57 ± 13.50 years; male = 196 [76.9%]), complications leading to generator or lead replacement occurred in 32 patients (12.5%). The results revealed no significant difference between the patients with and without complications regarding gender and age (P = 0.206 and P = 0.824, respectively). Also, no significant difference was found between the two groups concerning the ejection fraction (P = 0.271). Lead fracture was the most frequent lead-related complication and was observed in 17 patients (6.6%). Besides, it was mainly observed in the RV leads. Generator-related complications leading to generator replacement were observed in 2 patients (0.7%). Conclusions: Despite considerable improvements in the ICD technology, the rate of the ICD complications leading to device replacement and surgical revision, especially those related to the leads, is still clinically important. PMID:24936484

  14. Economic evaluations of implantable cardioverter defibrillators: a systematic review.

    PubMed

    García-Pérez, Lidia; Pinilla-Domínguez, Pilar; García-Quintana, Antonio; Caballero-Dorta, Eduardo; García-García, F Javier; Linertová, Renata; Imaz-Iglesia, Iñaki

    2015-11-01

    The aim of this paper was to review the cost-effectiveness studies of implantable cardioverter defibrillators (ICD) for primary or secondary prevention of sudden cardiac death (SCD). A systematic review of the literature published in English or Spanish was performed by electronically searching MEDLINE and MEDLINE in process, EMBASE, NHS-EED, and EconLit. Some keywords were implantable cardioverter defibrillator, heart failure, heart arrest, myocardial infarction, arrhythmias, syncope, sudden death. Selection criteria were the following: (1) full economic evaluations published after 1995, model-based studies or alongside clinical trials (2) that explored the cost-effectiveness of ICD with or without associated treatment compared with placebo or best medical treatment, (3) in adult patients for primary or secondary prevention of SCD because of ventricular arrhythmias. Studies that fulfilled these criteria were reviewed and data were extracted by two reviewers. The methodological quality of the studies was assessed and a narrative synthesis was prepared. In total, 24 studies were included: seven studies on secondary prevention and 18 studies on primary prevention. Seven studies were performed in Europe. For secondary prevention, the results showed that the ICD is considered cost-effective in patients with more risk. For primary prevention, the cost-effectiveness of ICD has been widely studied, but uncertainty about its cost-effectiveness remains. The cost-effectiveness ratios vary between studies depending on the patient characteristics, methodology, perspective, and national settings. Among the European studies, the conclusions are varied, where the ICD is considered cost-effective or not dependent on the study. PMID:25323413

  15. Beam Profile Disturbances from Implantable Pacemakers or Implantable Cardioverter-Defibrillator Interactions

    SciTech Connect

    Gossman, Michael S.; Nagra, Bipinpreet; Graves-Calhoun, Alison; Wilkinson, Jeffrey

    2011-01-01

    The medical community is advocating for progressive improvement in the design of implantable cardioverter-defibrillators and implantable pacemakers to accommodate elevations in dose limitation criteria. With advancement already made for magnetic resonance imaging compatibility in some, a greater need is present to inform the radiation oncologist and medical physicist regarding treatment planning beam profile changes when such devices are in the field of a therapeutic radiation beam. Treatment plan modeling was conducted to simulate effects induced by Medtronic, Inc.-manufactured devices on therapeutic radiation beams. As a continuation of grant-supported research, we show that radial and transverse open beam profiles of a medical accelerator were altered when compared with profiles resulting when implantable pacemakers and cardioverter-defibrillators are placed directly in the beam. Results are markedly different between the 2 devices in the axial plane and the sagittal planes. Vast differences are also presented for the therapeutic beams at 6-MV and 18-MV x-ray energies. Maximum changes in percentage depth dose are observed for the implantable cardioverter-defibrillator as 9.3% at 6 MV and 10.1% at 18 MV, with worst distance to agreement of isodose lines at 2.3 cm and 1.3 cm, respectively. For the implantable pacemaker, the maximum changes in percentage depth dose were observed as 10.7% at 6 MV and 6.9% at 18 MV, with worst distance to agreement of isodose lines at 2.5 cm and 1.9 cm, respectively. No differences were discernible for the defibrillation leads and the pacing lead.

  16. Anomalous ECG downloads from semi-automatic external defibrillators.

    PubMed

    Calle, P A; Vanhaute, O; Ranhoff, J F; Buylaert, W A

    1998-08-01

    The coincidental print-out by two different Laerdal systems (subsequently called 'system A' and 'system B') of the same medical control module (MCM) for a Laerdal Heartstart 2000 semi-automatic external defibrillator (SAED) led to the discovery of three deficiencies in the information storage and printing processes. First, we noted that the impedance reported via system A was consistently higher. Second, we found the attachment of 'mysterious' ECG samples in the reports from system B, but not from system A. A third problem was the unpredictable (in)ability of system B to print out the information from the MCMs. Further investigations with help from the company suggested that the above-mentioned problems were caused by incompatibilities between the software in the different parts of equipment used (i.e. SAED devices, MCMs, printing systems and a computer program to store the information in a database). These observations demonstrate the need for strict medical supervision on all aspects of a SAED project, and for feed-back from clinicians to manufacturers. PMID:9863574

  17. A fiber optic sensor system for control of rate-adaptive cardiac pacemakers and implantable defibrillators.

    PubMed

    Müller, Stefan; Hexamer, Martin; Werner, Jürgen

    2006-12-01

    Commercially available cardiac pacemakers and implantable cardioverters/defibrillators (ICDs) predominantly use an intracardiac-derived electrocardiogram (ECG) for the detection of arrhythmias. To achieve automatic control of the heart frequency in accordance with cardiovascular strain and improved detection of life-threatening arrhythmias, it is desirable to monitor the heart by an input signal correlated with the hemodynamic state. One possible approach to derive such a signal is to measure the inotropy (mechanical contraction strength of the heart muscle). For this purpose, an optoelectronic measurement system has been designed. The fundamental function of the system has been shown in earlier investigations using an isolated beating pig heart. In this paper the design of two algorithms for use in pacemakers and ICDs based on a fiber optic sensor signal is presented. PMID:17155869

  18. Remote monitoring and follow-up of pacemakers and implantable cardioverter defibrillators

    PubMed Central

    Burri, Haran; Senouf, David

    2009-01-01

    In the era of communication technology, new options are now available for following-up patients implanted with pacemakers (PMs) and defibrillators (ICDs). Most major companies offer devices with wireless capabilities that communicate automatically with home transmitters, which then relay data to the physician, thereby allowing remote patient follow-up and monitoring. These systems are being widely used in the USA for remote follow-up, and have been more recently introduced in Europe, where their adoption is increasing. In this article, we describe the currently existing systems, review the available evidence in the literature regarding remote follow-up and monitoring of PMs and ICDs, and finally discuss some unresolved issues. PMID:19470595

  19. Does reducing capacitance have potential for further miniaturisation of implantable defibrillators?

    PubMed Central

    Alt, E.; Evans, F.; Wolf, P. D.; Pasquantonio, J.; Stotts, L.; Heinz, S.; Schömig, A.

    1997-01-01

    OBJECTIVE: To determine whether considerably smaller capacitors could replace 125 microF capacitors as the standard for use in implantable defibrillators. METHODS: Measured energy, impedance, voltage, and current delivered were compared at defibrillation threshold in 10 mongrel dogs for defibrillation using 75 microF and 125 microF capacitors alternated randomly. Defibrillation was attempted with biphasic shocks of comparable tilt between an endocardial lead in the right ventricular apex and a "dummy" active can of an experimental implantable device placed in the subpectoral position. RESULTS: A reduction of capacitor size of 40% was associated with an increase in voltage of 21% and in current of 22%. With a 65% tilt, no significant differences were found between the two capacitances with respect to the impedance or energy required for defibrillation. CONCLUSIONS: Multiple advances in electrode material, electrode configuration, shock morphology, and shock polarity have reduced defibrillation energy requirements. Smaller capacitors could be used in implantable cardioverter/defibrillators without a major decrease in effectiveness. PMID:9093040

  20. [Implantable Cardioverter Defibrillator and Perioperative Magnet Application: A Case Report].

    PubMed

    Inoue, Miho; Tokuhira, Natsuko; Sawa, Teiji; Ibuki, Takae

    2015-02-01

    An implantable cardioverter defibrillator (ICD) can falsely recognize noise by monopolar electrocautery as tachyarrhythmia and deliver inappropriate antitachycardia therapy. Application of a clinical magnet on an ICD suspends antitachycardia therapy, but it has not been widely used for this purpose. A 67-year-old male underwent laryngopharyngectomy, cervical esophagectomy, right neck dissection, tracheostomy and reconstruction with free jejunal transplant for recurrent hypopharyngeal cancer. He had an ICD (PARADYM DR8550, Sorin) implanted below the left clavicle for ventricular tachycardia and prolonged QT syndrome. During the operation, a clinical magnet was left on the ICD to disable antitachycardia therapy. The magnet mode of the ICD provided asynchronous AAI pacing at 96 beats x min(-1). The surgery proceeded uneventfully. No episode of ventricular tachyarrythmia or pacing inhibition by electromagnetic interference was observed on electrocardiogram. This case illustrated the potential role of a clinical magnet as an alternative to reprogramming of an ICD by a programmer in the perioperative management of a patient with an ICD when a technical expert to operate a programmer is not available. PMID:26121817

  1. Frozen shoulder syndrome associated with subpectoral defibrillator implantation.

    PubMed

    Burke, M C; Drinan, K; Kopp, D E; Kall, J G; Verdino, R J; Paydak, H; Wilber, D J

    1999-10-01

    Pectoral implantation of transvenous non-thoracotomy internal cardioverter defibrillators (ICD) has resulted in very few complications whether placed subpectorally or subcutaneously. We report the case of a 68 year old man with a subpectorally implanted MINI-plus (Cardiac Pacemakers, Incorporated, St. Paul, Mn.) transvenous ICD who developed nearly instantaneous severe ipsilateral shoulder pain and immobilization. The symptoms progressed despite aggressive physical therapy. We elected to remove the device from the pectoral site and place it in a traditional abdominal position due to the severity, duration and refractoriness of his symptoms. This procedure utilized the chronic Endotak DSP (Model 0125, Cardiac Pacemakers, Incorporated) transvenous lead, a compatible Endotak DSP lead extender (Model 6952, Cardiac Pacemakers, Incorporated) and the above described ICD. Immediate relief of symptoms was accomplished by relocation of the device to an abdominal site. This intervention should be reserved for patients with severely debilitating symptoms. Prospective comparison of subpectoral and subcutaneous surgical approaches with respect to patient comfort and acceptance and complications may be warranted. PMID:10490482

  2. Assessment of a remote monitoring system for implantable cardioverter defibrillators.

    PubMed

    Masella, Cristina; Zanaboni, Paolo; Di Stasi, Francesca; Gilardi, Serena; Ponzi, Patrizia; Valsecchi, Sergio

    2008-01-01

    We conducted a multicentre study in five Italian hospitals to assess the feasibility of a remote monitoring service for the follow-up of implanted cardiac devices. The system was designed to monitor device performance as well as physiological aspects of the patient's condition. Sixty-seven patients (mean age 64 years) affected by chronic heart failure and with a biventricular implantable cardioverter defibrillator for cardiac re-synchronization therapy (CRT-D) were enrolled for a three-month observation period. A total of 267 device recordings were transmitted through the ordinary telephone network, with a success rate of 99%. The telemonitoring service was more efficient than conventional face-to-face follow-up in terms of the time savings: both for physicians (4.7 minutes versus 15 minutes for remote and conventional monitoring) and for patients (6.6 minutes versus 116.3 minutes). In addition, a total of 23 clinical events occurred during the study, but only two cases required a clinic visit, thus reducing inappropriate hospital admissions. Finally, the service was well accepted by all the users. PMID:18776073

  3. Programming implantable cardioverter-defibrillators in primary prevention: higher or later.

    PubMed

    Clementy, Nicolas; Pierre, Bertrand; Simeon, Edouard; Lallemand, Bénédicte; Fauchier, Laurent; Babuty, Dominique

    2014-05-01

    Defibrillator shocks, appropriate or not, are associated with significant morbidity, as they decrease quality of life, can be involved in depression and anxiety, and are known to be proarrhythmic. Most recent data have even shown an association between shocks and overall mortality. As opposed to other defibrillator-related complications, the rate of inappropriate and unnecessary shocks can (and should) be decreased with adequate programming. This review focuses on the different programming strategies and tips available to reduce the rate of shocks in primary prevention patients with left ventricular dysfunction implanted with a defibrillator, as well as some of the manufacturers' device specificities. PMID:24834904

  4. Detection of refrigerator-associated 60 Hz alternating current as ventricular fibrillation by an implantable defibrillator.

    PubMed

    Al Khadra, Ayman S; Al Jutaily, Abdulaziz; Al Shuhri, Salem

    2006-03-01

    This report describes a patient with an implantable defibrillator who suffered an inappropriate defibrillation shock upon retrieving some food items from his inadequately earthed refrigerator. Noise typical of electrical interference can be observed in the stored electrogram of the episode. The patient was instructed to earth his home appliances, but he decided to avoid his refrigerator altogether, and has had no subsequent shocks. PMID:16627434

  5. Ambient temperature and activation of implantable cardioverter defibrillators

    NASA Astrophysics Data System (ADS)

    McGuinn, L.; Hajat, S.; Wilkinson, P.; Armstrong, B.; Anderson, H. R.; Monk, V.; Harrison, R.

    2013-09-01

    The degree to which weather influences the occurrence of serious cardiac arrhythmias is not fully understood. To investigate, we studied the timing of activation of implanted cardiac defibrillators (ICDs) in relation to daily outdoor temperatures using a fixed stratum case-crossover approach. All patients attending ICD clinics in London between 1995 and 2003 were recruited onto the study. Temperature exposure for each ICD patient was determined by linking each patient's postcode of residence to their nearest temperature monitoring station in London and the South of England. There were 5,038 activations during the study period. Graphical inspection of ICD activation against temperature suggested increased risk at lower but not higher temperatures. For every 1 °C decrease in ambient temperature, risk of ventricular arrhythmias up to 7 days later increased by 1.2 % (95 % CI -0.6 %, 2.9 %). In threshold models, risk of ventricular arrhythmias increased by 11.2 % (0.5 %, 23.1 %) for every 1° decrease in temperature below 2 °C. Patients over the age of 65 exhibited the highest risk. This large study suggests an inverse relationship between ambient outdoor temperature and risk of ventricular arrhythmias. The highest risk was found for patients over the age of 65. This provides evidence about a mechanism for some cases of low-temperature cardiac death, and suggests a possible strategy for reducing risk among selected cardiac patients by encouraging behaviour modification to minimise cold exposure.

  6. Sensing and detection in Medtronic implantable cardioverter defibrillators.

    PubMed

    Brown, Mark L; Swerdlow, Charles D

    2016-09-01

    Ensuring sensing and detection of ventricular tachycardia (VT) and ventricular fibrillation (VF) was a prerequisite for the clinical trials that established the survival benefit of implantable cardioverter defibrillators (ICDs). However, for decades, a high incidence of unnecessary shocks limited patients' and physicians' acceptance of ICD therapy. Oversensing, misclassification of supraventricular tachycardia (SVT) as VT, and self-terminating VT accounted for the vast majority of unnecessary shocks. Medtronic ICDs utilize sensitive baseline settings with minimal blanking periods to ensure accurate sensing of VF, VT, and SVT electrograms. Programmable algorithms reject oversensing caused by far-field R waves, T waves, and non-physiologic signals caused by lead failure. A robust hierarchy of SVT-VT discriminators minimize misclassification of SVT as VT. These features, combined with evidence-based programming, have reduced the 1‑year inappropriate shock rate to 1.5 % for dual-/triple-chamber ICDs and to 2.5 % for single-chamber ICDs. PMID:27624809

  7. Dual-chamber implantable cardioverter-defibrillator. Is it useful in patient with permanent atrial fibrillation?

    PubMed

    Porres-Aracama, José M; Cerezuela, José Luis; García-Urra, Francisco; Luque-Lezcano, Oscar; Herrero, Vicente

    2016-08-01

    In patients with permanent atrial fibrillation (AF) and implantable cardioverter-defibrillator (ICD) implant indication, a single-chamber device is the choice because AF does not provide interesting information for the treatment. It is very unusual to find patients with permanent AF that coexist with atrial tachycardia with various degree of Atrioventricular block. PMID:27525075

  8. Inappropriate shocks delivered by implantable cardiac defibrillators during oversensing of activity of diaphagmatic muscle

    PubMed Central

    Babuty, D; Fauchier, L; Cosnay, P

    1999-01-01

    Two cases are reported (both men, one 72 and one 54 years old) of inappropriate shocks delivered by an implantable cardiac defibrillator (ICD) device, which oversensed the myopotentials induced by deep breathing and Valsalva manoeuvre. No damage to leads was associated with the oversensing of myopotentials. The mechanism of the inappropriate shocks was determined using real time electrograms. Modification of the duration of ventricular detection and decrease in sensitivity made it possible to avoid the oversensing of myopotentials and to deliver ICD treatment.

 Keywords: implantable cardiac defibrillator;  inappropriate shocks;  myopotentials PMID:10220554

  9. Ventricular tachycardia initiated by high energy cardioversion in a patient with an implantable cardioverter defibrillator.

    PubMed Central

    Chinushi, M.; Aizawa, Y.; Higuchi, K.

    1997-01-01

    A transvenous implantable cardioverter defibrillator (ICD) was implanted into a 58 year old woman with idiopathic dilated cardiomyopathy who had drug refractory monomorphic ventricular tachycardia (VT). Antitachycardia pacing failed to terminate the VT; termination was attempted at 24 J, which was above the defibrillation threshold. When cardioversion at 24 J was delivered, VT with a different morphology and slower rate was reproducibly initiated. At 3 J, however, the original VT was successfully terminated without initiation of the slower VT. A new VT may be induced by high energy cardioversion. This may be a manifestation of the proarrhythmic potential of ICDs. PMID:9155621

  10. Interference from a hand held radiofrequency remote control causing discharge of an implantable defibrillator.

    PubMed

    Man, K C; Davidson, T; Langberg, J J; Morady, F; Kalbfleisch, S J

    1993-08-01

    A 46-year-old man with a history of sustained monomorphic ventricular tachycardia underwent an implantation of a third generation multiprogrammable implantable cardioverter defibrillator. One year post implant, while manipulating a remote control to a radiofrequency modulated toy car, the patient experienced a defibrillator discharge not preceded by an arrhythmia prodrome. Subsequent interrogation of the defibrillator revealed that a 34-joule shock had been delivered and had been preceded by RR intervals ranging from 141-406 msec, consistent with sensing lead noise. The remote control utilizes a 12-volt battery and has a carrier frequency of 75.95 MHz and a modulating frequency of 50 Hz. Evaluation of the remote control and defibrillator interaction revealed that the remote control was able to trigger tachyarrhythmia sensing and reproduce the clinical episode. Interference was present only when the remote control was within 8 cm of the pulse generator and at specific angles relative to the device and only when the antenna length was > 45 cm. Interference was eliminated when a ground wire was attached to the antenna and when an aluminium shield was placed between the pulse generator and the remote control. This case report suggests that patients with third generation multiprogrammable defibrillators should be cautioned against close contact with potential sources of electromagnetic interference, such as remote control units. PMID:7690947

  11. Examination of the Effect of Implantable Cardioverter-Defibrillators on Health-Related Quality of Life

    PubMed Central

    Noyes, Katia; Corona, Ethan; Veazie, Peter; Dick, Andrew W.; Zhao, Hongwei; Moss, Arthur J.

    2015-01-01

    Background While implantable cardioverter-defibrillators (ICDs) improve survival, their benefit in terms of health-related quality of life (HRQOL) is negligible. Objective To examine how shocks and congestive heart failure (CHF) mediate the effect of ICDs on HRQOL. Methods The US patients from the MADIT-II (Multicenter Automatic Defibrillator Trial-II) trial (n = 983) were randomized to receive an ICD or medical treatment only. HRQOL was assessed using the Health Utility Index 3 at baseline and 3, 12, 24, and 36 months following randomization. Logistic regressions were used to test for the effect of ICDs on the CHF indicator, and linear regressions were used to examine the effect of ICD shocks and CHF on HRQOL in living patients. We used a Monte Carlo simulation and a parametric Weibull distribution survival model to test for the effect of selective attrition. Observations were clustered by patients and robust standard errors (RSEs) were used to control for the non-independence of multiple observations provided by the same patient. Results Patients in the ICD arm had 41% higher odds of experiencing CHF since their last assessment compared with those in the control arm (RSE = 0.19, p = 0.01). Developing CHF reduced HRQOL at the subsequent visit by 0.07 (p < 0.01). Having ICD shocks reduced overall HRQOL by 0.04 (p = 0.04) at the subsequent assessment. The negative effect of ICD firing on HRQOL was an order of magnitude greater than the effect of CHF. Conclusions A higher prevalence of CHF and shocks among patients with ICDs and their negative effect on HRQOL may partially explain the lack of HRQOL benefit of ICD therapy. PMID:19929037

  12. Infections after cardioverter-defibrillator implantation: observations in 335 patients over 10 years.

    PubMed Central

    Trappe, H. J.; Pfitzner, P.; Klein, H.; Wenzlaff, P.

    1995-01-01

    OBJECTIVE--To determine the incidence of infection after implantation of a cardioverter-defibrillator and the management of this complication. SUBJECTS--335 consecutive patients who had a cardioverter-defibrillator implanted between January 1984 and December 1993. MAIN OUTCOME MEASURES--Incidence of infection within the first month after implantation (early infection) and after the first month (late infection). RESULTS--Infections associated with cardioverter-defibrillator devices occurred in 13 patients (3.9%) during a mean follow up of 22 (11) months. All patients had general signs of inflammation, fever (> 37.5 degrees C), and leucocytosis (> 10,000/ml) with or without purulent drainage. Five patients (38%) had infections during the first implantation, whereas eight patients (62%) had infections after replacement of the pulse generator. Early infection was observed in four patients (31%) and late infection in nine (69%). Incidence of infection was higher in patients who underwent epicardial cardioverter-defibrillator implantation (12/207 patients, 5.8%) than in those who received nonthoracotomy lead systems (1/125 patients, 0.8%) (P < 0.05). Infections were caused by staphyloccocus in 10 patients, pseudomonas in two patients, and streptococcus in one patient. The whole device had to be removed in all patients. During a mean follow up of 39 (29) months seven patients died: six of congestive heart failure and one of myocardial reinfarction. CONCLUSIONS--Infection, one of the most serious complications after cardioverter-defibrillator implantation, is associated with increased morbidity and mortality. When infection occurs the system must be removed to avoid a fatal outcome. PMID:7888255

  13. Erroneous discharge of an implantable cardioverter defibrillator caused by an electric razor.

    PubMed

    Seifert, T; Block, M; Borggrefe, M; Breithardt, G

    1995-08-01

    We report an unusual case of the erroneous discharge of a third-generation multiprogrammable implantable cardioverter defibrillator in a 64-year-old patient with a history of recurrent ventricular tachycardias caused by electromagnetic interference while shaving with an electric razor. Electromagnetic interference was related to a defect in the electrode's insulation and could not be provoked in an intact electrode. PMID:7479183

  14. Implantable Cardioverter-Defibrillator Discharge in a Patient with Dilated Cardiomyopathy: What Is the Mechanism?

    PubMed

    Docekal, Jermey; Singh, David K

    2016-03-01

    The response to antitachycardia pacing can sometimes reveal clues about tachycardia mechanisms. This article discusses a case in which the diagnosis of typical atrioventricular nodal reciprocating tachycardia could be firmly established from the implantable cardioverter-defibrillator interrogation alone. PMID:26920189

  15. Safety of Electromagnetic Articulography in Patients with Pacemakers and Implantable Cardioverter-Defibrillators

    ERIC Educational Resources Information Center

    Joglar, Jose A.; Nguyen, Carol; Garst, Diane M.; Katz, William F.

    2009-01-01

    Purpose: "Electromagnetic articulography (EMA)" uses a helmet to create alternating magnetic fields for tracking speech articulator movement. An important safety consideration is whether EMA magnetic fields interfere with the operation of speakers' pacemakers or implantable cardioverter-defibrillators (ICDs). In this investigation, individuals…

  16. [Tachycardia detection in implantable cardioverter-defibrillators by Sorin/LivaNova : Algorithms, pearls and pitfalls].

    PubMed

    Kolb, Christof; Ocklenburg, Rolf

    2016-09-01

    For physicians involved in the treatment of patients with implantable cardioverter-defibrillators (ICDs) the knowledge of tachycardia detection algorithms is of paramount importance. This knowledge is essential for adequate device selection during de-novo implantation, ICD replacement, and for troubleshooting during follow-up. This review describes tachycardia detection algorithms incorporated in ICDs by Sorin/LivaNova and analyses their strengths and weaknesses. PMID:27605232

  17. The dilemma of implantable cardioverter-defibrillator therapy in the geriatric population

    PubMed Central

    Revenco, Diana; Morgan, James P; Tsao, Lana

    2011-01-01

    Current guidelines for implantable cardioverter-defibrillator (ICD) therapy in heart failure patients were established by multiple device trials; however, very few geriatric patients (patients ≥ 65 years old) were included in these studies. This article explores the controversies of ICD implantation in the geriatric population, management of delivered ICD therapy in this age group, and the end of life care in patients with ICD. PMID:22783305

  18. Longevity of implantable cardioverter defibrillators: a comparison among manufacturers and over time

    PubMed Central

    von Gunten, Simon; Schaer, Beat A.; Yap, Sing-Chien; Szili-Torok, Tamas; Kühne, Michael; Sticherling, Christian; Osswald, Stefan; Theuns, Dominic A.M.J.

    2016-01-01

    Aims Longevity of implantable cardioverter defibrillators (ICDs) is crucial for patients and healthcare systems as replacements impact on infection rates and cost-effectiveness. Aim was to determine longevity using very large databases of two teaching hospitals with a high number of replacements and a rather homogeneous distribution among manufacturers. Methods and results The study population consists of all patients in whom an ICD was inserted in. All ICD manufacturers operating in Switzerland and the Netherlands and all implanted ICDs were included. Implantable cardioverter defibrillator replacements due to normal battery depletion were considered events, and other replacements were censored. Longevity was assessed depending on manufacturers, pacing mode, implant before/after 2006, and all parameters combined. We analysed data from 3436 patients in whom 4881 ICDs [44.2% VVI-ICDs, 27.4% DDD-ICDs, 26.3% cardiac resynchronization therapy (CRT)-ICDs, 2.0% subcutaneous ICDs] were implanted. The four major manufacturers had implant shares between 18.4 and 31.5%. Replacement due to battery depletion (27.4%) was performed for 1339 ICDs. Patient survival at 5 years was 80.1%. Longevity at 5 years improved in contemporary compared with elderly ICDs [63.9–80.6% across all ICDs, of 73.7–92.1% in VVIs, 58.2–76.1% in DDDs, and of 47.1–66.3% in CRT defibrillators, all P value < 0.05]. Remarkable differences were seen among manufacturers, and those with better performance in elderly ICDs were not those with better performance in contemporary ones. Conclusion Implantable cardioverter defibrillator longevity increased in contemporary models independent of manufacturer and pacing mode. Still, significant differences exist among manufacturers. These results might impact on device selection. PMID:26609076

  19. Tachycardia detection in modern implantable cardioverter-defibrillators.

    PubMed

    Brüggemann, Thomas; Dahlke, Daniel; Chebbo, Amin; Neumann, Ilka

    2016-09-01

    Implantable cardioverter-defibrillators (ICD) have to reliably sense, detect, and treat malignant ventricular tachyarrhythmias. Inappropriate treatment of non life-threatening tachyarrhythmias should be avoided. This article outlines the functionality of ICDs developed and manufactured by BIOTRONIK. Proper sensing is achieved by an automatic sensitivity control which can be individually tailored to solve special under- and oversensing situations. The programming of detection zones for ventricular fibrillation (VF), ventricular tachycardia (VT), and zones to monitor other tachyarrhythmias is outlined. Dedicated single-chamber detection algorithms based on average heart rate, cycle length variability, sudden rate onset, and changes in QRS morphology as used in ICDs by BIOTRONIK are described in detail. Preconditions and confirmation algorithms for therapy deliveries as antitachycardia pacing (ATP) and high energy shocks are explained. Finally, a detailed description of the dual-chamber detection algorithm SMART is given. It comprises additional detection criteria as stability of atrial intervals, 1:1 conduction, atrial-ventricular (AV) multiplicity, AV trend, and AV regularity to differentiate between ventricular and supraventricular tachyarrhythmias. PMID:27576695

  20. Axillary vein technique for pacemaker and implantable defibrillator leads implantation: a safe and alternative approach?

    PubMed

    Migliore, Federico; Curnis, Antonio; Bertaglia, Emanuele

    2016-04-01

    Different methods for venous access are used for permanent pacemaker or implantable cardioverter defibrillator (ICD), of which subclavian vein puncture technique is the most widely practised. Although this approach is relatively easy to learn, quick and offers high success rates, it may be associated with potential serious acute complications including pneumothorax, emopneumothorax, brachial plexus injury and longer-term complications such as lead fracture, loss of lead insulation and subclavian crush syndrome especially in young patients with ICD leads. Axillary vein approach seems to be a favourable technique not only for the prevention of acute complications but also to reduce lead failure including lead insulation and lead fracture prevention with a consequently better long-term lead survival compared with the classical subclavian approach. Although randomized studies are lacking, recent reports not only evaluated the safety and effectiveness of new fluoroscopic axillary venous puncture technique, but also compared it with the conventional intrathoracic subclavian venous puncture technique for the implantation of leads in permanent pacing. Various techniques of axillary vein puncture have been proposed ranging from a blind percutaneous puncture to the use of different tools such as contrast venography and ultrasound. In this article, we report a case of subclavian crush syndrome, the use of a modified Bellot's technique of axillary vein puncture that we currently use and the potential benefits of axillary vein puncture for pacemaker and ICD leads implantation compared with subclavian approach to avoid acute and long-term lead complications. PMID:25252042

  1. Evaluation of safety and efficacy of pacemaker and defibrillator implantation by axillary incision in pediatric patients.

    PubMed

    Lee, Joselyn C R; Shannon, Kevin; Boyle, Noel G; Klitzner, Thomas S; Bersohn, Malcolm M

    2004-03-01

    We successfully implanted 11 pacemakers, 6 defibrillators, and 1 biventricular pacemaker in 18 pediatric patients (15 female; 4 to 15 years, average age: 9) using the retropectoral transvenous approach with a hidden axillary incision. The average follow-up period was 24 months (range 49 months). Eight patients had congenital structural heart conditions (d-transposition of great arteries S/P Mustard operation, d-transposition of great arteries S/P arterial switch operation, truncus arteriosus, right ventricular diverticula, ventricular septal defect, hypertrophic cardiomyopathy). Four patients had acquired heart conditions (dilated cardiomyopathy, myocarditis). Excellent sensing and pacing thresholds were achieved in all attempted implantations. There was no pneumothorax. There was one lead dislodgement. One lead fracture distant from the subclavian vein occurred 4 months after implantation. Implantation of pacemakers and defibrillators via axillary incisions can be safe and effective in pediatric patients. This approach avoids skin erosion when implanting large devices such as defibrillators or biventricular devices in small patients with limited muscle mass while achieving superior aesthetic results. The axillary or extrathoracic venous entry site avoids subclavian crush syndrome. PMID:15009854

  2. Dental management of a patient fitted with subcutaneous Implantable Cardioverter Defibrillator device and concomitant warfarin treatment

    PubMed Central

    Shah, Altaf Hussain; Khalil, Hesham Saleh; Kola, Mohammed Zaheer

    2015-01-01

    Automated Implantable Cardioverter Defibrillators (AICD), simply known as an Implantable Cardioverter Defibrillator (ICD), has been used in patients for more than 30 years. An Implantable Cardioverter Defibrillator (ICD) is a small battery-powered electrical impulse generator that is implanted in patients who are at a risk of sudden cardiac death due to ventricular fibrillation, ventricular tachycardia or any such related event. Typically, patients with these types of occurrences are on anticoagulant therapy. The desired International Normalized Ratio (INR) for these patients is in the range of 2–3 to prevent any subsequent cardiac event. These patients possess a challenge to the dentist in many ways, especially during oral surgical procedures, and these challenges include risk of sudden death, control of post-operative bleeding and pain. This article presents the dental management of a 60 year-old person with an ICD and concomitant anticoagulant therapy. The patient was on multiple medications and was treated for a grossly neglected mouth with multiple carious root stumps. This case report outlines the important issues in managing patients fitted with an ICD device and at a risk of sudden cardiac death. PMID:26236132

  3. Single lead catheter of implantable cardioverter-defibrillator with floating atrial sensing dipole implanted via persistent left superior vena cava

    PubMed Central

    Malagù, Michele; Toselli, Tiziano; Bertini, Matteo

    2016-01-01

    Persistent left superior vena cava (LSVC) is a congenital anomaly with 0.3%-1% prevalence in the general population. It is usually asymptomatic but in case of transvenous lead positioning, i.e., for pacemaker or implantable cardioverter defibrillator (ICD), may be a cause for significant complications or unsuccessful implantation. Single lead ICD with atrial sensing dipole (ICD DX) is a safe and functional technology in patients without congenital abnormalities. We provide a review of the literature and a case report of successful implantation of an ICD DX in a patient with LSVC and its efficacy in treating ventricular arrhythmias. PMID:27152145

  4. Serratia marcescens: A Rare Cause of Recurrent Implantable Cardioverter Defibrillator Site Infection

    PubMed Central

    Hawkey, S.; Choy, AM.

    2015-01-01

    We present a unique case of a patient who experienced recurrent infections of his implantable cardioverter defibrillator (ICD) site with the bacterium Serratia marcescens. This report highlights the virulence of this bacterium, its resistance to antibiotic therapy, and its ability to remain latent for prolonged periods between episodes of sepsis. It also demonstrates the merits of reimplanting devices at different sites in the context of Serratia marcescens infection. PMID:26605092

  5. Overview of implantable cardioverter defibrillator and cardiac resynchronisation therapy in heart failure management

    PubMed Central

    Chia, Pow-Li; Foo, David

    2016-01-01

    Clinical trials have established the benefits of implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) in the treatment of heart failure patients. As adjuncts to guideline-directed medical therapy, ICDs confer mortality benefits from sudden cardiac arrest, while CRT reduces mortality, hospitalisation rates and improves functional capacity. This review discusses the use of ICDs and CRT devices in heart failure management, outlining the evidence supporting their use, indications and contraindications. PMID:27440409

  6. Questions to Ask Your Doctor--Implantable Cardioverter Defibrillator (ICD)

    MedlinePlus

    ... implanted to restore normal heart rhythm and prevent sudden cardiac death. To help you understand what it does and how it may affect you or your family member before and after implantation, ask your doctor or healthcare team any ...

  7. Hospice Use Following Implantable Cardioverter-Defibrillator Implantation in Older Patients

    PubMed Central

    Reynolds, Matthew R.; Normand, Sharon-Lise; Parzynski, Craig S.; Spertus, John A.; Mor, Vincent; Mitchell, Susan L.

    2016-01-01

    Background— Older recipients of implantable cardioverter-defibrillators (ICDs) are at increased risk for short-term mortality in comparison with younger patients. Although hospice use is common among decedents aged >65, its use among older ICD recipients is unknown. Methods and Results— Medicare patients aged >65 matched to data in the National Cardiovascular Data Registry – ICD Registry from January 1, 2006 to March 31, 2010 were eligible for analysis (N=194 969). The proportion of ICD recipients enrolled in hospice, cumulative incidence of hospice admission, and factors associated with time to hospice enrollment were evaluated. Five years after device implantation, 50.9% of patients were either deceased or in hospice. Among decedents, 36.8% received hospice services. The cumulative incidence of hospice enrollment, accounting for the competing risk of death, was 4.7% (95% confidence interval [CI], 4.6%–4.8%) within 1 year and 21.3% (95% CI, 20.7%–21.8%) at 5 years. Factors most strongly associated with shorter time to hospice enrollment were older age (adjusted hazard ratio, 1.77; 95% CI, 1.73–1.81), class IV heart failure (versus class I; adjusted hazard ratio, 1.79; 95% CI, 1.66–1.94); ejection fraction <20 (adjusted hazard ratio, 1.57; 95% CI, 1.48–1.67), and greater hospice use among decedents in the patients’ health referral region. Conclusions— More than one-third of older patients dying with ICDs receive hospice care. Five years after implantation, half of older ICD recipients are either dead or in hospice. Hospice providers should be prepared for ICD patients, whose clinical trajectories and broader palliative care needs require greater focus. PMID:27016104

  8. Indications for dual-chamber (DDD) pacing in implantable cardioverter-defibrillator patients.

    PubMed

    Santini, M; Ansalone, G; Auriti, A; Magris, B; Pandozi, C; Altamura, G

    1996-09-12

    New technologic development of implantable cardioverter-defibrillators (ICDs) keeps up with the exponential increase of their use for primary and secondary prevention of sudden cardiac death. The first-generation ICD with limited shock capability alone could be considered adequate in most cardiac arrest victims, but it was not suitable for sudden death prevention in all high-risk patients with cardiac disease. The second-generation ICD was comprised of hybrid pacemaker-defibrillator systems that provided on-demand ventricular antibradycardia pacing. The third-generation devices include additional functions, such as antitachycardia pacing for ventricular tachycardia (VT) reversion and low-energy ventricular cardioversion, in addition to ventricular defibrillation and single-chamber ventricular demand pacing. In the near future, advanced dual-chamber atrioventricular (AV) pacing and defibrillating systems will also be available. The dual chamber ICD will allow atrial inhibited/dual-chamber (AAI/DDD) rate-responsive pacing, simultaneous atrial and ventricular sensing to optimize the arrhythmia identification, and ICD shock delivery in the proper arrhythmia-related chamber. Clinical benefits of these devices compared with their cost and complexity will require careful evaluation. PMID:8820847

  9. Implantation of a defibrillator in a patient with an upper airway stimulation device.

    PubMed

    Ong, Adrian A; O'Brien, Terrence X; Nguyen, Shaun A; Gillespie, M Boyd

    2016-02-01

    The patient is a 62-year-old man with continuous positive airway pressure-intolerant obstructive sleep apnea who was enrolled in a study for a hypoglossal nerve upper airway stimulation device (UAS). Nearly 2.5 years later, he was admitted to the hospital for unstable angina. Diagnostic workup revealed a prior myocardial infarction, an ejection fraction of 30% on maximal medical therapy, and episodes of nonsustained ventricular tachycardia. During hospitalization, the patient received an implantable cardioverter defibrillator (ICD). This is the first reported case of simultaneous use of a UAS and an ICD, and we report no untoward device interference between the two implantable devices. PMID:26403681

  10. Magnetic resonance imaging in patients with a subcutaneous implantable cardioverter-defibrillator

    PubMed Central

    Keller, Jiří; Neužil, Petr; Vymazal, Josef; Janotka, Marek; Brada, Jiří; Žáček, Radovan; Vopálka, Roman; Weichet, Jiří; Reddy, Vivek Y.

    2015-01-01

    Aims Our aim was to evaluate the potential for safely imaging patients with a new type of implantable cardioverter-defibrillator called the subcutaneous implantable cardioverter-defibrillator (S-ICD) in a 1.5 T magnetic resonance imaging (MRI) scanner. With the increasing number of patients with cardiac implantable devices who are indicated for MRI, there is a growing need for establishing MRI compatibility of cardiac implantable devices. Methods and Results Patients with implanted S-ICD systems underwent one or more types of anatomical MRI scans. The S-ICD was programmed off and patients were monitored throughout the imaging procedure. Device function was evaluated pre- and post-scan. Patients were asked to report immediately any pain, torqueing movement, or heating sensation in the area of the pocket or electrode. Fifteen patients underwent a total of 22 examinations at 1.5 T. Scans included brain, spine, knee, and heart. Two patients were re-scanned due to complaints of heating over the can during lumbar scans, which was caused by a thermistor probe placed on the skin to measure skin temperature. All the remaining scans occurred without incident. No evidence of device malfunction was observed. Conclusion This study is the first to domonstrate the feasibility of exposing S-ICD patients to MRI using the scanning and monitoring protocol described. More data are required to support S-ICD as a MRI conditional device. PMID:25687749

  11. The implantable cardioverter defibrillator: technology, indications, and impact on cardiovascular survival.

    PubMed

    Bhatia, Atul; Cooley, Ryan; Berger, Marcie; Blanck, Zalmen; Dhala, Anwer; Sra, Jasbir; Axtell-Mcbride, Kathleen; Vandervort, Cheryl; Akhtar, Masood

    2004-06-01

    Since the introduction of the implantable cardioverter defibrillator (ICD) for the management of patients with high risk of arrhythmic SCD, there has been increasing use of this device. Its basic promise to effectively terminate ventricular tachycardia (VT)-ventricular fibrillation (VF) has been repeatedly met. In several randomized trials, the ICD has been shown to be superior to conventional anti-arrhythmic therapy, both in patients with documented VT-VF (secondary prevention) and those with high risk such as left ventricular ejection fraction and no prior sustained VT-VF (primary prevention). In both groups, the ICD showed overall and cardiac mortality reduction. The device now can more accurately detect VT-VF and differentiate these from other arrhythmias through a series of algorithms and direct-chamber sensing. Therapy options include painless antitachycardia pacing, low-energy cardioversion, and high-energy defibrillation. The technique implant is now simple as a pacemaker with one lead attached to an active (hot) can functioning as the other electrode. Among other improvements is its weight, volume, multiprogrammability, and storage of information,dual-chamber pacing and sensing, dual-chamber defibrillation, and addition of biventricular pacing for cardiac synchronization. It is anticipated that further improvement in ICD technology will take place and the list of indications will grow. PMID:15159713

  12. T-wave alternans negative coronary patients with low ejection and benefit from defibrillator implantation

    NASA Technical Reports Server (NTRS)

    Hohnloser, S. H.; Ikeda, T.; Bloomfield, D. M.; Dabbous, O. H.; Cohen, R. J.

    2003-01-01

    In a trial of prophylactic implantation of a defibrillator, a mortality benefit was seen among patients with previous myocardial infarction and a left-ventricular ejection fraction of 0.30 or less. We identified 129 similar patients from two previously published clinical trials in which microvolt T-wave alternans testing was prospectively assessed. At 24 months of follow-up, no sudden cardiac death or cardiac arrest was seen among patients who tested T-wave alternans negative, compared with an event rate of 15.6% among the remaining patients. Testing of T-wave alternans seems to identify patients who are at low risk of ventricular tachyarrhythmic event and who may not benefit from defibrillator therapy.

  13. Patients with pacemaker or implantable cardioverter-defibrillator.

    PubMed

    Schulman, Peter M; Rozner, Marc A; Sera, Valerie; Stecker, Eric C

    2013-11-01

    The preparation of patients with a cardiac implantable electronic device (CIED) for the perioperative period necessitates familiarity with recommendations from the American Society of Anesthesiologists and Heart Rhythm Society. Even clinicians who are not CIED experts should understand the indications for implantation, as well as the basic functions, operations, and limitations of these devices. Before any scheduled procedure, proper CIED function should be verified and a specific CIED prescription obtained. Acquiring the requisite knowledge base and developing the systems to competently manage the CIED patient ensures safe and efficient perioperative care. PMID:24182719

  14. Association of Physician Certification and Outcomes Among Patients Receiving an Implantable Cardioverter-Defibrillator

    PubMed Central

    Curtis, Jeptha P.; Luebbert, Jeffrey J.; Wang, Yongfei; Rathore, Saif S.; Chen, Jersey; Heidenreich, Paul A.; Hammill, Stephen C.; Lampert, Rachel I.; Krumholz, Harlan M.

    2009-01-01

    Context Allowing nonelectrophysiologists to perform implantable cardioverter-defibrillator (ICD) procedures is controversial. However, it is not known whether outcomes of ICD implantation vary by physician specialty. Objective To determine the association of implanting physician certification with outcomes following ICD implantation. Design, Setting, and Patients Retrospective cohort study using cases submitted to the ICD Registry performed between January 2006 and June 2007. Patients were grouped by the certification status of the implanting physician into mutually exclusive categories: electrophysiologists, nonelectrophysiologist cardiologists, thoracic surgeons, and other specialists. Hierarchical logistic regression models were developed to determine the independent association of physician certification with outcomes. Main Outcome Measures In-hospital procedural complication rates and the proportion of patients meeting criteria for a defibrillator with cardiac resynchronization therapy (CRT-D) who received that device. Results Of 111 293 ICD implantations included in the analysis, 78 857 (70.9%) were performed by electrophysiologists, 24 399 (21.9%) by nonelectrophysiologist cardiologists, 1862 (1.7%) by thoracic surgeons, and 6175 (5.5%) by other specialists. Compared with patients whose ICD was implanted by electrophysiologists, patients whose ICD was implanted by either nonelectrophysiologist cardiologists or thoracic surgeons were at increased risk of complications in both unadjusted (electrophysiologists, 3.5% [2743/78 857]; nonelectrophysiologist cardiologists, 4.0% [970/24 399]; thoracic surgeons, 5.8% [108/1862]; P < .001) and adjusted analyses (relative risk [RR] for nonelectrophysiologist cardiologists, 1.11 [95% confidence interval {CI}, 1.01–1.21]; RR for thoracic surgeons, 1.44 [95% CI, 1.15–1.79]). Among 35 841 patients who met criteria for CRT-D, those whose ICD was implanted by physicians other than electrophysiologists were significantly

  15. The learning curve associated with the introduction of the subcutaneous implantable defibrillator

    PubMed Central

    Knops, Reinoud E.; Brouwer, Tom F.; Barr, Craig S.; Theuns, Dominic A.; Boersma, Lucas; Weiss, Raul; Neuzil, Petr; Scholten, Marcoen; Lambiase, Pier D.; Leon, Angel R.; Hood, Margaret; Jones, Paul W.; Wold, Nicholas; Grace, Andrew A.; Olde Nordkamp, Louise R.A.; Burke, Martin C.

    2016-01-01

    Aims The subcutaneous implantable cardioverter defibrillator (S-ICD) was introduced to overcome complications related to transvenous leads. Adoption of the S-ICD requires implanters to learn a new implantation technique. The aim of this study was to assess the learning curve for S-ICD implanters with respect to implant-related complications, procedure time, and inappropriate shocks (IASs). Methods and results In a pooled cohort from two clinical S-ICD databases, the IDE Trial and the EFFORTLESS Registry, complications, IASs at 180 days follow-up and implant procedure duration were assessed. Patients were grouped in quartiles based on experience of the implanter and Kaplan–Meier estimates of complication and IAS rates were calculated. A total of 882 patients implanted in 61 centres by 107 implanters with a median of 4 implants (IQR 1,8) were analysed. There were a total of 59 patients with complications and 48 patients with IAS. The complication rate decreased significantly from 9.8% in Quartile 1 (least experience) to 5.4% in Quartile 4 (most experience) (P = 0.02) and non-significantly for IAS from 7.9 to 4.8% (P = 0.10). Multivariable analysis demonstrated a hazard ratio of 0.78 (P = 0.045) for complications and 1.01 (P = 0.958) for IAS. Dual-zone programming increased with experience of the individual implanter (P < 0.001), which reduced IAS significantly in the multivariable model (HR 0.44, P = 0.01). Procedure time decreased from 75 to 65 min (P < 0.001). The complication rate and procedure time stabilized after Quartile 2 (>13 implants). Conclusion There is a short and significant learning curve associated with physicians adopting the S-ICD. Performance stabilizes after 13 implants. PMID:26324840

  16. Safety and Cost-Effectiveness of Same-Day Cardiac Resynchronization Therapy and Implantable Cardioverter Defibrillator Implantation.

    PubMed

    Atherton, Gavin; McAloon, Christopher James; Chohan, Bhaveek; Heining, Dominic; Anderson, Benjamin; Barker, Jethro; Randeva, Harpal; Osman, Faizel

    2016-05-01

    Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillator (ICD) implantation improve morbidity and mortality in selected patients. Many centers still admit patients overnight. We evaluated the safety, feasibility, and cost savings of same-day CRT/ICD device implantation by performing a retrospective study of all consecutive elective CRT/ICD implants at a tertiary center from January 2009 to April 2013. All emergency and/or inpatient cases were excluded. Data were collected on baseline demographics, implantation indication, procedure details, complications (categorized as immediate [≤24 hours], short term [24 hours to 6 weeks], medium term [6 weeks to 4 months], and long term [>4 months]), and mortality (30 day and 1 year). Comparisons were made between those having planned same-day versus overnight stay procedures. A cost analysis was performed to evaluate cost savings of the same-day policy. A total of 491 devices were implanted during this period: 267 were elective (54 planned overnight, 213 planned same-day) of which 229 were CRT pacemakers or CRT defibrillators and 38 ICDs. There were 26 total overall complications (9.7%) with no significant differences between planned same-day versus planned overnight stay cohorts (9.4% vs 11.1%, p = 0.8) and specifically no differences in immediate, short-, medium-, and long-term complications at follow-up. The 30-day and 1-year mortality rates did not differ between the two groups. An overnight stay at our hospital costs $450 (£300); our cost saving during this period was $91,800 (£61,200). Same-day CRT/ICD implantation is safe, feasible, and associated with significant cost savings. It provides significant advantages for patients and health care providers, especially given the current financial climate. PMID:26993428

  17. [Semi-automatic defibrillators does not always interpret heart rhythms correctly. Five patients were defibrillated despite non-shockable rhythms].

    PubMed

    Wangenheim, Burkard; Israelsson, Johan; Lindstaedt, Michael; Carlsson, Jörg

    2015-01-01

    Automated external defibrillators (AED) have become an important part of the »the chain of survival« in case of sudden cardiac arrest (SCA), where early defibrillation is lifesaving. The American Heart Association demands that AEDs have a specificity of >99 % to recognize normal sinus rhythm and >95 % for the other non-shockable rhythms. Reports on their performance in the field are scarce. We present five cases in which AED recommended shock for apparently non-shockable rhythms. This indicates the necessity to systematically reevaluate AED performance. PMID:26241809

  18. Ventricular Arrhythmias in Apparently Normal Hearts: Who Needs an Implantable Cardiac Defibrillator?

    PubMed

    Tan, Alex Y; Ellenbogen, Kenneth

    2016-09-01

    Idiopathic ventricular tachycardia is often considered a benign form of ventricular arrhythmia in patients without apparent structural heart disease. However, a subset of patients may develop malignant ventricular arrhythmias and present with syncope and sudden cardiac arrest. Survivors of cardiac arrest are candidates for implantable cardiac defibrillators (ICDs). The indications for ICDs in patients with less than a full-blown cardiac arrest presentation but with electrocardiographically high-risk ectopy features remain uncertain. This article addresses some of the uncertainties and pitfalls in ICD risk stratification in this patient group and explores potential mechanisms for malignant conversion of benign premature ventricular complexes to sustained arrhythmia. PMID:27521094

  19. Implantable Cardioverter-Defibrillator Shock Caused by Uncommon Variety of Nonreentrant Atrioventricular Nodal Tachycardia.

    PubMed

    Singh, David K; Badhwar, Nitish

    2016-03-01

    This article reports a typical case of incessant double-fire tachycardia resulting in implantable cardioverter-defibrillator discharge caused by the device's misdiagnosis of ventricular tachycardia. At electrophysiology study, the presence of double-fire physiology was confirmed, and modification of the slow pathway resulted in elimination of repetitive double fires. Although this is an unusual entity, it is important to recognize, because it may be misdiagnosed as atrial fibrillation, resulting in inappropriate anticoagulation and/or antiarrhythmic therapy. Modification of the slow pathway and elimination of double-fire physiology can result in marked improvement in quality of life and reversal of tachycardia-mediated cardiomyopathy. PMID:26920170

  20. Electromagnetic Interference with Implantable Cardioverter Defibrillators Causing Inadvertent Shock: Case Report and Review of Current Literature

    PubMed Central

    Akhtar, Muhammad; Bhat, Tariq; Tantray, Mohmad; Lafferty, Chris; Faisal, Saiful; Teli, Sumaya; Bhat, Hilal; Raza, Muhammad; Khalid, Mariam; Biekht, Soad

    2014-01-01

    As the number of patients having implantable cardioverter defibrillator (ICD) devices is increasing, it is important for the physicians and patients to be aware of situations and conditions that can result in interference with normal functioning of these devices. There are multiple cases of malfunction of ICDs reported in literature and it may be of great significance to have an overview of these incidents for appropriate recognition and future prevention. Here we are reviewing the available literature as well as reporting an interesting case of electromagnetic interference (EMI) resulting from leak of current in pool water causing firing of ICD. PMID:25093004

  1. An Adverse Electrophysiological Interaction Between an Implantable Cardioverter-Defibrillator and a Ventricular Assist Device.

    PubMed

    Chhabra, Lovely; Hiendlmayr, Brett; Kluger, Jeffrey

    2015-01-01

    Many patients with left ventricular assist devices (LVAD) have implantable cardioverter defibrillators (ICDs) as part of the management of advanced heart failure. With increasing use and coexistence of these devices in patients with advanced cardiomyopathy, adverse interactions between these devices have been recognized. We herewith describe a rare adverse interaction of electromagnetic interference (EMI) between a third-generation, continuous-flow device (The HeartWare HVAD) and an ICD which resulted in the delivery of inappropriate ICD therapies. A schematic approach for the prevention and treatment of electromagnetic interference has also been described. PMID:26263716

  2. Development of a hybrid battery system for an implantable biomedical device, especially a defibrillator/cardioverter (ICD)

    NASA Astrophysics Data System (ADS)

    Drews, Jürgen; Wolf, R.; Fehrmann, G.; Staub, R.

    An implantable defibrillator battery has to provide pulse power capabilities as well as high energy density. Low self-discharge rates are mandatory and a way to check the remaining available capacity is necessary. These requirements are accomplished by a system consisting of a lithium/manganese dioxide 6 V battery, plus a lithium/iodine-cell. The use of a high rate 6 V double-cell design in combination with a high energy density cell reduces the total volume required by the power source within an implantable defibrillator. The design features and performance data of the hybrid system are described.

  3. [Full dental rehabilitation of a patient with implantable cardioverter defibrillator].

    PubMed

    Imre, Ildikó; Tóth, Zsuzsanna

    2012-06-01

    During dental rehabilitation of a patient with ICD, an upper telescope retained overdenture with acrylic baseplate and lower cantilever bridges were constructed. In the consultation following the anamnesis and the clinical examination, the cardiologist did not believe antibiotic profilaxis to be necessary, adding that it is advisable to avoid the use of ultrasonic depurator and electrocauter. Nowadays after saving the life the improving of patient's better quality of life is an important aspect. The risk of ICD-implantation is minimal however, not negligible, the patient can pursue a way of life free of limitation. According to the latest trends, the number of ICD-implantations will increase exponentially in the near future, due to the aging of the population, the simplification and safeness of implantation and the increase of patients who can be treated with the device. In case of arritmia or putative dysfunction, the latest ICD-s are able to send emergency alert to the arritmia centre with the help of an outer transmitter. Probably the system will completely change the follow-up of patients with ICD within the next few years, clinical researches of its efficiency are going on at present. PMID:22826909

  4. Evaluation of defibrillation safety and shock reduction in implantable cardioverter-defibrillator patients with increased time to detection: A randomized SANKS study

    PubMed Central

    Noro, Mahito; Zhu, Xin; Takagi, Takahito; Sahara, Naohiko; Narabayashi, Yuriko; Hashimoto, Hikari; Ito, Naoshi; Enomoto, Yoshinari; Kujime, Shingo; Sakai, Tuyoshi; Sakata, Takao; Matushita, Noriko; Fukamizu, Seiji; Okano, Yoshifumi; Anami, Yoshiaki; Tejima, Tomoyuki; Kuroiwa, Kouji; Ikeda, Takanori; Sakurada, Harumizu; Sugi, Kaoru

    2014-01-01

    Abstract11Abstract publication information: The abstracts of this study were presented at the conferences below:[1] Mahito N, Naoshi I, Yoshinari E, et al. Evaluation of defibrillation safety with the increased number of sensing to reduce shocks for ventricular fibrillation in Japanese ICD patients. 5th APHRS; 2012.[2] Mahito N, Xin Z, Naoshi I, et al. Evaluation of Defibrillation Safety with the increased Number of Sensing to Reduce Shocks for Ventricular Tachyarrhythmia in Japanese ICD Patients – SANKS STUDY. Venue of the 8th Tawara-Aschoff-Meeting; 2012. Background The need for ways to minimize the number of implantable cardioverter-defibrillator (ICD) shocks is increasing owing to the risk of its adverse effects on life expectancy. Studies have shown that a longer detection time for ventricular tachyarrhythmia reduces the safety of therapies, in terms of syncope and mortality, but not substantially in terms of the success rate. We aimed to evaluate the effects of increased number of intervals to detect (NID) VF on the safety of ICD shock therapy and on the reduction of inappropriate shocks. Methods The present study was a prospective, multicenter, randomized, crossover study. Randomized VF induction testing with NID 18/24 or 30/40 was performed to compare the success rate of defibrillation with a 25-J shock and the time to detection. Inappropriate shock episodes were simulated retrospectively to evaluate a possibility of episodes avoidable at NID 24/32 and 30/40. Results Thirty-one consecutive patients implanted with an ICD or cardiac resynchronization therapy-defibrillator (CRT-D) were enrolled in this study. The success rate of defibrillation was 100% in both NID groups at the first shock. The time from VF induction to detection showed a significant increase in the NID 30/40 group (6.16±1.29 s vs. 9.00±1.31 s, p<0.001). Among the 120 patients implanted with an ICD or CRT-D, 10 experienced 32 inappropriate shock episodes. The inappropriate shock

  5. [Resuscitation - Basic Life Support in adults and application of automatic external defibrillators].

    PubMed

    Bohn, Andreas; Seewald, Stephan; Wnent, Jan

    2016-03-01

    Witnesses of a sudden cardiac arrest play a key-role in resuscitation. Lay-persons should therefore be trained to recognize that a collapsed person who is not breathing at all or breathing normally might suffer from cardiac arrest. Information of professional emergency medical staff by lay-persons and their initiation of cardio-pulmonary-resuscitation-measures are of great importance for cardiac-arrest victims. Ambulance-dispatchers have to support lay-rescuers via telephone. This support includes the localisation of the nearest Automatic External Defibrillator (AED). Presentation of agonal breathing or convulsions due to brain-hypoxia need to be recognized as potential early signs of cardiac arrest. In any case of cardiac arrest chest-compressions need to be started. There is insufficiant data to recommend "chest-compression-only"-CPR as being equally sufficient as cardio-pulmonary-resuscitation including ventilation. Rescuers trained in ventilation should therefore combine compressions and ventilations at a 30:2-ratio. Movement of the chest is being used as a sign of sufficient ventilation. High-quality chest-compressions of at least 5 cm of depth, not exceeding 6 cm, are recommended at a ratio of 100-120 chest conpressions/min. Interruption of chest-compression should be avoided. At busy public places AED should be available to enable lay-rescuers to apply early defibrillation. PMID:27022697

  6. Implantable cardioverter defibrillator dysfunction during and after magnetic resonance imaging.

    PubMed

    Anfinsen, Ole-Gunnar; Berntsen, Rolf Franck; Aass, Halfdan; Kongsgaard, Erik; Amlie, Jan Peder

    2002-09-01

    This report describes a patient in whom a MRI of the brain was performed without realizing that an ICD had been implanted 8 days previously. Electromagnetic noise induced during the MRI was detected as ventricular fibrillation and nearly caused inappropriate shocks. Charge time during MRI was prolonged. The battery indicator switched to "end of life," but this was reversed by capacitor reformation. These problems could have been avoided by inactivating the ICD prior to MRI. Three months later, the pacing threshold increased from 0.4 V per 0.5 ms at implantation to 2.8 V per 0.5. It is still uncertain whether radiofrequency current heating at the electrode tip caused the increased pacing threshold or if this would have occurred independently of the MRI. MRI of patients with an active ICD may cause life-threatening complications, and it is unknown if MRI may be safely performed if the ICD is inactivated. Therefore, MRI of patients with an ICD remains contraindicated. PMID:12380781

  7. Home monitoring of implantable cardioverter-defibrillators: interpretation reliability of the second-generation “IEGM Online” system

    PubMed Central

    Nägele, Herbert; Lipoldová, Jolana; Oswald, Hanno; Klein, Gunnar; Elvan, Arif; Vester, Ernst; Bauer, Wolfgang; Bondke, Hansjürgen; Reif, Sebastian; Daub, Claudia; Menzel, Frank; Schrader, Jürgen; Zach, Göran

    2015-01-01

    Aims Intracardiac electrograms (IEGMs) are essential for the assessment of implantable cardioverter-defibrillator (ICD) function. The Biotronik Home Monitoring systems transmit an ‘IEGM Online’ that is shorter than the full-length programmer IEGM due to technical constrains. The aim of this study was to evaluate the accuracy of the physician's classification of the underlying rhythm based on the second-generation IEGM Online. Methods and results In total, 1533 patients treated with single- and dual-chamber ICDs and cardiac resynchronization therapy defibrillators were enrolled at 67 investigational sites and followed for 15 months. The investigators classified the rhythm shown in IEGM Online as ventricular tachycardia, ventricular fibrillation, atrial fibrillation, other supraventricular tachyarrhythmia, oversensing due to lead failure, T-wave oversensing, or other rhythm. At the next in-office follow-up, the investigators classified independently the rhythm seen in the corresponding programmer IEGM. The two rhythm classifications were compared thereafter. Both IEGM Online and programmer IEGM were available in 2099 arrhythmic or oversensing events, of which 146 (7.0%) were classified as other rhythm or artefacts and were excluded as inconclusive or atypical. The remaining 1953 events, affecting 352 patients (23.0%), were classified correctly in 1803 cases (92.3%). The accuracy of rough rhythm classification as ventricular, supraventricular, or oversensing was 97.2%. Conclusion The Lumax and IEGM Online HD Evaluation study demonstrates that remote IEGM analysis is reasonably accurate in a remote monitoring system that transmits shorter IEGM than the full-length programmer IEGM for the sake of frequent, fully automatic data transmission. PMID:25567067

  8. Implantation of a dual chamber pacing and sensing single pass defibrillation lead.

    PubMed

    Gradaus, R; Block, M; Dorszewski, A; Schriever, C; Hammel, D; Scheld, H H; Borggrefe, M; Breithardt, G; Böcker, D

    2001-04-01

    Dual-chamber ICDs are increasingly used to avoid inappropriate shocks due to supraventricular tachycardias. Additionally, many ICD patients will probably benefit from dual chamber pacing. The purpose of this pilot study was to evaluate the intraoperative performance and short-term follow-up of an innovative single pass right ventricular defibrillation lead capable of bipolar sensing and pacing in the right atrium and ventricle. Implantation of this single pass right ventricular defibrillation lead was successful in all 13 patients (age 63 +/- 8 years; LVEF 0.44 +/- 0.16; New York Heart Association [NYHA] 2.4 +/- 0.4, previous open heart surgery in all patients). The operation time was 79 +/- 29 minutes, the fluoroscopy time 4.7 +/- 3.1 minutes. No perioperative complications occurred. The intraoperative atrial sensing was 1.7 +/- 0.5 mV, the atrial pacing threshold product was 0.20 +/- 0.14 V/ms (range 0.03-0.50 V/ms). The defibrillation threshold was 8.8 +/- 2.7 J. At prehospital discharge and at 1-month and 3-month follow-up, atrial sensing was 1.9 +/- 0.9, 2.1 +/- 0.5, and 2.7 +/- 0.6 mV, respectively, (P = NS, P < 0.05, P < 0.05 to implant, respectively), the mean atrial threshold product 0.79, 1.65, and 1.29 V/ms, respectively. In two patients, an intermittent exit block occurred in different body postures. All spontaneous and induced ventricular arrhythmias were detected and terminated appropriately. Thus, in a highly selected patient group, atrial and ventricular sensing and pacing with a single lead is possible under consideration of an atrial pacing dysfunction in 17% of patients. PMID:11341077

  9. Transtelephonic monitoring and transmission of stored arrhythmia detection and therapy data from an implantable cardioverter defibrillator.

    PubMed

    Fetter, J G; Stanton, M S; Benditt, D G; Trusty, J; Collins, J

    1995-08-01

    A new transtelephonic monitoring device designed for use with implantable cardioverter defibrillators (ICDs) was evaluated. It is capable of interrogating ICDs and transmitting the following data via telephone: programmed parameters (e.g., ventricular tachycardia [VT] and ventricular fibrillation [VF] detection, therapies), number of VT and VF episodes, identification of successful therapies, the 20 cycle lengths preceding the last episode detected, the 10 cycle lengths after the last delivered therapy, battery voltage, and real-time transmission of the patient's rhythm. Eighteen patients (mean age 64 +/- 17 years; 15 males) were implanted with an ICD and epicardial lead system. The patients who did not live near the primary hospital were provided with this transmitter and instructed to transmit monthly and whenever presyncope, syncope, or a shock were experienced. Five hundred ten episodes of spontaneous arrhythmia (495 VT, 15 VF) were detected in 14 of 18 patients in a 24-month period and the success of each therapy (antitachycardia pacing, cardioversion 0.4-34 J, defibrillation 34 J) was analyzed. The number of therapies delivered and their success (%) in terminating the arrhythmia were: 380 ramp/86%, 116 burst/84%, 119 cardioversion/57%, and 15 defibrillations/100%. Sixty-three (42%) of the 152 transmissions indicated an arrhythmia. Twenty-five (16%) of the 152 were transmitted because of symptoms. Sixteen (9.7%) of 165 VT episodes could not be terminated by the full set of programmed VT therapies. Analysis of the pre- and post-episode intervals along with the patient's transmitted rhythm indicated that sinus tachycardia or atrial fibrillation were likely responsible for these episodes.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7479174

  10. Weather and triggering of ventricular arrhythmias in patients with implantable cardioverter-defibrillators.

    PubMed

    Nguyen, Jennifer L; Laden, Francine; Link, Mark S; Schwartz, Joel; Luttmann-Gibson, Heike; Dockery, Douglas W

    2015-01-01

    Outdoor ambient weather has been hypothesized to be responsible for the seasonal distribution of cardiac arrhythmias. Because people spend most of their time indoors, we hypothesized that weather-related arrhythmia risk would be better estimated using an indoor measure or an outdoor measure that correlates well with indoor conditions, such as absolute humidity. The clinical records of 203 patients in eastern Massachusetts, USA, with an implantable cardioverter-defibrillator were abstracted for arrhythmias between 1995 and 2002. We used case-crossover methods to examine the association between weather and ventricular arrhythmia (VA). Among 84 patients who experienced 787 VAs, lower estimated indoor temperature (odds ratio (OR)=1.16, 95% confidence interval (CI) 1.05-1.27 for a 1 °C decrease in the 24-h average) and lower absolute humidity (OR=1.06, 95% CI 1.03-1.08 for a 0.5 g/m(3) decrease in the 96-h average) were associated with increased risk. Lower outdoor temperature increased risk only in warmer months, likely attributable to the poor correlation between outdoor and indoor temperature during cooler months. These results suggest that lower temperature and drier air are associated with increased risk of VA onset among implantable cardioverter-defibrillator patients. PMID:24169878

  11. Subcutaneous implantable cardioverter defibrillators in children, young adults and patients with congenital heart disease.

    PubMed

    Bordachar, Pierre; Marquié, Christelle; Pospiech, Thomas; Pasquié, Jean-Luc; Jalal, Zakaria; Haissaguerre, Michel; Thambo, Jean-Benoit

    2016-01-15

    The demonstration of severe complications in patients implanted with a transvenous implantable cardioverter defibrillator (ICD) has led to the development of devices equipped with a subcutaneous lead. This new technique offers numerous advantages but also certain disadvantages. Various studies or anecdotal clinical cases have specifically been conducted with this subcutaneous defibrillation system in children and/or patients with congenital heart disease. Results of these studies suggest: 1) a high feasibility despite being limited by a selection process that excludes patients requiring permanent pacing and patients declared ineligible during pre-screening; 2) good efficacy of electrical shocks in reducing induced or spontaneous ventricular arrhythmias; 3) in this specific subset of patients, 2 types of complications have been particularly described: a risk of device exteriorization and infection, and a large number of inappropriate therapies primarily related to T-wave oversensing. The subcutaneous ICD could therefore constitute the gold standard for patients with complex congenital heart disease with no venous access to the heart or with a persistent shunt increasing the risk of systemic emboli as well as in young patients with channelopathy or hypertrophic cardiomyopathy not requiring long-term pacing. Technological change (reduction in device size, better differentiation between R- and T-waves, possibility of pacing if device coupled with a leadless pacemaker) could reduce the limitations and complications and thereby increase the indications in this sub-group of patients. PMID:26519678

  12. Weather and triggering of ventricular arrhythmias in patients with implantable cardioverter-defibrillators

    PubMed Central

    Nguyen, Jennifer L.; Laden, Francine; Link, Mark S.; Schwartz, Joel; Luttmann-Gibson, Heike; Dockery, Douglas W.

    2015-01-01

    Outdoor ambient weather has been hypothesized to be responsible for the seasonal distribution of cardiac arrhythmias. Because people spend most of their time indoors, we hypothesized that weather-related arrhythmia risk would be better estimated using an indoor measure or an outdoor measure that correlates well with indoor conditions, such as absolute humidity. The clinical records of 203 patients in eastern Massachusetts, USA, with an implantable cardioverter-defibrillator were abstracted for arrhythmias between 1995 and 2002. We used case-crossover methods to examine the association between weather and ventricular arrhythmia (VA). Among 84 patients who experienced 787 VAs, lower estimated indoor temperature (odds ratio (OR) = 1.16, 95% confidence interval (CI) 1.05–1.27 for a 1 °C decrease in the 24-h average) and lower absolute humidity (OR = 1.06, 95% CI 1.03–1.08 for a 0.5 g/m3 decrease in the 96-h average) were associated with increased risk. Lower outdoor temperature increased risk only in warmer months, likely attributable to the poor correlation between outdoor and indoor temperature during cooler months. These results suggest that lower temperature and drier air are associated with increased risk of VA onset among implantable cardioverter-defibrillator patients. PMID:24169878

  13. Florid psychopathology in patients receiving shocks from implanted cardioverter-defibrillators

    PubMed Central

    Bourke, J.; Turkington, D.; Thomas, G.; McComb, J.; Tynan, M.

    1997-01-01

    Objectives—To increase awareness of the potential for disabling anxiety and depression in patients receiving shocks from implanted cardioverter-defibrillators (ICDs).
Patients and methods—ICDs are implanted in patients at this hospital for control of serious ventricular tachyarrhythmias inadequately controlled by drug treatment, who are unsuitable for map guided antiarrhythmic surgery. All are reviewed regularly at a dedicated ICD clinic and are advised to make contact between visits if they experience shocks. Symptoms of anxiety or depression were not actively sought, nor was a patient support group operating at the time of this data collection. When overt psychopathology was identified, patients were referred to a designated psychiatrist for management.
Results—Over a six year period, six (17%) of 35 patients with ICDs developed florid psychiatric problems after experiencing shocks. None had premorbid psychiatric predisposition. Of the six patients suffering severe psychiatric problems, four were men, their age range was 30-63 years, and left ventricular ejection fraction was 18-40%. All shocks were appropriate for clinical arrhythmias and ranged in frequency from two in six months to 111 in 24 hours. All six patients manifested severe anxiety, focused on fear of future shocks. Depression was also evident in three patients and two had become housebound. All responded within weeks to anxiolytic or antidepressant drugs, combined with relaxation and cognitive therapies. Ongoing psychiatric therapy was refused by one patient, and was required for between three and 18 months in the remainder. One patient died and one received a cardiac transplant during the follow up period (median 27.5 months, range 8-43).
Conclusions—Because ICD implantation occurs against a complex medical background with inevitable psychological stress, all such patients should be considered at high risk for developing psychopathology.

 Keywords: implantable cardioverter-defibrillators

  14. Removal of the broken part of implantable cardioverter-defibrillator's electrode causing pulmonary embolism via femoral vein.

    PubMed

    Zencir, Cemil; Selvi, Mithat; Elbi, Huseyin; Cetin, Mustafa; Gungor, Hasan; Akgullu, Cagdas; Badak, Muharrem Ismail

    2015-12-01

    A 66-year-old patient with idiopathic dilated cardiomyopathy underwent transvenous extraction of an implantable cardioverter-defibrillator. The distal part of the electrode was broken during manual traction through the left subclavian vein. In the present case, we showed a rare complication of transvenous lead extraction and its management. PMID:26995444

  15. iPad2® Use in Patients With Implantable Cardioverter Defibrillators Causes Electromagnetic Interference: The EMIT Study

    PubMed Central

    Kozik, Teri M.; Chien, Gianna; Connolly, Therese F.; Grewal, Gurinder S.; Liang, David; Chien, Walter

    2014-01-01

    Background Over 140 million iPads® have been sold worldwide. The iPad2®, with magnets embedded in its frame and Smart Cover and 3G cellular data capability, can potentially cause electromagnetic interference in implantable cardioverter defibrillators. This can lead to potentially life‐threatening situations in patients. The goal of this study was to determine whether the iPad2® can cause electromagnetic interference in patients with implantable cardioverter defibrillators. Methods and Results Twenty‐seven patients with implantable cardioverter defibrillators were studied. The iPad2® was held at reading distance and placed directly over the device with cellular data capability activated and deactivated. The manufacturers/models of devices and the patients' body mass index were noted. The presence of electromagnetic interference was detected by using a programmer supplied by each manufacturer. Magnet mode with suspension of anti‐tachycardia therapy was triggered in 9 (33%) patients. All occurred when the iPad2® was placed directly over the device. The cellular data status did not cause interference and no noise or oversensing was noted. There was no significant difference between the mean body mass index of the groups with or without interference. Conclusions The iPad2® can trigger magnet mode in implantable cardioverter defibrillators when laid directly over the device. This is potentially dangerous if patients should develop life‐threatening arrhythmias at the same time. As new electronic products that use magnets are produced, the potential risk to patients with implantable defibrillators needs to be addressed. PMID:24721802

  16. Significance of intraoperative testing in right-sided implantable cardioverter-defibrillators

    PubMed Central

    2013-01-01

    Background Implantation of implantable cardioverter-defibrillators (ICD) from the left pectoral region is the standard therapeutical method. Increasing numbers of system revisions due to lead dysfunction and infections will consecutively increase the numbers of right-sided implantations. The reliability of devices implanted on the right pectoral side remains controversially discussed, and the question of testing these devices remains unanswered. Methods In a prospectively designed study all 870 patients (60.0±14 years, 689 male) who were treated with a first ICD from July 2005 until May 2012 and tested intraoperatively according to the testing protocol were analyzed. The indication for implantation was primary prophylactic in 71.5%. Underlying diseases included ischemic cardiomyopathy (50%), dilative cardiomyopathy (37%), and others (13%). Mean ejection faction was 27±12%. Implantation site was right in 4.5% and left in 95.5%. Results Five patients supplied with right-sided ICD (13%, p = 0.02 as compared to left-sided) failed initial intraoperative testing with 21 J. 3 patients were male. The age of the patients failing intraoperative testing with right-sided devices appeared higher than of patients with left-sided devices (p = 0.07). The ejection fraction was 28±8%. All patients reached a sufficient DFT ≤ 21 J after corrective procedures. Conclusion Implantation of ICDs on the right side results in significantly higher failure rate of successful termination of intraoperatively induced ventricular fibrillation. The data of our study suggest the necessity of intraoperative ICD testing in right-sided implanted ICDs. PMID:23577747

  17. Use of implantable cardioverter-defibrillators in athletes: A systematic review.

    PubMed

    Liz Almeida, Ricardo; Providência, Rui; Gonçalves, Lino

    2015-06-01

    International guidelines exclude athletes with implantable cardioverter-defibrillators (ICDs) from participating in sports, except those of low intensity (category IA, such as golf, billiards or bowling). However, these guidelines are based on expert consensus, and thus the safety and risks of participating in sports in this population are still largely unknown in the medical community. We performed a systematic review of the literature in PubMed using the following search string: "((sudden cardiac death) AND (sport OR physical exercise)) AND defibrillator". After the application of pre-defined inclusion and exclusion criteria, 36 results were selected, which are explored in this paper. Preliminary results on ICD use in this population appear to demonstrate the safety and efficacy of the device in this context. Further studies, with longer follow-up and with larger samples, may provide stronger evidence to support these findings. In the meantime, disqualifying almost all ICD patients from participating in sports, without taking into consideration their individual needs and characteristics, may be prejudicial to a considerable number of patients by preventing them from exercising their profession or engaging in recreational sport, for which their risk of sudden cardiac death may be low. PMID:26050225

  18. Preliminary single center clinical experience of the use of a new implantable cardioverter defibrillator.

    PubMed

    Morgan, J M; Roberts, P R; Allen, S; Kallok, M J

    1998-12-01

    We report a single center's preliminary clinical experience of the Sentinel (Angeion, Minneapolis, MN) implantable cardioverter defibrillator (ICD), which employs novel technologies that offer the potential for significant reduction in ICD size. Thirty-three patients have received Sentinel ICDs with a mean follow-up of 450 (range 150-1023) days. Device shock therapy has been used to defibrillate/cardiovert 43 spontaneous episodes of malignant ventricular arrhythmia and 510 episodes of hemodynamically well tolerated ventricular arrhythmia have been pace-terminated (pace-termination failed in 6 episodes with subsequent delivery of appropriate shock therapy). There has been no arrhythmic death in this patient population. There have been 9 inappropriate shocks in 6 patients (in 2 patients for atrial fibrillation which had satisfied the algorithm detection criteria for high zone ventricular arrhythmia, in 3 for sinus tachycardia [rate greater than 180 beats per min] and in 1 due to device capacitor malfunction). Device replacement has been required for component malfunction in 3 patients. There have been no other major complications. Follow-up time to date is short and longterm device efficacy and performance remain unproven. However, our early clinical experience suggests that the innovations used to manufacture the Sentinel ICD have facilitated reduction in ICD size without compromising therapeutic efficacy. PMID:10027122

  19. Changing Views: Safety and Efficacy of Implantable Cardioverter- Defibrillator Therapy in Athletes.

    PubMed

    Pavlů, Luděk; Hutyra, Martin; Táborský, Miloš

    2015-11-01

    The implantable cardioverter-defibrillator (ICD) is highly effective in reducing sudden death from ventricular tachyarrhythmia among high-risk cardiac patients. Conventional advice given to patients with ICD is to avoid physical activity more strenuous than playing golf or bowling. This recommendation is given due to a theoretical risk of arrhythmia precipitation, and thus increased risk of death due to failure to defibrillate, injury resulting from loss of control caused by arrhythmia-related syncope or shock, and also due to sport related direct damage to the ICD system. Recent prospective data from an international registry involving 372 athletes with ICDs in situ and actively participating in sports has been published. This indicates that, although physical activity resulted in an increased number of shocks compared to rest, there was no significant difference between intensive physical activity and any other activity (10% vs. 8%, p=0.34) in frequency of shocks. Furthermore, over a median follow-up period of 31 months (21-46 months), in the period of sports activity and 2 hour rest directly after there were no occurrences of death, resuscitated arrest or arrhythmia, or shock-related injury. This data is likely to start a shift in every-day clinical decision-making leading to revision of the high level of precautions imposed on the rapidly enlarging ICD recipient population. PMID:26849548

  20. Current implantable cardioverter-defibrillator programming in Europe: the results of the European Heart Rhythm Association survey.

    PubMed

    Proclemer, Alessandro; Grazia Bongiorni, Maria; Etsner, Heidi; Todd, Derick; Sciaraffia, Elena; Blomström-Lundqvist, Carina

    2014-06-01

    The purpose of this European Heart Rhythm Association (EHRA) survey was to examine the current practice on the choice of implantable cardioverter-defibrillator (ICD) type, use of defibrillation testing, and ICD programming for detection and therapy of ventricular arrhythmias. In accordance with recent guidelines and the results of observational studies, the majority of EHRA research network centres reported a high utilization rate of dual-chamber ICDs in the presence of symptomatic and asymptomatic sinus node dysfunction, biventricular ICD in high-degree atrioventricular block and QRS duration <120 ms, and a limited use of defibrillation testing either in primary and secondary prevention settings. Activation of the long ventricular tachycardia (VT) detection window, slow VT zone, antitachycardia pacing before shock for slow and fast VT, and atrial tachyarrhythmia discrimination were considered useful in ICD programming for the majority of patients. PMID:24864305

  1. Subcutaneous Implantable Cardioverter-Defibrillator Implantation in a Patient with a Left Ventricular Assist Device Already in Place

    PubMed Central

    Subzposh, Faiz; Hankins, Shelley R.; Kutalek, Steven P.

    2015-01-01

    A 56-year-old man with ischemic cardiomyopathy, a biventricular implantable cardioverter-defibrillator (ICD), and a left ventricular assist device (LVAD) developed a pocket hematoma and infection after an ICD generator change. The biventricular ICD was extracted, and the patient was given a full course of antibiotics. Because he had no indications for bradycardia pacing or biventricular pacing, he was implanted with a subcutaneous ICD under full anticoagulation. There was no interference in sensing or shock delivery from the ICD. The LVAD readings were unchanged during and after the procedure. The patient had an uneventful postoperative course, and both devices were functioning normally. To our knowledge, this is the first reported case of the implantation of a subcutaneous ICD in the presence of an LVAD. This report illustrates that both devices can be implanted successfully in the same patient. In addition, the subcutaneous ICD minimizes the risk of bloodstream infections, which can be fatal in patients who have life-supporting devices such as an LVAD. PMID:25873825

  2. Sleeping with the fishes: electromagnetic interference causing an inappropriate implantable cardioverter defibrillator shock

    PubMed Central

    Knight, Hui Min; Cakebread, Holly Elizabeth; Gajendragadkar, Parag Ravindra; Duehmke, Rudolf Martin

    2014-01-01

    A 60-year-old man with a cardiac defibrillator implanted due to previous ventricular fibrillation arrest and ischaemic cardiomyopathy received a shock while cleaning his fish pond. At the time, his immersed arm was close to a submersed water pump, but the patient was asymptomatic. As a result of the shock he lost consciousness, but collapsed backwards, away from the pond. Interrogation of the device revealed a high-frequency artefact that was sensed by the device and triggered a shock. Device parameters were otherwise normal. Subsequently, the submersed water pump was found to be the source of an external alternating current leak and was identified as the likely cause of the inappropriate shock due to electromagnetic interference (EMI). Awareness of potential sources of EMI along with evaluation of data with a detailed clinical history is warranted in all cases. PMID:24879728

  3. [Practical questions around individual with a pacemaker or an implantable cardioverter defibrillator].

    PubMed

    Manaouil, Cécile; Fantoni, Sophie; Montpellier, Dominique; Tordjman, Eric; Jarde, Olivier

    2012-07-01

    An individual with a pacemaker can ask his GP for information about potential problems associated with the device. Should a pacemaker continue to be used by end-of-life patients? Should a pacemaker be stopped in a limited care situation? What precautions should be taken when treating a patient with a pacemaker? Pacemakers and implantable defibrillators are sensitive to electromagnetic interference (EMI). Medically, MRIs are theoretically contraindicated, even though examinations could be performed without a major problem, and special precautions should be taken when using an electrosurgical cutter or radiotherapy. In case of death, a doctor or embalmer must remove the patient's pacemaker due to its risk of explosion during cremation. Doctors who sign cremation forms have a legal obligation to provide such information. It may affect an employee's ability to work. Are there some professions that are not well suited for individuals with a pacemaker? PMID:22138293

  4. Legal and organizational aspects of remote cardiac monitoring: the example of implantable cardioverter defibrillators.

    PubMed

    Vinck, Imgard; De Laet, Chris; Stroobandt, Serge; Van Brabandt, Hans

    2012-09-01

    The remote monitoring of implantable cardioverter defibrillators (ICDs) recently emerged as an attractive technological innovation that proved to be reasonably safe in partially replacing the in-clinic follow-ups of ICD patients with no or only mild symptoms. Apart from the fact that strong evidence about any additional clinical benefits and/or cost-efficiency are still awaited, legal and organizational hurdles remain in place, hampering any possibility for adoption of remote cardiac monitoring. This paper identifies a number of legal and organizational constraints which urgently need to be addressed. An elaboration of the specific juridical guidance for the interpretation and application of the relevant legislation is called for. PMID:22345377

  5. No Electromagnetic Interference Occurred in a Patient with a HeartMate II Left Ventricular Assist System and a Subcutaneous Implantable Cardioverter-Defibrillator.

    PubMed

    Raman, Ajay Sundara; Shabari, Farshad Raissi; Kar, Biswajit; Loyalka, Pranav; Hariharan, Ramesh

    2016-04-01

    The use of subcutaneous implantable cardioverter-defibrillators is a novel option for preventing arrhythmia-mediated cardiac death in patients who are at risk of endovascular-device infection or in whom venous access is difficult. However, the potential for electromagnetic interference between subcutaneous defibrillators and left ventricular assist devices is largely unknown. We report the case of a 24-year-old man in whom we observed no electromagnetic interference between a subcutaneous implanted cardioverter-defibrillator and a HeartMate II Left Ventricular Assist System, at 3 different pump speeds. To our knowledge, this is the first report of such findings in this circumstance. PMID:27127441

  6. No Electromagnetic Interference Occurred in a Patient with a HeartMate II Left Ventricular Assist System and a Subcutaneous Implantable Cardioverter-Defibrillator

    PubMed Central

    Raman, Ajay Sundara; Kar, Biswajit; Loyalka, Pranav; Hariharan, Ramesh

    2016-01-01

    The use of subcutaneous implantable cardioverter-defibrillators is a novel option for preventing arrhythmia-mediated cardiac death in patients who are at risk of endovascular-device infection or in whom venous access is difficult. However, the potential for electromagnetic interference between subcutaneous defibrillators and left ventricular assist devices is largely unknown. We report the case of a 24-year-old man in whom we observed no electromagnetic interference between a subcutaneous implanted cardioverter-defibrillator and a HeartMate II Left Ventricular Assist System, at 3 different pump speeds. To our knowledge, this is the first report of such findings in this circumstance. PMID:27127441

  7. Home monitoring report from a single lead Lumax DX implantable cardioverter defibrillator: New observations in a new system.

    PubMed

    Konstantino, Yuval; Kleiman, Alex; Amit, Guy

    2016-06-01

    A 56-year-old man underwent a single lead Lumax 640 DX implantable cardioverter defibrillator implantation for primary prevention of sudden cardiac death. A DX system consists of a single lead, which provides atrial as well as ventricular electrograms, and enhances atrial arrhythmia detection. Three months after the implantation, high-frequency episodes were detected on the far field and the atrial channels, but not on the bipolar right ventricular channel; these were classified as atrial tachycardia. In the present report, we discussed the unusual pattern of the artifacts that was related to an electromagnetic interference detected by the novel DX system. PMID:27354868

  8. The Gulf Implantable Cardioverter-defibrillator Registry: Rationale, Methodology, and Implementation

    PubMed Central

    Alsheikh-Ali, Alawi A.; Hersi, Ahmad S.; Hamad, Adel K. S.; Al Fagih, Ahmed R.; Al-Samadi, Faisal M.; Almusaad, Abdulmohsen M.; Bokhari, Fayez A.; Al-Kandari, Fawzia; Al-Ghamdi, Bandar S.; Al Rawahi, Najib; Asaad, Nidal; Alkaabi, Salem; Daoulah, Amin; Zaky, Hosam A.; Elhag, Omer; Al Hebaishi, Yahya S.; Sweidan, Raed; Alanazi, Haitham; Chase, David; Sabbour, Hani; Al Meheiri, Mohammad; Al Abri, Ismail; Amin, Mohammad; Dagriri, Khaled; Ahmed, Adil O.; Shafquat, Azam; Khan, Shahul Hameed

    2015-01-01

    Background: The implantable cardioverter-defibrillator (ICD) is effective in the prevention of sudden cardiac death in high-risk patients. Little is known about ICD use in the Arabian Gulf. We designed a study to describe the characteristics and outcomes of patients receiving ICDs in the Arab Gulf region. Methods: Gulf ICD is a prospective, multi-center, multinational, and observational study. All adult patients 18 years or older, receiving a de novo ICD implant and willing to sign a consent form will be eligible. Data on baseline characteristics, ICD indication, procedure and programing, in-hospital, and 1-year outcomes will be collected. Target enrollment is 1500 patients, which will provide adequate precision across a wide range of expected event rates. Results: Fifteen centers in six countries are enrolling patients (Saudi Arabia, United Arab Emirates, Kuwait, Oman, Bahrain, and Qatar). Two-thirds of the centers have dedicated electrophysiology laboratories, and in almost all centers ICDs are implanted exclusively by electrophysiologists. Nearly three-quarters of the centers reported annual ICD implant volumes of ≤150 devices, and pulse generator replacements constitute <30% of implants in the majority of centers. Enrollment started in December 2013, and accrual rate increased as more centers entered the study reaching an average of 98 patients per month. Conclusions: Gulf ICD is the first prospective, observational, multi-center, and multinational study of the characteristics and, the outcomes of patients receiving ICDs in the Arab Gulf region. The study will provide valuable insights into the utilization of and outcomes related to ICD therapy in the Gulf region. PMID:26900416

  9. Implantable Cardioverter Defibrillators in Octogenarians: Clinical Outcomes From a Single Center

    PubMed Central

    Wilson, D.G.; Ahmed, N.; Nolan, R.; Frontera, A.; Thomas, G.; Duncan, E.R.

    2016-01-01

    Aims Limited data exist on outcomes in very elderly ICD recipients. We describe outcomes in new ICD and Cardiac Resynchronisation Therapy with Defibrillator (CRT-D) implants in octogenarians at our institution. Methods Patients aged 80 years and above who underwent de novo ICD or CRT-D implantation from January 2006 to July 2012 were identified. Clinical data were collected from the procedural record, medical and ICD notes. Baseline characteristics were compared using independent sample t test for continuous variables and Fisher’s exact test for categorical variables. Kaplan-Meier curves were constructed. Results Ten per cent of all new ICD/CRT-D implants were aged 80 years and over. Median age was 83.0 years. Median follow-up was 29 months. Death occurred in 17 (34%). Median time to death was 23 months. Three deaths (6%) occurred within 12 months of ICD implantation. Appropriate therapy (ATP or shock) occurred in 19 (38%). Inappropriate therapy occurred in 6 (12%). Rates of appropriate shocks and inappropriate therapy (shocks and ATP) and significant valvular incompetence were higher amongst deceased patients (P=0.03 OR 5.9 95% CI 1.3-27) and (P=0.02 OR 12 95% CI 1.3-112). Univariate analysis identified diuretic use (P=0.008 95% C.I. 0.05 to 0.63) and appropriate shock (P= 0.025 95% C.I. 1.25 to 26.3) as predictors of mortality. Conclusion Octogenarians make up a small but increasing number of ICD recipients. This study highlights high survival rates at one year with acceptable rates of appropriate and inappropriate device therapy. Ongoing debate regarding the appropriateness of ICD in very elderly patients is warranted. PMID:25852237

  10. Remote monitoring of implantable cardioverter-defibrillators. Problems and implications using a telemonitoring system.

    PubMed

    Siebermair, J; Clauss, S; Martens, E; Schuessler, F; Oversohl, N; Haserueck, N; Estner, H L; Kääb, S; Wakili, R

    2015-04-01

    The rising number of implantable devices has led to an increase in device-related workload, e.g., regular interrogation follow-up visits. Telemonitoring systems for implantable cardioverter-defibrillators (ICDs) seem to be a promising tool for reducing workload and costs, and they have the potential of optimizing patient care. However, issues such as practical functionality of ICD telemonitoring in daily routine may affect its broad implementation. The objective of this study was to evaluate potential problems during the implementation of a telemonitoring system, Medtronic CareLink™ (CL™) with respect to the installation and data transmission process. A total of 159 patients with ICDs who were equipped with the CL™ system were evaluated and followed up for 16 months regarding the success rate of the first data transmission via the telemonitoring system. In this cohort, a high rate of nontransmission of 23.9 % was observed after the 16-month follow-up. A detailed interview of these patients (no transmission) revealed that the main reasons for failed transmissions were due to the patients' loss of interest in the concept (approximately 50 %) as well as technical problems (approximately 25 %) with setting up the system. These results indicate that telemonitoring systems bear potential problems and that the evaluation of patient motivation and technical support options seems to play an important role in establishing the functionality of these systems. PMID:24848864

  11. Cost-effectiveness of implantable cardioverter-defibrillators in Brugada syndrome treatment.

    PubMed

    Wang, Kai; Yamauchi, Kazunobu; Li, Ping; Kato, Hiroki; Kobayashi, Makoto; Kato, Ken; Shimizu, Yoshiyuki

    2008-02-01

    Brugada syndrome is characterized by an ST-segment elevation in the right precordial ECG leads and a high incidence of sudden death in patients with structurally normal hearts. Some trials have demonstrated that the cost-effectiveness of ICD implantation treatment in patients with structurally abnormal hearts is more favorable than that of control treatment. We used Treeage pro 2005 to estimate costs and survival among the Brugada syndrome patients who received either an ICD or were treated by control therapy of Ito-blocking properties (quinidine) or beta-blockers (propranolol). In conclusion, our analysis suggests that prophylactic implantation of an ICD has good cost-effectiveness in patients with Brugada syndrome who are at high risk of sudden death. ICD treatment has shown a cost-effectiveness ratio below $9591 per QALY gained from trials of defibrillator vs beta-blockers for Unexplained Death in Thailand (DEBUT). The control therapy of quinidine may be a good choice for patients who are infants or living in developing countries. PMID:18333406

  12. The implantable defibrillator and antiarrhythmic drugs--competitive and complementary treatment for severe ventricular arrhythmia.

    PubMed

    Dorian, P; Newman, D

    1993-11-01

    Most patients with a history of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) are at high risk of recurrence. Implanted defibrillators (ICDs) are highly effective in sensing and converting VT or VF to a perfusing rhythm. "Conventional" antiarrhythmic agents, which primarily block cardiac sodium channels, are relatively ineffective in preventing arrhythmia recurrence; amiodarone and sotalol appear to be effective in reducing recurrence and mortality rates, although the extent of benefit is not well understood. Despite the apparent advantage of ICDs, they have short- and long-term complications, are costly, and their benefit in prolonging the quantity or quality of life remains unproven. Randomized clinical trials which compare the effect of ICDs with that of antiarrhythmic drugs on mortality, cost, and quality of life will be necessary to understand how patients with malignant arrhythmias ought to be treated. If an ICD is implanted, adjunctive therapies need to be considered to treat the underlying heart disease and to derive optimum benefit from the device. Drugs may have beneficial or adverse interactions with devices, and the full understanding of these interactions requires further study. PMID:8269662

  13. Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators: a literature review.

    PubMed

    Zaremba, Tomas; Jakobsen, Annette Ross; Søgaard, Mette; Thøgersen, Anna Margrethe; Riahi, Sam

    2016-04-01

    An increasing number of patients with implantable cardiac rhythm devices undergo radiotherapy (RT) for cancer and are thereby exposed to the risk of device failure. Current safety recommendations seem to have limitations by not accounting for the risk of pacemakers and implantable cardioverter defibrillators malfunctioning at low radiation doses. Besides scant knowledge about optimal safety measures, only little is known about the exact prevalence of patients with devices undergoing RT. In this review, we provide a short overview of the principles of RT and present the current evidence on the predictors and mechanisms of device malfunctions during RT. We also summarize practical recommendations from recent publications and from the industry. Strongly associated with beam energy of photon RT, device malfunctions occur at ∼3% of RT courses, posing a substantial issue in clinical practice. Malfunctions described in the literature typically consist of transient software disturbances and only seldom manifest as a permanent damage of the device. Through close cooperation between cardiologists and oncologists, a tailored individualized approach might be necessary in this patient group in waiting time for updated international guidelines in the field. PMID:26041870

  14. “That’s Like an Act of Suicide” Patients’ Attitudes Toward Deactivation of Implantable Defibrillators

    PubMed Central

    Mehta, Davendra; Siddiqui, Saima; Teitelbaum, Ezra; Zeidman, Jessica; Singson, Magdelena; Pe, Elena; Bradley, Elizabeth H.; Morrison, R. Sean

    2007-01-01

    Objective To understand potential patient barriers to discussions about implantable cardioverter defibrillator (ICD) deactivation in patients with advanced illness. Design Qualitative focus groups. Participants Fifteen community-dwelling, ambulatory patients with ICDs assigned to focus groups based on duration of time since implantation and whether they had ever received a shock from their device. Approach A physician and a social worker used a predetermined discussion guide to moderate the groups, and each session was audiotaped and subsequently transcribed. Transcripts were analyzed using the method of constant comparison. Results No participant had ever discussed deactivation with their physician nor knew that deactivation was an option. Patients expressed a great deal of anxiety about receiving shocks from their device. Participants discussed why they needed the device and expressed desire for more information about the device; however, they would not engage in conversations about deactivating the ICD. One patient described deactivation “like an act of suicide” and all patients believed that the device was exclusively beneficial. Patients also expressed a desire to have their physician make the decision about deactivation. Conclusions None of the patients in our study knew that they might need to deactivate their ICD as their health worsens. These community-dwelling outpatients were not willing to discuss the issue of ICD deactivation and their attitudes about deactivation might impede patients from engaging in these conversations. These findings are in contrast to findings in other advance care planning research and may be related to the unique nature of the ICD. PMID:18095037

  15. Implantable Heart Aid

    NASA Technical Reports Server (NTRS)

    1984-01-01

    CPI's human-implantable automatic implantable defibrillator (AID) is a heart assist system, derived from NASA's space circuitry technology, that can prevent erratic heart action known as arrhythmias. Implanted AID, consisting of microcomputer power source and two electrodes for sensing heart activity, recognizes onset of ventricular fibrillation (VF) and delivers corrective electrical countershock to restore rhythmic heartbeat.

  16. Longitudinal changes in intracardiac repolarization lability in patients with implantable cardioverter-defibrillator

    PubMed Central

    Guduru, Abhilash; Lansdown, Jason; Chernichenko, Daniil; Berger, Ronald D.; Tereshchenko, Larisa G.

    2013-01-01

    Background: While it is known that elevated baseline intracardiac repolarization lability is associated with the risk of fast ventricular tachycardia (FVT)/ventricular fibrillation (VF), the effect of its longitudinal changes on the risk of FVT/VF is unknown. Methods and Results: Near-field (NF) right ventricular (RV) intracardiac electrograms (EGMs) were recorded every 3–6 months at rest in 248 patients with structural heart disease [mean age 61.2 ± 13.3; 185(75%) male; 162(65.3%) ischemic cardiomyopathy] and implanted cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) [201 (81%) primary prevention]. Intracardiac beat-to-beat QT variability index (QTVINF) was measured on NF RV EGM. During the first study phase (median 18 months), participants made on average 2.4 visits. Then remote follow-up was continued for an additional median period of 3 years. Average QTVINF did not change during the first year after ICD implantation (−0.342 ± 0.603 at baseline vs. −0.262 ± 0.552 at 6 months vs. −0.334 ± 0.603 at 12 months); however, it decreased thereafter (−0.510 ± 0.603 at 18 months; P = 0.042). Adjusted population-averaged GEE model showed that the odds of developing FVT/VF increased by 75% for each 1 unit increase in QTVINF. (OR 1.75 [95%CI 1.05–2.92]; P = 0.031). However, individual patient–specific QTVINF trends (increasing, decreasing, flat) varied from patient to patient. For a given patient, the odds of developing FVT/VF were not associated with increasing or decreasing QTVINF over time [OR 1.27; (95%CI 0.05–30.10); P = 0.881]. Conclusion: While on average the odds of FVT/VF increased with an increase in QTVINF, patient-specific longitudinal trends in QTVINF did not affect the odds of FVT/VF. PMID:23964242

  17. New insights into defibrillation of the heart from realistic simulation studies

    PubMed Central

    Trayanova, Natalia A.; Rantner, Lukas J.

    2014-01-01

    Cardiac defibrillation, as accomplished nowadays by automatic, implantable devices, constitutes the most important means of combating sudden cardiac death. Advancing our understanding towards a full appreciation of the mechanisms by which a shock interacts with the heart, particularly under diseased conditions, is a promising approach to achieve an optimal therapy. The aim of this article is to assess the current state-of-the-art in whole-heart defibrillation modelling, focusing on major insights that have been obtained using defibrillation models, primarily those of realistic heart geometry and disease remodelling. The article showcases the contributions that modelling and simulation have made to our understanding of the defibrillation process. The review thus provides an example of biophysically based computational modelling of the heart (i.e. cardiac defibrillation) that has advanced the understanding of cardiac electrophysiological interaction at the organ level, and has the potential to contribute to the betterment of the clinical practice of defibrillation. PMID:24798960

  18. A new transvenous internal cardioverter-defibrillator: implantation technique, complications, and short-term follow-up.

    PubMed

    Jordaens, L; Vertongen, P; Provenier, F; Trouerbach, J W; Poelaert, J; Herregods, L

    1995-02-01

    Twenty-four patients with ventricular fibrillation or sustained ventricular tachycardia underwent implantation of a new transvenous defibrillator. All patients had a device implanted without thoracotomy. High placement of a shock lead in the anonymous vein and inversion of the shock-wave polarity allowed avoidance of placement of subcutaneous patches. Implantation time decreased from 138 minutes for the first 12 patients to 82 minutes for the last 12 patients, with 4 and 11 subpectoral pockets, respectively. Three patients required a minor reintervention. No bleeding or infection occurred. One episode of pulmonary edema and one pulmonary embolism were seen in the postoperative course. No postoperative deaths were observed. During a mean follow-up period of 4.12 months, 58% of the 24 patients had symptomatic arrhythmic episodes, with shocks in 50% of the 24. Inappropriate shocks were delivered in three cases (atrial fibrillation and T-wave sensing). One episode was not terminated even with four internal shocks. One patient had ventricular fibrillation because of a sensing problem. By reprogramming of sensitivity, back-up pacing, and adjustment of drug therapy these arrhythmic complications could be prevented. Pectoral implantation of a cardioverter-defibrillator is easy and can be performed by cardiologists experienced in pacemaker implantation. Careful postoperative observation, reprogramming after the first spontaneous event, and prehospital discharge induction of ventricular fibrillation will prevent arrhythmic complications. PMID:7832096

  19. Sleep, Psychosocial Functioning, and Device-Specific Adjustment in Patients with Implantable Cardioverter Defibrillators (ICDs).

    PubMed

    McCrae, Christina S; Roth, Alicia J; Ford, Jessica; Crew, Earl C; Conti, Jamie B; Berry, Richard B; Sears, Samuel F

    2016-01-01

    Rates of sleep disorders and associated adjustment were examined in patients with implantable cardioverter defibrillators (ICDs; n = 42; Mage = 61.57, SD = 12.60). One night of ambulatory polysomnography, 14 days of sleep diaries, and questionnaires (mood, sleepiness, fatigue, device acceptance) were administered. Controlling for ischemia, MANCOVA examined adjustment by sleep diagnosis. Apnea was most common (28.6%), followed by Insomnia (16.7%) and Comorbid Insomnia/Apnea (11.9%). Patients with insomnia reported poorer mood, greater sleepiness, and lower device acceptance than good sleepers; they also demonstrated poorer mood and less ICD device acceptance than patients with sleep apnea. Patients with comorbid insomnia/apnea also exhibited poorer mood and less ICD device acceptance than good sleepers; however, comorbid patients did not significantly differ from insomnia or apnea patients on any measure. Those with disordered sleep (regardless of type) reported greater fatigue than good sleepers. Assessment (and treatment) of difficulties with sleep, mood, fatigue, and device acceptance may be important for the comprehensive clinical management of ICD patients. Further research appears warranted. PMID:25174823

  20. Lithium-manganese dioxide cells for implantable defibrillator devices-Discharge voltage models

    NASA Astrophysics Data System (ADS)

    Root, Michael J.

    The discharge potential behavior of lithium-manganese dioxide cells designed for implantable cardiac defibrillators was characterized as a function of extent of cell depletion for tests designed to discharge the cells for times between 1 and 7 years. The discharge potential curves may be separated into two segments from 0 ≤ x ≤ ∼0.51 and ∼0.51 ≤ x ≤ 1.00, where x is the dimensionless extent of discharge referenced to the rated cell capacity. The discharge potentials conform to Tafel kinetics in each segment. This behavior allows the discharge potential curves to be predicted for an arbitrary discharge load and long term discharge performance may be predicted from short term test results. The discharge potentials may subsequently be modeled by fitting the discharge curves to empirical functions like polynomials and Padé approximants. A function based on the Nernst equation that includes a term accounting for nonideal interactions between lithium ions and the cathode host material, such as the Redlich-Kister relationship, also may be used to predict discharge behavior.

  1. A trial design for evaluation of empiric programming of implantable cardioverter defibrillators to improve patient management.

    PubMed

    Morgan, John M; Sterns, Laurence D; Hanson, Jodi L; Ousdigian, Kevin T; Otterness, Mary F; Wilkoff, Bruce L

    2004-11-12

    The delivery of implantable cardioverter defibrillator (ICD) therapy is sophisticated and requires the programming of over 100 settings. Physicians tailor these settings with the intention of optimizing ICD therapeutic efficacy, but the usefulness of this approach has not been studied and is unknown. Empiric programming of settings such as anti-tachycardia pacing (ATP) has been demonstrated to be effective, but an empiric approach to programming all VT/VF detection and therapy settings has not been studied. A single standardized empiric programming regimen was developed based on key strategies with the intention of restricting shock delivery to circumstances when it is the only effective and appropriate therapy. The EMPIRIC trial is a worldwide, multi-center, prospective, one-to-one randomized comparison of empiric to physician tailored programming for VT/VF detection and therapy in a broad group of about 900 dual chamber ICD patients. The trial will provide a better understanding of how particular programming strategies impact the quantity of shocks delivered and facilitate optimization of complex ICD programming. PMID:15541169

  2. Magnetic resonance imaging safety in pacemaker and implantable cardioverter defibrillator patients: how far have we come?

    PubMed

    Nordbeck, Peter; Ertl, Georg; Ritter, Oliver

    2015-06-21

    Magnetic resonance imaging (MRI) has long been regarded a general contraindication in patients with cardiovascular implanted electronic devices such as cardiac pacemakers or cardioverter defibrillators (ICDs) due to the risk of severe complications and even deaths caused by interactions of the magnetic resonance (MR) surrounding and the electric devices. Over the last decade, a better understanding of the underlying mechanisms responsible for such potentially life-threatening complications as well as technical advances have allowed an increasing number of pacemaker and ICD patients to safely undergo MRI. This review lists the key findings from basic research and clinical trials over the last 20 years, and discusses the impact on current day clinical practice. With 'MR-conditional' devices being the new standard of care, MRI in pacemaker and ICD patients has been adopted to clinical routine today. However, specific precautions and specifications of these devices should be carefully followed if possible, to avoid patient risks which might appear with new MR technology and further increasing indications and patient numbers. PMID:25796053

  3. Psychological effects of implantable cardioverter defibrillator shocks. A review of study methods

    PubMed Central

    Manzoni, Gian Mauro; Castelnuovo, Gianluca; Compare, Angelo; Pagnini, Francesco; Essebag, Vidal; Proietti, Riccardo

    2015-01-01

    Background: The implantable cardioverter defibrillator (ICD) saves lives but clinical experience suggests that it may have detrimental effects on mental health. The ICD shock has been largely blamed as the main offender but empirical evidence is not consistent, perhaps because of methodological differences across studies. Objective: To appraise methodologies of studies that assessed the psychological effects of ICD shock and explore associations between methods and results. Data Sources: A comprehensive search of English articles that were published between 1980 and 30 June 2013 was applied to the following electronic databases: PubMed, EMBASE, NHS HTA database, PsycINFO, Sciencedirect and CINAHL. Review Methods: Only studies testing the effects of ICD shock on psychological and quality of life outcomes were included. Data were extracted according to a PICOS pre-defined sheet including methods and study quality indicators. Results: Fifty-four observational studies and six randomized controlled trials met the inclusion criteria. Multiple differences in methods that were used to test the psychological effects of ICD shock were found across them. No significant association with results was observed. Conclusions: Methodological heterogeneity of study methods is too wide and limits any quantitative attempt to account for the mixed findings. Well-built and standardized research is urgently needed. PMID:25698991

  4. Quality of Life in Patients with an Implantable Cardioverter Defibrillator: A Systematic Review

    PubMed Central

    Tomzik, Juliane; Koltermann, Katharina C.; Zabel, Markus; Willich, Stefan N.; Reinhold, Thomas

    2015-01-01

    Despite the indisputable mortality advantages of implantable cardioverter defibrillators (ICDs), no consensus exists regarding their impact on quality of life (QoL). This systematic review investigates differences in QoL between patients with ICDs and controls. We systematically searched the MEDLINE, EMBASE, Cochrane, Web of Science, and PsychINFO databases. Articles were included if they were published after the year 2000 and reported on original studies with a control group. Five randomized controlled trials with a total of 5,138 patients and 10 observational studies with a total of 1,513 patients met the inclusion criteria. Nine studies found comparable QoL for ICD recipients and patients in the control groups, three studies found an increased QoL for ICD patients, and three studies found a decreased QoL for ICD patients. The question of whether QoL relates to ICD therapy cannot be answered conclusively due to the heterogeneity of the existing studies. Lower QoL was apparent among patients with an ICD who experienced several device discharges. Medical staff should be particularly aware of the signs of both psychological and physical disorders in these patients. Further investigations on QoL in ICD patients are desirable, but ethical reasons restrict the conduct of randomized trials. PMID:26664905

  5. Arrhythmia Management in the Elderly-Implanted Cardioverter Defibrillators and Prevention of Sudden Death.

    PubMed

    Manian, Usha; Gula, Lorne J

    2016-09-01

    We present an overview of arrhythmia management in elderly patients as it pertains to implantable cardioverter defibrillator (ICD) therapy and prevention of sudden death. Treatment of arrhythmia in elderly patients is fraught with challenges pertaining to goals of care and patient frailty. With an ever increasing amount of technology available, realistic expectations of therapy need to balance quality and quantity of life. The ICD is an important treatment option for selected patients at risk of ventricular arrhythmia and sudden cardiac death. However, the incidence of sudden death as a percentage of all-cause mortality decreases with age. Studies have reported that 20% of elderly patients might die within 1 year of an episode of life-threatening ventricular arrhythmia, but most because of nonarrhythmic causes. This illustrates the 'sudden cardiac death paradox,' with a great proportion of death in elderly patients, even those at risk for ventricular arrhythmias, attributable to medical conditions that cannot be addressed by an ICD. We discuss current practices in ICD therapy in elderly patients, existing evidence from registries and clinical trials, approaches to risk stratification, and important ethical considerations. Although the decision on whether ICD insertion is appropriate in the elderly population remains an area of uncertainty from an evidence-based and ethical perspective, we offer insight on potential clinical and research strategies for this growing population. PMID:27568872

  6. Spiritual well-being may buffer psychological distress in patients with implantable cardioverter defibrillators (ICD).

    PubMed

    Salmoirago-Blotcher, Elena; Crawford, Sybil; Tran, Chau; Goldberg, Robert; Rosenthal, Lawrence; Ockene, Ira

    2012-10-01

    Psychological distress is common in patients with implantable cardioverter defibrillators (ICDs) and has been associated with a worse prognosis. The authors examined whether spiritual wellbeing is associated with reduced psychological distress in patients with ICDs. The Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing (FACIT-SWB) questionnare and the Hospital Anxiety and Depression Scale (HADS) were used to measure spiritual wellbeing and overall psychological distress. Multivariate linear regression was used to explore the relationship between these variables.The study sample included 46 ICD outpatients (32 M, 14 F; age range 43-83). An inverse association between HADS and FACIT-SWB scores was found, persisting after adjustment for demographics, anxiety/depression, medications, therapist support, and functional status (F = 0.001; β= -0.31, CI: -0.44, -0.19). In conclusion, spiritual wellbeing was independently associated with lower psychological distress in ICD outpatients. Spiritual wellbeing could act as a protective factor against psychological distress in these high-risk patients. PMID:23050210

  7. Spiritual well-being may buffer psychological distress in patients with implantable cardioverter defibrillators (ICD)

    PubMed Central

    Salmoirago-Blotcher, Elena; Crawford, Sybil; Tran, Chau; Goldberg, Robert; Rosenthal, Lawrence; Ockene, Ira

    2012-01-01

    Psychological distress is common in patients with implantable cardioverter defibrillators (ICDs) and has been associated with a worse prognosis. The authors examined whether spiritual wellbeing is associated with reduced psychological distress in patients with ICDs. The Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing (FACIT-SWB) questionnare and the Hospital Anxiety and Depression Scale (HADS) were used to measure spiritual wellbeing and overall psychological distress. Multivariate linear regression was used to explore the relationship between these variables. The study sample included 46 ICD outpatients (32 M, 14 F; age range 43–83). An inverse association between HADS and FACIT-SWB scores was found, persisting after adjustment for demographics, anxiety/depression, medications, therapist support, and functional status (F = 0.001; β= −0.31, CI: −0.44, −0.19). In conclusion, spiritual wellbeing was independently associated with lower psychological distress in ICD outpatients. Spiritual wellbeing could act as a protective factor against psychological distress in these high-risk patients. PMID:23050210

  8. Magnetic resonance imaging safety in pacemaker and implantable cardioverter defibrillator patients: how far have we come?

    PubMed Central

    Nordbeck, Peter; Ertl, Georg; Ritter, Oliver

    2015-01-01

    Magnetic resonance imaging (MRI) has long been regarded a general contraindication in patients with cardiovascular implanted electronic devices such as cardiac pacemakers or cardioverter defibrillators (ICDs) due to the risk of severe complications and even deaths caused by interactions of the magnetic resonance (MR) surrounding and the electric devices. Over the last decade, a better understanding of the underlying mechanisms responsible for such potentially life-threatening complications as well as technical advances have allowed an increasing number of pacemaker and ICD patients to safely undergo MRI. This review lists the key findings from basic research and clinical trials over the last 20 years, and discusses the impact on current day clinical practice. With ‘MR-conditional’ devices being the new standard of care, MRI in pacemaker and ICD patients has been adopted to clinical routine today. However, specific precautions and specifications of these devices should be carefully followed if possible, to avoid patient risks which might appear with new MR technology and further increasing indications and patient numbers. PMID:25796053

  9. Effect of age on survival and causes of death after primary prevention implantable cardioverter-defibrillator implantation.

    PubMed

    Fauchier, Laurent; Marijon, Eloi; Defaye, Pascal; Piot, Olivier; Sadoul, Nicolas; Perier, Marie-Cecile; Gras, Daniel; Klug, Didier; Algalarrondo, Vincent; Bordachar, Pierre; Deharo, Jean-Claude; Leclercq, Christophe; Babuty, Dominique; Boveda, Serge

    2015-05-15

    The benefit of implantable cardioverter-defibrillators (ICDs) remains controversial in elderly patients and may be attenuated by a greater risk of nonarrhythmic death. We examined the effect of age on outcomes after prophylactic ICD implantation. All patients with coronary artery disease or dilated cardiomyopathy implanted with an ICD for primary prevention of sudden cardiac death in 12 French medical centers were included in a retrospective observational study. The 5,534 ICD recipients were divided according to age: 18 to 59 years (n = 2,139), 60 to 74 years (n = 2,693), and ≥75 years (n = 702). Greater prevalences of coronary artery disease and atrial fibrillation at the time of implant were observed with increasing age (both p <0.0001). During a mean follow-up of 3.1 ± 2.0 years, the annual mortality rate increased with age: 3.1% per year for age 18 to 59 years, 5.7% per year for age 60 to 74 years, and 7.5% per year for age ≥75 years (p <0.001). Older age was independently associated with a greater risk of death (adjusted odds ratio 1.43, 95% confidence interval 1.14 to 1.80 for age 60 to 74 years; and adjusted odds ratio 1.65, 95% confidence interval 1.22 to 2.22 for age >75 years). Proportions of cardiac deaths (55.2%, 57.6%, and 57.0%, p = 0.84), including ICD-unresponsive sudden death (9.9%, 6.0%, and 10.6%, p = 0.08), and rates of appropriate ICD therapies were similar in the 3 age groups. Older age was independently associated with a higher rate of early complications and a lower rate of inappropriate therapies. In conclusion, older patients exhibited higher global mortality after ICD implantation for primary prevention, whereas rates of sudden deaths and of appropriate device therapies were similar across age groups. PMID:25784518

  10. Influence of radiotherapy on the latest generation of implantable cardioverter-defibrillators

    SciTech Connect

    Hurkmans, Coen W. . E-mail: Coen.Hurkmans@cze.nl; Scheepers, Egon; Springorum, Bob G.F.; Uiterwaal, Hans

    2005-09-01

    Purpose: Radiotherapy can influence the functioning of pacemakers and implantable cardioverter-defibrillators (ICDs). ICDs offer the same functionality as pacemakers, but are also able to deliver a high-voltage shock to the heart if needed. Guidelines for radiotherapy treatment of patients with an implanted rhythm device have been published in 1994 by The American Association of Physicists in Medicine, and are based only on experience with pacemakers. Data on the influence of radiotherapy on ICDs are limited. The objective of our study is to determine the influence of radiotherapy on the latest generation of ICDs. Methods and Materials: Eleven modern ICDs have been irradiated in our department. The irradiation was performed with a 6-MV photon beam. The given dose was fractionated up to a cumulative dose of 120 Gy. Two to 5 days passed between consecutive irradiations. Frequency, output, sensing, telemetry, and shock energy were monitored. Results: Sensing interference by ionizing radiation on all ICDs has been demonstrated. For four ICDs, this would have caused the inappropriate delivery of a shock because of interference. At the end of the irradiation sessions, all devices had reached their point of failure. Complete loss of function was observed for four ICDs at dose levels between 0.5 Gy and 1.5 Gy. Conclusions: The effect of radiation therapy on the newest generation of ICDs varies widely. If tachycardia monitoring and therapy are functional (programmed on) during irradiation, the ICD might inappropriately give antitachycardia therapy, often resulting in a shock. Although most ICDs did not fail below 80 Gy, some devices had already failed at doses below 1.5 Gy. Guidelines are formulated for the treatment of patients with an ICD.

  11. Referring Physicians’ Discordance with the Primary Prevention Implantable Cardioverter-Defibrillator Guidelines: A National Survey

    PubMed Central

    Castellanos, Jorge M; Smith, Lisa M; Varosy, Paul D.; Dehlendorf, Christine; Marcus, Gregory M

    2012-01-01

    BACKGROUND The ACC/AHA/HRS Guidelines provide patient selection criteria for primary prevention implantable cardioverter-defibrillators (ICDs). For unknown reasons, guideline discordant practice is common. OBJECTIVE To determine referring physicians’ concordance with the primary prevention ICD guidelines. METHODS We mailed a survey regarding ICD guidelines and individual practice characteristics to a random national sample of 3,000 physicians, 1/3rd each specializing in family medicine, internal medicine, and general cardiology, selected from the American Medical Association Masterfile. RESULTS Sixty-four percent with correct contact information responded. Three hundred and ninety-five (28%, 95% CI 25–30%) respondents never refer patients with the intent of consideration for a primary prevention ICD, including 7% (95% CI 5–10%) of cardiologists. Two hundred and twelve (15%, 95% CI 13–17%) believe ventricular arrhythmias are required before a primary prevention ICD is indicated; 525 (36%, 95% CI 34–39%) believe an ejection fraction > 40% warrants a primary prevention ICD; and 361 (25%, 95% CI 23–27%) would refer a patient for a primary prevention ICD within 40 days of a myocardial infarction. In multivariate analyses, family practice physicians and physicians residing in the Western US most often provided guideline-discordant answers, while cardiologists and those that refer to an electrophysiologist most often provided guideline-concordant answers. Primary care physicians that manage heart failure patients without referral to a subspecialist were not more likely to provide guideline concordant answers. CONCLUSIONS Answers discordant with the primary prevention ICD guidelines were common, suggesting that referring physician beliefs are an important barrier to appropriate patient referrals for primary prevention ICD implantation. PMID:22306794

  12. Utilization and likelihood of radiologic diagnostic imaging in patients with implantable cardiac defibrillators

    PubMed Central

    Reynolds, Matthew R.; Ryan, Michael P.; Wolff, Steven D.; Mollenkopf, Sarah A.; Turakhia, Mintu P.

    2015-01-01

    Purpose To examine imaging utilization in a matched cohort of patients with and without implantable cardioverter defibrillators (ICD) and to project magnetic resonance imaging (MRI) utilization over a 10‐year period. Materials and Methods The Truven Health MarketScan Commercial claims and Medicare Supplemental health insurance claims data were used to identify patients with continuous health plan enrollment in 2009–2012. Patients with ICDs were identified using ICD‐9 and CPT codes, and matched to patients with the same demographic and comorbidity profile, but no record of device implantation. Diagnostic imaging utilization was compared across the matched cohorts, in total, by imaging categories, and in subpopulations of stroke, back pain, and joint pain. MRI use in the nonimplant group over the 4‐year period was extrapolated out to 10 years for ICD‐indicated patients. Results A cohort of 18,770 matched patients were identified; average age 65.5 ± 13.38 and 21.9% female. ICD patients had significantly less MRI imaging (0.23 0.70 SD vs. 0.00 0.08 SD, P < 0.0001) than nonimplant patients. Among patients with records of stroke/transient ischemic attack (TIA) (ICD 5%, nonimplant 4%) and accompanying diagnostic imaging, 44% of nonimplant patients underwent MRI vs. 1% of ICD patients (P < 0.0001). Forecast models estimated that 53% to 64% of ICD‐eligible patients may require an MRI within 10 years. Conclusion MRI utilization is lower in ICD patients compared to nonimplant patients, yet the burden of incident stroke/TIA, back, and joint pain suggests an unmet need for MR‐conditional devices. J. MAGN. RESON. IMAGING 2016;43:115–127. PMID:26118943

  13. Long-Term Performance of the Riata/ST Implantable Cardioverter-Defibrillator Lead.

    PubMed

    Ströker, Erwin; de Asmundis, Carlo; Vanduynhoven, Philippe; De Vadder, Katrien; De Vusser, Philip; Mullens, Wilfried; Chierchia, Gian-Battista; Brugada, Pedro; Czapla, Jens; La Meir, Mark; Wellens, Francis; Van Herendael, Hugo; Rivero-Ayerza, Maximo

    2016-03-01

    Riata and Riata ST implantable cardioverter-defibrillator leads are prone to structural and electrical failure (EF). Our objective was to evaluate Riata/ST lead performance over a long-term follow-up. Of 184 patients having undergone Riata/ST and Riata ST Optim lead implantation from September 2003 to June 2008, 154 patients were evaluated for EF and radiographic conductor externalization (CE). Survival analysis for EF was performed for Riata/ST leads, both for failure-free lead survival and cumulative hazard. Subanalysis on 7Fr leads was performed to evaluate EF and CE rates both for different Riata ST lead management (monitoring vs proactive) and between Riata ST and Riata ST Optim leads. During a mean follow-up of 7 years, Riata/ST lead EF rate was 13% overall. Similar failure-free survival rate was noted for 7Fr as for 8Fr leads (log-rank, p = 0.63). Of all failed leads, 64% failed only after 5 years of follow-up. Compared with the absolute failure rate of 1.84% per device year, cumulative hazard analysis for leads surviving past 5 years revealed an estimated failure rate of 7% per year. No clinical or procedural predictors for EF were found. The subanalysis on 7Fr leads showed an excellent outcome both for a proactive lead management approach as for Optim leads. In conclusion, long-term survival of the Riata/ST lead is impaired with an accelerating EF risk over time. An initial exponential trend was followed by a linear lead failure pattern for leads surviving past 5 years, corresponding to an estimated 7% annual EF rate. These findings may have repercussions on the lead management strategy in patients currently surviving with a Riata/ST lead to prevent significant clinical events like inappropriate shocks or failed device interventions. PMID:26762730

  14. Comprehensive cardiac rehabilitation programme for implantable cardioverter-defibrillator patients: a randomised controlled trial

    PubMed Central

    Fitchet, A; Doherty, P J; Bundy, C; Bell, W; Fitzpatrick, A P; Garratt, C J

    2003-01-01

    Objective: To investigate the effects of a 12 week comprehensive cardiac rehabilitation (CCR) programme on patients who have undergone implantation of an implantable cardioverter-defibrillator (ICD). Design: Sixteen patients with ICDs (14 (88%) male, mean (SD) age 58 (10) years, range 34–74 years) were randomised to either attend an individually tailored CCR programme or receive usual care. They then changed to the alternative regimen for a further 12 weeks. Exercise capacity was assessed using a treadmill exercise test at baseline, after usual care, after CCR and 12 weeks after CCR to assess maintenance effects. Hospital anxiety and depression (HAD) scores were recorded at each stage. Results: Exercise times (min:s; mean (SD)) increased by 16% from a baseline mean of 9:55 (2:33) to 11:11 (2:17) following attendance at CCR (95% confidence interval (CI) 0:34 to 1:58; p = 0.001). This improvement was maintained 12 weeks after attendance at CCR, at 11:20 (2:17) (p = 1.00). HAD scores for anxiety and depression decreased during CCR from a baseline of 13.4 (3.6) to 8.1 (3.6), 95% CI 3.5 to 7.0 (p < 0.001) and 9.9 (3.4) to 6.7 (2.9), 95% CI 1.9 to 4.4 (p = 0.002), respectively. These improvements were maintained at 12 weeks after CCR. No ventricular arrhythmias or ICD discharges occurred during the exercise components of the CCR. The total number of ventricular arrhythmias and ICD discharges was similar 12 weeks before, during, and 12 weeks after CCR. Conclusions: CCR appears to be safe for patients with ICDs. It can improve exercising ability and lower the levels of psychological distress. A larger multicentre study is recommended to confirm these findings. PMID:12527665

  15. Disparity in utilization of implantable cardioverter-defibrillators in treatment of heart failure based on sex and race.

    PubMed

    Steiner, Hillel A; Miller, John M

    2008-01-01

    Evaluation of: Hernandez AF, Fonarow GC, Lang L et al.:Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure.JAMA298(13), 1525-1532 (2007) [1] . Disparity of utilization of proven therapies for treatment of cardiac disease according to gender and ethnicity has been well documented in various aspects of cardiac care. Implanted cardiac defibrillators (ICDs) are devices that have been proven to prevent sudden cardiac death. This retrospective study examined ICD use in heart-failure patients who had an indication for ICD implantation, from the "Get with the Guidelines" program. The patients were stratified by gender and ethnicity (Black vs White). The overall rate of utilization (or intention for utilization) of ICDs was 35%, while among women and Black people the rate was significantly lower, at 27 and 23%, respectively, with the lowest rate being for Black women (28%). These findings suggest a bias against implantation of such devices in women and Black people, which is not explained by clinical variables. PMID:19072448

  16. Prevalence and outcomes of patients receiving implantable cardioverter-defibrillators for primary prevention not based on guidelines.

    PubMed

    Levine, Yehoshua C; Tuttle, Mark K; Rosenberg, Michael A; Goldberg, Randal; Matos, Jason; Samuel, Michelle; Kramer, Daniel B; Buxton, Alfred E

    2015-06-01

    Implantable cardioverter-defibrillator (ICD) implantation outside practice guidelines remains contentious, particularly during the mandated waiting periods in patients with recent cardiac events. We assessed the prevalence and outcomes of non-guideline-based (NGB) ICD implantations in a tertiary academic medical center, with a specific focus on adjudication of arrhythmia events. All patients who underwent initial primary prevention ICD implantation at our institution from 2004 to 2012 were categorized as having received guideline-based (GB) or NGB implants and were retrospectively assessed for first episode of appropriate ICD therapy and total mortality. Of 807 patients, 137 (17.0%) received NGB implants. During a median follow-up of 2.9 years, patients with NGB implants had similar times to first appropriate ICD therapy (median time to event 1.94 vs 2.17 years in patients with GB implants, p = 0.20). After multivariable analysis, patients with NGB implants remained at higher risk for death (hazard ratio 1.54, 95% confidence interval 1.1 to 2.2, p = 0.03) but not appropriate ICD therapy (hazard ratio 0.83, 95% confidence interval 0.5 to 1.3, p = 0.51). Furthermore, only 1 of 125 patients who underwent implant within the 40-day waiting period after myocardial infarction or 3-month waiting period after revascularization or cardiomyopathy diagnosis received an appropriate therapy within this period. In conclusion, few patients received NGB ICD implants in our academic medical center. Although these patients have similar long-term risk of receiving appropriate ICD therapy compared with patients with GB implants, this risk is very low during the waiting periods mandated by clinical practice guidelines. These results suggest that there is little need to rush into implanting ICDs during these waiting periods. PMID:25840578

  17. Patient barriers to implantable cardioverter defibrillator implantation for the primary prevention of sudden cardiac death in patients with heart failure and reduced ejection fraction

    PubMed Central

    Chan, Laura Lihua; Lim, Choon Pin; Aung, Soe Tin; Quetua, Paul; Ho, Kah Leng; Chong, Daniel; Teo, Wee Siong; Sim, David; Ching, Chi Keong

    2016-01-01

    INTRODUCTION Device therapy is efficacious in preventing sudden cardiac death (SCD) in patients with reduced ejection fraction. However, few who need the device eventually opt to undergo implantation and even fewer reconsider their decisions after deliberation. This is due to many factors, including unresolved patient barriers. This study identified the factors that influenced patients’ decision to decline implantable cardioverter defibrillator (ICD) implantation, and those that influenced patients who initially declined an implant to reconsider having one. METHODS A single-centre survey was conducted among 240 patients who had heart failure with reduced ejection fraction and met the ICD implantation criteria, but had declined ICD implantation. RESULTS Participants who refused ICD implantation were mostly male (84%), Chinese (71%), married (72%), currently employed (54%), and had up to primary or secondary education (78%) and monthly income of < SGD 3,000 (51%). Those who were more likely to reconsider their decision were aware that SCD was a consequence of heart failure with reduced ejection fraction, knowledgeable of the preventive role of ICDs, currently employed and aware that their doctor strongly recommended the implant. Based on multivariate analysis, knowledge of the role of ICDs for primary prophylaxis was the most important factor influencing patient decision. CONCLUSION This study identified the demographic and social factors of patients who refused ICD therapy. Knowledge of the role of ICDs in preventing SCD was found to be the strongest marker for reconsidering ICD implantation. Measures to address this information gap may lead to higher rates of ICD implantation. PMID:27075476

  18. Performance of 2014 NICE defibrillator implantation guidelines in heart failure risk stratification

    PubMed Central

    Cubbon, Richard M; Witte, Klaus K; Kearney, Lorraine C; Gierula, John; Byrom, Rowenna; Paton, Maria; Sengupta, Anshuman; Patel, Peysh A; MN Walker, Andrew; Cairns, David A; Rajwani, Adil; Hall, Alistair S; Sapsford, Robert J; Kearney, Mark T

    2016-01-01

    Objective Define the real-world performance of recently updated National Institute for Health and Care Excellence guidelines (TA314) on implantable cardioverter-defibrillator (ICD) use in people with chronic heart failure. Methods Multicentre prospective cohort study of 1026 patients with stable chronic heart failure, associated with left ventricular ejection fraction (LVEF) ≤45% recruited in cardiology outpatient departments of four UK hospitals. We assessed the capacity of TA314 to identify patients at increased risk of sudden cardiac death (SCD) or appropriate ICD shock. Results The overall risk of SCD or appropriate ICD shock was 2.1 events per 100 patient-years (95% CI 1.7 to 2.6). Patients meeting TA314 ICD criteria (31.1%) were 2.5-fold (95% CI 1.6 to 3.9) more likely to suffer SCD or appropriate ICD shock; they were also 1.5-fold (95% CI 1.1 to 2.2) more likely to die from non-cardiovascular causes and 1.6-fold (95% CI 1.1 to 2.3) more likely to die from progressive heart failure. Patients with diabetes not meeting TA314 criteria experienced comparable absolute risk of SCD or appropriate ICD shock to patients without diabetes who met TA314 criteria. Patients with ischaemic cardiomyopathy not meeting TA314 criteria experienced comparable absolute risk of SCD or appropriate ICD shock to patients with non-ischaemic cardiomyopathy who met TA314 criteria. Conclusions TA314 can identify patients with reduced LVEF who are at increased relative risk of sudden death. Clinicians should also consider clinical context and the absolute risk of SCD when advising patients about the potential risks and benefits of ICD therapy. PMID:26857212

  19. Primary Prevention Implantable Cardioverter-Defibrillators and Survival in Older Women

    PubMed Central

    Zeitler, Emily P.; Hellkamp, Anne S.; Fonarow, Gregg C.; Hammill, Stephen C.; Curtis, Lesley H.; Hernandez, Adrian F.; Al-Khalidi, Hussein R.; Curtis, Jeptha P.; Heidenreich, Paul A.; Anstrom, Kevin J.; Peterson, Eric D.; Mark, Daniel B.; Hammill, Bradley G.; Sanders, Gillian D.; Al-Khatib, Sana M.

    2015-01-01

    OBJECTIVES The purpose of this study was to assess the benefit of primary prevention implantable cardioverter defibrillators (ICDs) in women. BACKGROUND Clinical trials of primary prevention ICDs enrolled a limited number of women. METHODS Using a propensity score method, we matched 490 women ≥65 years of age who received an ICD during a hospitalization for heart failure in the National Cardiovascular Data Registry ICD Registry from January 1, 2006, through December 31, 2007, to 490 ICD-eligible women without an ICD hospitalized for heart failure in the Get With The Guidelines for Heart Failure database from January 1, 2006, through December 31, 2009. The primary endpoint was all-cause mortality obtained from the Medicare Claims Database. An identical analysis was conducted in men. RESULTS Median follow-up for patients with an ICD was 4.6 years versus 3.2 years for patients with no ICD. Compared with women with no ICD, those with an ICD were younger and less frequently white. In the matched cohorts, the survival of women with an ICD was significantly longer than that of women without an ICD (adjusted hazard ratio: 0.79, 95% confidence interval: 0.66 to 0.95; p = 0.013). Similarly, men with an ICD had longer survival than men without an ICD (adjusted hazard ratio: 0.73, 95% confidence interval: 0.65 to 0.83; p < 0.0001). There was no interaction between sex and the presence of an ICD with respect to survival (p = 0.44). CONCLUSIONS Among older women with left ventricular dysfunction, a primary prevention ICD was associated with a significant survival benefit that was nearly identical to that seen in men. These findings support the use of primary prevention ICDs in eligible patients regardless of sex. PMID:25543969

  20. BAYESIAN META-ANALYSIS ON MEDICAL DEVICES: APPLICATION TO IMPLANTABLE CARDIOVERTER DEFIBRILLATORS

    PubMed Central

    Youn, Ji-Hee; Lord, Joanne; Hemming, Karla; Girling, Alan; Buxton, Martin

    2012-01-01

    Objectives: The aim of this study is to describe and illustrate a method to obtain early estimates of the effectiveness of a new version of a medical device. Methods: In the absence of empirical data, expert opinion may be elicited on the expected difference between the conventional and modified devices. Bayesian Mixed Treatment Comparison (MTC) meta-analysis can then be used to combine this expert opinion with existing trial data on earlier versions of the device. We illustrate this approach for a new four-pole implantable cardioverter defibrillator (ICD) compared with conventional ICDs, Class III anti-arrhythmic drugs, and conventional drug therapy for the prevention of sudden cardiac death in high risk patients. Existing RCTs were identified from a published systematic review, and we elicited opinion on the difference between four-pole and conventional ICDs from experts recruited at a cardiology conference. Results: Twelve randomized controlled trials were identified. Seven experts provided valid probability distributions for the new ICDs compared with current devices. The MTC model resulted in estimated relative risks of mortality of 0.74 (0.60–0.89) (predictive relative risk [RR] = 0.77 [0.41–1.26]) and 0.83 (0.70–0.97) (predictive RR = 0.84 [0.55–1.22]) with the new ICD therapy compared to Class III anti-arrhythmic drug therapy and conventional drug therapy, respectively. These results showed negligible differences from the preliminary results for the existing ICDs. Conclusions: The proposed method incorporating expert opinion to adjust for a modification made to an existing device may play a useful role in assisting decision makers to make early informed judgments on the effectiveness of frequently modified healthcare technologies. PMID:22559753

  1. Readability and Content of Patient Education Material Related to Implantable Cardioverter Defibrillators

    PubMed Central

    Strachan, Patricia H.; de Laat, Sonya; Carroll, Sandra L.; Schwartz, Lisa; Vaandering, Katie; Toor, Gurjit K.; Arthur, Heather M.

    2012-01-01

    Background Implantable cardioverter defibrillators (ICDs) are increasingly offered to patients for primary prevention of sudden cardiac death. Candidates for ICD receive ICD-related patient education material when they make decisions to consent or decline a primary prevention ICD. Printed patient education material directed at ICD candidates has not been the focus of direct appraisal. Objective We evaluated the readability and content of ICD-related print education materials made available to patients who were enrolled in a study involving patient decision making for ICD from 3 ICD sites in southern Ontario, Canada. Methods All ICD print materials referred to during interviews and/or that were available in ICD site waiting rooms were collected for analysis. Readability testing was conducted using the SMOG (“simple measurement of gobbledygook”) and Fry methods. The material was evaluated according to selected plain-language criteria, thematic content analysis, and rhetoric analysis. Results Twenty-one print materials were identified and analyzed. Documents were authored by device manufacturers, tertiary care hospitals, and cardiac support organizations. Although many documents adhered to plain-language recommendations, text-reading levels were higher than recommended. Twelve major content themes were identified. Content focused heavily on the positive aspects of living with the device to the exclusion of other possible information that could be relevant to the decisions that patients made. Conclusions Print-based patient education materials for ICD candidates are geared to a highly literate population. The focus on positive information to the exclusion of potentially negative aspects of the ICD, or alternatives to accepting 1, could influence and/or confuse patients about the purpose and implications of this medical device. Development of print materials is indicated that includes information about possible problems and that would be relevant for the

  2. Influence of secondary neutrons induced by proton radiotherapy for cancer patients with implantable cardioverter defibrillators

    PubMed Central

    2012-01-01

    Background Although proton radiotherapy is a promising new approach for cancer patients, functional interference is a concern for patients with implantable cardioverter defibrillators (ICDs). The purpose of this study was to clarify the influence of secondary neutrons induced by proton radiotherapy on ICDs. Methods The experimental set-up simulated proton radiotherapy for a patient with an ICD. Four new ICDs were placed 0.3 cm laterally and 3 cm distally outside the radiation field in order to evaluate the influence of secondary neutrons. The cumulative in-field radiation dose was 107 Gy over 10 sessions of irradiation with a dose rate of 2 Gy/min and a field size of 10 × 10 cm2. After each radiation fraction, interference with the ICD by the therapy was analyzed by an ICD programmer. The dose distributions of secondary neutrons were estimated by Monte-Carlo simulation. Results The frequency of the power-on reset, the most serious soft error where the programmed pacing mode changes temporarily to a safety back-up mode, was 1 per approximately 50 Gy. The total number of soft errors logged in all devices was 29, which was a rate of 1 soft error per approximately 15 Gy. No permanent device malfunctions were detected. The calculated dose of secondary neutrons per 1 Gy proton dose in the phantom was approximately 1.3-8.9 mSv/Gy. Conclusions With the present experimental settings, the probability was approximately 1 power-on reset per 50 Gy, which was below the dose level (60-80 Gy) generally used in proton radiotherapy. Further quantitative analysis in various settings is needed to establish guidelines regarding proton radiotherapy for cancer patients with ICDs. PMID:22284700

  3. Sustaining cyborgs: sensing and tuning agencies of pacemakers and implantable cardioverter defibrillators.

    PubMed

    Oudshoorn, Nelly

    2015-02-01

    Recently there has been a renewed interest in cyborgs, and particularly in new and emerging fusions of humans and technologies related to the development of human enhancement technologies. These studies reflect a trend to follow new and emerging technologies. In this article, I argue that it is important to study 'older' and more familiar cyborgs as well. Studying 'the old' is important because it enables us to recognize hybrids' embodied experiences. This article addresses two of these older hybrids: pacemakers and implantable cardioverter defibrillators inserted in the bodies of people suffering from heart-rhythm disturbances. My concern with hybrid bodies is that internal devices seem to present a complex and neglected case if we wish to understand human agency. Their 'users' seem to be passive because they cannot exert any direct control over the working of their devices. Technologies inside bodies challenge a longstanding tradition of theorizing human-technology relations only in terms of technologies external to the body. Cyborg theory is problematic as well because most studies tend to conceptualize the cyborg merely as a discursive entity and silence the voices of people living as cyborgs. Inspired by feminist research that foregrounds the materiality of the lived and intimate relations between bodies and technologies, I argue that creating these intimate relations requires patients' active involvement in sustaining their hybrid bodies. Based on observations of these monitoring practices in a Dutch hospital and interviews with patients and technicians, the article shows that heart cyborgs are far from passive. On the contrary, their unique experience in sensing the entangled agencies of technologies and their own heart plays a crucial role in sustaining their hybrid bodies. PMID:25803917

  4. Under-Utilization of Implantable Cardioverter Defibrillators in Patients with Heart Failure - The Current State of Sudden Cardiac Death Prophylaxis

    PubMed Central

    Pillarisetti, Jayasree; Emert, Martin; Biria, Mazda; Chotia, Rashaad; Guda, Rajeshwer; Bommana, Sudharani; Pimentel, Rhea; Vacek, James; Dendi, Raghuveer; Berenbom, Loren; Dawn, Buddhadeb; Lakkireddy, Dhanunjaya

    2016-01-01

    Background Despite ACC/AHA guidelines indicating implantable cardioverter defibrillator (ICD) as class I therapy for primary prevention of sudden cardiac death in patients with EF≤35%, ICD utilization rates in real world practice have been low. Objective To determine the rate of ICD implantation at a tertiary care academic center and to assess the reasons for under-utilization of the same. Methods Review of a prospectively collected database which included all patients diagnosed with an EF≤35% was performed to assess the rate of ICD implantation and mortality. Reasons for non-implantation of ICD were then assessed from detailed chart review. Results A total of 707 patients (age 69.4 ± 14.1 years) with mean EF of 26±7% were analyzed. Only 28% (200/707) of patients had ICDs implanted. Mortality was lower in the group with ICD (25% vs 37%, p=0.004). When patients who either died or were lost to follow-up prior to 2005 were excluded, ICD utilization rate was still low at 37.6%. The most common reason for non-implantation of ICD was physicians not discussing this option with their patients. Patient refusal was the second most common reason. Conclusions ICD Implantation rates for primary prevention of SCD in patients with EF≤35% is low. Physician and patient education should be addressed to improve the utilization rates. PMID:25852239

  5. Downward delegation of implantable cardioverter defibrillator decision-making in a restricted-resource environment: the pitfalls of bedside rationing.

    PubMed

    Simpson, Christopher S; Hoffmaster, Barry; Dorian, Paul

    2005-05-15

    Implantable cardioverter defibrillators have been shown to reduce all-cause mortality in some patient populations at risk of sudden death. New Canadian guidelines recommend implantable cardioverter defibrillator therapy for these patients. However, the need for these devices exceeds the funded volumes in many Canadian jurisdictions. As a result, rationing of this resource has been necessary. While rationing at the macro (Ministry of Health) and meso (hospital) levels has achieved some level of acceptance by society, the responsibility for the decisions taken at the micro (individual) patient level actually rests with the physician at the bedside. This 'bedside rationing' creates a moral dilemma for physicians, who are torn between their traditional fiduciary role as 'patient advocate' and the competing role of 'gatekeeper'. This 'downward delegation' of rationing decision-making obscures the reality that rationing occurs, and encourages covert, opaque and inconsistent approaches. The remedy is the development of fair, legitimate procedures for making rationing decisions that include guidelines that structure and constrain those decisions. Macro- and meso-level stakeholders must also recognize and take responsibility for their part in restricting resources in a broadly inclusive and transparent process. PMID:15940358

  6. Implantable Cardioverter-Defibrillators at End of Battery Life: Opportunities for Risk (Re)-Stratification in ICD Recipients.

    PubMed

    Merchant, Faisal M; Quest, Tammie; Leon, Angel R; El-Chami, Mikhael F

    2016-02-01

    Although implantable cardioverter-defibrillators (ICDs) are frequently viewed as a lifelong commitment in that patients are routinely scheduled for generator exchange (GE) at end of battery life, several considerations should prompt a reevaluation of risks and benefits before GE. Compared with initial ICD implant, patients receiving replacement devices are older, and have more comorbidities and shorter life expectancy, all of which may limit the benefit of ICD therapy following GE. Additionally, GE is associated with significant complications, including infection, which may increase the risk of mortality. In this paper, we review recent data regarding opportunities for risk stratification before GE, with a particular focus on those with improved left ventricular function and those who have not experienced ICD therapies during the first battery life. We also provide a broader perspective on ICD therapy, focusing on how decisions regarding GE may affect goals of care at the end of life. PMID:26821633

  7. Inappropriate implantable cardioverter defibrillator shocks in fractured Sprint Fidelis leads associated with 'appropriate' interrogation.

    PubMed

    Farwell, David; Redpath, Calum; Birnie, David; Gollob, Michael; Lemery, Robert; Posan, Emoke; Green, Martin

    2008-06-01

    We present two patients with fractures within the pace-sense circuit of their Medtronic Sprint Fidelis leads who received inappropriate shocks from their Medtronic defibrillators during device interrogation. This was not simply a coincidence, but due to electromagnetic interference induced within the Sprint Fidelis lead by the device programmer during two-way communication with the defibrillator. Our subsequent investigations have uncovered at least two other similar incidents in Canada. We have also discovered that the Medtronic 'Auto-resume' feature may leave future patients uniquely vulnerable to such inappropriate shocks in the future. PMID:18456645

  8. Serum-Based Oxylipins Are Associated with Outcomes in Primary Prevention Implantable Cardioverter Defibrillator Patients

    PubMed Central

    Zhang, Yiyi; Guallar, Eliseo; Blasco-Colmenares, Elena; Harms, Amy C.; Vreeken, Rob J.; Hankemeier, Thomas; Tomaselli, Gordon F.; Cheng, Alan

    2016-01-01

    Introduction Individuals with systolic heart failure are at risk of ventricular arrhythmias and all-cause mortality. Little is known regarding the mechanisms underlying these events. We sought to better understand if oxylipins, a diverse class of lipid metabolites derived from the oxidation of polyunsaturated fatty acids, were associated with these outcomes in recipients of primary prevention implantable cardioverter defibrillators (ICDs). Methods Among 479 individuals from the PROSE-ICD study, baseline serum were analyzed and quantitatively profiled for 35 known biologically relevant oxylipin metabolites. Associations with ICD shocks for ventricular arrhythmias and all-cause mortality were evaluated using Cox proportional hazards models. Results Six oxylipins, 17,18-DiHETE (HR = 0.83, 95% CI 0.70 to 0.99 per SD change in oxylipin level), 19,20-DiHDPA (HR = 0.79, 95% CI 0.63 to 0.98), 5,6-DiHETrE (HR = 0.73, 95% CI 0.58 to 0.91), 8,9-DiHETrE (HR = 0.76, 95% CI 0.62 to 0.95), 9,10-DiHOME (HR = 0.81, 95% CI 0.65 to 1.00), and PGF1α (HR = 1.33, 95% CI 1.04 to 1.71) were associated with the risk of appropriate ICD shock after multivariate adjustment for clinical factors. Additionally, 4 oxylipin-to-precursor ratios, 15S-HEPE / FA (20:5-ω3), 17,18-DiHETE / FA (20:5-ω3), 19,20-DiHDPA / FA (20:5-ω3), and 5S-HEPE / FA (20:5-ω3) were positively associated with the risk of all-cause mortality. Conclusion In a prospective cohort of patients with primary prevention ICDs, we identified several novel oxylipin markers that were associated with appropriate shock and mortality using metabolic profiling techniques. These findings may provide new insight into the potential biologic pathways leading to adverse events in this patient population. PMID:27281224

  9. Correlation of Geomagnetic Activity with Implantable Cardioverter Defibrillator Shocks and Antitachycardia Pacing

    PubMed Central

    Ebrille, Elisa; Konecny, Tomas; Konecny, Dana; Spacek, Radim; Jones, Paul; Ambroz, Pavel; DeSimone, Christopher V; Powell, Brian D; Hayes, David L; Friedman, Paul A; Asirvatham, Samuel J

    2016-01-01

    Objective Small-scale observational studies have suggested that geomagnetic activity (GMA) may negatively correlate with the frequency of life-threatening arrhythmias. We investigated a potential relationship between implantable cardioverter defibrillator (ICD) therapies and daily GMA recorded in a large database. Patients and Methods The ALTITUDE database, derived from the Boston Scientific LATITUDE remote monitoring system, was retrospectively analyzed for the frequency of ICD therapies. Daily GMA was expressed as the planetary K-index and the integrated A-index and graded as Levels I – quiet, II – unsettled, III – active, and IV – storm. Results A daily mean of 59,468 ± 11,397 patients were monitored between 2009 and 2012. The distribution of days according to GMA was: Level I 75%, Level II 18%, Level III 5%, Level IV 2%. The daily number of ICD shocks received per 1000 active patients in the database was 1.29 ± 0.47, 1.17 ± 0.46, 1.03 ± 0.37, and 0.94 ± 0.29 on Level I, Level II, Level III, and Level IV days respectively; the daily sum of shocks and antitachycardia pacing (ATP) therapies was 9.29 ± 2.86, 8.46 ± 2.45, 7.92 ± 1.80, and 7.83 ± 2.28 on quiet, unsettled, active and storm days respectively. A statistically significant inverse relationship between GMA and the frequency of ICD therapies was identified, with the most pronounced difference between Level I and Level IV days (p < .001 for shocks, p = .008 for shocks + ATP). Conclusion In a large scale cohort analysis, ICD therapies were delivered less frequently on days of higher GMA, confirming the previous pilot data and suggesting that higher GMA does not pose an increased risk of arrhythmias using ICD therapies as a surrogate marker. Further studies are needed to gain an in-depth understanding of the underlying mechanisms. PMID:25659238

  10. Outcomes After Implantable Cardioverter-Defibrillator Generator Replacement for Primary Prevention of Sudden Cardiac Death

    PubMed Central

    Madhavan, Malini; Waks, Jonathan W.; Friedman, Paul A.; Kramer, Daniel B.; Buxton, Alfred E.; Noseworthy, Peter A.; Mehta, Ramila A.; Hodge, David O.; Higgins, Angela Y.; Webster, Tracy L.; Witt, Chance M.; Cha, Yong-Mei; Gersh, Bernard J.

    2016-01-01

    Background The effectiveness of implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden death in patients with an ejection fraction (EF) ≤35% and clinical heart failure is well established. However, outcomes after replacement of the ICD generator in patients with recovery of EF to >35% and no previous therapies are not well characterized. Methods and Results Between 2001 and 2011, generator replacement was performed at 2 tertiary medical centers in 253 patients (mean age, 68.3±12.7 years; 82% men) who had previously undergone ICD placement for primary prevention but subsequently never received appropriate ICD therapy. EF had recovered to >35% in 72 of 253 (28%) patients at generator replacement. During median (quartiles) follow-up of 3.3 (1.8–5.3) years after generator replacement, 68 of 253 (27%) experienced appropriate ICD therapy. Patients with EF ≤35% were more likely to experience ICD therapy compared with those with EF >35% (12% versus 5% per year; hazard ratio, 3.57; P=0.001). On multivariable analysis, low EF predicted appropriate ICD therapy after generator replacement (hazard ratio, 1.96 [1.35–2.87] per 10% decrement; P=0.001). Death occurred in 25% of patients 5 years after generator replacement. Mortality was similar in patients with EF ≤35% and >35% (7% versus 5% per year; hazard ratio, 1.10; P=0.68). Atrial fibrillation (3.24 [1.63–6.43]; P<0.001) and higher blood urea nitrogen (1.28 [1.14–1.45] per increase of 10 mg/dL; P<0.001) were associated with mortality. Conclusions Although approximately one fourth of patients with a primary prevention ICD and no previous therapy have EF >35% at the time of generator replacement, these patients continue to be at significant risk for appropriate ICD therapy (5% per year). These data may inform decisions on ICD replacement. PMID:26921377

  11. Implantable Cardioverter Defibrillators for Primary Prevention of Sudden Cardiac Death in CKD: A Meta-analysis of Patient-Level Data from 3 Randomized Trials

    PubMed Central

    Pun, Patrick H.; Al-Khatib, Sana M.; Han, Joo Yoon; Edwards, Rex; Bardy, Gust H.; Bigger, J. Thomas; Buxton, Alfred E.; Moss, Arthur J.; Lee, Kerry L.; Steinman, Richard; Dorian, Paul; Hallstrom, Al; Cappato, Riccardo; Kadish, Alan H.; Kudenchuk, Peter J.; Mark, Daniel B.; Hess, Paul L.; Inoue, Lurdes Y. T.; Sanders, Gillian D.

    2014-01-01

    Background The benefit of a primary prevention implantable cardioverter defibrillator (ICD) among patients with chronic kidney disease (CKD) is uncertain. Study Design Meta-analysis of patient-level data from randomized controlled trials. Setting & Population Patients with symptomatic heart failure and left ventricular ejection fraction of <35%. Selection Criteria for Studies From 7 available randomized control studies with patient level data, we selected studies with available data on important covariates. Studies without patient-level data on baseline eGFR were excluded. Intervention Primary prevention ICD versus usual care Outcomes Mortality, re-hospitalizations, and effect modification by estimated GFR (eGFR) Results We included data from the Multicenter Automatic Defibrillator Implantation Trial I (MADIT-I), MADIT-II, and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). 2,867 patients were included; 36.3% had at least stage 3 CKD (eGFR<60). The Kaplan-Meier estimate of the probability of death during follow-up was 43.3% among 1,334 patients receiving usual care and 35.8% among 1,533 ICD recipients. After adjustment for baseline differences, there was evidence that the survival benefit of ICDs in comparison to usual care depends on eGFR (posterior probability for null interaction p <0.001). The ICD was associated with survival benefit among patients with an eGFR ≥ 60 (adjusted HR (aHR)=0.49 [95% posterior credible interval (PCI) 0.24-0.95]) but not among patients with eGFR <60 (aHR = 0.80 [95% PCI 0.40-1.53]). eGFR did not modify the association between the ICD and re-hospitalizations. Limitations Few patients with eGFR <30 were available. Differences in trial-to-trial measurement techniques may lead to residual confounding. Conclusions Reductions in baseline eGFR decrease the survival benefit associated with the ICD. These findings should be confirmed by additional studies specifically targeting patients with varying levels of eGFR. PMID:24518128

  12. Improved internal defibrillation efficacy with a biphasic waveform.

    PubMed

    Fain, E S; Sweeney, M B; Franz, M R

    1989-02-01

    Clinically available automatic implantable defibrillators use a monophasic truncated exponential waveform shock; after delivery the charge remaining on the device's capacitors is "dumped" internally and wasted. The efficacy of a monophasic and biphasic truncated exponential defibrillation waveform produced by a single capacitor discharge was compared in seven closed-chest, pentobarbital-anesthetized dogs. Defibrillation leads consisted of a new deployable intrapericardial electrode system. The monophasic waveform was positive and 6 msec in duration. The biphasic waveform had a positive phase identical to that of the monophasic waveform and a negative phase of equal duration with its initial voltage equal to 50% of the final voltage of the positive phase. Defibrillation shocks of varying initial voltage were delivered to construct curves of the percentage of successful defibrillation versus initial voltage and delivered energy, and the voltage and energy required for 50% (V50 and E50, respectively) and 80% (V80 and E80, respectively) success were compared. The biphasic waveform had significantly lower initial voltage (V50: 194 +/- 48 volts vs 227 +/- 48 volts, p less than 0.001; V80: 217 +/- 55 volts vs 256 +/- 66 volts, p less than 0.02) and energy (E50: 2.7 +/- 1.3 joules vs 3.4 +/- 1.5 joules, p less than 0.01; E80: 3.4 +/- 1.6 joules vs 4.3 +/- 2.2 joules, p less than 0.05) requirements than the monophasic waveform. It is concluded that a biphasic waveform produced by a single discharge that uses the "free" energy remaining on the capacitors significantly reduces the initial voltage and energy requirements for successful defibrillation and may improve the efficacy of future automatic implantable defibrillators. PMID:2916410

  13. Determining the risks of magnetic resonance imaging at 1.5 tesla for patients with pacemakers and implantable cardioverter defibrillators.

    PubMed

    Cohen, Jennifer D; Costa, Heather S; Russo, Robert J

    2012-12-01

    Conventional pacemaker and implantable cardioverter-defibrillator product labeling currently cautions against exposure to magnetic resonance imaging (MRI). However, there is a growing clinical need for MRI, without an acceptable alternative imaging modality in many patients with cardiac devices. The purpose of this study was to determine the risk of MRI at 1.5 T for patients with cardiac devices by measuring the frequency of device failures and clinically relevant device parameter changes. Data from a single-center retrospective review of 109 patients with pacemakers and implantable cardioverter-defibrillators (the MRI group) who underwent 125 clinically indicated MRI studies were compared to data from a prospective cohort of 50 patients with cardiac devices who did not undergo MRI (the control group). In the MRI group, there were no deaths, device failures requiring generator or lead replacement, induced arrhythmias, losses of capture, or electrical reset episodes. Decreases in battery voltage of ≥0.04 V occurred in 4%, pacing threshold increases of ≥0.5 V in 3%, and pacing lead impedance changes of ≥50 Ω in 6%. Although there were statistically significant differences between the MRI and control groups for the mean change in pacing lead impedance (-6.2 ± 23.9 vs 3.0 ± 22.1 Ω) and left ventricular pacing threshold (-0.1 ± 0.3 vs 0.1 ± 0.2 V), these differences were not clinically important. In conclusion, MRI in patients with cardiac devices resulted in no device or lead failures. A small number of clinically relevant changes in device parameter measurements were noted. However, these changes were similar to those in a control group of patients who did not undergo MRI. PMID:22921995

  14. Failure of a novel silicone–polyurethane copolymer (Optim™) to prevent implantable cardioverter-defibrillator lead insulation abrasions

    PubMed Central

    Hauser, Robert G.; Abdelhadi, Raed H.; McGriff, Deepa M.; Kallinen Retel, Linda

    2013-01-01

    Aim The purpose of this study was to determine if Optim™, a unique copolymer of silicone and polyurethane, protects Riata ST Optim and Durata implantable cardioverter-defibrillator (ICD) leads (SJM, St Jude Medical Inc., Sylmar, CA, USA) from abrasions that cause lead failure. Methods and results We searched the US Food and Drug Administration's (FDA's) Manufacturers and User Device Experience (MAUDE) database on 13 April 2012 using the simple search terms ‘Riata ST Optim™ abrasion analysis’ and ‘Durata abrasion analysis’. Lead implant time was estimated by subtracting 3 months from the reported lead age. The MAUDE search returned 15 reports for Riata ST Optim™ and 37 reports for Durata leads, which were submitted by SJM based on its analyses of returned leads for clinical events that occurred between December 2007 and January 2012. Riata ST Optim™ leads had been implanted 29.1 ± 11.7 months. Eight of 15 leads had can abrasions and three abrasions were caused by friction with another device, most likely another lead. Four of these abrasions resulted in high-voltage failures and one death. One failure was caused by an internal insulation defect. Durata leads had been implanted 22.2 ± 10.6 months. Twelve Durata leads had can abrasions, and six leads had abrasions caused by friction with another device. Of these 18 can and other device abrasions, 13 (72%) had electrical abnormalities. Low impedances identified three internal insulation abrasions. Conclusions Riata ST Optim™ and Durata ICD leads have failed due to insulation abrasions. Optim™ did not prevent these abrasions, which developed ≤4 years after implant. Studies are needed to determine the incidence of these failures and their clinical implications. PMID:22915789

  15. Implantable Cardioverter-Defibrillator Shock after Stenting Across the Device Leads.

    PubMed

    Mehra, Sanjay; Chelu, Mihail Gabriel

    2016-02-01

    A 45-year-old man with nonischemic cardiomyopathy and end-stage renal disease had lived uneventfully with a cardiac resynchronization therapy defibrillator (CRT-D) for 5 years. Less than a month before presenting at our institution, he had undergone stenting of his partially occluded subclavian vein, to relieve stenosis of the ipsilateral arteriovenous fistula that was used for his hemodialysis. The CRT-D subsequently discharged. Device interrogation revealed that electrical noise originating from leads damaged by the stent had caused the inappropriate shock and intermittent electrical discharges thereafter. The patient was highly traumatized by these events and insisted upon device removal, which deprived him of a potentially life-saving intervention. He later had a cardiac arrest that resulted in sustained profound hypoxic ischemic encephalopathy with minimal neurologic recovery: his family placed him in a long-term care facility on ventilator support, with a tracheostomy and feeding tube. This situation might have been avoided through collaboration between the interventional radiologist and the electrophysiologist. To our knowledge, this is the first report of a patient with nonischemic cardiomyopathy and end-stage renal disease who presented with inappropriate defibrillator discharge caused by lead damage secondary to stenting across the leads. PMID:27047295

  16. Cost-Utility Analysis of the EVOLVO Study on Remote Monitoring for Heart Failure Patients With Implantable Defibrillators: Randomized Controlled Trial

    PubMed Central

    Landolina, Maurizio; Marzegalli, Maurizio; Lunati, Maurizio; Perego, Giovanni B; Guenzati, Giuseppe; Curnis, Antonio; Valsecchi, Sergio; Borghetti, Francesca; Borghi, Gabriella; Masella, Cristina

    2013-01-01

    Background Heart failure patients with implantable defibrillators place a significant burden on health care systems. Remote monitoring allows assessment of device function and heart failure parameters, and may represent a safe, effective, and cost-saving method compared to conventional in-office follow-up. Objective We hypothesized that remote device monitoring represents a cost-effective approach. This paper summarizes the economic evaluation of the Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators (EVOLVO) study, a multicenter clinical trial aimed at measuring the benefits of remote monitoring for heart failure patients with implantable defibrillators. Methods Two hundred patients implanted with a wireless transmission–enabled implantable defibrillator were randomized to receive either remote monitoring or the conventional method of in-person evaluations. Patients were followed for 16 months with a protocol of scheduled in-office and remote follow-ups. The economic evaluation of the intervention was conducted from the perspectives of the health care system and the patient. A cost-utility analysis was performed to measure whether the intervention was cost-effective in terms of cost per quality-adjusted life year (QALY) gained. Results Overall, remote monitoring did not show significant annual cost savings for the health care system (€1962.78 versus €2130.01; P=.80). There was a significant reduction of the annual cost for the patients in the remote arm in comparison to the standard arm (€291.36 versus €381.34; P=.01). Cost-utility analysis was performed for 180 patients for whom QALYs were available. The patients in the remote arm gained 0.065 QALYs more than those in the standard arm over 16 months, with a cost savings of €888.10 per patient. Results from the cost-utility analysis of the EVOLVO study show that remote monitoring is a cost-effective and dominant solution. Conclusions Remote management of heart

  17. Construction of intracardiac vectorcardiogram from implantable cardioverter-defibrillator intracardiac electrograms.

    PubMed

    Ghafoori, Elyar; Kabir, Muammar M; Cao, Jian; Shvilkin, Alexei; Tereshchenko, Larisa G

    2015-01-01

    We constructed an intracardiac vectorcardiogram from 3 configurations of intracardiac cardiovertor defibrilator (ICD) electrograms (EGMs). Six distinctive 3 lead combinations were selected out of five leads: can to right ventricular coil (RVC); RVC to superior vena cava coil (SVC); atrial lead tip (A-tip) to right ventricular (RV)-ring; can to RV-ring; RV-tip to RVC, in a patient with dual chamber ICD. Surface spatial QRS-T angle (119.8°) was similar to intracardiac spatial QRS-T angle derived from ICD EGMs combination A (101.3°), B (96.1°), C (92.8°), D (95.2), E (99.0), F (96.2) and median (101.5). Future validation of the novel method is needed. PMID:25987408

  18. Public Claims about Automatic External Defibrillators: An Online Consumer Opinions Study

    PubMed Central

    2011-01-01

    Background Patients are no longer passive recipients of health care, and increasingly engage in health communications outside of the traditional patient and health care professional relationship. As a result, patient opinions and health related judgements are now being informed by a wide range of social, media, and online information sources. Government initiatives recognise self-delivery of health care as a valuable means of responding to the anticipated increased global demand for health resources. Automated External Defibrillators (AEDs), designed for the treatment of Sudden Cardiac Arrest (SCA), have recently become available for 'over the counter' purchase with no need for a prescription. This paper explores the claims and argumentation of lay persons and health care practitioners and professionals relating to these, and how these may impact on the acceptance, adoption and use of these devices within the home context. Methods We carry out a thematic content analysis of a novel form of Internet-based data: online consumer opinions of AED devices posted on Amazon.com, the world's largest online retailer. A total of #83 online consumer reviews of home AEDs are analysed. The analysis is both inductive, identifying themes that emerged from the data, exploring the parameters of public debate relating to these devices, and also driven by theory, centring around the parameters that may impact upon the acceptance, adoption and use of these devices within the home as indicated by the Technology Acceptance Model (TAM). Results Five high-level themes around which arguments for and against the adoption of home AEDs are identified and considered in the context of TAM. These include opinions relating to device usability, usefulness, cost, emotional implications of device ownership, and individual patient risk status. Emotional implications associated with AED acceptance, adoption and use emerged as a notable factor that is not currently reflected within the existing TAM

  19. Contemporary strategies for risk stratification and prevention of sudden death with the implantable defibrillator in hypertrophic cardiomyopathy.

    PubMed

    Maron, Barry J; Maron, Martin S

    2016-05-01

    Hypertrophic cardiomyopathy (HCM) is regarded as the most common nontraumatic cause of sudden death (SD) in young people (including trained athletes). Introduction of implantable cardioverter-defibrillators (ICD) to HCM 15 years ago represented a new paradigm for clinical practice and probably the most significant advance in management of this disease. ICDs offer protection against SD by terminating potentially lethal ventricular tachyarrhythmias (11%/year secondary and 4%/year primary prevention), although implant decisions are weighed against the possibility of device-related complications (5%/year). ICDs have altered the natural history of HCM, creating the opportunity for extended or normal longevity for many patients. However, assessing SD risk and targeting appropriate candidates for prophylactic device therapy can be compounded by unpredictability of the underlying arrhythmogenic substrate, evident by delays ≥10 years between implant and first ICD intervention. Multiple or a single strong risk marker within the clinical profile of an individual HCM patient can justify consideration for a primary-prevention ICD when combined with physician judgment and shared decision making. The role of the mathematical SD risk score proposed by the European Society of Cardiology to identify patients who benefit from ICD therapy is incompletely resolved. Contemporary treatment interventions and advanced risk stratification using ≥1 conventional markers have served the HCM patient population well, with reduced disease-related mortality rates across all age groups to <1%/year, due largely to the penetration of ICDs into HCM practice. Prevention of SD has now become an integral, albeit challenging, component of HCM management, contributing importantly to its emergence as a contemporary treatable cardiac disease. PMID:26749314

  20. Replacement of implantable cardioverter defibrillators and cardiac resynchronization therapy devices: results of the European Heart Rhythm Association survey.

    PubMed

    Tilz, Roland; Boveda, Serge; Deharo, Jean-Claude; Dobreanu, Dan; Haugaa, Kristina H; Dagres, Nikolaos

    2016-06-01

    The aim of this EP Wire was to assess the management, indications, and techniques for implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) device replacement in Europe. A total of 24 centres in 14 European countries completed the questionnaire. All centres were members of the European Heart Rhythm Association Electrophysiology Research Network. Replacement procedures were performed by electrophysiologists in 52% of the centres, by cardiologists in 33%, and both in the remaining centres. In the majority of centres, the procedures were performed during a short hospitalization (<2 days; 61.2%), or on an outpatient basis (28%). The overwhelming majority of centres reported that they replaced ICDs at the end of battery life. Only in a small subset (<10%) of patients with ICD for primary prevention and without ventricular tachycardia (VT) since implantation, ICD was not replaced. In inherited primary arrhythmia syndromes, 80% of the centres always replaced the ICD at the end of battery life. After VT ablation, only few centres (9%) explanted or downgraded the device that was previously implanted for secondary prevention, but only in those patients without new VT episodes. Patient's life expectancy <1 year was the most commonly reported reason (61%) to downgrade from a CRT-D to a CRT-P device. While warfarin therapy was continued in 47% of the centres, non-vitamin K oral anticoagulants were discontinued without bridging 24 h prior to replacement procedures in 60%. Finally, in 65% of the centres, VT induction and shock testing during ICD and CRT-D replacement were performed only in the case of leads with a warning or with borderline measurements. This survey provides a snapshot of the perioperative management, indications, and techniques of ICD and CRT device replacement in Europe. It demonstrates some variations between participating centres, probably related to local policies and to the heterogeneity of the ICD population. PMID

  1. Potential clinical impact of cardiovascular magnetic resonance assessment of ejection fraction on eligibility for cardioverter defibrillator implantation

    PubMed Central

    2012-01-01

    Background For the primary prevention of sudden cardiac death, guidelines provide left ventricular ejection fraction (EF) criteria for implantable cardioverter defibrillator (ICD) placement without specifying the technique by which it should be measured. We sought to investigate the potential impact of performing cardiovascular magnetic resonance (CMR) for EF on ICD eligibility. Methods The study population consisted of patients being considered for ICD implantation who were referred for EF assessment by CMR. Patients who underwent CMR within 30 days of echocardiography were included. Echocardiographic EF was determined by Simpson’s biplane method and CMR EF was measured by Simpson’s summation of discs method. Results Fifty-two patients (age 62±15 years, 81% male) had a mean EF of 38 ± 14% by echocardiography and 35 ± 14% by CMR. CMR had greater reproducibility than echocardiography for both intra-observer (ICC, 0.98 vs 0.94) and inter-observer comparisons (ICC 0.99 vs 0.93). The limits of agreement comparing CMR and echocardiographic EF were – 16 to +10 percentage points. CMR resulted in 11 of 52 (21%) and 5 of 52 (10%) of patients being reclassified regarding ICD eligibility at the EF thresholds of 35 and 30% respectively. Among patients with an echocardiographic EF of between 25 and 40%, 9 of 22 (41%) were reclassified by CMR at either the 35 or 30% threshold. Echocardiography identified only 1 of the 6 patients with left ventricular thrombus noted incidentally on CMR. Conclusions CMR resulted in 21% of patients being reclassified regarding ICD eligibility when strict EF criteria were used. In addition, CMR detected unexpected left ventricular thrombus in almost 10% of patients. Our findings suggest that the use of CMR for EF assessment may have a substantial impact on management in patients being considered for ICD implantation. PMID:23043729

  2. Automatic Model Generation Framework for Computational Simulation of Cochlear Implantation.

    PubMed

    Mangado, Nerea; Ceresa, Mario; Duchateau, Nicolas; Kjer, Hans Martin; Vera, Sergio; Dejea Velardo, Hector; Mistrik, Pavel; Paulsen, Rasmus R; Fagertun, Jens; Noailly, Jérôme; Piella, Gemma; González Ballester, Miguel Ángel

    2016-08-01

    Recent developments in computational modeling of cochlear implantation are promising to study in silico the performance of the implant before surgery. However, creating a complete computational model of the patient's anatomy while including an external device geometry remains challenging. To address such a challenge, we propose an automatic framework for the generation of patient-specific meshes for finite element modeling of the implanted cochlea. First, a statistical shape model is constructed from high-resolution anatomical μCT images. Then, by fitting the statistical model to a patient's CT image, an accurate model of the patient-specific cochlea anatomy is obtained. An algorithm based on the parallel transport frame is employed to perform the virtual insertion of the cochlear implant. Our automatic framework also incorporates the surrounding bone and nerve fibers and assigns constitutive parameters to all components of the finite element model. This model can then be used to study in silico the effects of the electrical stimulation of the cochlear implant. Results are shown on a total of 25 models of patients. In all cases, a final mesh suitable for finite element simulations was obtained, in an average time of 94 s. The framework has proven to be fast and robust, and is promising for a detailed prognosis of the cochlear implantation surgery. PMID:26715210

  3. Symbolic Dynamics Analysis of Short Data Sets: an Application to Heart Rate Variability from Implantable Defibrillator Devices

    NASA Astrophysics Data System (ADS)

    Zebrowski, Jan J.; Baranowski, Rafal; Przybylski, Andrzej

    2003-07-01

    A method is described for the assessment of the complexity of short data sets by nonlinear dynamics. The method was devised for and tested on human heart rate recordings approximately 2000 to 9000 RR intervals long which were extracted from the memory of implantable defibrillator devices (ICD). It is, however, applicable in a more general context. The ICDs are meant to control life-threatening episodes of ventricular tachycardia and/or ventricular fibrillation by applying a electric shock to the heart through intracardiac electrodes. It is well known that conventional ICD algorithms yield approximately 20--30 % of spurious interventions. The main aim of this work is to look for nonlinear dynamics methods to enhance the appropriateness of the ICD intervention. We first showed that nonlinear dynamics methods first applied to 24-hour heart rate variability analysis were able to detect the need for the ICD intervention. To be applicable to future ICD use, the methods must also be low in computational requirements. Methods to analyse the complexity of the short and non-stationary sets were devised. We calculated the Shannon entropy of symbolic words obtained in a sliding 50 beat window and analysed the dependence of this complexity measure on the time. Precursors were found extending much earlier time than the time the standard ICD algorithms span.

  4. Physicians' preferences and attitudes about end-of-life care in patients with an implantable cardioverter-defibrillator.

    PubMed

    Sherazi, Saadia; Daubert, James P; Block, Robert C; Jeevanantham, Vinodh; Abdel-Gadir, Khalid; DiSalle, Michael R; Haley, James M; Shah, Abrar H

    2008-10-01

    Clinical guidance is deficient regarding deactivation of implantable cardioverter-defibrillators (ICDs) in patients with terminal illnesses. We hypothesized that many physicians are apprehensive about discussing ICD deactivation with their dying patients. Thus, we conducted an anonymous survey of all the physicians in the Department of Medicine at Unity Health System in Rochester, NY. The survey collected information about the knowledge and preferences of these physicians regarding the medical, ethical, and legal issues involved in caring for patients with an ICD and terminal illness. Of the 204 surveys distributed, 87 (43%) were returned. Among the physicians who responded, 64 (74%) reported experience caring for a patient with an ICD and terminal illness. Forty physicians (46%) either thought it was illegal or were not sure if it was legal to deactivate an ICD in these circumstances. However, if reassured about the legality of discontinuing ICD therapy, 79 (91%) of these same respondents said that they would be willing to discuss voluntary ICD deactivation with their dying patients. With increased knowledge about managing the withdrawal of this potentially life-prolonging therapy, physicians are likely to become more skilled at caring for dying patients with an ICD. PMID:18828973

  5. Anger-induced T-wave alternans predicts future ventricular arrhythmias in patients with implantable cardioverter-defibrillators

    PubMed Central

    Lampert, Rachel; Shusterman, Vladimir; Burg, Matthew; McPherson, Craig; Batsford, William; Goldberg, Anna; Soufer, Robert

    2014-01-01

    Objective To determine whether T-wave alternans (TWA) induced by anger in a laboratory setting predicts future ventricular arrhythmias (VT/VF) in patients with implantable cardioverter-defibrillators (ICDs). Background Anger can precipitate spontaneous VT/VF, and induce TWA. Whether anger-induced TWA predicts future arrhythmias is unknown. Methods Sixty-two patients with ICDs underwent ambulatory ECG during a mental stress protocol, three months post-implant. TWA was analyzed using time-domain methods. After ≥ 1 year follow-up, ICD stored data was reviewed to determine incidence of ICD-terminated VT/VF. Results Patients with ICD-terminated arrhythmias during follow-up (N=10) had higher TWA induced by anger, 13.2uV (iqr 9.3-16), compared to 9.3uV (7.5-11.5) (p<0.01). Patients in the highest quartile of anger-induced TWA (>11.9uV, N=15) were more likely to experience arrhythmias by one year than those in the lower quartiles, (33% versus 4%), and during extended follow-up (40% versus 9%, p<0.01 for both.) In multivariable regression controlling for ejection fraction, prior clinical arrhythmia, and wide QRS, anger-induced TWA remained a significant predictor of arrhythmia, with likelihood in the top quartile 10.8 times that of other patients (CI 1.6-113, p<0.05.) Conclusion Anger-induced TWA predicts future ventricular arrhythmias in patients with ICDs, suggesting that emotion-induced repolarization instability may be one mechanism linking stress and sudden death. Whether there is a clinical role for anger-induced TWA testing requires further study. PMID:19245968

  6. Cognitive-Behavioral Treatment of Posttraumatic Stress in Patients With Implantable Cardioverter Defibrillators: Results From a Randomized Controlled Trial.

    PubMed

    Ford, Jessica; Rosman, Lindsey; Wuensch, Karl; Irvine, Jane; Sears, Samuel F

    2016-08-01

    Approximately 20% of patients with implantable cardioverter defibrillators (ICDs) suffer from posttraumatic stress disorder (PTSD) due to a history of cardiac arrest, device implantation, and ICD shock. There has been very little examination of treatment of PTSD symptoms in these patients. This study evaluated the effect of a specific cognitive-behavioral therapy (CBT) intervention for ICD patients with high levels of PTSD symptoms: a manualized program consisting of 8 telephone sessions with a trained counselor, a patient education book, and a stress management procedure on compact disc. Participants were 193 ICD patients, who were randomized to CBT or usual cardiac care (UCC) who completed self-report surveys at the time of recruitment and 6 and 12 months after initial measurement. Previous publication on the primary research evaluation questions reported that the CBT condition resulted in greater improvement on PTSD and depression symptoms than the UCC for the general population of ICD patients, but did not evaluate the effect on those with elevated symptoms of PTSD. The authors conducted secondary analyses of the effect of treatment on high and low PTSD symptom groups based on a cutoff for the Impact of Event Scale-Revised (Weiss & Marmar, 1997). Participants in the CBT group who had high symptoms experienced significantly greater symptom reduction from baseline to 12 months (d = 2.44, p = .021) than the UCC group (d = 1.12). Participants with low symptoms had small reductions regardless of group assignment (d = 0.16, p = .031). ICD-focused CBT was sufficient to produce a large, statistically significant reduction in PTSD symptoms in ICD patients with indications for treatment. PMID:27415850

  7. Primary prevention implantable cardioverter defibrillators in end-stage kidney disease patients on dialysis: a matched cohort study

    PubMed Central

    Pun, Patrick H.; Hellkamp, Anne S.; Sanders, Gillian D.; Middleton, John P.; Hammill, Stephen C.; Al-Khalidi, Hussein R.; Curtis, Lesley H.; Fonarow, Gregg C.; Al-Khatib, Sana M.

    2015-01-01

    Background Sudden cardiac death is the leading cause of death among end-stage kidney disease patients (ESKD) on dialysis, but the benefit of primary prevention implantable cardioverter defibrillators (ICDs) in this population is uncertain. We conducted this investigation to compare the mortality of dialysis patients receiving a primary prevention ICD with matched controls. Methods We used data from the National Cardiovascular Data Registry's ICD Registry to select dialysis patients who received a primary prevention ICD, and the Get with the Guidelines-Heart Failure Registry to select a comparator cohort. We matched ICD recipients and no-ICD patients using propensity score techniques to reduce confounding, and overall survival was compared between groups. Results We identified 108 dialysis patients receiving primary prevention ICDs and 195 comparable dialysis patients without ICDs. One year (3-year) mortality was 42.2% (68.8%) in the ICD registry cohort compared with 38.1% (75.7%) in the control cohort. There was no significant survival advantage associated with ICD [hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.66–1.13, log-rank P = 0.29]. After propensity matching, our analysis included 86 ICD patients and 86 matched controls. Comparing the propensity-matched cohorts, 1 year (3 years) mortality was 43.4% (74.0%) in the ICD cohort and 39.7% (76.6%) in the control cohort; there was no significant difference in mortality outcome between groups (HR = 0.94, 95% CI: 0.67–1.31, log-rank P = 0.71). Conclusions We did not observe a significant association between primary prevention ICDs and reduced mortality among ESKD patients receiving dialysis. Consideration of the potential risks and benefits of ICD implantation in these patients should be undertaken while awaiting the results of definitive clinical trials. PMID:25404241

  8. Efficacy of cognitive behavioral therapy in reducing psychiatric symptoms in patients with implantable cardioverter defibrillator: an integrative review

    PubMed Central

    Maia, A.C.C.O.; Braga, A.A.; Soares-Filho, G.; Pereira, V.; Nardi, A.E.; Silva, A.C.

    2014-01-01

    This article is a systematic review of the available literature on the benefits that cognitive behavioral therapy (CBT) offers patients with implanted cardioverter defibrillators (ICDs) and confirms its effectiveness. After receiving the device, some patients fear that it will malfunction, or they remain in a constant state of tension due to sudden electrical discharges and develop symptoms of anxiety and depression. A search with the key words “anxiety”, “depression”, “implantable cardioverter”, “cognitive behavioral therapy” and “psychotherapy” was carried out. The search was conducted in early January 2013. Sources for the search were ISI Web of Knowledge, PubMed, and PsycINFO. A total of 224 articles were retrieved: 155 from PubMed, 69 from ISI Web of Knowledge. Of these, 16 were written in a foreign language and 47 were duplicates, leaving 161 references for analysis of the abstracts. A total of 19 articles were eliminated after analysis of the abstracts, 13 were eliminated after full-text reading, and 11 articles were selected for the review. The collection of articles for literature review covered studies conducted over a period of 13 years (1998-2011), and, according to methodological design, there were 1 cross-sectional study, 1 prospective observational study, 2 clinical trials, 4 case-control studies, and 3 case studies. The criterion used for selection of the 11 articles was the effectiveness of the intervention of CBT to decrease anxiety and depression in patients with ICD, expressed as a ratio. The research indicated that CBT has been effective in the treatment of ICD patients with depressive and anxiety symptoms. Research also showed that young women represented a risk group, for which further study is needed. Because the number of references on this theme was small, further studies should be carried out. PMID:24652325

  9. Assessing the psychosocial impact of the ICD: a national survey of implantable cardioverter defibrillator health care providers.

    PubMed

    Sears, S F; Todaro, J F; Urizar, G; Lewis, T S; Sirois, B; Wallace, R; Sotile, W; Curtis, A B; Conti, J B

    2000-06-01

    The implantable cardioverter defibrillator (ICD) provides a survival advantage over antiarrhythmic medications for patients with life-threatening ventricular arrhythmias. However, the effect of ICD therapy on quality-of-life and psychosocial functioning are not as well understood. Health care providers (e.g., physicians, nurses) can serve as a valuable source of information related to these ICD outcomes. The purpose of this study was to investigate health care provider perceptions regarding: (1) the quality-of-life and psychosocial functioning of their ICD recipients, (2) the concerns or problems reported by ICD recipients, and (3) the degree of provider comfort in managing these concerns. The final sample of health care providers (n = 261) rated ICD recipients' global quality-of-life and psychosocial functioning, and specific concerns about health care, lifestyle, special population adjustment, marital and family adjustment, and emotional well-being. With regard to quality-of-life, health care providers reported that the majority of ICD recipients were functioning better (38%) or about the same (47%) than before implantation. However, health care providers reported that 15% of recipients experienced worse quality-of-life postimplantation. Similarly, health care providers indicated that 10%-20% of ICD recipients experienced worse emotional functioning and strained family relationships. Moreover, issues related to driving, dealing with ICD shocks, and depression were the most common ICD recipient concerns. Significant differences were noted between physicians and nurses/other health care professionals on a wide range of psychosocial issues. Health care providers generally reported the most comfort dealing with traditional medical issues (i.e., patient adherence), and the least comfort in managing emotional well-being issues (e.g., depression and anxiety). These results suggest that routine attention to ICD quality-of-life and psychosocial outcomes is indicated for

  10. Rationale and design of a prospective study of the efficacy of a remote monitoring system used in implantable cardioverter defibrillator follow-up: the Lumos-T Reduces Routine Office Device Follow-Up Study (TRUST) study.

    PubMed

    Varma, Niraj

    2007-12-01

    Increased implantable cardioverter defibrillator (ICD) implant volumes (and product advisories/recalls) pose management challenges. Most device interrogations at 3- to 6-month routine follow-up visits are "nonactionable," that is, require no clinically significant reprogramming, lead revision, or initiation or up-titration of antiarrhythmic medications. Conversely, implanted devices collect important diagnostic data (eg, atrial fibrillation onset, system integrity) that remain concealed between device interrogations. Remote monitoring may resolve some of these challenges, but has not been studied in a large-scale clinical trial. Home Monitoring (HM) uses automatic (without patient intervention) data and electrogram transmissions with rapid (<24 hours) event notification of significant (including silent) events. The Lumos-T Reduces Routine Office Device Follow-Up Study (TRUST) is a multicenter, prospective, randomized study enrolling 1000 ICD patients designed to test whether HM can safely reduce the number of scheduled nonactionable office device interrogations by 50% and provide early detection and notification of cardiac and/or device problems. After enrollment, TRUST patients are randomized 2:1 to either HM or to control (ie, HM off) arms and are seen for an in-office follow-up 3 months postimplant. At subsequent 3-month intervals, control patients have conventional office visits, whereas in HM, patient data are remotely retrieved and evaluated. In HM patients, early notification may automatically occur between periodic checks for compromised system integrity (battery, lead parameters, high-voltage circuitry) or arrhythmia occurrence (eg, atrial fibrillation, ventricular arrhythmia). All study patients will have a final office visit 15 months after implant. The results of TRUST may confirm the role of remote monitoring as an intensive surveillance mechanism for device management. PMID:18035071

  11. Gender, Racial, and Health Insurance Differences in the Trend of Implantable Cardioverter-Defibrillator (ICD) Utilization: A United States Experience Over the Last Decade.

    PubMed

    Patel, Nileshkumar J; Edla, Sushruth; Deshmukh, Abhishek; Nalluri, Nikhil; Patel, Nilay; Agnihotri, Kanishk; Patel, Achint; Savani, Chirag; Patel, Nish; Bhimani, Ronak; Thakkar, Badal; Arora, Shilpkumar; Asti, Deepak; Badheka, Apurva O; Parikh, Valay; Mitrani, Raul D; Noseworthy, Peter; Paydak, Hakan; Viles-Gonzalez, Juan; Friedman, Paul A; Kowalski, Marcin

    2016-02-01

    Prior studies have highlighted disparities in cardiac lifesaving procedure utilization, particularly among women and in minorities. Although there has been a significant increase in implantable cardioverter-defibrillator (ICD) insertion, socioeconomic disparities still exist in the trend of ICD utilization. With the use of the Nationwide Inpatient Sample from 2003 through 2011, we identified subjects with ICD insertion (procedure code 37.94) and cardiac resynchronization defibrillator (procedure code 00.50, 00.51) as codified by the International Classification of Diseases, Ninth Revision, Clinical Modification. Overall, 1 020 076 ICDs were implanted in the United States from 2003 to 2011. We observed an initial increase in ICD utilization by 51%, from 95 062 in 2003 to 143 262 in 2006, followed by a more recent decline. The majority of ICDs were implanted in men age ≥65 years. Implantation of ICDs was 2.5× more common in men than in women (402 per million vs 163 per million). Approximately 95% of the ICDs were implanted in insured patients, and 5% were used in the uninsured population. There has been a significant increase in ICD implantation in blacks, from 162 per million in 2003 to 291 per million in 2011. We found a significant difference in the volume of ICD implants between the insured and the uninsured patient populations. Racial disparities have narrowed significantly in comparison with those noted in earlier studies and are now more reflective of the population demographics at large. On the other hand, significant gender disparities continue to exist. PMID:26799597

  12. Magnetic resonance imaging, pacemakers and implantable cardioverter-defibrillators: current situation and clinical perspective

    PubMed Central

    Götte, M.J.W.; Rüssel, I.K.; de Roest, G.J.; Germans, T.; Veldkamp, R.F.; Knaapen, P.; Allaart, C.P.; van Rossum, A.C.

    2010-01-01

    New developments and expanding indications have resulted in a significant increase in the number of patients with pacemakers and internal cardioverterdefibrillators (ICDs). Because of its unique capabilities, magnetic resonance imaging (MRI) has become one of the most important imaging modalities for evaluation of the central nervous system, tumours, musculoskeletal disorders and some cardiovascular diseases. As a consequence of these developments, an increasing number of patients with implanted devices meet the standard indications for MRI examination. Due to the presence of potential life-threatening risks and interactions, however, pacemakers and ICDs are currently not approved by the Food and Drug Administration (FDA) for use in an MRI scanner. Despite these limitations and restrictions, a limited but still growing number of studies reporting on the effects and safety issues of MRI and implanted devices have been published. Because physicians will be increasingly confronted with the issue of MRI in patients with implanted devices, this overview is given. The effects of MRI on an implanted pacemaker and/or ICDs and vice versa are described and, based on the current literature, a strategy for safe performance of MRI in these patients is proposed. (Neth Heart J 2010;18:31-7.) PMID:20111641

  13. Effect of Advancing Age and Multiple Chronic Conditions on Mortality in Patients with End-Stage Renal Disease after Implantable Cardioverter-Defibrillator Placement

    PubMed Central

    Krishnaswami, Ashok; Kiley, Mary-Lou; Anthony, Faith F; Chen, Yuexin; Chen, Jason; Rajagopal, Sumanth; Liu, Taylor I; Young, Charlie; Paxton, Elizabeth W

    2016-01-01

    Context: There is insufficient information on the effect that advancing age and multiple chronic conditions (MCC) have on mortality after placement of an implantable cardioverter-defibrillator in patients with end-stage renal disease (ESRD) vs non-ESRD. Objective: To assess whether a differential effect of age and MCC exists between ESRD and non-ESRD. Design: Population-based, retrospective cohort study using data from the national Kaiser Permanente Cardiac Device Registry of patients who underwent placement of an implantable cardioverter-defibrillator between January 1, 2007, and December 31, 2013. Main Outcome Measures: All-cause mortality. Results: Of 7825 patients with implantable cardioverter-defibrillator placement, ESRD-affected patients constituted 4.0% of the cohort (n = 311), were similar in age (p = 0.91), and presented with a larger comorbidity burden (3.3 ± 1.3 vs 2.4 ± 1.5, p < 0.001). The effect of advancing age (every 5 years) on mortality in the ESRD cohort (hazard ratio [HR] = 1.11, 95% confidence interval [CI] = 1.03–1.20) was less than in the non-ESRD cohort (HR = 1.28, 95% CI = 1.25–1.32). Similarly, the effect of each additional comorbidity in the ESRD cohort was less (HR = 1.04, 95% CI = 0.91–1.19) than in the non-ESRD group (HR = 1.20, 95% CI = 1.16–1.25). Lastly, ESRD was independently associated with a 3-fold greater hazard of mortality. Conclusions: Advancing age and increasing number of MCC have a differential effect on mortality risk in patients with ESRD compared with their non-ESRD counterparts. Future studies should focus on assessment of nonlinear relationships of age, MCC, and naturally occurring clusters of MCC on mortality. PMID:26562307

  14. Development and Testing of an Intervention to Improve Outcomes for Partners Following Receipt of an Implantable Cardioverter Defibrillator in the Patient

    PubMed Central

    Dougherty, Cynthia M.; Thompson, Elaine A.; Kudenchuk, Peter J.

    2013-01-01

    The purpose of this article is to describe 3 foundational studies and how their results were used to formulate, design, and test a novel partner intervention for implementation in the immediate post-ICD (implantable cardioverter defibrillator) period after returning home. Nursing’s expanding role into chronic illness management in the creation of evidence-based practice is highlighted. A randomized clinical trial comparing 2 intervention programs is being conducted with patients who receive an ICD for the first time and their intimate partners. Primary outcomes are physical functioning, psychological adjustment, relationship impact, and health care utilization. PMID:23107992

  15. Costs of remote monitoring vs. ambulatory follow-ups of implanted cardioverter defibrillators in the randomized ECOST study

    PubMed Central

    Guédon-Moreau, Laurence; Lacroix, Dominique; Sadoul, Nicolas; Clémenty, Jacques; Kouakam, Claude; Hermida, Jean-Sylvain; Aliot, Etienne; Kacet, Salem

    2014-01-01

    Aims The Effectiveness and Cost of ICD follow-up Schedule with Telecardiology (ECOST) trial evaluated prospectively the economic impact of long-term remote monitoring (RM) of implantable cardioverter defibrillators (ICDs). Methods and results The analysis included 310 patients randomly assigned to RM (active group) vs. ambulatory follow-ups (control group). Patients in the active group were seen once a year unless the system reported an event mandating an ambulatory visit, while patients in the control group were seen in the ambulatory department every 6 months. The costs of each follow-up strategy were compared, using the actual billing documents issued by the French health insurance system, including costs of (i) (a) ICD-related ambulatory visits and transportation, (b) other ambulatory visits, (c) cardiovascular treatments and procedures, and (ii) hospitalizations for the management of cardiovascular events. The ICD and RM system costs were calculated on the basis of the device remaining longevity at the end of the study. The characteristics of the study groups were similar. Over a follow-up of 27 months, the mean non-hospital costs per patient-year were €1695 ± 1131 in the active, vs. €1952 ± 1023 in the control group (P = 0.04), a €257 difference mainly due to device management. The hospitalization costs per patient-year were €2829 ± 6382 and €3549 ± 9714 in the active and control groups, respectively (P = 0.46). Adding the ICD to the non-hospital costs, the savings were €494 (P = 0.005) or, when the monitoring system was included, €315 (P = 0.05) per patient-year. Conclusion From the French health insurance perspective, the remote management of ICD patients is cost saving. Clinical trials registration NCT00989417, www.clinicaltrials.gov PMID:24614572

  16. Characteristics associated with low treatment satisfaction in patients with implanted cardioverter defibrillators: results from the LICAD study.

    PubMed

    Ladwig, Karl-Heinz; Deisenhofer, Isabelle; Simon, Heidi; Schmitt, Claus; Baumert, Jens J

    2005-06-01

    The evaluation of low treatment satisfaction (LTS) with an implanted cardioverter defibrillator (ICD) remains a neglected area of clinical research. However, a trustful attitude toward an ICD is crucial. Within the scope of ICD health technology assessment, we searched for predictors of LTS. Of 195 ICD patients enrolled (mean 59.8 years, standard deviation 12.6), 163 (83.6%) were men and 26 (16.4%) were women. We measured anxiety, helplessness, and depression with standardized instruments and LTS with 11 dichotomous items concerning a mistrustful attitude, a negative body image, and low appraisal. A total of 47 (24.1%) patients were considered as LTS patients. Multivariate logistic regression was used for assessment of LTS. Adjusted for age and survey, LTS was significantly more prevalent in depressed, anxious, and phobic patients. Multivariate logistic regression including medical and psychological covariates revealed the experience of > or =5 shocks with an odds ratio (OR) of 10.17 (95% CI 3.57-29.00, P < or = 0.001), being employed with an OR of 8.07 (95% CI 2.39-27.19, P < or = 0.001), and feelings of helplessness (OR 4.61, 95% CI 1.79-11.90, P < or = 0.002) as the most important predictors for LTS. Women had a slightly not significant effect on LTS. Age, educational status, and depression were not significant. LTS patients required more support for living with the ICD (P < or = 0.001). Thus, LTS serves as surrogate measure for deteriorated psychic health. Clinicians should be advised to identify LTS patients and to consider psychotherapeutic counseling for them. PMID:15955182

  17. A pilot study of a mindfulness based stress reduction program in adolescents with implantable cardioverter defibrillators or pacemakers.

    PubMed

    Freedenberg, Vicki A; Thomas, Sue A; Friedmann, Erika

    2015-04-01

    Adolescents with implantable cardioverter defibrillators (ICDs) or pacemakers (PMs) face unique challenges that can cause psychosocial distress. Psychosocial interventions are effective for adults with cardiac devices and could potentially impact adolescents' adjustment to these devices. Mindfulness Based Stress Reduction (MBSR) is a structured psycho-educational program that includes meditation, yoga, and group support and has been studied extensively among adults. This study examined the feasibility of the MBSR program for adolescents with ICDs/PMs, a population previously unexamined in the research literature. The participants completed measures of anxiety and depression (Hospital Anxiety and Depression Scale) and coping (Responses to Stress Questionnaire) at baseline and after the six-session MBSR intervention. Mean age of the cohort (n = 10) was 15 ± 3 years, 6 were male, 6 had a PM, and 4 had an ICD. Feasibility was demonstrated by successful recruitment of 10 participants, 100 % participation and completion. Anxiety decreased significantly following the intervention, with a large effect size, t[9] = 3.67, p < .01, ŋ (2) = .59. Anxiety frequency decreased from baseline to post-intervention (Fisher's exact test p = .024), and 90 % of participants reported decreased anxiety scores post-intervention. Coping skills related negatively to anxiety (r = -.65, p = .04) and depression (r = -.88, p = .001). Post-intervention, the group independently formed their own Facebook group and requested to continue meeting monthly. Although generalizability is limited due to the small sample size, this successful pilot study paves the way for larger studies to examine the efficacy of MBSR interventions in adolescents with high-risk cardiac diagnoses. PMID:25519914

  18. Radiography of Cardiac Conduction Devices: A Pictorial Review of Pacemakers and Implantable Cardioverter Defibrillators

    PubMed Central

    Torres-Ayala, Stephanie C; Santacana-Laffitte, Guido; Maldonado, José

    2014-01-01

    Cardiac conduction devices (CCDs) depend on correct anatomic positioning to function properly. Chest radiography is the preferred imaging modality to evaluate CCD's anatomic location, lead wire integrity, and help in identifying several complications. In this pictorial review, our goal is to familiarize radiologists with CCD implantation techniques, appropriate positioning of the device, common causes of malfunction, methods to improve report accuracy, and assure maximal therapeutic benefit. PMID:25806132

  19. Prostate brachytherapy postimplant dosimetry: Automatic plan reconstruction of stranded implants

    SciTech Connect

    Chng, N.; Spadinger, I.; Morris, W. J.; Usmani, N.; Salcudean, S.

    2011-01-15

    Purpose: Plan reconstruction for permanent implant prostate brachytherapy is the process of determining the correspondence between planned and implanted seeds in postimplant analysis. Plan reconstruction informs many areas of brachytherapy quality assurance, including the verification of seed segmentation, misplacement and migration assessment, implant simulations, and the dosimetry of mixed-activity or mixed-species implants. Methods: An algorithm has been developed for stranded implants which uses the interseed spacing constraints imposed by the suture to improve the accuracy of reconstruction. Seventy randomly selected clinical cases with a mean of 23.6 (range 18-30) needles and mean density of 2.0 (range 1.6-2.6) 2.0 (range 1.6-2.6) seeds/cm{sup 3} were automatically reconstructed and the accuracy compared to manual reconstructions performed using a custom 3D graphical interface. Results: Using the automatic algorithm, the mean accuracy of the assignment relative to manual reconstruction was found to be 97.7{+-}0.5%. Fifty-two of the 70 cases (74%) were error-free; of seeds in the remaining cases, 96.7{+-}0.3% were found to be attributed to the correct strand and 97.0{+-}0.3% were correctly connected to their neighbors. Any necessary manual correction using the interface is usually straightforward. For the clinical data set tested, neither the number of seeds or needles, average density, nor the presence of clusters was found to have an effect on reconstruction accuracy using this method. Conclusions: Routine plan reconstruction of stranded implants can be performed with a high degree of accuracy to support postimplant dosimetry and quality analyses.

  20. Prediction of Appropriate Shocks Using 24-Hour Holter Variables and T-Wave Alternans After First Implantable Cardioverter-Defibrillator Implantation in Patients With Ischemic or Nonischemic Cardiomyopathy.

    PubMed

    Seegers, Joachim; Bergau, Leonard; Expósito, Pascal Muñoz; Bauer, Axel; Fischer, Thomas H; Lüthje, Lars; Hasenfuß, Gerd; Friede, Tim; Zabel, Markus

    2016-07-01

    In patients treated with implantable cardioverter defibrillator (ICD), prediction of both overall survival and occurrence of shocks is important if improved patient selection is desired. We prospectively studied the predictive value of biomarkers and indexes of cardiac and renal function and spectral microvolt T-wave alternans testing and 24-hour Holter variables in a population who underwent first ICD implantation. Consecutive patients in sinus rhythm with ischemic or dilated cardiomyopathy scheduled for primary or secondary prophylactic ICD implantation were enrolled. Exercise microvolt T-wave alternans and 24-hour Holter for number of ventricular premature contractions (VPCs), deceleration capacity, heart rate variability, and heart rate turbulence were done. Death of any cause and first appropriate ICD shock were defined as end points. Over 33 ± 15 months of follow-up, 36 of 253 patients (14%) received appropriate shocks and 39 of 253 patients (15%) died. Only 3 of 253 patients (1%) died after receiving at least 1 appropriate shock. In univariate analyses, New York Heart Association class, ejection fraction, N-terminal pro brain-type natriuretic peptide (NT-proBNP), renal function, ICD indication, deceleration capacity, heart rate variability, and heart rate turbulence were predictive of all-cause mortality and VPC number and deceleration capacity predicted first appropriate shock. NT-proBNP (≥1,600 pg/ml) was identified as the only independent predictor of all-cause mortality (hazard ratio 3.0, confidence interval 1.3 to 7.3, p = 0.014). In contrast, VPC number predicted appropriate shocks (hazard ratio 2.3, confidence interval 1.0 to 5.5, p = 0.047) as the only independent risk marker. In conclusion, NT-proBNP is a strong independent predictor of mortality in a typical prospective cohort of newly implanted patients with ICD, among many electrocardiographic and clinical variables studied. Number of VPCs was identified as a predictor of appropriate shocks

  1. Roles and indications for use of implantable defibrillator and resynchronization therapy in the prevention of sudden cardiac death in heart failure.

    PubMed

    Biton, Yitschak; Baman, Jayson R; Polonsky, Bronislava

    2016-07-01

    Implantable devices are indicated in the primary and secondary prevention of potentially life-threatening ventricular tachyarrhythmias in patients with heart failure. Early studies, including the landmark MADIT trials, showed that implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices can play a significant role in aborting and preventing ventricular arrhythmias, respectively, that can cause sudden cardiac death. To this day, there have been a number of randomized controlled trials, with respective substudy analyses, that have attempted to better understand the indications for these interventions in patient care. Here, we summarize the major results of these studies, and we discuss the role of ICD therapy for both ischemic and non-ischemic cardiomyopathy, emerging evidence in support of wearable defibrillators, and the impact of modified ICD programming strategies on patient outcomes. Regarding CRT therapy, the phenomenon of ventricular reverse remodeling is an important prognostic indicator in preventing future ventricular tachyarrhythmia episodes. In summation, we provide an overview of the possible selection criteria that can be used in identifying appropriate patients for ICD and/or CRT therapy, as supported by the data. PMID:26910804

  2. An updated review of implantable cardioverter/defibrillators, induced anxiety, and quality of life.

    PubMed

    Bostwick, J Michael; Sola, Christopher L

    2007-12-01

    During the past 2 years the number of studies examining psychopathology and quality of life after ICD implantation has increased dramatically. Variables assessed have included recipient age, gender, and social support network. How recipients respond to having the device, particularly after experiencing firing, has been evaluated in light of new depression and anxiety disorder diagnoses as well as premorbid personality structure. Now the picture of what is known is, if anything, cloudier than it was 2 years ago, with little definitive and much contradictory data emerging in most of these categories. It still seems clear that in a significant minority of ICD recipients the device negatively affects quality of life, probably more so if it fires. Education about life with the device before receiving it remains paramount. Reports continue to appear of patients developing new-onset diagnosable anxiety disorders such as panic and posttraumatic stress disorder. Until recently the strongest predictors of induced psychopathology were considered to be the frequency and recency of device firing. It now seems that preimplantation psychologic variables such as degree of optimism or pessimism and an anxious personality style may confer an even greater risk than previously thought. Certainly many variables factor into the induction of psychopathology in these patients. Among these factors are age, gender, and perception of control of shocks, as well as the predictability of shocks and psychologic attributions made by the patient regarding the device. Another source of variability is this population's medical heterogeneity. Some patients receive ICDs after near-death experiences; others get them as anticipatory prophylaxis. Some have longstanding and entrenched heart disease; others were apparently healthy before sudden dangerous arrhythmias. Diagnoses as diverse as myocardial infarction in the context of advanced coronary artery disease and dilated cardiomyopathy after acute viral

  3. Circadian variations in the occurrence of ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators.

    PubMed

    Kozák, Milan; Krivan, Lubomír; Semrád, Borivoj

    2003-03-01

    A circadian distribution has been demonstrated in episodes of sudden cardiac death, acute myocardial infarction, ventricular premature complexes, heart rate variability, and ventricular tachyarrhythmias. The aim of this study was to evaluate the circadian distribution of ventricular tachyarrhythmia episodes in a population of ICD patients. Data were gathered from 72 patients (55 men, 17 women; mean age 62.7 +/- 12.2 years, mean LVEF 0.0037 +/- 0.0011) with ICDs implanted for standard indications. Patients were followed every 3 months over a mean period of 21 +/- 12.8 months. At each examination, symptoms at arrhythmia onset and perception of ICD therapy were recorded, and the ICD memory was interrogated. During follow-up, 1,023 episodes' of malignant ventricular arrhythmias were detected and effectively terminated, 506 of which were fully analyzed. A morning peak in ventricular tachyarrhythmias was demonstrated between 7:00 and 11:00 AM, and an afternoon peak between 6:00 and 7:00 PM. A significantly lower occurrence of VT was observed at 1:00 AM and between 4:00 and 6:00 AM. A circadian distribution in the occurrence of ventricular tachycardias was found. The three striking features of the data are: the early morning peak (about three hours after waking up), relatively stable incidence throughout waking hours, and decline in incidence in the previous period. PMID:12698674

  4. Implantable acoustic-beacon automatic fish-tracking system

    NASA Technical Reports Server (NTRS)

    Mayhue, R. J.; Lovelady, R. W.; Ferguson, R. L.; Richards, C. E.

    1977-01-01

    A portable automatic fish tracking system was developed for monitoring the two dimensional movements of small fish within fixed areas of estuarine waters and lakes. By using the miniature pinger previously developed for this application, prototype tests of the system were conducted in the York River near the Virginia Institute of Marine Science with two underwater listening stations. Results from these tests showed that the tracking system could position the miniature pinger signals to within + or - 2.5 deg and + or - 135 m at ranges up to 2.5 km. The pingers were implanted in small fish and were successfully tracked at comparable ranges. No changes in either fish behavior or pinger performance were observed as a result of the implantation. Based on results from these prototype tests, it is concluded that the now commercially available system provides an effective approach to underwater tracking of small fish within a fixed area of interest.

  5. Results of ENHANCED Implantable Cardioverter Defibrillator Programming to Reduce Therapies and Improve Quality of Life (from the ENHANCED-ICD Study).

    PubMed

    Mastenbroek, Mirjam H; Pedersen, Susanne S; van der Tweel, Ingeborg; Doevendans, Pieter A; Meine, Mathias

    2016-02-15

    Novel implantable cardioverter defibrillator (ICD) discrimination algorithms and programming strategies have significantly reduced the incidence of inappropriate shocks, but there are still gains to be made with respect to reducing appropriate but unnecessary antitachycardia pacing (ATP) and shocks. We examined whether programming a number of intervals to detect (NID) of 60/80 for ventricular tachyarrhythmia (VT)/ventricular fibrillation (VF) detection was safe and the impact of this strategy on (1) adverse events related to ICD shocks and syncopal events; (2) ATPs/shocks; and (3) patient-reported outcomes. The "ENHANCED Implantable Cardioverter Defibrillator programming to reduce therapies and improve quality of life" study (ENHANCED-ICD study) was a prospective, safety-monitoring study enrolling 60 primary and secondary prevention patients at the University Medical Center Utrecht. Patients implanted with any type of ICD with SmartShock technology and aged 18 to 80 years were eligible to participate. In all patients, a prolonged NID 60/80 was programmed. The cycle length for VT/fast VT/VF was 360/330/240 ms, respectively. Programming a NID 60/80 proved safe for ICD patients. Because of the new programming strategy, unnecessary ICD therapy was prevented in 10% of ENHANCED-ICD patients during a median follow-up period of 1.3 years. With respect to patient-reported outcomes, levels of distress were highest and perceived health status lowest at the time of implantation, which both gradually improved during follow-up. In conclusion, the ENHANCED-ICD study demonstrates that programming a NID 60/80 for VT/VF detection is safe for ICD patients and does not negatively impact their quality of life. PMID:26732419

  6. Association Between Comorbidities and Outcomes in Heart Failure Patients With and Without an Implantable Cardioverter-Defibrillator for Primary Prevention

    PubMed Central

    Khazanie, Prateeti; Hellkamp, Anne S; Fonarow, Gregg C; Bhatt, Deepak L; Masoudi, Frederick A; Anstrom, Kevin J; Heidenreich, Paul A; Yancy, Clyde W; Curtis, Lesley H; Hernandez, Adrian F; Peterson, Eric D; Al-Khatib, Sana M

    2015-01-01

    Background Implantable cardioverter-defibrillator (ICD) therapy is associated with improved outcomes in patients with heart failure (HF), but whether this association holds among older patients with multiple comorbid illnesses and worse HF burden remains unclear. Methods and Results Using the National Cardiovascular Data Registry’s ICD Registry and the Get With The Guidelines–Heart Failure (GWTG-HF) registry linked with Medicare claims, we examined outcomes associated with primary-prevention ICD versus no ICD among HF patients aged ≥65 years in clinical practice. We included patients with an ejection fraction ≤35% who received (ICD Registry) and who did not receive (GWTG-HF) an ICD. Compared with patients with an ICD, patients in the non-ICD group were older and more likely to be female and white. In matched cohorts, the 3-year adjusted mortality rate was lower in the ICD group versus the non-ICD group (46.7% versus 55.8%; adjusted hazard ratio [HR] 0.76; 95% CI 0.69 to 0.83). There was no associated difference in all-cause readmission (HR 0.99; 95% CI 0.92 to 1.08) but a lower risk of HF readmission (HR 0.88; 95% CI 0.80 to 0.97). When compared with no ICD, ICDs were also associated with better survival in patients with ≤3 comorbidities (HR 0.77; 95% CI 0.69 to 0.87) and >3 comorbidities (HR 0.77; 95% CI 0.64 to 0.93) and in patients with no hospitalization for HF (HR 0.75; 95% CI 0.65 to 0.86) and at least 1 prior HF hospitalization (HR 0.69; 95% CI 0.58 to 0.82). In subgroup analyses, there were no interactions between ICD and mortality risk for comorbidity burden (P=0.95) and for prior HF hospitalization (P=0.46). Conclusion Among older HF patients, ICDs for primary prevention were associated with lower risk of mortality even among those with high comorbid illness burden and prior HF hospitalization. PMID:26251283

  7. Large Controlled Observational Study on Remote Monitoring of Pacemakers and Implantable Cardiac Defibrillators: A Clinical, Economic, and Organizational Evaluation

    PubMed Central

    2016-01-01

    Background Patients with implantable devices such as pacemakers (PMs) and implantable cardiac defibrillators (ICDs) should be followed up every 3–12 months, which traditionally required in-clinic visits. Innovative devices allow data transmission and technical or medical alerts to be sent from the patient's home to the physician (remote monitoring). A number of studies have shown its effectiveness in timely detection and management of both clinical and technical events, and endorsed its adoption. Unfortunately, in daily practice, remote monitoring has been implemented in uncoordinated and rather fragmented ways, calling for a more strategic approach. Objective The objective of the study was to analyze the impact of remote monitoring for PM and ICD in a “real world” context compared with in-clinic follow-up. The evaluation focuses on how this service is carried out by Local Health Authorities, the impact on the cardiology unit and the health system, and organizational features promoting or hindering its effectiveness and efficiency. Methods A multi-center, multi-vendor, controlled, observational, prospective study was conducted to analyze the impact of remote monitoring implementation. A total of 2101 patients were enrolled in the study: 1871 patients were followed through remote monitoring of PM/ICD (I-group) and 230 through in-clinic visits (U-group). The follow-up period was 12 months. Results In-clinic device follow-ups and cardiac visits were significantly lower in the I-group compared with the U-group, respectively: PM, I-group = 0.43, U-group = 1.07, P<.001; ICD, I-group = 0.98, U-group = 2.14, P<.001. PM, I-group = 0.37, U-group = 0.85, P<.001; ICD, I-group = 1.58, U-group = 1.69, P=.01. Hospitalizations for any cause were significantly lower in the I-group for PM patients only (I-group = 0.37, U-group = 0.50, P=.005). There were no significant differences regarding use of the emergency department for both PM and ICD patients. In the I-group, 0.30 (PM

  8. Primary Prevention of Sudden Cardiac Death in Adults with Transposition of the Great Arteries: A Review of Implantable Cardioverter-Defibrillator Placement

    PubMed Central

    Cedars, Ari M.

    2015-01-01

    Transposition of the great arteries encompasses a set of structural congenital cardiac lesions that has in common ventriculoarterial discordance. Primarily because of advances in medical and surgical care, an increasing number of children born with this anomaly are surviving into adulthood. Depending upon the subtype of lesion or the particular corrective surgery that the patient might have undergone, this group of adult congenital heart disease patients constitutes a relatively new population with unique medical sequelae. Among the more common and difficult to manage are cardiac arrhythmias and other sequelae that can lead to sudden cardiac death. To date, the question of whether implantable cardioverter-defibrillators should be placed in this cohort as a preventive measure to abort sudden death has largely gone unanswered. Therefore, we review the available literature surrounding this issue. PMID:26413012

  9. Implantable cardioverter-defibrillator therapy in a 34-year-old patient with eating disorders and after the third sudden cardiac arrest.

    PubMed

    Piotrowicz, Ewa; Orzechowski, Piotr; Bilinska, Maria; Przybylski, Andrzej; Szumowski, Lukasz; Piotrowicz, Ryszard

    2015-03-01

    Eating disorders (ED) such as anorexia nervosa and bulimia are psychiatric diseases associated with the highest mortality rate of any other psychiatric disorders. More recently, long-term outcome studies with follow-up of over 20 years report a mortality of between 15% and 18% (Casiero and Frishman, Cardiol Rev 14(5), 227, 2006). The sudden death secondary to arrhythmias is often the cause of death in these patients (Casiero and Frishman, Cardiol Rev 14(5), 227, 2006). A case of life-threatening ventricular arrhythmia (VA) in a patient with ED is presented. Clinical records (cardiologic, psychiatric), electrocardiograms, echocardiogram, coronary angiogram, cardiac magnetic resonance, and endocrine diagnostics were performed. Finally a cardioverter-defibrillator (ICD) was implanted in the patient after her third cardiac arrest. An optimal approach to antiarrhythmic therapy in such patients is a real challenge for a cardiologist. PMID:24535846

  10. A Young Man Presenting with Pleuritic Chest Pain and Fever after Electrophysiological Study and Implantable Cardioverter-Defibrillator Placement: Diagnostic Difficulties and Value of Bedside Thoracic Sonography

    PubMed Central

    Faraone, Antonio; Fortini, Alberto

    2015-01-01

    We describe the case of a 23-year-old man presenting with recurrent pleuritic chest pain and prolonged fever after electrophysiology testing and placement of an implantable cardioverter-defibrillator because of a suspected arrhythmogenic right ventricular dysplasia. The clinical suspicion was initially directed toward pneumonia with pleural effusion and later toward an infection of the cardiac device complicated by septic pulmonary embolism. The definitive diagnosis of pulmonary embolism and infarction was suggested by a point-of-care thoracic sonography, performed at the bedside by a clinician caring for the patient, and then confirmed by contrast enhanced computed tomography, which also showed thrombosis of the left iliofemoral vein, site of percutaneous puncture for cardiac catheterization. Prolonged fever was attributable to a concomitant Epstein-Barr virus primary infection that acted as confounding factor. The present report confirms the value of bedside thoracic sonography in the diagnostic evaluation of patients with nonspecific respiratory symptoms. PMID:26576159

  11. Implantable Cardioverter Defibrillator

    MedlinePlus

    ... How Does an ICD Work During ICD Surgery After ICD Surgery What Are the Risks Lifestyle Clinical Trials Links Related Topics Arrhythmia Heart Attack How the Heart Works Pacemakers Sudden Cardiac Arrest Send a link to NHLBI to ...

  12. Implantable cardioverter defibrillator - discharge

    MedlinePlus

    ... your body. Be careful around metal detectors and security wands. Handheld security wands may interfere with your ICD. Show your ... card and ask to be hand searched. Most security gates at airports and stores are okay. But ...

  13. Implantable cardioverter defibrillator - discharge

    MedlinePlus

    ... leave the hospital, you will be given a card to keep in your wallet. This card lists the details of your ICD and has contact information for emergencies. Carry your ICD identification card with you AT ALL TIMES. The information it ...

  14. Implantable cardioverter-defibrillator

    MedlinePlus

    ... food tips Heart attack - discharge Heart disease - risk factors Heart failure ... Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed ...

  15. Implantable Cardioverter Defibrillator

    MedlinePlus

    ... under the skin. Like pacemakers , ICDs contain a generator containing a computer, battery, and wires called “leads” ... while the other end is connected to the generator. The battery in the generator lasts 5-8 ...

  16. Surgery for postinfarction ventricular tachycardia in the pre-implantable cardioverter defibrillator era: early and long term outcomes in 100 consecutive patients

    PubMed Central

    Bourke, J; Campbell, R; McComb, J; Furniss, S; Doig, J; Hilton, C

    1999-01-01

    OBJECTIVE—To report outcome following surgery for postinfarction ventricular tachycardia undertaken in patients before the use of implantable defibrillators.
DESIGN—A retrospective review, with uniform patient selection criteria and surgical and mapping strategy throughout. Complete follow up. Long term death notification by OPCS (Office of Population Censuses and Statistics) registration.
SETTING—Tertiary referral centre for arrhythmia management.
PATIENTS—100 consecutive postinfarction patients who underwent map guided endocardial resection at this hospital in the period 1981-91 for drug refractory ventricular tachyarrhythmias.
RESULTS—Emergency surgery was required for intractable arrhythmias in 28 patients, and 32 had surgery within eight weeks of infarction ("early"). Surgery comprised endocardial resections in all, aneurysmectomy in 57, cryoablations in 26, and antiarrhythmic ventriculotomies in 11. Twenty five patients died < 30 days after surgery, 21 of cardiac failure. This high mortality reflects the type of patients included in the series. Only 12 received antiarrhythmic drugs after surgery. Perioperative mortality was related to preoperative left ventricular function and the context of surgery. Mortality rates for elective surgery more than eight weeks after infarction, early surgery, emergency surgery, and early emergency surgery were 18%, 31%, 46%, and 50%, respectively. Actuarial survival rates at one, three, five, and 10 years after surgery were 66%, 62%, 57%, and 35%.
CONCLUSIONS—Surgery offers arrhythmia abolition at a risk proportional to the patient's preoperative risk of death from ventricular arrhythmias. The long term follow up results suggest a continuing role for surgery in selected patients even in the era of catheter ablation and implantable defibrillators.


Keywords: arrhythmias; myocardial infarction; surgical management PMID:10409528

  17. Longevity of implantable cardioverter-defibrillators for cardiac resynchronization therapy in current clinical practice: an analysis according to influencing factors, device generation, and manufacturer

    PubMed Central

    Landolina, Maurizio; Curnis, Antonio; Morani, Giovanni; Vado, Antonello; Ammendola, Ernesto; D'onofrio, Antonio; Stabile, Giuseppe; Crosato, Martino; Petracci, Barbara; Ceriotti, Carlo; Bontempi, Luca; Morosato, Martina; Ballari, Gian Paolo; Gasparini, Maurizio

    2015-01-01

    Aims Device replacement at the time of battery depletion of implantable cardioverter-defibrillators (ICDs) may carry a considerable risk of complications and engenders costs for healthcare systems. Therefore, ICD device longevity is extremely important both from a clinical and economic standpoint. Cardiac resynchronization therapy defibrillators (CRT-D) battery longevity is shorter than ICDs. We determined the rate of replacements for battery depletion and we identified possible determinants of early depletion in a series of patients who had undergone implantation of CRT-D devices. Methods and results We retrieved data on 1726 consecutive CRT-D systems implanted from January 2008 to March 2010 in nine centres. Five years after a successful CRT-D implantation procedure, 46% of devices were replaced due to battery depletion. The time to device replacement for battery depletion differed considerably among currently available CRT-D systems from different manufacturers, with rates of batteries still in service at 5 years ranging from 52 to 88% (log-rank test, P < 0.001). Left ventricular lead output and unipolar pacing configuration were independent determinants of early depletion [hazard ratio (HR): 1.96; 95% 95% confidence interval (CI): 1.57–2.46; P < 0.001 and HR: 1.58, 95% CI: 1.25–2.01; P < 0.001, respectively]. The implantation of a recent-generation device (HR: 0.57; 95% CI: 0.45–0.72; P < 0.001), the battery chemistry and the CRT-D manufacturer (HR: 0.64; 95% CI: 0.47–0.89; P = 0.008) were additional factors associated with replacement for battery depletion. Conclusion The device longevity at 5 years was 54%. High left ventricular lead output and unipolar pacing configuration were associated with early battery depletion, while recent-generation CRT-Ds displayed better longevity. Significant differences emerged among currently available CRT-D systems from different manufacturers. PMID:25976906

  18. Age dependent efficacy of implantable cardioverter-defibrillator treatment: observations in 450 patients over an 11 year period

    PubMed Central

    Trappe, H.; Pfitzner, P.; Achtelik, M.; Fieguth, H.

    1997-01-01

    Objective—To determine whether implantable cardioverter-defibrillator (ICD) treatment is beneficial in elderly patients with life threatening ventricular tachyarrhythmias.
Design—Since January 1984, ICDs were implanted in 450 patients to evaluate surgical risk, complications and mean survival in relation to patient age; 81 patients (18%) were ⩽ 50 years at the time of ICD implant, 254 patients (56%) were between 51 and 64 years, and the remaining 115 (26%) were ⩾ 65 years. Epicardial lead systems were implanted in 209 patients (46%), while transvenous lead systems were implanted in 241 (54%).
Results—13 patients (3%) died perioperatively, more often after epicardial (11 of 209 patients, 5%) than after transvenous ICD implantation (one of 241 patients, < 1%) (p < 0.05). During a mean (SD) follow up of 28 (24) months (range < 1 to 114 months), 90 patients (20%) died. Of these, nine (2%) died from sudden arrhythmic death; five (1%) died suddenly, probably as a result of non-arrhythmic causes; 55 (12%) died from other cardiac causes (congestive heart failure, myocardial infarction); and 21 (5%) died from non-cardiac causes. The three, five, and seven year survival for arrhythmic mortality was 95% in patients ⩽ 50 years compared with a three year survival of 93% and a five and seven year survival of 91% in patients of 51 to 64 years, and a three, five, and seven year survival of 99% in patients ⩾ 65 years. 362 patients (80%) received ICD discharges (21 (43) shocks per patient), with a similar incidence among all three patient groups (⩽ 50 years, 80%; 51 to 64 years, 81%; ⩾ 65 years, 79%). The time interval between ICD implant and the first ICD treatment was shorter in patients ⩾ 65 years (8 (8) months) than in patients between 51 and 64 years (11 (14) months) or ⩽ 50 years (11 (11) months) (p < 0.05). Survival time following first appropriate shock was 30 (24) months in patients ⩽ 50 years, 30 (26

  19. Effect of Angiotensin Converting Enzyme Inhibitors and Receptor Blockers on Appropriate Implantable Cardiac Defibrillator Shock in Patients with Severe Systolic Heart Failure (From the GRADE Multicenter Study)

    PubMed Central

    AlJaroudi, Wael A.; Refaat, Marwan M.; Habib, Robert H.; Al-Shaar, Laila; Singh, Madhurmeet; Gutmann, Rebecca; Bloom, Heather L.; Dudley, Samuel C.; Ellinor, Patrick T.; Saba, Samir F.; Shalaby, Alaa A.; Weiss, Raul; McNamara, Dennis M.; Halder, Indrani; London, Barry

    2015-01-01

    Sudden cardiac death (SCD) is a leading cause of mortality in patients with cardiomyopathy. While angiotensin converting enzyme inhibitors (ACEi) and receptor blockers (ARB) decrease cardiac mortality in these cohorts, their role in preventing SCD has not been well established. We sought to determine whether the use of ACEi or ARB in patients with cardiomyopathy is associated with a lower incidence of appropriate implantable cardiac defibrillator (ICD) shocks in the Genetic Risk Assessment of Defibrillator Events (GRADE) study which included subjects with an ejection fraction of ≤30% and ICDs. Treatment with ACEi/ARB versus no ACEi/ARB was physician dependent. There were 1509 patients (mean age [SD] 63[12] years, 80% male, mean [SD] EF 21% [6%]) with 1213 (80%) on ACEi/ARB, and 296 (20%) not on ACEi/ARB. We identified 574 propensity matched patients (287 in each group). After a mean (SD) of 2.5(1.9) years, there were 334 (22%) appropriate shocks in the entire cohort. The use of ACEi/ARB was associated with lower incidence of shocks at 1, 3 and 5 years in the matched cohort (7.7%, 16.7%, 18.5% vs. 13.2%, 27.5%, and 32.0% (RR= 0.61[0.43–0.86], p =0.005). Among patients with GFR >60 and 30–60 ml/min/1.73m2, those on no-ACEi/ARB were at 45% and 77% increased risk of ICD shock as compared to those on ACEi/ARB, respectively. ACEi/ARB were associated with significant lower incidence of appropriate ICD shock in patients with cardiomyopathy and GFR ≥30 ml/min/1.73m2, and with neutral effect among those GFR <30 ml/min/1.73m2. PMID:25682436

  20. Remote monitoring of implantable cardioverter defibrillator patients: a safe, time-saving, and cost-effective means for follow-up

    PubMed Central

    Raatikainen, M.J. Pekka; Uusimaa, Paavo; van Ginneken, Mireille M.E.; Janssen, Jacques P.G.; Linnaluoto, Markku

    2008-01-01

    Aims The purpose of this prospective study was to investigate whether internet-based remote monitoring offers a safe, practical, and cost-effective alternative to the in-office follow-up visits of patients with an implantable cardioverter defibrillator (ICD). Methods and results Forty-one patients (62 ± 10 years, range 41–76, 83% male) with previously implanted ICD were followed for 9 months. One-hundred and nineteen scheduled and 18 unscheduled data transmissions were performed. There were no device-related adverse events. Over 90% of the patients found the system easy to use. Physicians reported the system as being ‘very easy’ or ‘easy’ to use and found the data comparable to traditional device interrogation in 99% of the cases. They were able to address all unscheduled data transmissions remotely. Compared with the in-office visits, remote monitoring required less time from patients (6.9 ± 5.0 vs. 182 ± 148 min, P < 0.001) and physicians (8.4 ± 4.5 vs. 25.8 ± 17.0 min, P < 0.001) to complete the follow-up. Substitution of two routine in-office visits during the study by remote monitoring reduced the overall cost of routine ICD follow-up by 524€ per patient (41%). Conclusion Remote monitoring offers a safe, feasible, time-saving, and cost-effective solution to ICD follow-up. PMID:18703585

  1. Appropriate evaluation and treatment of heart failure patients after implantable cardioverter-defibrillator discharge: time to go beyond the initial shock.

    PubMed

    Mishkin, Joseph D; Saxonhouse, Sherry J; Woo, Gregory W; Burkart, Thomas A; Miles, William M; Conti, Jamie B; Schofield, Richard S; Sears, Samuel F; Aranda, Juan M

    2009-11-24

    Multiple clinical trials support the use of implantable cardioverter-defibrillators (ICDs) for prevention of sudden cardiac death in patients with heart failure (HF). Unfortunately, several complicating issues have arisen from the universal use of ICDs in HF patients. An estimated 20% to 35% of HF patients who receive an ICD for primary prevention will experience an appropriate shock within 1 to 3 years of implant, and one-third of patients will experience an inappropriate shock. An ICD shock is associated with a 2- to 5-fold increase in mortality, with the most common cause being progressive HF. The median time from initial ICD shock to death ranges from 168 to 294 days depending on HF etiology and the appropriateness of the ICD therapy. Despite this prognosis, current guidelines do not provide a clear stepwise approach to managing these high-risk patients. An ICD shock increases HF event risk and should trigger a thorough evaluation to determine the etiology of the shock and guide subsequent therapeutic interventions. Several combinations of pharmacologic and device-based interventions such as adding amiodarone to baseline beta-blocker therapy, adjusting ICD sensitivity, and employing antitachycardia pacing may reduce future appropriate and inappropriate shocks. Aggressive HF surveillance and management is required after an ICD shock, as the risk of sudden cardiac death is transformed to an increased HF event risk. PMID:19926003

  2. Automatic Frequency Controller for Power Amplifiers Used in Bio-Implanted Applications: Issues and Challenges

    PubMed Central

    Hannan, Mahammad A.; Hussein, Hussein A.; Mutashar, Saad; Samad, Salina A.; Hussain, Aini

    2014-01-01

    With the development of communication technologies, the use of wireless systems in biomedical implanted devices has become very useful. Bio-implantable devices are electronic devices which are used for treatment and monitoring brain implants, pacemakers, cochlear implants, retinal implants and so on. The inductive coupling link is used to transmit power and data between the primary and secondary sides of the biomedical implanted system, in which efficient power amplifier is very much needed to ensure the best data transmission rates and low power losses. However, the efficiency of the implanted devices depends on the circuit design, controller, load variation, changes of radio frequency coil's mutual displacement and coupling coefficients. This paper provides a comprehensive survey on various power amplifier classes and their characteristics, efficiency and controller techniques that have been used in bio-implants. The automatic frequency controller used in biomedical implants such as gate drive switching control, closed loop power control, voltage controlled oscillator, capacitor control and microcontroller frequency control have been explained. Most of these techniques keep the resonance frequency stable in transcutaneous power transfer between the external coil and the coil implanted inside the body. Detailed information including carrier frequency, power efficiency, coils displacement, power consumption, supplied voltage and CMOS chip for the controllers techniques are investigated and summarized in the provided tables. From the rigorous review, it is observed that the existing automatic frequency controller technologies are more or less can capable of performing well in the implant devices; however, the systems are still not up to the mark. Accordingly, current challenges and problems of the typical automatic frequency controller techniques for power amplifiers are illustrated, with a brief suggestions and discussion section concerning the progress of

  3. Automatic frequency controller for power amplifiers used in bio-implanted applications: issues and challenges.

    PubMed

    Hannan, Mahammad A; Hussein, Hussein A; Mutashar, Saad; Samad, Salina A; Hussain, Aini

    2014-01-01

    With the development of communication technologies, the use of wireless systems in biomedical implanted devices has become very useful. Bio-implantable devices are electronic devices which are used for treatment and monitoring brain implants, pacemakers, cochlear implants, retinal implants and so on. The inductive coupling link is used to transmit power and data between the primary and secondary sides of the biomedical implanted system, in which efficient power amplifier is very much needed to ensure the best data transmission rates and low power losses. However, the efficiency of the implanted devices depends on the circuit design, controller, load variation, changes of radio frequency coil's mutual displacement and coupling coefficients. This paper provides a comprehensive survey on various power amplifier classes and their characteristics, efficiency and controller techniques that have been used in bio-implants. The automatic frequency controller used in biomedical implants such as gate drive switching control, closed loop power control, voltage controlled oscillator, capacitor control and microcontroller frequency control have been explained. Most of these techniques keep the resonance frequency stable in transcutaneous power transfer between the external coil and the coil implanted inside the body. Detailed information including carrier frequency, power efficiency, coils displacement, power consumption, supplied voltage and CMOS chip for the controllers techniques are investigated and summarized in the provided tables. From the rigorous review, it is observed that the existing automatic frequency controller technologies are more or less can capable of performing well in the implant devices; however, the systems are still not up to the mark. Accordingly, current challenges and problems of the typical automatic frequency controller techniques for power amplifiers are illustrated, with a brief suggestions and discussion section concerning the progress of

  4. Long-term follow up of patients with implantable cardioverter-defibrillators and mild, moderate, or severe impairment of left ventricular function.

    PubMed Central

    Trappe, H. J.; Wenzlaff, P.; Pfitzner, P.; Fieguth, H. G.

    1997-01-01

    OBJECTIVE: To determine whether patients with life threatening ventricular tachyarrhythmias, impaired left ventricular function, and severe heart failure will benefit from implantable cardioverter-defibrillator (ICD) treatment. DESIGN: 410 patients were followed up after ICD implant. Left ventricular function was assessed by the New York Heart Association (NYHA) functional class of heart failure: 50 patients (12%) were in NYHA I-II, 151 (37%) in NYHA II, 117 (29%) in NYHA II-III, and 92 (22%) in NYHA III. Epicardial ICD implantation was performed in 209 patients (51%) and 201 patients (49%) received non-thoracotomy ICDs. RESULTS: Perioperatively, 12 patients (3%) died, more often after epicardial ICD implant (11/209 patients, 5%) than after transvenous implant (1/201 patients, < 1%) (P < 0.05). During a mean (SD) follow up of 28 (24) months (range < 1 to 114 months), 90 patients (23%) died: nine (2%) died from sudden arrhythmia; five (1%) also died suddenly but probably not from arrhythmic causes; 55 (14%) died from cardiac causes (congestive heart failure, myocardial reinfarction); 21 (5%) died from non-cardiac causes. The three year, five year, and seven year survival was 92-96% for arrhythmic mortality in NYHA class I, II and III, compared to a three year survival of 94% and a five year and seven year survival of 84% for patients in NYHA class II-III. 338 patients (82%) received ICD shocks (21 (SD 43) shocks per patient); patients in NYHA class II (83%), class II-III (84%), and class III (90%) received ICD discharges more often than those in class I-II (64%) (P < 0.05). The mean (SD) time interval between ICD implant and the first ICD shock was shorter in NYHA class II (16 (17) months), class II-III (19 (27) months), and class III (16 (19) months) than in class 0-I (22 (24) months) (P < 0.05). CONCLUSIONS: Patients with mild, moderate, and severe left ventricular dysfunction benefit from ICD treatment and these patients survive for a considerable time after the

  5. Automatic segmentation of intra-cochlear anatomy in post-implantation CT of unilateral cochlear implant recipients.

    PubMed

    Reda, Fitsum A; McRackan, Theodore R; Labadie, Robert F; Dawant, Benoit M; Noble, Jack H

    2014-04-01

    A cochlear implant (CI) is a neural prosthetic device that restores hearing by directly stimulating the auditory nerve using an electrode array that is implanted in the cochlea. In CI surgery, the surgeon accesses the cochlea and makes an opening where he/she inserts the electrode array blind to internal structures of the cochlea. Because of this, the final position of the electrode array relative to intra-cochlear anatomy is generally unknown. We have recently developed an approach for determining electrode array position relative to intra-cochlear anatomy using a pre- and a post-implantation CT. The approach is to segment the intra-cochlear anatomy in the pre-implantation CT, localize the electrodes in the post-implantation CT, and register the two CTs to determine relative electrode array position information. Currently, we are using this approach to develop a CI programming technique that uses patient-specific spatial information to create patient-customized sound processing strategies. However, this technique cannot be used for many CI users because it requires a pre-implantation CT that is not always acquired prior to implantation. In this study, we propose a method for automatic segmentation of intra-cochlear anatomy in post-implantation CT of unilateral recipients, thus eliminating the need for pre-implantation CTs in this population. The method is to segment the intra-cochlear anatomy in the implanted ear using information extracted from the normal contralateral ear and to exploit the intra-subject symmetry in cochlear anatomy across ears. To validate our method, we performed experiments on 30 ears for which both a pre- and a post-implantation CT are available. The mean and the maximum segmentation errors are 0.224 and 0.734mm, respectively. These results indicate that our automatic segmentation method is accurate enough for developing patient-customized CI sound processing strategies for unilateral CI recipients using a post-implantation CT alone. PMID

  6. Implantable Heart Aid

    NASA Technical Reports Server (NTRS)

    1980-01-01

    Medrad utilized NASA's Apollo technology to develop a new device called the AID implantable automatic pulse generator which monitors the heart continuously, recognizes the onset of ventricular fibrillation and delivers a corrective electrical shock. AID pulse generator is, in effect, a miniaturized version of the defibrillator used by emergency squads and hospitals to restore rhythmic heartbeat after fibrillation, but has the unique advantage of being permanently available to the patient at risk. Once implanted, it needs no specially trained personnel or additional equipment. AID system consists of a microcomputer, a power source and two electrodes which sense heart activity.

  7. Usefulness of cardiac resynchronisation therapy devices and implantable cardioverter defibrillators in the treatment of heart failure due to severe systolic dysfunction: systematic review of clinical trials and network meta-analysis

    PubMed Central

    García García, M A; Rosero Arenas, M A; Ruiz Granell, R; Chorro Gascó, F J; Martínez Cornejo, A

    2016-01-01

    Aim To assess the effectiveness of cardiac resynchronisation therapy (CRT), implantable cardioverter defibrillator (ICD) therapy, and the combination of these devices (CRT+ICD) in adult patients with left ventricular dysfunction and symptomatic heart failure. Methods A comprehensive systematic review of randomised clinical trials was conducted. Several electronic databases (PubMed, Embase, Ovid, Cochrane, ClinicalTrials.gov) were reviewed. The mortality rates between treatments were compared. A network was established comparing the various options, and direct, indirect and mixed comparisons were made using multivariate meta-regression. The degree of clinical and statistical homogeneity was assessed. Results 43 trials involving 13 017 patients were reviewed. Resynchronisation therapy, defibrillators, and combined devices (CRT+ICD) are clearly beneficial compared to optimal medical treatment, showing clear benefit in all of these cases. In a theoretical order of efficiency, the first option is combined therapy (CRT+ICD), the second is CRT, and the third is defibrillator implantation (ICD). Given the observational nature of these comparisons, and the importance of the overlapping CIs, we cannot state that the combined option (CRT+ICD) offers superior survival benefit compared to the other two options. Conclusions The combined option of CRT+ICD seems to be better than the option of CRT alone, although no clear improvement in survival was found for the combined option. It would be advisable to perform a direct comparative study of these two options. PMID:27326223

  8. Impact of Magnesium L-Lactate on Occurrence of Ventricular Arrhythmias in Patients with Implantable Cardioverter Defibrillators: A Randomized, Placebo-Controlled Trial

    PubMed Central

    Baker, William L; Kluger, Jeffrey; Coleman, Craig I; White, C Michael

    2015-01-01

    Background: We evaluated the antiarrhythmic efficacy and quality of life (QoL) impact of oral magnesium Llactate on patients with an implantable cardioverter defibrillator (ICD). Methods: This prospective, double-blind, placebo-controlled trial randomized 70 patients with an ICD to receive oral magnesium L-lactate 3 tablets twice daily (504mg elemental magnesium daily) or matching placebo for 12 months. Patients were seen at baseline, 12, 24, 36, and 52 weeks. The primary endpoints were the cumulative occurrence of ICD therapy [either shock or anti-tachycardia pacing (ATP)] or QoL between the groups. Results: Among the 70 randomized patients with a mean ± SD follow-up of 6.4 ± 4.1 months, 10 patients in the placebo group and 8 in the magnesium group experienced either ICD shock or ATP [HR 0.84, 95% CI 0.33 to 2.12; p=0.706]. Without significant arrhythmia suppression, only minimal effects on QoL were seen. Eighty six percent of all patients had serum intracellular magnesium deficiency. Conclusion: In our underpowered trial, patients with ICDs had intracellular magnesium deficiency but oral magnesium Llactate only nonsignificantly reduced the occurrence of ICD therapies and had little impact on HrQoL. PMID:27006710

  9. Improving the appropriateness of sudden arrhythmic death primary prevention by implantable cardioverter-defibrillator therapy in patients with low left ventricular ejection fraction. Point of view

    PubMed Central

    Disertori, Marcello; Gulizia, Michele M.; Casolo, Giancarlo; Delise, Pietro; Di Lenarda, Andrea; Di Tano, Giuseppe; Lunati, Maurizio; Mestroni, Luisa; Salerno-Uriarte, Jorge; Tavazzi, Luigi

    2016-01-01

    It is generally accepted that the current guidelines for the primary prevention of sudden arrhythmic death, which are based on ejection fraction, do not allow the optimal selection of patients with low left ventricular ejection fraction of ischemic and nonischemic etiology for implantation of a cardioverter-defibrillator. Ejection fraction alone is limited in both sensitivity and specificity. An analysis of the risk of sudden arrhythmic death with a combination of multiple tests (ejection fraction associated with one or more arrhythmic risk markers) could partially compensate for these limitations. We propose a polyparametric approach for defining the risk of sudden arrhythmic death using ejection fraction in combination with other clinical and arrhythmic risk markers (i.e. late gadolinium enhancement cardiac magnetic resonance, T-wave alternans, programmed ventricular stimulation, autonomic tone, and genetic testing) that have been validated in nonrandomized trials. In this article, we examine these approaches to identify three subsets of patients who cannot be comprehensively assessed by the current guidelines: patients with ejection fraction of 35% or less and a relatively low risk of sudden arrhythmic death despite the ejection fraction value; patients with ejection fraction of 35% or less and high competitive risk of death due to evolution of heart failure or noncardiac causes; and patients with ejection fraction between 35 and 45% with relatively high risk of sudden arrhythmic death despite the ejection fraction value. PMID:26895401

  10. Integrated approach for smart implantable cardioverter defibrillator (ICD) device with real time ECG monitoring: use of flexible sensors for localized arrhythmia sensing and stimulation

    PubMed Central

    Puri, Munish; Chapalamadugu, Kalyan C.; Miranda, Aimon C.; Gelot, Shyam; Moreno, Wilfrido; Adithya, Prashanth C.; Law, Catherine; Tipparaju, Srinivas M.

    2013-01-01

    Arrhythmias are the most common cause of death associated with sudden death and are common in US and worldwide. Cardiac resynchronization therapy (CRT), evolving from pacemakers and development of implantable cardioverter defibrillator (ICD), has been adopted for therapeutic use and demonstrated benefits in patients over the years due to its design and intricate functionality. Recent research has been focused on significant design improvement and efforts are dedicated toward device size reduction, weight and functionality in commercially available ICD's since its invention in the 1960's. Commercially available CRT-D has shown advancement on both clinical and technical side. However, improved focus is required on the device miniaturization, technologically supported and integrated wireless based system for real time heart monitoring electrocardiogram (ECG). In the present report a concise overview for the state-of-the art technology in ICDs and avenues for future development are presented. A unique perspective is also included for ICD device miniaturization and integration of flexible sensing array. Sensor array integration along with its capabilities for identifying localized arrhythmia detection and targeted stimulation for enhancing ICD device capabilities is reviewed. PMID:24167492

  11. Comparison of the Effects of High-Energy Photon Beam Irradiation (10 and 18 MV) on 2 Types of Implantable Cardioverter-Defibrillators

    SciTech Connect

    Hashii, Haruko; Hashimoto, Takayuki; Okawa, Ayako; Shida, Koichi; Isobe, Tomonori; Hanmura, Masahiro; Nishimura, Tetsuo; Aonuma, Kazutaka; Sakae, Takeji; Sakurai, Hideyuki

    2013-03-01

    Purpose: Radiation therapy for cancer may be required for patients with implantable cardiac devices. However, the influence of secondary neutrons or scattered irradiation from high-energy photons (≥10 MV) on implantable cardioverter-defibrillators (ICDs) is unclear. This study was performed to examine this issue in 2 ICD models. Methods and Materials: ICDs were positioned around a water phantom under conditions simulating clinical radiation therapy. The ICDs were not irradiated directly. A control ICD was positioned 140 cm from the irradiation isocenter. Fractional irradiation was performed with 18-MV and 10-MV photon beams to give cumulative in-field doses of 600 Gy and 1600 Gy, respectively. Errors were checked after each fraction. Soft errors were defined as severe (change to safety back-up mode), moderate (memory interference, no changes in device parameters), and minor (slight memory change, undetectable by computer). Results: Hard errors were not observed. For the older ICD model, the incidences of severe, moderate, and minor soft errors at 18 MV were 0.75, 0.5, and 0.83/50 Gy at the isocenter. The corresponding data for 10 MV were 0.094, 0.063, and 0 /50 Gy. For the newer ICD model at 18 MV, these data were 0.083, 2.3, and 5.8 /50 Gy. Moderate and minor errors occurred at 18 MV in control ICDs placed 140 cm from the isocenter. The error incidences were 0, 1, and 0 /600 Gy at the isocenter for the newer model, and 0, 1, and 6 /600Gy for the older model. At 10 MV, no errors occurred in control ICDs. Conclusions: ICD errors occurred more frequently at 18 MV irradiation, which suggests that the errors were mainly caused by secondary neutrons. Soft errors of ICDs were observed with high energy photon beams, but most were not critical in the newer model. These errors may occur even when the device is far from the irradiation field.

  12. Effect of angiotensin-converting enzyme inhibitors and receptor blockers on appropriate implantable cardiac defibrillator shock in patients with severe systolic heart failure (from the GRADE Multicenter Study).

    PubMed

    AlJaroudi, Wael A; Refaat, Marwan M; Habib, Robert H; Al-Shaar, Laila; Singh, Madhurmeet; Gutmann, Rebecca; Bloom, Heather L; Dudley, Samuel C; Ellinor, Patrick T; Saba, Samir F; Shalaby, Alaa A; Weiss, Raul; McNamara, Dennis M; Halder, Indrani; London, Barry

    2015-04-01

    Sudden cardiac death (SCD) is a leading cause of mortality in patients with cardiomyopathy. Although angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) decrease cardiac mortality in these cohorts, their role in preventing SCD has not been well established. We sought to determine whether the use of ACEi or ARB in patients with cardiomyopathy is associated with a lower incidence of appropriate implantable cardiac defibrillator (ICD) shocks in the Genetic Risk Assessment of Defibrillator Events study that included subjects with an ejection fraction of ≤30% and ICDs. Treatment with ACEi/ARB versus no-ACEi/ARB was physician dependent. There were 1,509 patients (mean age [SD] 63 [12] years, 80% men, mean [SD] EF 21% [6%]) with 1,213 (80%) on ACEi/ARB and 296 (20%) not on ACEi/ARB. We identified 574 propensity-matched patients (287 in each group). After a mean (SD) of 2.5 (1.9) years, there were 334 (22%) appropriate shocks in the entire cohort. The use of ACEi/ARB was associated with lower incidence of shocks at 1, 3, and 5 years in the matched cohort (7.7%, 16.7%, and 18.5% vs 13.2%, 27.5%, and 32.0%; RR = 0.61 [0.43 to 0.86]; p = 0.005). Among patients with glomerular filtration rate (GFR) >60 and 30 to 60 ml/min/1.73 m(2), those on no-ACEi/ARB were at 45% and 77% increased risk of ICD shock compared with those on ACEi/ARB, respectively. ACEi/ARB were associated with significant lower incidence of appropriate ICD shock in patients with cardiomyopathy and GFR ≥30 ml/min/1.73 m(2) and with neutral effect in those with GFR <30 ml/min/1.73 m(2). PMID:25682436

  13. Performance of re-used pacemakers and implantable cardioverter defibrillators compared with new devices at Groote Schuur Hospital in Cape Town, South Africa

    PubMed Central

    Jama, Zimasa V; Chin, Ashley; Mayosi, Bongani M; Badri, Motasim

    2015-01-01

    Objectives Little is known about the performance of re-used pacemakers and implantable cardioverter defibrillators (ICDs) in Africa. We sought to compare the risk of infection and the rate of malfunction of re-used pacemakers and ICDs with new devices implanted at Groote Schuur Hospital in Cape Town, South Africa. Methods This was a retrospective case comparison study of the performance of re-used pacemakers and ICDs in comparison with new devices implanted at Groote Schuur Hospital over a 10-year period. The outcomes were incidence of device infection, device malfunction, early battery depletion, and device removal due to infection, malfunction, or early battery depletion. Results Data for 126 devices implanted in 126 patients between 2003 and 2013 were analysed, of which 102 (81%) were pacemakers (51 re-used and 51 new) and 24 (19%) were ICDs (12 re-used and 12 new). There was no device infection, malfunction, early battery depletion or device removal in either the re-used or new pacemaker groups over the median follow up of 15.1 months [interquartile range (IQR), 1.3–36.24 months] for the re-used pacemakers, and 55.8 months (IQR, 20.3–77.8 months) for the new pacemakers. In the ICD group, no device infection occurred over a median follow up of 35.9 months (IQR, 17.0–70.9 months) for the re-used ICDs and 45.7 months (IQR, 37.6–53.7 months) for the new ICDs. One device delivered inappropriate shocks, which resolved without intervention and with no harm to the patient. This re-used ICD subsequently needed generator replacement 14 months later. In both the pacemaker and ICD groups, there were no procedure-non-related infections documented for the respective follow-up periods. Conclusion No significant differences were found in performance between re-used and new pacemakers and ICDs with regard to infection rates, device malfunction, battery life and device removal for complications. Pacemaker and ICD re-use is feasible and safe and is a viable option for

  14. [Multiple inappropriate defibrillator shocks due to insulation failure of a Biotronik Linox defibrillator lead with externalized conductor].

    PubMed

    Elfarra, Hamdi; Moosdorf, Rainer; Rybinski, Leszek; Grimm, Wolfram

    2016-03-01

    In this article the case of a patient who received a total of 35 inappropriate defibrillator shocks due to insulation failure with externalized conductor of a Biotronik Linox® lead is described. The implanted defibrillator was immediately inactivated and the failed lead was extracted using a laser sheath system. PMID:26848762

  15. A shocking past: a walk through generations of defibrillation development.

    PubMed

    Gutbrod, Sarah R; Efimov, Igor R

    2014-05-01

    Defibrillation is one of the most successful and widely recognized applications of electrotherapy. Yet the historical road to its first successful application in a patient and the innovative adaptation to an implantable device is marred with unexpected turns, political and personal setbacks, and public and scientific condemnation at each new idea. Driven by dedicated scientists and ever-advancing creative applications of new technologies, from electrocardiography to high density mapping and computational simulations, the field of defibrillation persevered and continued to evolve to the life-saving tool it is today. In addition to critical technological advances, the history of defibrillation is also marked by the plasticity of the theory of defibrillation. The advancing theories of success have propelled the campaign for reducing the defibrillation energy requirement, instilling hope in the development of a painless and harmless electrical defibrillation strategy. PMID:24759279

  16. Automated External Defibrillator

    MedlinePlus

    ... from the NHLBI on Twitter. What Is an Automated External Defibrillator? An automated external defibrillator (AED) is a portable device that ... Institutes of Health Department of Health and Human Services USA.gov

  17. Perceptions of an implantable cardioverter-defibrillator: A qualitative study of families with a history of sudden life-threatening cardiac events and recommendations to improve care

    PubMed Central

    Linder, Jarrett; Hidayatallah, Nadia; Stolerman, Marina; McDonald, Thomas V.; Marion, Robert; Walsh, Christine; Dolan, Siobhan

    2014-01-01

    Objective To identify major concerns associated with implantable cardioverter-defibrillators (ICDs) and to provide recommendations to adult and pediatric physicians involved in the care of patients with ICDs. Background Cardiac ion channelopathies are a well-recognized cause of sudden cardiac death in infants, children, adolescents, and young adults. ICDs are effective in preventing sudden death from fatal arrhythmias in patients with known cardiac channelopathies. There is a paucity of research on the effect of ICDs on quality of life in patients with cardiac channelopathy diagnoses, especially young patients. Methods A qualitative study interviewing patients and families affected by inherited arrhythmias was conducted. Fifty participants with personal or family histories of cardiac events or sudden death were interviewed individually or in focus groups by clinical psychologists. All interviews were transcribed verbatim and then analyzed and coded based on current qualitative research theory to identify themes related to the research question. Twenty-four participants discussed ICDs in their interviews. Results Participants reported concerns about ICDs, and these concerns were categorized into six themes: (1) comprehension and physician-patient communication; (2) anxiety; (3) restrictions and fallacies; (4) complications; (5) utility; and (6) alternative therapy. Participants noted communication breakdowns between providers and their colleagues, and between providers and their patients. Participants and their families experienced many different forms of anxiety, including worry about the aesthetics of the ICDs and fears of being shocked. Multiple restrictions, fallacies, and complications were also cited. Conclusion Interview themes were used to formulate recommendations for counseling and educating patients with ICDs. PMID:25383067

  18. Perspectives on Withdrawing Pacemaker and Implantable Cardioverter-Defibrillator Therapies at End of Life: Results of a Survey of Medical and Legal Professionals and Patients

    PubMed Central

    Kapa, Suraj; Mueller, Paul S.; Hayes, David L.; Asirvatham, Samuel J.

    2010-01-01

    OBJECTIVE: To determine the opinions of medical professionals, legal professionals, and patients regarding the withdrawal of implantable cardioverter-defibrillator (ICD) and pacemaker therapy at the end of life. PARTICIPANTS AND METHODS: A survey regarding 5 cases that focused on withdrawal of ICD or pacemaker therapy at the end of life was constructed and sent to 5270 medical professionals, legal professionals, and patients. The survey was administered from March 1, 2008, to March 1, 2009. RESULTS: Of the 5270 recipients of the survey, 658 (12%) responded. In a terminally ill patient requesting that his ICD be turned off, most legal professionals (90% [63/70]), medical professionals (98% [330/336]), and patients (85% [200/236]) agreed the ICD should be turned off. Most legal professionals (89%), medical professionals (87%), and patients (79%) also considered withdrawal of pacemaker therapy in a non–pacemaker-dependent patient appropriate. However, significantly more legal (81%) than medical professionals (58%; P<.001) or patients (68%, P=.02) agreed with turning off a pacemaker in the pacemaker-dependent patient. A similar number of legal professionals thought turning off a device was legal regardless of whether it was an ICD or pacemaker (45% vs 38%; P=.50). However, medical professionals were more likely to perceive turning off an ICD as legal than turning off a pacemaker (85% vs 41%; P<.001). CONCLUSION: Most respondents thought device therapy should be withdrawn if the patient requested its withdrawal at the end of life. However, opinions of medical professionals and patients tended to be dependent on the type of device, with turning off ICDs being perceived as more acceptable than turning off pacemakers, whereas legal professionals tended to perceive all devices as similar. Thus, education and discussion regarding managing devices at the end of life are important when having end-of-life discussions and making end-of-life decisions to better understand

  19. Survival Benefit of the Primary Prevention Implantable Cardioverter-Defibrillator Among Older Patients: Does Age Matter? An Analysis of Pooled Data From 5 Clinical Trials

    PubMed Central

    Hess, Paul L.; Al-Khatib, Sana M.; Han, Joo Y.; Edwards, Rex; Bardy, Gust H.; Bigger, J. Thomas; Buxton, Alfred; Cappato, Riccardo; Dorian, Paul; Hallstrom, Al; Kadish, Alan H.; Kudenchuk, Peter J.; Lee, Kerry L.; Mark, Daniel B.; Moss, Arthur J.; Steinman, Richard; Inoue, Lurdes Y.T.; Sanders, Gillian

    2015-01-01

    Background The impact of patient age on the risks of death or rehospitalization after primary prevention implantable cardioverter-defibrillator (ICD) placement is uncertain. Methods and Results Data from 5 major ICD trials were merged: MADIT-I, MUSTT, MADIT-II, DEFINITE, and SCD-HeFT . Median age at enrollment was 62 (interquartile range 53-70) years. Compared with their younger counterparts, older patients had a greater burden of comorbid illness. In unadjusted exploratory analyses, ICD recipients were less likely to die than non-recipients in all age groups: hazard ratio (HR) 0.48, 95% posterior credible interval (PCI) 0.33-0.69 among patients <55 years; HR 0.69, 95%PCI 0.53-0.90 among patients 55-64 years; HR 0.67, 95%PCI 0.53-0.85 among patients 65-74 years; and HR 0.54, 95%PCI 0.37-0.78 among patients > 75 years. Sample sizes were limited among patients > 75 years. In adjusted Bayesian Weibull modeling, point estimates indicate ICD efficacy persists but is attenuated with increasing age. There was evidence of an interaction between age and ICD treatment on survival (two-sided posterior tail probability of no interaction < 0.01). Using an adjusted Bayesian logistic regression model, there was no evidence of an interaction between age and ICD treatment on rehospitalization (two-sided posterior tail probability of no interaction 0.44). Conclusions In this analysis, the survival benefit of the ICD exists but is attenuated with increasing age. The latter finding may be due to the higher burden of comorbid illness, competing causes of death, or limited sample size of older patients. There was no evidence that age modifies the association between ICD treatment and rehospitalization. PMID:25669833

  20. Use of the Wearable Cardioverter Defibrillator in High-Risk Populations.

    PubMed

    Lamichhane, Madhab; Safadi, Abdul; Surapaneni, Phani; Salehi, Negar; Thakur, Ranjan K

    2016-08-01

    The United States Food and Drug Administration has approved the wearable cardioverter defibrillator (WCD) for use in patients who are at high risk for sudden cardiac arrest (SCA) and who do not yet have an established indication for an implantation cardioverter defibrillator (ICD) or have contraindications for device implantation for various reasons. The WCD is typically used for primary prevention in (1) high-risk patients with reduced left ventricular ejection fraction (LVEF) ≤35 % after recent acute myocardial infarction (MI) during the 40-day ICD waiting period, (2) before and after coronary artery bypass graft or percutaneous coronary intervention during the 90-day ICD waiting period, (3) after recently diagnosed nonischemic dilated cardiomyopathy (NICM) during the 3- to 9-month medical therapy optimization period, or (4) for those with inherited proarrhythmic conditions such as long QT syndrome or hypertrophic cardiomyopathy. Unlike the automatic external defibrillator, the WCD does not require assistance from bystanders for therapy and conscious patients can delay or avert therapy with the use of response buttons. The WCD exhibits a small risk of inappropriate shock, mostly due to supraventricular tachycardia and/or electrical noise. Multiple non-randomized observational studies have shown high efficacy in detection and appropriate shock therapy for sustained ventricular tachyarrhythmias. This paper discusses the use of the WCD for prevention of SCA in patients with various cardiac substrates. PMID:27319008

  1. Automatic segmentation of intra-cochlear anatomy in post-implantation CT

    NASA Astrophysics Data System (ADS)

    Reda, Fitsum A.; Dawant, Benoit M.; McRackan, Theodore R.; Labadie, Robert F.; Noble, Jack H.

    2013-03-01

    A cochlear implant (CI) is a neural prosthetic device that restores hearing by directly stimulating the auditory nerve with an electrode array. In CI surgery, the surgeon threads the electrode array into the cochlea, blind to internal structures. We have recently developed algorithms for determining the position of CI electrodes relative to intra-cochlear anatomy using pre- and post-implantation CT. We are currently using this approach to develop a CI programming assistance system that uses knowledge of electrode position to determine a patient-customized CI sound processing strategy. However, this approach cannot be used for the majority of CI users because the cochlea is obscured by image artifacts produced by CI electrodes and acquisition of pre-implantation CT is not universal. In this study we propose an approach that extends our techniques so that intra-cochlear anatomy can be segmented for CI users for which pre-implantation CT was not acquired. The approach achieves automatic segmentation of intra-cochlear anatomy in post-implantation CT by exploiting intra-subject symmetry in cochlear anatomy across ears. We validated our approach on a dataset of 10 ears in which both pre- and post-implantation CTs were available. Our approach results in mean and maximum segmentation errors of 0.27 and 0.62 mm, respectively. This result suggests that our automatic segmentation approach is accurate enough for developing customized CI sound processing strategies for unilateral CI patients based solely on postimplantation CT scans.

  2. Estimating dose to implantable cardioverter-defibrillator outside the treatment fields using a skin QED diode, optically stimulated luminescent dosimeters, and LiF thermoluminescent dosimeters

    SciTech Connect

    Chan, Maria F.; Song, Yulin; Dauer, Lawrence T.; Li Jingdong; Huang, David; Burman, Chandra

    2012-10-01

    The purpose of this work was to determine the relative sensitivity of skin QED diodes, optically stimulated luminescent dosimeters (OSLDs) (microStar Trade-Mark-Sign DOT, Landauer), and LiF thermoluminescent dosimeters (TLDs) as a function of distance from a photon beam field edge when applied to measure dose at out-of-field points. These detectors have been used to estimate radiation dose to patients' implantable cardioverter-defibrillators (ICDs) located outside the treatment field. The ICDs have a thin outer case made of 0.4- to 0.6-mm-thick titanium ({approx}2.4-mm tissue equivalent). A 5-mm bolus, being the equivalent depth of the devices under the patient's skin, was placed over the ICDs. Response per unit absorbed dose-to-water was measured for each of the dosimeters with and without bolus on the beam central axis (CAX) and at a distance up to 20 cm from the CAX. Doses were measured with an ionization chamber at various depths for 6- and 15-MV x-rays on a Varian Clinac-iX linear accelerator. Relative sensitivity of the detectors was determined as the ratio of the sensitivity at each off-axis distance to that at the CAX. The detector sensitivity as a function of the distance from the field edge changed by {+-} 3% (1-11%) for LiF TLD-700, decreased by 10% (5-21%) for OSLD, and increased by 16% (11-19%) for the skin QED diode (Sun Nuclear Corp.) at the equivalent depth of 5 mm for 6- or 15-MV photon energies. Our results showed that the use of bolus with proper thickness (i.e., {approx}d{sub max} of the photon energy) on the top of the ICD would reduce the scattered dose to a lower level. Dosimeters should be calibrated out-of-field and preferably with bolus equal in thickness to the depth of interest. This can be readily performed in clinic.

  3. Development and feasibility testing of decision support for patients who are candidates for a prophylactic implantable defibrillator: a study protocol for a pilot randomized controlled trial

    PubMed Central

    2013-01-01

    Background Patients, identified to be at risk for but who have never experienced a potentially lethal cardiac arrhythmia, have the option of receiving an implantable cardioverter defibrillator (ICD) as prophylaxis against sudden cardiac death - a primary prevention indication. In Canada, there is no clear framework to support patients’ decision-making for these devices. Decision support, using a decision aid, could moderate treatment-related uncertainty and prepare patients to make well-informed decisions. Patient decision aids provide information on treatment options, risks, and benefits, to help patients clarify their values for outcomes of treatment options. The objectives of this research are: 1) develop a decision aid, 2) evaluate the decision aid, and 3) determine the feasibility of conducting a trial. Methods/design A development panel comprised of the core investigative team, health service researchers, decision science experts, cardiovascular healthcare practitioners, and ICD patient representatives will collaborate to provide input on the content and format of the aid. To generate probabilities to include in the aid, we will synthesize primary prevention ICD evidence. To obtain anonymous input about the facts and content, we will employ a modified Delphi process. To evaluate the draft decision aid will invite ICD patients and their families (n = 30) to rate its acceptability. After we evaluate the aid, to determine the feasibility, we will conduct a feasibility pilot randomized controlled trial (RCT) in new ICD candidates (n = 80). Participants will be randomized to receive a decision aid prior to specialist consultation versus usual care. Results from the pilot RCT will determine the feasibility of research processes; inform sample size calculation, measure decision quality (knowledge, values, decision conflict) and the influence of health related quality of life on decision-making. Discussion Our study seeks to develop a decision aid, for patients

  4. Cost–consequence analysis of daily continuous remote monitoring of implantable cardiac defibrillator and resynchronization devices in the UK

    PubMed Central

    Burri, Haran; Sticherling, Christian; Wright, David; Makino, Koji; Smala, Antje; Tilden, Dominic

    2013-01-01

    Aims The need for ongoing and lifelong follow-up (FU) of patients with cardiac implantable electric devices (CIED) requires significant resources. Remote CIED management has been established as a safe alternative to conventional periodical in-office FU (CFU). An economic model compares the long-term cost and consequences of using daily Home Monitoring® (HM) instead of CFU. Methods and results A cost–consequence evaluation comparing HM vs. CFU was performed using a Markov cohort model and data relating to events and costs identified via a systematic review of the literature. The model is conservative, without assuming a reduction of cardiovascular events by HM such as decompensated heart failure or mortality, or considering cost savings such as for transportation. Also cost savings due to an improved timing of elective device replacement, and fewer FU visits needed in patients near device replacement are not considered. Over 10 years, HM is predicted to be cost neutral at about GBP 11 500 per patient in either treatment arm, with all costs for the initial investment into HM and fees for ongoing remote monitoring included. Fewer inappropriate shocks (−51%) reduce the need for replacing devices for battery exhaustion (−7%); the number of FU visits is predicted to be halved by HM. Conclusion From a UK National Health Service perspective, HM is cost neutral over 10 years. This is mainly accomplished by reducing the number of battery charges and inappropriate shocks, resulting in fewer device replacements, and by reducing the number of in-clinic FU visits. PMID:23599169

  5. Automatic electrode configuration selection for image-guided cochlear implant programming

    NASA Astrophysics Data System (ADS)

    Zhao, Yiyuan; Dawant, Benoit M.; Noble, Jack H.

    2015-03-01

    Cochlear implants (CIs) are neural prosthetics that stimulate the auditory nerve pathways within the cochlea using an implanted electrode array to restore hearing. After implantation, the CI is programmed by an audiologist who determines which electrodes are active, i.e., the electrode configuration, and selects other stimulation settings. Recent clinical studies by our group have shown that hearing outcomes can be significantly improved by using an image-guided electrode configuration selection technique we have designed. Our goal in this work is to automate the electrode configuration selection step with the long term goal of developing a fully automatic system that can be translated to the clinic. Until now, the electrode configuration selection step has been performed by an expert with the assistance of image analysis-based estimates of the electrode-neural interface. To automatically determine the electrode configuration, we have designed an optimization approach and propose the use of a cost function with feature terms designed to interpret the image analysis data in a similar fashion as the expert. Further, we have designed an approach to select parameters in the cost function using our database of existing electrode configuration plans as training data. The results we present show that our automatic approach results in electrode configurations that are better or equally as good as manually selected configurations in over 80% of the cases tested. This method represents a crucial step towards clinical translation of our image-guided cochlear implant programming system.

  6. Automatic pre- to intra-operative CT registration for image-guided cochlear implant surgery

    PubMed Central

    Reda, Fitsum A.; Noble, Jack H.; Labadie, Robert F.; Dawant, Benoit M.

    2015-01-01

    Percutaneous cochlear implantation (PCI) is a minimally invasive image-guided cochlear implant approach, where access to the cochlea is achieved by drilling a linear channel from the skull surface to the cochlea. The PCI approach requires pre- and intra-operative planning. Computation of a safe linear drilling trajectory is performed in a pre-operative CT. This trajectory is mapped to intra-operative space using the transformation matrix that registers the pre- and intra-operative CTs. However, the difference in orientation between the pre- and intra-operative CTs is too extreme to be recovered by standard, gradient descent based registration methods. Thus far, the registration has been initialized manually by an expert. In this work we present a method that aligns the scans completely automatically. We compared the performance of the automatic approach to the registration approach when an expert does the manual initialization on 11 pairs of scans. There is a maximum difference of 0.18 mm between the entry and target points of the trajectory mapped with expert initialization and the automatic registration method. This suggests that the automatic registration method is accurate enough to be used in a PCI surgery. PMID:22922692

  7. Manual for the psychotherapeutic treatment of acute and post-traumatic stress disorders following multiple shocks from implantable cardioverter defibrillator (ICD)

    PubMed Central

    Jordan, Jochen; Titscher, Georg; Peregrinova, Ludmila; Kirsch, Holger

    2013-01-01

    Background: In view of the increasing number of implanted cardioverter defibrillators (ICD), the number of people suffering from so-called “multiple ICD shocks” is also increasing. The delivery of more than five shocks (appropriate or inappropriate) in 12 months or three or more shocks (so called multiple shocks) in a short time period (24 hours) leads to an increasing number of patients suffering from severe psychological distress (anxiety disorder, panic disorder, adjustment disorder, post-traumatic stress disorder). Untreated persons show chronic disease processes and a low rate of spontaneous remission and have an increased morbidity and mortality. Few papers have been published concerning the psychotherapeutic treatment for these patients. Objective: The aim of this study is to develop a psychotherapeutic treatment for patients with a post-traumatic stress disorder or adjustment disorder after multiple ICD shocks. Design: Explorative feasibility study: Treatment of 22 patients as a natural design without randomisation and without control group. The period of recruitment was three years, from March 2007 to March 2010. The study consisted of two phases: in the first phase (pilot study) we tested different components and dosages of psychotherapeutic treatments. The final intervention programme is presented in this paper. In the second phase (follow-up study) we assessed the residual post-traumatic stress symptoms in these ICD patients. The time between treatment and follow-up measurement was 12 to 30 months. Population: Thirty-one patients were assigned to the Department of Psychocardiology after multiple shocks. The sample consisted of 22 patients who had a post-traumatic stress disorder or an adjustment disorder and were willing and able to participate. They were invited for psychological treatment. 18 of them could be included into the follow-up study. Methods: After the clinical assessment at the beginning and at the end of the inpatient treatment a post

  8. Subcutaneous Implantable Cardioverter-Defibrillator

    MedlinePlus

    ... discriminator functions and lacks antitachycardia pacing. Expanded Programmability Programming that allows lower shock energies and the ability ... the original device and placed in a new one. Postprocedural hospitalization is occasionally needed. Replacement procedures can ...

  9. Initial dynamics of the EKG during an electrical defibrillation of the heart

    NASA Technical Reports Server (NTRS)

    Bikov, I. I.; Chebotarov, Y. P.; Nikolaev, V. G.

    1980-01-01

    In tests on 11 mature dogs, immobilized by means of an automatic blocking and synchronization system, artefact free EKG were obtained, beginning 0.04-0.06 sec after passage of a defibrillating current. Different versions of the start of fibrillation were noted, in application of the defibrillating stimulus in the early phase of the cardiac cycle. A swinging phenomenon, increasing amplitude, of fibrillation was noted for 0.4-1.5 sec after delivery of a subthreshold stimulus. Conditions for a positive outcome of repeated defibrillation were found, and a relationship was noted between the configuration of the exciting process with respect to the lines of force of the defibrillating current and the defibrillation threshold. It was shown that the initial EKG dynamics after defibrillation is based on a gradual shift of the pacemaker from the myocardium of the ventricles to the sinus node, through phases of atrioventricular and atrial automatism.

  10. Defibrillator/monitor/pacemakers.

    PubMed

    2003-05-01

    Defibrillator/monitors allow operators to assess and monitor a patient's ECG and, when necessary, deliver a defibrillating shock to the heart. When integral noninvasive pacing is added, the device is called a defibrillator/monitor/pacemaker. In this Evaluation, we present our findings for two newly evaluated models, the Welch Allyn PIC 50 and the Zoll M Series CCT, and we summarize our findings for the previously evaluated models that are still on the market. We rate the models for the following applications: general crash-cart use, in-hospital transport use, and emergency medical service (EMS) use. PMID:12827940

  11. [Usage of a defibrillator].

    PubMed

    Inomata, Masahiko

    2011-04-01

    Guideline 2010 for cardiopulmonary resuscitation was released the other day. There is no big change in the use of a defibrillator. Asynchronous defibrillation is used as a therapy for VF and pulseless VT. When you find a patient, start CPR immediately and prepare a defibrillator. About the value of energy, comply a recommended value of defibrillator's manufacturer with biphasic waveform, on the other hand, deliver 360J shock with monophasic waveform. Cardioversion is used as a therapy for supraventricular arrhythmia like atrial fibrillation. It is important to synchronize with QRS complex on ECG surely and deliver a shock. If it is not synchronized surely, there is a possibility to occur VF. Transcutaneous pacing is used as a therapy for bradycardia. It produces a depolarization of myocardium by giving current stimulus from a surface of a body, and force a heart to contract. It is usually carried out at demand mode, and confirmed that a heart contracts certainly. Defibrillator is an only device to terminate VF and pulseless VT and it is important to test defibrillator usually so that it can be used any time it is necessary. PMID:21591425

  12. Design of the evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study to assess the ability of remote monitoring to treat and triage patients more effectively

    PubMed Central

    Marzegalli, Maurizio; Landolina, Maurizio; Lunati, Maurizio; Perego, Giovanni B; Pappone, Alessia; Guenzati, Giuseppe; Campana, Carlo; Frigerio, Maria; Parati, Gianfranco; Curnis, Antonio; Colangelo, Irene; Valsecchi, Sergio

    2009-01-01

    Background Heart failure patients with implantable defibrillators (ICD) frequently visit the clinic for routine device monitoring. Moreover, in the case of clinical events, such as ICD shocks or alert notifications for changes in cardiac status or safety issues, they often visit the emergency department or the clinic for an unscheduled visit. These planned and unplanned visits place a great burden on healthcare providers. Internet-based remote device interrogation systems, which give physicians remote access to patients' data, are being proposed in order to reduce routine and interim visits and to detect and notify alert conditions earlier. Methods The EVOLVO study is a prospective, randomized, parallel, unblinded, multicenter clinical trial designed to compare remote ICD management with the current standard of care, in order to assess its ability to treat and triage patients more effectively. Two-hundred patients implanted with wireless-transmission-enabled ICD will be enrolled and randomized to receive either the Medtronic CareLink® monitor for remote transmission or the conventional method of in-person evaluations. The purpose of this manuscript is to describe the design of the trial. The results, which are to be presented separately, will characterize healthcare utilizations as a result of ICD follow-up by means of remote monitoring instead of conventional in-person evaluations. Trial registration ClinicalTrials.gov: NCT00873899 PMID:19538734

  13. Effect of cardiac resynchronization therapy with implantable cardioverter defibrillator versus cardiac resynchronization therapy with pacemaker on mortality in heart failure patients: results of a high-volume, single-centre experience

    PubMed Central

    Kutyifa, Valentina; Geller, Laszlo; Bogyi, Peter; Zima, Endre; Aktas, Mehmet K; Ozcan, Emin Evren; Becker, David; Nagy, Vivien Klaudia; Kosztin, Annamaria; Szilagyi, Szabolcs; Merkely, Bela

    2014-01-01

    Aims There are limited and contradictory data on the effects of CRT with implantable cardioverter defibrillator (CRT-D) on mortality as compared with CRT with pacemaker (CRT-P). Methods and results We evaluated the long-term outcome of patients implanted with a CRT-D or CRT-P device in our high-volume single-centre experience. Data on all-cause mortality were derived from clinic visits and the Hungarian National Healthcare Fund Death Registry. Kaplan–Meier survival analyses and multivariate Cox regression models were used to evaluate all-cause mortality in patients with CRT-D vs. CRT-P, stratified by the aetiology of cardiomyopathy. From 2000 to 2011, 1122 CRT devices, 693 CRT-P (LVEF 28.2 ± 7.4%) and 429 CRT-D (LVEF 27.6 ± 6.4%), were implanted at our centre. During the median follow-up of 28 months, 379 patients died from any cause, 250 patients (36%) with an implanted CRT-P and 129 patients (30%) with an implanted CRT-D. There was no evidence of mortality benefit in patients implanted with a CRT-D compared with a CRT-P in the total cohort [hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.73–1.32, P = 0.884]. In patients with ischaemic cardiomyopathy, CRT-D treatment was associated with a significant 30% risk reduction in all-cause mortality compared with an implanted CRT-P (HR 0.70, 95% CI 0.51–0.97, P = 0.03). In non-ischaemic patients, there was no mortality benefit of CRT-D over CRT-P (HR 0.98, 95% CI 0.73–1.32, P = 0.894, interaction P-value = 0.15). Conclusions In heart failure patients with ischaemic cardiomyopathy, CRT-D was associated with a mortality benefit compared with CRT-P, but no benefit of CRT-D over CRT-P in mortality was observed in non-ischaemic cardiomyopathy. PMID:25379962

  14. Automatic tracking of arbitrarily shaped implanted markers in kilovoltage projection images: A feasibility study

    PubMed Central

    Regmi, Rajesh; Lovelock, D. Michael; Hunt, Margie; Zhang, Pengpeng; Pham, Hai; Xiong, Jianping; Yorke, Ellen D.; Goodman, Karyn A.; Rimner, Andreas; Mostafavi, Hassan; Mageras, Gig S.

    2014-01-01

    Purpose: Certain types of commonly used fiducial markers take on irregular shapes upon implantation in soft tissue. This poses a challenge for methods that assume a predefined shape of markers when automatically tracking such markers in kilovoltage (kV) radiographs. The authors have developed a method of automatically tracking regularly and irregularly shaped markers using kV projection images and assessed its potential for detecting intrafractional target motion during rotational treatment. Methods: Template-based matching used a normalized cross-correlation with simplex minimization. Templates were created from computed tomography (CT) images for phantom studies and from end-expiration breath-hold planning CT for patient studies. The kV images were processed using a Sobel filter to enhance marker visibility. To correct for changes in intermarker relative positions between simulation and treatment that can introduce errors in automatic matching, marker offsets in three dimensions were manually determined from an approximately orthogonal pair of kV images. Two studies in anthropomorphic phantom were carried out, one using a gold cylindrical marker representing regular shape, another using a Visicoil marker representing irregular shape. Automatic matching of templates to cone beam CT (CBCT) projection images was performed to known marker positions in phantom. In patient data, automatic matching was compared to manual matching as an approximate ground truth. Positional discrepancy between automatic and manual matching of less than 2 mm was assumed as the criterion for successful tracking. Tracking success rates were examined in kV projection images from 22 CBCT scans of four pancreas, six gastroesophageal junction, and one lung cancer patients. Each patient had at least one irregularly shaped radiopaque marker implanted in or near the tumor. In addition, automatic tracking was tested in intrafraction kV images of three lung cancer patients with irregularly shaped

  15. Automatic tracking of arbitrarily shaped implanted markers in kilovoltage projection images: A feasibility study

    SciTech Connect

    Regmi, Rajesh; Lovelock, D. Michael; Hunt, Margie; Zhang, Pengpeng; Pham, Hai; Xiong, Jianping; Yorke, Ellen D.; Mageras, Gig S.; Goodman, Karyn A.; Rimner, Andreas; Mostafavi, Hassan

    2014-07-15

    Purpose: Certain types of commonly used fiducial markers take on irregular shapes upon implantation in soft tissue. This poses a challenge for methods that assume a predefined shape of markers when automatically tracking such markers in kilovoltage (kV) radiographs. The authors have developed a method of automatically tracking regularly and irregularly shaped markers using kV projection images and assessed its potential for detecting intrafractional target motion during rotational treatment. Methods: Template-based matching used a normalized cross-correlation with simplex minimization. Templates were created from computed tomography (CT) images for phantom studies and from end-expiration breath-hold planning CT for patient studies. The kV images were processed using a Sobel filter to enhance marker visibility. To correct for changes in intermarker relative positions between simulation and treatment that can introduce errors in automatic matching, marker offsets in three dimensions were manually determined from an approximately orthogonal pair of kV images. Two studies in anthropomorphic phantom were carried out, one using a gold cylindrical marker representing regular shape, another using a Visicoil marker representing irregular shape. Automatic matching of templates to cone beam CT (CBCT) projection images was performed to known marker positions in phantom. In patient data, automatic matching was compared to manual matching as an approximate ground truth. Positional discrepancy between automatic and manual matching of less than 2 mm was assumed as the criterion for successful tracking. Tracking success rates were examined in kV projection images from 22 CBCT scans of four pancreas, six gastroesophageal junction, and one lung cancer patients. Each patient had at least one irregularly shaped radiopaque marker implanted in or near the tumor. In addition, automatic tracking was tested in intrafraction kV images of three lung cancer patients with irregularly shaped

  16. A Comparison of the Quality of Life of Patients With an Entirely Subcutaneous Implantable Defibrillator System Versus a Transvenous System (from the EFFORTLESS S-ICD Quality of Life Substudy).

    PubMed

    Pedersen, Susanne S; Mastenbroek, Mirjam H; Carter, Nathan; Barr, Craig; Neuzil, Petr; Scholten, Marcoen; Lambiase, Pier D; Boersma, Lucas; Johansen, Jens B; Theuns, Dominic A M J

    2016-08-15

    The first clinical results from the Evaluation of Factors Impacting Clinical Outcome and Cost Effectiveness of the subcutaneous implantable cardioverter defibrillator (EFFORTLESS S-ICD) Registry on the entirely S-ICD system are promising, but the impact of the S-ICD system on patients' quality of life (QoL) is not known. We evaluated the QoL of patients with an S-ICD against an unrelated cohort with a transvenous (TV)-ICD system during 6 months of follow-up. Consecutively implanted patients with an S-ICD system were matched with patients with a TV-ICD system on a priori selected variables including baseline QoL. QoL was measured with the Short-Form Health Survey at baseline, 3, and 6 months after implant and compared using multivariable modeling with repeated measures. Patients with an S-ICD (n = 167) versus a TV-ICD system (n = 167) did not differ significantly on physical (p = 0.8157) and mental QoL scores (p = 0.9080) across baseline, 3, and 6 months after implantation in adjusted analyses. The evolution in physical (p = 0.0503) and mental scores (p = 0.3772) during follow-up was similar for both cohorts, as indicated by the nonsignificant interaction effect for ICD system by time. Both patients with an S-ICD system and a TV-ICD system experienced significant improvements in physical and mental QoL between time of implant and 3 months (both p's <0.0001) and between time of implant and 6 months (both p's <0.0001) but not between 3 and 6 months (both p's >0.05). In conclusion, these first results show that the QoL of patients with an S-ICD versus TV-ICD system is similar and that patients with either system experience improvements in QoL on the short term. PMID:27353211

  17. Towards Low Energy Atrial Defibrillation

    PubMed Central

    Walsh, Philip; Kodoth, Vivek; McEneaney, David; Rodrigues, Paola; Velasquez, Jose; Waterman, Niall; Escalona, Omar

    2015-01-01

    A wireless powered implantable atrial defibrillator consisting of a battery driven hand-held radio frequency (RF) power transmitter (ex vivo) and a passive (battery free) implantable power receiver (in vivo) that enables measurement of the intracardiacimpedance (ICI) during internal atrial defibrillation is reported. The architecture is designed to operate in two modes: Cardiac sense mode (power-up, measure the impedance of the cardiac substrate and communicate data to the ex vivo power transmitter) and cardiac shock mode (delivery of a synchronised very low tilt rectilinear electrical shock waveform). An initial prototype was implemented and tested. In low-power (sense) mode, >5 W was delivered across a 2.5 cm air-skin gap to facilitate measurement of the impedance of the cardiac substrate. In high-power (shock) mode, >180 W (delivered as a 12 ms monophasic very-low-tilt-rectilinear (M-VLTR) or as a 12 ms biphasic very-low-tilt-rectilinear (B-VLTR) chronosymmetric (6ms/6ms) amplitude asymmetric (negative phase at 50% magnitude) shock was reliably and repeatedly delivered across the same interface; with >47% DC-to-DC (direct current to direct current) power transfer efficiency at a switching frequency of 185 kHz achieved. In an initial trial of the RF architecture developed, 30 patients with AF were randomised to therapy with an RF generated M-VLTR or B-VLTR shock using a step-up voltage protocol (50–300 V). Mean energy for successful cardioversion was 8.51 J ± 3.16 J. Subsequent analysis revealed that all patients who cardioverted exhibited a significant decrease in ICI between the first and third shocks (5.00 Ω (SD(σ) = 1.62 Ω), p < 0.01) while spectral analysis across frequency also revealed a significant variation in the impedance-amplitude-spectrum-area (IAMSA) within the same patient group (|∆(IAMSAS1-IAMSAS3)[1 Hz − 20 kHz] = 20.82 Ω-Hz (SD(σ) = 10.77 Ω-Hz), p < 0.01); both trends being absent in all patients that failed to cardiovert. Efficient

  18. Towards Low Energy Atrial Defibrillation.

    PubMed

    Walsh, Philip; Kodoth, Vivek; McEneaney, David; Rodrigues, Paola; Velasquez, Jose; Waterman, Niall; Escalona, Omar

    2015-01-01

    A wireless powered implantable atrial defibrillator consisting of a battery driven hand-held radio frequency (RF) power transmitter (ex vivo) and a passive (battery free) implantable power receiver (in vivo) that enables measurement of the intracardiac impedance (ICI) during internal atrial defibrillation is reported. The architecture is designed to operate in two modes: Cardiac sense mode (power-up, measure the impedance of the cardiac substrate and communicate data to the ex vivo power transmitter) and cardiac shock mode (delivery of a synchronised very low tilt rectilinear electrical shock waveform). An initial prototype was implemented and tested. In low-power (sense) mode, >5 W was delivered across a 2.5 cm air-skin gap to facilitate measurement of the impedance of the cardiac substrate. In high-power (shock) mode, >180 W (delivered as a 12 ms monophasic very-low-tilt-rectilinear (M-VLTR) or as a 12 ms biphasic very-low-tilt-rectilinear (B-VLTR) chronosymmetric (6ms/6ms) amplitude asymmetric (negative phase at 50% magnitude) shock was reliably and repeatedly delivered across the same interface; with >47% DC-to-DC (direct current to direct current) power transfer efficiency at a switching frequency of 185 kHz achieved. In an initial trial of the RF architecture developed, 30 patients with AF were randomised to therapy with an RF generated M-VLTR or B-VLTR shock using a step-up voltage protocol (50-300 V). Mean energy for successful cardioversion was 8.51 J ± 3.16 J. Subsequent analysis revealed that all patients who cardioverted exhibited a significant decrease in ICI between the first and third shocks (5.00 Ω (SD(σ) = 1.62 Ω), p < 0.01) while spectral analysis across frequency also revealed a significant variation in the impedance-amplitude-spectrum-area (IAMSA) within the same patient group (|∆(IAMSAS1-IAMSAS3)[1 Hz - 20 kHz] = 20.82 Ω-Hz (SD(σ) = 10.77 Ω-Hz), p < 0.01); both trends being absent in all patients that failed to cardiovert. Efficient

  19. [The Wearable Cardioverter-Defibrillator (WCD)].

    PubMed

    Helms, Thomas M; Müller, A; Schwab, J O; Bänsch, D; Karle, C; Klingenheben, T; Zugck, C; Perings, C

    2015-06-01

    While the implantable cardioverter-defibrillator (ICD) has been proven to be the best choice for patients with long-term risk for sudden cardiac arrest/sudden cardiac death (SCA/SCD), the question is how to manage patients with only temporary risk, e.g., during the guidelines-recommended waiting period until the decision for an ICD can be made. These patient groups should be monitored around the clock to guarantee a lifesaving shock within a few minutes, if necessary.These conditions can be accomplished by the wearable cardioverter-defibrillator (WCD) in the outpatient sector. The WCD is worn on the skin and consists of four nonadhesive ECG electrodes as well as three defibrillation electrodes-two at the back and one at the front-embedded in a garment. The defibrillation unit is connected via a cord and can be worn over the shoulder or on a belt. Cardiac events can be recorded and retrospectively analyzed by the treating physician.The WCD is a safe and effective measure to terminate potentially lethal ventricular tachycardia and ventricular fibrillation. It may be used early after myocardial infarction with reduced left ventricular ejection fraction (LVEF), as well as for patients with acute heart failure in nonischemic cardiomyopathy with uncertain cause and prognosis. In addition, it may be used for patients waiting for heart transplantation, for patients who cannot be implanted an ICD due to comorbidities, and for patients after explantation of their ICD, e.g., because of infection until reimplantation.One may expect that risk stratification of patients with the WCD will lead to even better selection for ICD use. PMID:25939989

  20. Methods for testing automatic mode switching in patients implanted with DDD(R) pacemakers.

    PubMed

    Lau, Chu-Pak; Mascia, Franco; Corbucci, Giorgio; Padeletti, Luigi

    2004-01-01

    The assessment of automatic mode switching (AMS) algorithms is impossible in vivo, due to a low chance of seeing the patient at the onset of a spontaneous episode of atrial fibrillation (AF). As the induction of AF to test AMS has clinical concerns, three alternative and non-invasive techniques may be proposed for this purpose: myopotentials, chest wall stimulation, and an external supraventricular arrhythmia simulator. The first method is simple and does not require additional equipment, even though in some patients adequate signals cannot be generated with a soft effort such as handgrip or hand compression. The main advantage of the chest wall stimulation method is the possibility that it be performed in every implanting center, since it is based on the use of standard devices for cardiac stimulation. The method based on the external supraventricular arrhythmia simulator allows the most detailed of the ECG traces, but it needs a dedicated electronic device. PMID:15080575

  1. The Effect of Automatic Gain Control Structure and Release Time on Cochlear Implant Speech Intelligibility

    PubMed Central

    Khing, Phyu P.; Swanson, Brett A.; Ambikairajah, Eliathamby

    2013-01-01

    Nucleus cochlear implant systems incorporate a fast-acting front-end automatic gain control (AGC), sometimes called a compression limiter. The objective of the present study was to determine the effect of replacing the front-end compression limiter with a newly proposed envelope profile limiter. A secondary objective was to investigate the effect of AGC speed on cochlear implant speech intelligibility. The envelope profile limiter was located after the filter bank and reduced the gain when the largest of the filter bank envelopes exceeded the compression threshold. The compression threshold was set equal to the saturation level of the loudness growth function (i.e. the envelope level that mapped to the maximum comfortable current level), ensuring that no envelope clipping occurred. To preserve the spectral profile, the same gain was applied to all channels. Experiment 1 compared sentence recognition with the front-end limiter and with the envelope profile limiter, each with two release times (75 and 625 ms). Six implant recipients were tested in quiet and in four-talker babble noise, at a high presentation level of 89 dB SPL. Overall, release time had a larger effect than the AGC type. With both AGC types, speech intelligibility was lower for the 75 ms release time than for the 625 ms release time. With the shorter release time, the envelope profile limiter provided higher group mean scores than the front-end limiter in quiet, but there was no significant difference in noise. Experiment 2 measured sentence recognition in noise as a function of presentation level, from 55 to 89 dB SPL. The envelope profile limiter with 625 ms release time yielded better scores than the front-end limiter with 75 ms release time. A take-home study showed no clear pattern of preferences. It is concluded that the envelope profile limiter is a feasible alternative to a front-end compression limiter. PMID:24312408

  2. Emergency Care of Patients with Pacemakers and Defibrillators.

    PubMed

    Allison, Michael G; Mallemat, Haney A

    2015-08-01

    Devices such as pacemakers and implantable cardioverter-defibrillators (ICDs) are commonly inserted to treat unstable cardiac rhythm disturbances. Despite the benefits of these devices on mortality and morbidity rates, patients often present to the emergency department with complaints related to device insertion or malfunction. Emergency physicians must be able to rapidly identify potential life threats caused by pacemaker malfunction, ICD firing, and complications associated with implantation of the devices. PMID:26226872

  3. Semi-automatic attenuation of cochlear implant artifacts for the evaluation of late auditory evoked potentials.

    PubMed

    Viola, Filipa Campos; De Vos, Maarten; Hine, Jemma; Sandmann, Pascale; Bleeck, Stefan; Eyles, Julie; Debener, Stefan

    2012-02-01

    Electrical artifacts caused by the cochlear implant (CI) contaminate electroencephalographic (EEG) recordings from implanted individuals and corrupt auditory evoked potentials (AEPs). Independent component analysis (ICA) is efficient in attenuating the electrical CI artifact and AEPs can be successfully reconstructed. However the manual selection of CI artifact related independent components (ICs) obtained with ICA is unsatisfactory, since it contains expert-choices and is time consuming. We developed a new procedure to evaluate temporal and topographical properties of ICs and semi-automatically select those components representing electrical CI artifact. The CI Artifact Correction (CIAC) algorithm was tested on EEG data from two different studies. The first consists of published datasets from 18 CI users listening to environmental sounds. Compared to the manual IC selection performed by an expert the sensitivity of CIAC was 91.7% and the specificity 92.3%. After CIAC-based attenuation of CI artifacts, a high correlation between age and N1-P2 peak-to-peak amplitude was observed in the AEPs, replicating previously reported findings and further confirming the algorithm's validity. In the second study AEPs in response to pure tone and white noise stimuli from 12 CI users that had also participated in the other study were evaluated. CI artifacts were attenuated based on the IC selection performed semi-automatically by CIAC and manually by one expert. Again, a correlation between N1 amplitude and age was found. Moreover, a high test-retest reliability for AEP N1 amplitudes and latencies suggested that CIAC-based attenuation reliably preserves plausible individual response characteristics. We conclude that CIAC enables the objective and efficient attenuation of the CI artifact in EEG recordings, as it provided a reasonable reconstruction of individual AEPs. The systematic pattern of individual differences in N1 amplitudes and latencies observed with different stimuli at

  4. Automatic calibration of the inlet pressure sensor for the implantable continuous-flow ventricular assist device.

    PubMed

    Shi, Wei; Saito, Itsuro; Isoyama, Takashi; Nakagawa, Hidemoto; Inoue, Yusuke; Ono, Toshiya; Kouno, Akimasa; Imachi, Kou; Abe, Yusuke

    2011-06-01

    Significant progress in the development of implantable ventricular assist devices using continuous-flow blood pumps has been made recently. However, a control method has not been established. The blood pressure in the inflow cannula (inlet pressure) is one of the candidates for performing an adequate control. This could also provide important information about ventricle sucking. However, no calibration method for an inlet pressure sensor exists. In this study, an automatic calibration algorithm of the inlet pressure sensor from the pressure waveform at the condition of ventricle sucking was proposed. The calibration algorithm was constructed based on the consideration that intrathoracic pressure could be substituted for atmospheric pressure because the lung is open to air. We assumed that the inlet pressure at the releasing point of the sucking would represent the intrathoracic pressure, because the atrial pressure would be low owing to the sucking condition. A special mock circulation system that can reproduce ventricle sucking was developed to validate the calibration algorithm. The calibration algorithm worked well with a maximum SD of 2.1 mmHg for 3-min measurement in the mock circulation system. While the deviation was slightly large for an elaborate calibration, it would still be useful as a primitive calibration. The influence of the respiratory change and other factors as well as the reliability of the calibration value should be investigated with an animal experiment as a next step. PMID:21373781

  5. Measuring defibrillator surface potentials for simulation verification.

    PubMed

    Tate, Jess; Stinstra, Jeroen; Pilcher, Thomas; Poursaid, Ahrash; Saarel, Elizabeth; MacLeod, Rob

    2011-01-01

    Though implantable cardioverter defibrillators (ICDs) are increasing in use in both adults and children, little progress has been devoted to optimizing device and electrode placement. To facilitate effective ICD placement, especially in pediatric cases, we have developed a predictive model that evaluates the efficacy of a delivered shock. We have also developed an experimental validation approach based on measurements from clinical cases. The approach involves obtaining body surface potential maps of ICD discharges during implantation surgery using a limited lead selection and body surface estimation algorithm. Comparison of the simulated and measured potentials yielded very similar patterns and a typical correlation greater than 0.93, suggesting that the predictive simulation generates realistic potential values. This validation approach provides confidence in application of the simulation pipeline and offers areas to focus future improvements. PMID:22254294

  6. A Fortuitous Syncope. The pitfalls of Integrated Bipolar Defibrillator Leads

    PubMed Central

    Salukhe, Tushar V; Wright, Ian; Wright, Matthew; Kanagaratnam, Prapa; O'Neill, Mark D

    2008-01-01

    Myopotential oversensing in implantable defibrillators causing inhibition of pacing and inappropriate therapies is well described. Current literature is dominated by reports of diaphragmatic muscle as the source of such far-field oversensing. Those reporting pectoral muscle sources were invariably due to unipolar sensing circuits, incorrect DF-1 connections or inappropriate programming. We report an interesting case of pectoral muscle myopotential oversensing causing inhibition of bradycardia pacing leading to presyncope and syncope. PMID:18982142

  7. Pacemaker and Defibrillator Lead Extraction

    MedlinePlus

    ... to cure the infection without completely removing all hardware from the body. This requires removal of the ... Footnotes References Figures & Tables Info & Metrics eLetters Article Tools Print Citation Tools Pacemaker and Defibrillator Lead Extraction ...

  8. Implantable Microimagers

    PubMed Central

    Ng, David C.; Tokuda, Takashi; Shiosaka, Sadao; Tano, Yasuo; Ohta, Jun

    2008-01-01

    Implantable devices such as cardiac pacemakers, drug-delivery systems, and defibrillators have had a tremendous impact on the quality of live for many disabled people. To date, many devices have been developed for implantation into various parts of the human body. In this paper, we focus on devices implanted in the head. In particular, we describe the technologies necessary to create implantable microimagers. Design, fabrication, and implementation issues are discussed vis-à-vis two examples of implantable microimagers; the retinal prosthesis and in vivo neuro-microimager. Testing of these devices in animals verify the use of the microimagers in the implanted state. We believe that further advancement of these devices will lead to the development of a new method for medical and scientific applications.

  9. What Is an Automated External Defibrillator?

    MedlinePlus

    ANSWERS by heart Treatments + Tests What Is an Automated External Defibrillator? An automated external defibrillator (AED) is a lightweight, portable device ... AED? Non-medical personnel such as police, fire service personnel, flight attendants, security guards and other lay ...

  10. Automatism

    PubMed Central

    McCaldon, R. J.

    1964-01-01

    Individuals can carry out complex activity while in a state of impaired consciousness, a condition termed “automatism”. Consciousness must be considered from both an organic and a psychological aspect, because impairment of consciousness may occur in both ways. Automatism may be classified as normal (hypnosis), organic (temporal lobe epilepsy), psychogenic (dissociative fugue) or feigned. Often painstaking clinical investigation is necessary to clarify the diagnosis. There is legal precedent for assuming that all crimes must embody both consciousness and will. Jurists are loath to apply this principle without reservation, as this would necessitate acquittal and release of potentially dangerous individuals. However, with the sole exception of the defence of insanity, there is at present no legislation to prohibit release without further investigation of anyone acquitted of a crime on the grounds of “automatism”. PMID:14199824

  11. 21 CFR 870.5325 - Defibrillator tester.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Defibrillator tester. 870.5325 Section 870.5325...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Therapeutic Devices § 870.5325 Defibrillator tester. (a) Identification. A defibrillator tester is a device that is connected to the output of...

  12. 21 CFR 870.5325 - Defibrillator tester.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Defibrillator tester. 870.5325 Section 870.5325...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Therapeutic Devices § 870.5325 Defibrillator tester. (a) Identification. A defibrillator tester is a device that is connected to the output of...

  13. [Future of implantable electrical cardiac devices].

    PubMed

    Daubert, Jean-Claude; Behaghel, Albin; Leclercq, Christophe; Mabo, Philippe

    2014-03-01

    Major improvements in implantable electrical cardiac devices have been made during the last two decades, notably with the advent of automatic internal defibrillation (ICD) to prevent sudden arrhythmic death, and cardiac resynchronisation (CRT) to treat the discoordinated failing heart. They now constitute a major therapeutic option and may eventually supersede drug therapy. The coming era will be marked by a technological revolution, with improvements in treatment delivery, safety and efficacy, and an expansion of clinical indications. Leadless technologyfor cardiac pacemakers and defibrillators is already in the pipeline, endovascular leads currently being responsible for most long-term complications (lead failure, infection, vein thrombosis, etc.). Miniaturized pacemakers based on nanotechnology can now be totally implanted inside the right ventricle through the transvenous route, thus eliminating leads, pockets and scarring In the same way, totally subcutaneous ICD systems are now available, although they are currently only capable of delivering shocks, without pacing (including antitachycardia pacing). In CRT optimised delivery is important to improve clinical responses and to reduce the non-response rate (around 30 % with current technology). Endocardial left ventricular pacing could be a solution if it can be achieved at an acceptable risk. Multisite ventricular pacing is an alternative. Besides CRT neuromodulation, especially by vagal stimulation, is another important field of device researchfor heart failure. Preliminary clinical results are encouraging. PMID:26427291

  14. Synchronized defibrillation for ventricular fibrillation

    PubMed Central

    Manoharan, Ganesh; Navarro, Cesar; Walsh, Simon J; Allen, John D; Anderson, John McC; Adgey, AA Jennifer

    2012-01-01

    Objective: Optimization of defibrillation success is important to improve efficacy and minimize post-shock sequelae. Previous work has suggested an improvement in shock success when an intracardiac shock is delivered synchronized to the upslope of a VF wave. We investigated the efficacy of transthoracic defibrillation success using a novel external biphasic defibrillator which delivers shocks synchronized to the upslope of the surface ECG. Methods: A prospective, controlled, randomized study in a research institute laboratory of male and female pigs (54.2±1.8 kg). Ventricular fibrillation (VF) was induced in 10 anaesthetized and ventilated pigs. Shocks were delivered randomly from a biphasic defibrillator in synchronized or non-synchronized mode via self-adhesive electrode pads following 30 s of VF. Energy settings at 50, 70, 80, and 100J were randomly tested. VF amplitude, impedance, and shock outcome were recorded and analysed digitally. Results: A total of 300 shocks were delivered. Synchronized shocks were delivered on the upslope of the VF wave in 99% of cases. There was no significant difference in shock success between shocks delivered in synchronized or non-synchronized modes (p=0.695). There was no significant difference in the amplitude of VF between successful and unsuccessful shocks (p=0.163). Furthermore, there was no association between shock success and transthoracic impedance. Conclusion: The novel defibrillator used in this study was able to consistently deliver shocks on the upslope portion of the VF wave but did not show an improvement in shock success. PMID:24062919

  15. Mass transport limitation in implantable defibrillator batteries

    NASA Astrophysics Data System (ADS)

    Schmidt, C.; Tam, G.; Scott, E.; Norton, J.; Chen, K.

    Using cells with lithium reference electrodes, the power-limiting behavior in the lithium-SVO cell was shown to be due to a rapid voltage transition at the anode. A novel test cell was developed to explore the influence of current density, bulk LiAsF 6 concentration, separator type and separator proximity to the anode on the time to onset ( τ) of the anode polarization. The results were found to follow a relationship, iτ1/2∝ Cbulk, consistent with the Sand equation. This relationship also predicts that the critical concentration of LiAsF 6, at which onset of the anode polarization occurs, is near the solubility limit of LiAsF 6 in our system (around 3.5-4.0 M). This general phenomenon was found to be quantitatively similar for two dissimilar separator types, and the anode polarization could also be induced in the absence of separator at high concentration and current density. However, it appears that τ decreases with closer proximity of the separator to the anode surface (i.e. cell stack pressure), suggesting that the effect of separator is to inhibit convective transport to and from the Li surface.

  16. Who Needs an Implantable Cardioverter Defibrillator?

    MedlinePlus

    ... would make one likely) on the following tests. EKG (Electrocardiogram) An EKG is a simple, painless test that detects and ... beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical ...

  17. Clinical experience with the transvenous Medtronic Pacer Cardioverter Defibrillator (PCD) System.

    PubMed Central

    Golino, A; Pappone, C; Panza, A; Santomauro, M; Iorio, D; De Amicis, V; Chiariello, M; Spampinato, N

    1993-01-01

    We review our experience with the transvenous Medtronic Pacer Cardioverter Defibrillator System (Model 7217B), a multifunction implantable pacer defibrillator combined with a transvenous lead system (Transvene). From April 1991 to October 1992, we implanted this device in 19 consecutive patients (11 men and 8 women; average age, 56.5 years). Nine patients (47.4%), 5 with coronary artery disease and 4 with dilated cardiomyopathy, had an ejection fraction of < 30%. The average operative time was 129 minutes. In 18 patients (94.7%), the transvenous lead system provided effective sensing, pacing, and defibrillation during intraoperative testing. In each of these cases, the defibrillation threshold was less than 18 J. In 1 patient (5.3%), it was necessary to switch to epicardial leads, which were implanted through a left thoracotomy. All patients were extubated in the recovery room. The average hospital stay was 8 days. There was no early mortality or morbidity. During a maximum follow-up period of 17 months (mean, 9.2 months), no sudden death occurred. The implantable system terminated 245 ventricular tachycardia episodes in 14 patients (73.7%) and 82 ventricular fibrillation episodes in 13 patients (68.4%). Two hundred eleven (86.1%) of the ventricular tachycardia episodes were resolved by antitachycardia pacing alone. In 2 patients (10.5%), the caval electrode became dislocated; repositioning of the electrode was followed by repeat defibrillation threshold evaluation. Our experience shows that the transvenous Medtronic Pacer Cardioverter Defibrillator System provides safe, effective treatment of ventricular tachyarrhythmias. Because the perioperative mortality and morbidity are extremely low, use of this device may be particularly beneficial in patients with a high operative risk. Moreover, the lower number of unpleasant therapeutic shocks should increase patient a acceptance of the device. Images PMID:8298322

  18. Holter ECG for pacemaker/defibrillator carriers: what is its role in the era of remote monitoring?

    PubMed

    Diemberger, Igor; Gardini, Beatrice; Martignani, Cristian; Ziacchi, Matteo; Corzani, Alessandro; Biffi, Mauro; Boriani, Giuseppe

    2015-08-01

    Nowadays several diagnostic tools are available to investigate cardiovascular symptoms like palpitations, dizziness and syncope: ECG Holter (or ambulatory ECG, AECG), external and implantable event/loop recorders. Despite this technological burden, many diagnoses are still missed. In the meantime, we are facing an increasing use of implantable devices for cardiac pacing/defibrillation (CIED), which have rapidly evolved from simple pacing/shock boxes to devices including several diagnostic features. However, these functions are not adequately exploited in current clinical practice and several redundant diagnostic tests, like AECG, are still prescribed to CIED carriers, leading to an increase of costs and a delay in final diagnosis. This review is aimed at identifying the current role of AECG in CIED carriers in view of this technological improvement. First, we will briefly present the indications for AECG according to current guidelines. We will then provide a direct comparison of the different diagnostic features provided by AECG (and event/loop recorders) versus automatic diagnostic CIED to highlight the respective pros and cons. This will serve to carefully discuss these indications in view of the results of recent studies on CIED carriers, highlighting the need for proper implantation and follow-up. Eventually, we will provide useful hints to properly analyse AECG in CIED carriers, considering the different behaviours according to the implemented algorithms. We will conclude by suggesting updated indications for AECG. PMID:26001846

  19. A Comparative Survey of Pacemaker Implantation in Trinidad and Tobago in 2005 and 2009

    PubMed Central

    Henry, R; Dookie, T; Primus, E

    2014-01-01

    ABSTRACT Objective: The indications for permanent pacemaker implantations in Trinidad have expanded from initially symptomatic bradycardia to now include complex devices. A retrospective review of the available data was conducted to better understand the evolving trends in device implantation in Trinidad and Tobago. Methods: Data were collated from the two major implanting teams in Trinidad for the years 2005 and 2009. The two implanting centres were the Advanced Cardiovascular Institute (ACI) at Westshore Medical Centre and the Catheterization Laboratory of the Eric Williams Medical Sciences Complex (EWMSC). Data were based on retrospective collation using the implantation records. Results: The implantation rate for new devices increased from 39 per million to 103 per million population. The most common indications for new device implants in 2009 were high degree atrioventricular (AV) block (53%) and sick sinus syndrome (22%), with the notable appearance of congestive cardiomyopathy (13%) which was not present in the earlier cohort. Of particular note, 23 high-end devices were implanted in 2009. These were five cardiac-resynchronization therapy (CRT-P) devices, 14 automatic implantable cardio-defibrillator (AICD) devices and four combined cardiac-resynchronization therapy with defibrillator (CRT-D) devices versus none in 2005. Conclusions: In summary, over the period 2005 to 2009, a substantial increase in device implantation rates has occurred which now include high-end complex devices. Absolute rates, however, remain far below that of developed countries, indicating that the true need remains underserved. Furthermore, adjustment for gross domestic product suggests that the relatively buoyant economy of Trinidad and Tobago is capable of servicing a greater proportion of this need than is currently met. PMID:26108119

  20. Use of Automated External Defibrillators

    SciTech Connect

    Gregory K Christensen

    2009-02-01

    In an effort to improve survival from cardiac arrest, the American Heart Association (AHA) has promoted the Chain of Survival concept, describing a sequence of prehospital steps that result in improved survival after sudden cardiac arrest. These interventions include immediate deployment of emergency medical services, prompt cardiopulmonary resuscitation, early defibrillation when indicated, and early initiation of advanced medical care. Early defibrillation has emerged as the most important intervention with survival decreasing by 10% with each minute of delay in defibrillation. Ventricular Fibrillation (VF) is a condition in which there is uncoordinated contraction of the heart cardiac muscle of the ventricles in the heart, making them tremble rather than contract properly. VF is a medical emergency and if the arrhythmia continues for more than a few seconds, blood circulation will cease, and death can occur in a matter of minutes. During VF, contractions of the heart are not synchronized, blood flow ceases, organs begin to fail from oxygen deprivation and within 10 minutes, death will occur. When VF occurs, the victim must be defibrillated in order to establish the heart’s normal rhythm. On average, the wait for an ambulance in populated areas of the United States is about 11 minutes. In view of these facts, the EFCOG Electrical Safety Task Group initiated this review to evaluate the potential value of deployment and use of automated external defibrillators (AEDs) for treatment of SCA victims. This evaluation indicates the long term survival benefit to victims of SCA is high if treated with CPR plus defibrillation within the first 3-5 minutes after collapse. According to the American Heart Association (AHA), survival rates as high as 74% are possible if treatment and defibrillation is performed in the first 3 minutes. In contrast survival rates are only 5% where no AED programs have been established to provide prompt CPR and defibrillation. ["CPR statistics

  1. Defibrillation thresholds are lower with smaller storage capacitors.

    PubMed

    Leonelli, F M; Kroll, M W; Brewer, J E

    1995-09-01

    Present implantable cardioverter defibrillators use a wide range of capacitance values for the storage capacitor. However, the optimal capacitance value is unknown. We hypothesized that a smaller capacitor, by delivering its charge in a time closer to the heart chronaxie, should lower the defibrillation threshold (DFT). We compared the energy required to defibrillate 10 open-chest dogs, after 15 seconds of ventricular fibrillation, with a monophasic, time-truncated waveform delivered from either a 85-microF or a 140-microF capacitor. Shocks were delivered through a pair of 14-cm2 epicardial patch electrodes: The two capacitors were randomly tested twice with each dog using a modified 3-reversal method for each DFT determination. The average stored and delivered DFT energies for the 85-microF capacitor were 6.0 +/- 1.7 joules and 5.2 +/- 1.5 joules, respectively, compared to 6.7 +/- 1.7 joules and 6.0 +/- 1.5 joules for the 140-microF capacitor (P = 0.01 and P = 0.004, respectively). The mean leading edge voltages were higher, the pulse duration shorter, and the mean impedance lower for the 85-microF capacitor. The impedance was inversely related to the pulse duration and the voltage decay suggesting that, at least in part, the mechanism of improved defibrillation could be accounted for by the waveform electrical characteristics. There was an equal number of episodes of postshock bradyarrhythmias and tachyarrhythmias following discharges from each capacitor. Moreover, there was no relationship between the likelihood of these arrhythmias and either the initial voltage or the delivered current nor there was a higher number of episodes of postshock hypotension following the smaller capacitor discharges.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7491309

  2. Defibrillation safety in emergency helicopter transport.

    PubMed

    Dedrick, D K; Darga, A; Landis, D; Burney, R E

    1989-01-01

    Rotary aircraft play a growing role in the transport of critically ill patients who may require emergency treatment, including defibrillation, during transport. The close quarters and proximity of vital electronic equipment have generated concern among personnel carrying out defibrillation in the air. We address the chief safety issues in helicopter defibrillation by providing measurements of the transient leakage current resulting from contact with a paddle and tested in-flight electronic interference and survey the defibrillation experience of helicopter programs. Our data show that airborne defibrillation is safe. A maximum of 1.5 mA of transient leakage current was measured from a standard battery-powered defibrillator, well within the accepted safety standard of 50 mA. In flight, there was no interference with the avionics or medical equipment, and adequate clearance was available for personnel. Of the helicopter programs surveyed, 69 (87%) had defibrillated in flight without incident. We conclude that defibrillation can be performed in the helicopter without hesitation whether on the ground or in the air, provided standard defibrillation precautions are observed. PMID:2910165

  3. Defibrillator-Induced Tricuspid Abscess Presenting as Diabetic Ketoacidosis and Wound Ulceration

    PubMed Central

    Khan, Rafay; Arshed, Sabrina; Ahmed, Amar; Sen, Shuvendu; Yousif, Abdalla

    2016-01-01

    Right-sided endocarditis is predominantly seen in patients with a history of intravenous drug abuse. However, it is well shown in the literature to be associated with patients containing foreign bodies such as pacemakers, central venous lines, and in those with congenital heart disease. In patients with pacemaker leads and in those with automatic implantable cardioverter defibrillators (AICDs), it is important to suspect foreign body infection when there are signs and indications of bacteremia. When these leads become infected, they can spread the infection to the tricuspid valve resulting in vegetations. The proper management is removal of the infected lead and foreign body along with a prolonged course of antibiotics. However, it is unusual and a relatively rare entity to see foreign body infection resulting from a wound ulcer resulting in not only endocarditis but also abscess formation on the tricuspid valve. Here we report a case of a 60-year-old male with recent AICD placement presenting as diabetic ketoacidosis due to tricuspid abscess formation as a result of a foot ulcer. PMID:26668682

  4. Defibrillator-Induced Tricuspid Abscess Presenting as Diabetic Ketoacidosis and Wound Ulceration.

    PubMed

    Khan, Rafay; Arshed, Sabrina; Ahmed, Amar; Sen, Shuvendu; Yousif, Abdalla

    2016-01-01

    Right-sided endocarditis is predominantly seen in patients with a history of intravenous drug abuse. However, it is well shown in the literature to be associated with patients containing foreign bodies such as pacemakers, central venous lines, and in those with congenital heart disease. In patients with pacemaker leads and in those with automatic implantable cardioverter defibrillators (AICDs), it is important to suspect foreign body infection when there are signs and indications of bacteremia. When these leads become infected, they can spread the infection to the tricuspid valve resulting in vegetations. The proper management is removal of the infected lead and foreign body along with a prolonged course of antibiotics. However, it is unusual and a relatively rare entity to see foreign body infection resulting from a wound ulcer resulting in not only endocarditis but also abscess formation on the tricuspid valve. Here we report a case of a 60-year-old male with recent AICD placement presenting as diabetic ketoacidosis due to tricuspid abscess formation as a result of a foot ulcer. PMID:26668682

  5. Iranian Patients’ Experiences of the Internal Cardioverter Defibrillator Device Shocks: a Qualitative Study

    PubMed Central

    Pasyar, Nilofar; Sharif, Farkhondeh; Rakhshan, Mahnaz; Nikoo, Mohammad; Navab, Elham

    2015-01-01

    Introduction: Implantable Cardioverter Defibrillator (ICD) is a valuable treatment for the patients at risk of sudden cardiac death. In this method, after diagnosis of pathological cardiac rhythms, shock is automatically applied to normalize the rhythms. Shock is discharged when the patients are conscious, but the patients’ experiences of shock have remained unknown. Thus, this study aimed to identify and describe the patients’ experiences of shocks received from ICD. Methods: The present qualitative study was conducted through thematic analysis and semi-structured interviews on 9 patients mean age 41.55 (1.57) with ICD from November 2013 to July 2014. Data analysis was also performed simultaneously using constant comparative analysis. Results: In this study, two main themes, namely "with a parachute for life" and "Faced with nuisance", were obtained representing the patients’ experiences regarding ICD shock. With a parachute for life included subthemes, such as "Rebirth", "Comforter and healing", and "Life assurance". In addition, "Faced with nuisance" consisted of 2 subthemes of "Discomfort in moments of shock" and "Displeasure after shock". Conclusion: This study provided a basis for evaluation of patients nursing after discharge. By identification of the patients’ experiences regarding shock, the present study can help the professional health staff to efficiently play their roles and provide patients with holistic care. It can also be effective in designing behavioral and cognitive interventional programs to change the patients’ attitude and promote their adaptation with their conditions. PMID:26744727

  6. Experimental new automatic tools for robotic stereotactic neurosurgery: towards "no hands" procedure of leads implantation into a brain target.

    PubMed

    Mazzone, P; Arena, P; Cantelli, L; Spampinato, G; Sposato, S; Cozzolino, S; Demarinis, P; Muscato, G

    2016-07-01

    The use of robotics in neurosurgery and, particularly, in stereotactic neurosurgery, is becoming more and more adopted because of the great advantages that it offers. Robotic manipulators easily allow to achieve great precision, reliability, and rapidity in the positioning of surgical instruments or devices in the brain. The aim of this work was to experimentally verify a fully automatic "no hands" surgical procedure. The integration of neuroimaging to data for planning the surgery, followed by application of new specific surgical tools, permitted the realization of a fully automated robotic implantation of leads in brain targets. An anthropomorphic commercial manipulator was utilized. In a preliminary phase, a software to plan surgery was developed, and the surgical tools were tested first during a simulation and then on a skull mock-up. In such a way, several tools were developed and tested, and the basis for an innovative surgical procedure arose. The final experimentation was carried out on anesthetized "large white" pigs. The determination of stereotactic parameters for the correct planning to reach the intended target was performed with the same technique currently employed in human stereotactic neurosurgery, and the robotic system revealed to be reliable and precise in reaching the target. The results of this work strengthen the possibility that a neurosurgeon may be substituted by a machine, and may represent the beginning of a new approach in the current clinical practice. Moreover, this possibility may have a great impact not only on stereotactic functional procedures but also on the entire domain of neurosurgery. PMID:27194228

  7. Implantable cardioverter defibrillator clinic casualties: inadvertent reprogramming during routine implantable cardioverter defibrillator follow-up.

    PubMed

    Ozahowski, T P; Greenberg, M L; Mock, P; Holzberger, P T; Gerling, B; Zalinger, C; Perry, C

    1996-10-01

    On one occasion during a busy ICD follow-up clinic, the preceding patient's parameters for rate, PDF, and delay were inadvertently programmed into the subsequent patient's generator using the CPI Programmer Model 2035. This occurred after capacitor reformation, without pressing the "Program" button. The source of this reprogramming error was failure to clear the programmer memory of the previous patient's data, usually achieved by turning the programmer off between patients (or selecting "New Patient" from the menu). At our next ICD follow-up clinic, we purposely did not turn off the programmer between two sets of patients. On both occasions the above finding was repeated and confirmed. These observations indicate the potential for serious reprogramming errors that can occur simply by not clearing the programmer's memory between clinic patients. PMID:8904549

  8. Feasibility of public access to defibrillation.

    PubMed

    Caffrey, Sherry

    2002-06-01

    Immediate defibrillation is the single most effective therapy to reverse ventricular fibrillation cardiac arrest today. The once physician-only skill of defibrillation has entered mainstream society and is saving the lives of many sudden cardiac arrest (SCA) victims in a variety of settings. The automated external defibrillator (AED) and the concept of public access defibrillation (PAD) are a result of collaborative efforts between the American Heart Association (AHA) and medical manufacturers. Today, airports, airlines, casinos, cruise ships, and other public venues have modernized their first aid kits to include an AED. The success of these programs has ignited a trend in public safety and subsequently marketed the worth of AEDs in the home. Although optimal placement of AEDs remains uncertain, PAD is showing great promise in reducing the death rate from SCA. The lay public, both trained and untrained, is emerging as the next level of emergency care responders able to use a defibrillator. PMID:12386497

  9. First clinical evaluation of an atrial haemodynamic sensor lead for automatic optimization of cardiac resynchronization therapy

    PubMed Central

    Duncker, David; Delnoy, Peter Paul; Nägele, Herbert; Mansourati, Jacques; Mont, Lluís; Anselme, Frédéric; Stengel, Petra; Anselmi, Francesca; Oswald, Hanno; Leclercq, Christophe

    2016-01-01

    Aims One option to improve cardiac resynchronization therapy (CRT) responder rates lies in the optimization of pacing intervals. A haemodynamic sensor embedded in the SonRtip atrial lead measures cardiac contractility and provides a systematic automatic atrioventricular and interventricular delays optimization. This multi-centre study evaluated the safety and performance of the lead, up to 1 year. Methods and results A total of 99 patients were implanted with the system composed of the lead and a CRT-Defibrillator device. Patients were followed at 1, 3, 6, and 12 months post-implant. The primary safety objective was to demonstrate that the atrial lead complication free rate was superior to 90% at 3-months follow-up visit. A lead handling questionnaire was filled by implanting investigators. Lead electrical performances and the performance of the system to compute AV and VV delays were evaluated at each study visit over 1 year. The complication free rate at 3 months post-implant was 99.0% [95%CI 94.5–100.0%], P < 0.001. Electrical performances of the lead were adequate whatever the atrial lead position and remained stable over the study period. The optimization algorithm was able to compute AV and VV delays in 97% of patients, during >75% of the weeks. Conclusion The atrial lead is safe to implant and shows stable electrical performance over time. It therefore offers a promising tool for automatic CRT optimization to further improve responder rates to CRT. PMID:25976907

  10. Implantable loop recorder for recurrent syncopes.

    PubMed

    Babuty, D; Pierre, B; Grimard, C; Zannad, N; Marie, O; Fauchier, L

    2009-08-01

    Syncope is a common disorder which may recur and impair the survival and the quality of life of the patients. The objective of the investigation of syncope is to diagnose the cardiac etiology, as mortality rate is high. Implantable loop recorder or insertable cardiac monitor (ICM) is a useful tool to establish a correlation between syncope and heart rhythm. About half of implanted patients complain of a new syncope and about 50% of these patients had cardiac rhythm disturbances on ICM. The most frequent is a sinus bradycardia or sinus arrest, but these results depend on the age of patients, resting electrocardiography (ECG) abnormalities and structural cardiac disease. A classification of the mechanisms of recurrent syncopes has been defined with the results of the ISSUE study, separating the syncope due to primary cardiac arrhythmia from neurally-mediated syncope and from unknown syncope. The analysis of the presyncopal phase on the ICM restored ECG allows physicians to adapt the treatment (antiarrhytmic agents or pacemaker) and optimize the programming of the pacemaker when necessary. It is early recommended to implant the ICM in patients affected with syncope with normal physical examination, normal ECG and without structural heart disease and negative tilt testing. In the presence of cardiac disease, it is recommended to implant ICM after performing an electrophysiological study and tilt testing. In syncope patients with depressed left ventricular ejection fraction, the implantation of an automatic implantable cardiac defibrillator is preferable. The indications of the ICM tend to be extended to new syncope populations such as pediatric patients and epileptic population. Early application of ICM reduces the cost of the investigation of the patients suffering from syncope, especially when the electrophysiological study is avoided. In the future the implantation of the ICM should be early discussed in the Syncope Unit to shorten the duration and the cost of the

  11. Safety Of Mris In Patients With Pacemakers And Defibrillators

    PubMed Central

    Baher, Alex; Shah, Dipan

    2013-01-01

    With a burgeoning population, increases in life expectancy, and expanding indications, the number of patients with cardiac devices such as pacemakers and implantable cardioverter defibrillators continues to increase each year. A majority of these patients will develop an indication for magnetic resonance imaging (MRI) in their lifetime. MRIs have established themselves as one of the most powerful imaging tools for a variety of conditions. However, given the historic safety concerns, many physicians are reluctant to use MRIs in this patient population. In this paper, we discuss the potential adverse effects of MRIs in patients with cardiac devices, review key studies that have addressed strategies to limit adverse effects, and provide our cardiovascular MRI laboratory’s protocol for imaging patients with implanted cardiac devices. PMID:24066196

  12. Pacing and Defibrillators in Complex Congenital Heart Disease

    PubMed Central

    Chubb, Henry; O’Neill, Mark; Rosenthal, Eric

    2016-01-01

    Device therapy in the complex congenital heart disease (CHD) population is a challenging field. There is a myriad of devices available, but none designed specifically for the CHD patient group, and a scarcity of prospective studies to guide best practice. Baseline cardiac anatomy, prior surgical and interventional procedures, existing tachyarrhythmias and the requirement for future intervention all play a substantial role in decision making. For both pacing systems and implantable cardioverter defibrillators, numerous factors impact on the merits of system location (endovascular versus non-endovascular), lead positioning, device selection and device programming. For those with Fontan circulation and following the atrial switch procedure there are also very specific considerations regarding access and potential complications. This review discusses the published guidelines, device indications and the best available evidence for guidance of device implantation in the complex CHD population. PMID:27403295

  13. Unipolar ventricular pacing reduces inappropriate shocks from a separate cardioverter defibrillator in a post-Fontan patient.

    PubMed

    Cohen, Mitchell I; Jedeikin, Roy; Pfeiffer, Sharon; Pedersen, Scott

    2006-04-01

    This report describes a 20-year-old man with complex congenital heart disease and inappropriate epicardial implantable cardioverter defibrillator (ICD) shocks secondary to double counting of ventricular-paced spikes and QRS complexes from a separate bipolar epicardial dual-chamber pacemaker. Adjusting to a unipolar paced-ventricular mode resolved any double counting via pacemaker-ICD interaction. PMID:16627457

  14. Electrical Heart Defibrillation with Ion Channel Blockers

    NASA Astrophysics Data System (ADS)

    Feeney, Erin; Clark, Courtney; Puwal, Steffan

    Heart disease is the leading cause of mortality in the United States. Rotary electrical waves within heart muscle underlie electrical disorders of the heart termed fibrillation; their propagation and breakup leads to a complex distribution of electrical activation of the tissue (and of the ensuing mechanical contraction that comes from electrical activation). Successful heart defibrillation has, thus far, been limited to delivering large electrical shocks to activate the entire heart and reset its electrical activity. In theory, defibrillation of a system this nonlinear should be possible with small electrical perturbations (stimulations). A successful algorithm for such a low-energy defibrillator continues to elude researchers. We propose to examine in silica whether low-energy electrical stimulations can be combined with antiarrhythmic, ion channel-blocking drugs to achieve a higher rate of defibrillation and whether the antiarrhythmic drugs should be delivered before or after electrical stimulation has commenced. Progress toward a more successful, low-energy defibrillator will greatly minimize the adverse effects noted in defibrillation and will assist in the development of pediatric defibrillators.

  15. Impact of expanding indications on the safety of pacemakers and defibrillators.

    PubMed

    Maisel, William H

    2003-01-01

    The number of patients living with a pacemaker or implantable cardioverter defibrillator (ICD) increased markedly during the 1990's. Expanding device indications and increasing device sophistication has important implications for patient and device safety. While the FDA is responsible for assessing the safety and efficacy of medical devices, manufacturers, physicians, patients, medical professional societies, and legislators will all play a role in ensuring that medical device patients continue to receive safe, quality medical care. PMID:12766513

  16. Injury to the coronary arteries and related structures by implantation of cardiac implantable electronic devices.

    PubMed

    Pang, Benjamin J; Barold, S Serge; Mond, Harry G

    2015-04-01

    Damage to the coronary arteries and related structures from pacemaker and implantable cardioverter-defibrillator lead implantation is a rarely reported complication that can lead to myocardial infarction and pericardial tamponade that may occur acutely or even years later. We summarize the reported cases of injury to coronary arteries and related structures and review the causes of troponin elevation in the setting of cardiac implantable electronic device implantation. PMID:25564549

  17. [Is a physician liable for an unsafe implant?].

    PubMed

    Wijne, Rolinka P

    2015-01-01

    In recent years, various incidents involving unsafe implants have drawn a lot of attention. Examples include problems with breast prostheses (PIP implants), artificial hips (metal-on-metal hip prostheses) and synthetic mesh implants, and possible dysfunctional leads of implantable cardioverter defibrillators. This article highlights the regulations concerning physicians' liability if it transpires that the implants they used for the treatment of patients prove to be unsafe. PMID:27007937

  18. Comparative reproducibility of defibrillation threshold and upper limit of vulnerability.

    PubMed

    Swerdlow, C D; Davie, S; Ahern, T; Chen, P S

    1996-12-01

    The upper limit of vulnerability (ULV) is the strength at or above which VF is not induced when a stimulus is delivered during the vulnerable phase of the cardiac cycle. Previous studies have demonstrated a statistically significant correlation between the ULV and the defibrillation threshold (DFT) in groups of patients. However, the correlation between ULV and DFT may not be close in individual patients. This imperfect correlation may be due to physiological factors or to limitations of the measurement methods. The reproducibility of either DFT or ULV has not been studied critically. The purpose of this study was to compare the reproducibility of clinically applicable methods for determination of DFT and ULV. We prospectively studied 25 patients with a transvenous implantable cardioverter defibrillator (Medtronic 7219D) at postoperative electrophysiological study. DFT was defined as the lowest energy that defibrillated after 10 seconds of VF. The ULV was defined as the lowest energy that did not induce VF with three shocks at 0, 20, and 40 ms before the peak of the T wave in ventricular paced rhythm at a cycle length of 500 ms. Both the DFT and the ULV were determined twice for biphasic pulses using a three-step, midpoint protocol. There was no significant difference between the two determinations of DFT (10.1 +/- 5.9 J vs 10.4 +/- 5.8 J), the two determinations of ULV (13.4 +/- 6.8 J vs 13.8 +/- 6.6) or the DFT-ULV Pearson correlation coefficients for each determination (0.84, P < 0.001 vs 0.75, P < 0.001). To analyze reproducibility, Lin concordance coefficients for second determination versus first determination were constructed for both ULV and DFT. This coefficient is similar to the Pearson correlation coefficient, but measures closeness to the line of identity rather than the line of regression. The Lin concordance coefficient for ULV was higher than that for DFT (0.93, 95% CI 0.85-0.97 vs 0.64, 95% CI 0.33-0.82; P < 0.01). For paired comparison of

  19. Exchange of pacing or defibrillator leads following laser sheath extraction of non-functional leads in patients with ipsilateral obstructed venous access

    PubMed Central

    Bracke, F; van Gelder, L M; Sreeram, N; Meijer, A

    2000-01-01

    Occlusion of the subclavian or brachiocephalic vein in pacemaker or defibrillator patients prohibits ipsilateral implantation of new leads with standard techniques in the event of lead malfunction. Three patients are presented in whom laser sheath extraction of a non-functional lead was performed in order to recanalise the occluded vein and to secure a route for implantation of new leads. This technique avoids abandoning a useful subpectoral site for pacing or defibrillator therapy. The laser sheath does not affect normally functioning leads at the same site.


Keywords: laser sheath; venous occlusion; pacemaker; lead extraction PMID:10814646

  20. New horizon for infection prevention technology and implantable device.

    PubMed

    Kondo, Yusuke; Ueda, Marehiko; Kobayashi, Yoshio; Schwab, Joerg O

    2016-08-01

    There has been a significant increase in the number of patients receiving cardiovascular implantable electronic devices (CIED) over the last two decades. CIED infection represents a serious complication after CIED implantation and is associated with significant morbidity and mortality. Recently, newly advanced technologies have offered attractive and suitable therapeutic alternatives. Notably, the leadless pacemaker and anti-bacterial envelope decrease the potential risk of CIED infection and the resulting mortality, when it does occur. A completely subcutaneous implantable cardioverter defibrillator is also an alternative to the transvenous implantable cardioverter defibrillator (ICD), as it does not require implantation of any transvenous or epicardial leads. Among the patients who require ICD removal and subsequent antibiotics secondary to infection, the wearable cardioverter defibrillator represents an alternative approach to inpatient monitoring for the prevention of sudden cardiac death. In this review paper, we aimed to introduce the advanced technologies and devices for prevention of CIED infection. PMID:27588153

  1. Imaging of Ventricular Fibrillation and Defibrillation: The Virtual Electrode Hypothesis

    PubMed Central

    Boukens, Bastiaan J.; Gutbrod, Sarah R.; Efimov, Igor R.

    2016-01-01

    Ventricular fibrillation is the major underlying cause of sudden cardiac death. Understanding the complex activation patterns that give rise to ventricular fibrillation requires high resolution mapping of localized activation. The use of multi-electrode mapping unraveled re-entrant activation patterns that underlie ventricular fibrillation. However, optical mapping contributed critically to understanding the mechanism of defibrillation, where multi-electrode recordings could not measure activation patterns during and immediately after a shock. In addition, optical mapping visualizes the virtual electrodes that are generated during stimulation and defibrillation pulses, which contributed to the formulation of the virtual electrode hypothesis. The generation of virtual electrode induced phase singularities during defibrillation is arrhythmogenic and may lead to the induction of fibrillation subsequent to defibrillation. Defibrillating with low energy may circumvent this problem. Therefore, the current challenge is to use the knowledge provided by optical mapping to develop a low energy approach of defibrillation, which may lead to more successful defibrillation. PMID:26238060

  2. Automatic three-dimensional registration of intra-vascular optical coherence tomography images for the clinical evaluation of stent implantation over time

    NASA Astrophysics Data System (ADS)

    Ughi, Giovanni J.; Adriaenssens, Tom; Larsson, Matilda; Dubois, Christophe; Sinnaeve, Peter; Coosemans, Mark; Desmet, Walter; D'hooghe, Jan

    2012-01-01

    In the last decade a large number of new intracoronary devices (i.e. drug-eluting stents, DES) have been developed to reduce the risks related to bare metal stent (BMS) implantation. The use of this new generation of DES has been shown to substantially reduce, compared with BMS, the occurrence of restenosis and recurrent ischemia that would necessitate a second revascularization procedure. Nevertheless, safety issues on the use of DES persist and full understanding of mechanisms of adverse clinical events is still a matter of concern and debate. Intravascular Optical Coherence Tomography (IV-OCT) is an imaging technique able to visualize the microstructure of blood vessels with an axial resolution <20 μm. Due to its very high spatial resolution, it enables detailed in-vivo assessment of implanted devices and vessel wall. Currently, the aim of several major clinical trials is to observe and quantify the vessel response to DES implantation over time. However, image analysis is currently performed manually and corresponding images, belonging to different IV-OCT acquisitions, can only be matched through a very labor intensive and subjective procedure. The aim of this study is to develop and validate a new methodology for the automatic registration of IV-OCT datasets on an image level. Hereto, we propose a landmark based rigid registration method exploiting the metallic stent framework as a feature. Such a tool would provide a better understanding of the behavior of different intracoronary devices in-vivo, giving unique insights about vessel pathophysiology and performance of new generation of intracoronary devices and different drugs.

  3. Comparison of five different defibrillators using recommended energy protocols.

    PubMed

    Zelinka, M; Buić, D; Zelinka, I

    2007-09-01

    Biphasic defibrillators represent a great step ahead in defibrillation. The manufacturers claim that biphasic defibrillators are able to compensate for differences in transthoracic impedance. That should mean that all patients should be defibrillated with approximately the same amount of current, regardless of their transthoracic impedance. We assessed one monophasic and four biphasic defibrillators. The defibrillators were discharged into resistive loads of 50, 90 and 130 Omega, simulating transthoracic impedance. For each waveform we used energy protocols recommended by the manufacturers and guidelines 2005. Waveforms were observed with on a digitising oscilloscope on a current sensing resistor. We compared the electrical properties of different waveforms and two defibrillators with the same type of waveform. The influence of different impedance on shape, duration and amplitude of current flow were also observed for each waveform. Measurements showed a significant difference in current flow at different impedance loads. At low impedance the mean current is well above expectations for all the defibrillators studied and at high impedance load we observed a big reduction of current amplitude. We can conclude that the compensating mechanisms of biphasic defibrillators are, from electrical point of view, negligible. From the laws of physics it is practically impossible to keep same level of current at given time with same energy at higher impedance. That is why we should reconsider the use of different energy equivalents between patients with different transthoracic impedance and not between different defibrillation impulses. PMID:17466431

  4. Management of radiation therapy patients with cardiac defibrillator or pacemaker.

    PubMed

    Salerno, Francesca; Gomellini, Sara; Caruso, Cristina; Barbara, Raffaele; Musio, Daniela; Coppi, Tamara; Cardinale, Mario; Tombolini, Vincenzo; de Paula, Ugo

    2016-06-01

    The increasing growth of population with cardiac implantable electronic devices (CIEDs) such as Pacemaker (PM) and Implantable Cardiac Defibrillators (ICD), requires particular attention in management of patients needing radiation treatment. This paper updates and summarizes some recommendations from different international guidelines. Ionizing radiation and/or electromagnetic interferences could cause device failure. Current approaches to treatment in patients who have these devices vary among radiation oncology centres. We refer to the German Society of Radiation Oncology and Cardiology guidelines (ed. 2015); to the Society of Cardiology Australia and New Zealand Statement (ed. 2015); to the guidelines in force in the Netherlands (ed. 2012) and to the Italian Association of Radiation Oncology recommendations (ed. 2013) as reported in the guidelines for the treatment of breast cancer in patients with CIED. Although there is not a clear cut-off point, risk of device failure increases with increasing doses. Cumulative dose and pacing dependency have been combined to categorize patients into low-, medium- and high-risk groups. Measures to secure patient safety are described for each category. The use of energy ≤6MV is preferable and it's strongly recommended not to exceed a total dose of 2 Gy to the PM and 1 Gy for ICD. Given the dangers of device malfunction, radiation oncology departments should adopt all the measures designed to minimize the risk to patients. For this reason, a close collaboration between cardiologist, radiotherapist and physicist is necessary. PMID:26706454

  5. Frequent Home Monitoring of ICD Is Effective to Prevent Inappropriate Defibrillator Shock Delivery.

    PubMed

    Bifulco, Paolo; Argenziano, Luigi; Romano, Maria; Cesarelli, Mario; Sansone, Mario; Casella, Stefano; Nardi, Stefano

    2014-01-01

    Recently, in the context of telemedicine, telemonitoring services are gaining attention. They are offered, for example, to patients with implantable cardioverter defibrillators (ICDs). A major problem associated with ICD therapy is the occurrence of inappropriate shocks which impair patients' quality of life and may also be arrhythmogenic. The telemonitoring can provide a valid support to intensify followup visits, in order to improve the prevention of inappropriate defibrillator shock, thus enhancing patient safety. Inappropriate shock generally depends on atrial fibrillation, supraventricular tachycardia, and abnormal sensing (such as those caused by electromagnetic interferences). As a practical example, an unusual case of an ICD patient who risked an inappropriate shock while taking a shower is reported. Continuous remote telemonitoring was able to timely warn cardiologist via GSM-SMS, who were able to detect improper sensing examining the intracardiac electrogram via Web. Patient was promptly contacted and warned to not further come in contact with the hydraulic system and any electrical appliance to prevent an inappropriate defibrillator shock. This demonstrates the effectiveness and usefulness of continuous remote telemonitoring in supporting ICD patients. PMID:24592279

  6. Evaluation and automatic correction of metal-implant-induced artifacts in MR-based attenuation correction in whole-body PET/MR imaging

    NASA Astrophysics Data System (ADS)

    Schramm, G.; Maus, J.; Hofheinz, F.; Petr, J.; Lougovski, A.; Beuthien-Baumann, B.; Platzek, I.; van den Hoff, J.

    2014-06-01

    The aim of this paper is to describe a new automatic method for compensation of metal-implant-induced segmentation errors in MR-based attenuation maps (MRMaps) and to evaluate the quantitative influence of those artifacts on the reconstructed PET activity concentration. The developed method uses a PET-based delineation of the patient contour to compensate metal-implant-caused signal voids in the MR scan that is segmented for PET attenuation correction. PET emission data of 13 patients with metal implants examined in a Philips Ingenuity PET/MR were reconstructed with the vendor-provided method for attenuation correction (MRMaporig, PETorig) and additionally with a method for attenuation correction (MRMapcor, PETcor) developed by our group. MRMaps produced by both methods were visually inspected for segmentation errors. The segmentation errors in MRMaporig were classified into four classes (L1 and L2 artifacts inside the lung and B1 and B2 artifacts inside the remaining body depending on the assigned attenuation coefficients). The average relative SUV differences (\\varepsilon _{rel}^{av}) between PETorig and PETcor of all regions showing wrong attenuation coefficients in MRMaporig were calculated. Additionally, relative SUVmean differences (ɛrel) of tracer accumulations in hot focal structures inside or in the vicinity of these regions were evaluated. MRMaporig showed erroneous attenuation coefficients inside the regions affected by metal artifacts and inside the patients' lung in all 13 cases. In MRMapcor, all regions with metal artifacts, except for the sternum, were filled with the soft-tissue attenuation coefficient and the lung was correctly segmented in all patients. MRMapcor only showed small residual segmentation errors in eight patients. \\varepsilon _{rel}^{av} (mean ± standard deviation) were: ( - 56 ± 3)% for B1, ( - 43 ± 4)% for B2, (21 ± 18)% for L1, (120 ± 47)% for L2 regions. ɛrel (mean ± standard deviation) of hot focal structures were

  7. The epidemiology of defibrillation in a medical school complex.

    PubMed

    Shiner, S L; Gold, M I

    1984-02-01

    Defibrillation is the definitive treatment for ventricular fibrillation (VF). Participation of physicians, paramedical personnel and lay people in cardiopulmonary resuscitation has significantly increased the survival from ventricular fibrillation. The number of defibrillators has increased and their primary placement within the hospital and community has changed. We studied the location, age, history, characteristics and maintenance of every defibrillator (n = 190) within a three hospital, medical school complex. Most defibrillators had been acquired recently but some dated from 1967. More than 85% were plug-in, non-portable. The government hospital had the lowest ratio of defibrillators to beds, but its maintenance, reliability and records were ths most efficient. We conclude that the increase in the number of defibrillators and its modernization reflects their importance, and that the type of hospital determines the age, type of machine, maintenance, and quantity. PMID:6322270

  8. Arrhythmogenic Right Ventricular Cardiomyopathy: Risk Stratification and Indications for Defibrillator Therapy.

    PubMed

    Zorzi, Alessandro; Rigato, Ilaria; Bauce, Barbara; Pilichou, Kalliopi; Basso, Cristina; Thiene, Gaetano; Iliceto, Sabino; Corrado, Domenico

    2016-06-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetically determined disease which predisposes to life-threatening ventricular arrhythmias. The main goal of ARVC therapy is prevention of sudden cardiac death (SCD). Implantable cardioverter defibrillator (ICD) is the most effective therapy for interruption of potentially lethal ventricular tachyarrhythmias. Despite its life-saving potential, ICD implantation is associated with a high rate of complications and significant impact on quality of life. Accurate risk stratification is needed to identify individuals who most benefit from the therapy. While there is general agreement that patients with a history of cardiac arrest or hemodynamically unstable ventricular tachycardia are at high risk of SCD and needs an ICD, indications for primary prevention remain a matter of debate. The article reviews the available scientific evidence and guidelines that may help to stratify the arrhythmic risk of ARVC patients and guide ICD implantation. Other therapeutic strategies, either alternative or additional to ICD, will be also addressed. PMID:27147509

  9. [A 65-year-old man with wearable cardioverter/defibrillator early after acute myocardial infarction].

    PubMed

    Horlbeck, F W; Nickenig, G; Schwab, J O

    2015-09-01

    A 65-year-old man with severe coronary artery disease and coronary artery bypass graft presented with an acute posterior ST-elevation myocardial infarction. Immediate percutaneous coronary intervention resulted in successful revascularisation of the culprit lesion (RCx) with several remaining coronary stenoses. Despite the reduced left ventricular ejection fraction, no primary prevention indication for an implantable cardioverter/defibrillator early after myocardial infarction existed. Due to the complex coronary anatomy with several remaining stenotic vessels we regarded the patient to be at a particularly high risk for lethal ventricular arrhythmias and provided him with a wearable cardioverter defibrillator (WCD). Twenty-six days later, he experienced spontaneous ventricular tachycardia and fibrillation which was successfully treated with high voltage therapy by the WCD. Subsequently, we decided to implant him an ICD following secondary prevention indication. Besides established indications for primary prevention ICD therapy, some patients early after myocardial infarction may be at a particularly high risk for sudden cardiac death. Temporary protection with a WCD in carefully selected patients can offer a safe opportunity for later reevaluation of permanent ICD implantation depending on the course of left ventricular ejection fraction and the occurrence of arrhythmia. PMID:26338064

  10. Every second counts: innovations to increase timely defibrillation rates.

    PubMed

    Borak, Meredith; Francisco, Mary Ann; Stokas, Mary Ann; Maroney, Mary; Bednar, Valerie; Miller, Megan E; Pakieser-Reed, Katherine

    2014-01-01

    Early defibrillation is an essential step in the "chain of survival" for patients with in-hospital cardiac arrest. To increase the rate of early defibrillation by nurse first responders in noncritical care areas, our institution employed a quality resuscitation consultant, implemented nursing education programs, and standardized equipment and practices. Automated external defibrillator application by nurse first responders prior to advanced cardiac life support team arrival has improved from 15% in 2011 to 76% in 2013 (P < .001). PMID:24810907

  11. Unrecognized failure of a narrow caliber defibrillation lead: the role of defibrillation threshold testing in identifying an unprotected individual.

    PubMed

    Leong, Darryl P; van Erven, Lieselot

    2012-06-01

    In this case report we describe a short circuit in the Riata 1570 defibrillator lead (Riata 1570, St. Jude Medical, St. Paul, MN, USA) that was unsuspected owing to normal lead parameters until defibrillator threshold testing at the time of elective generator change. On this occasion, the short circuit manifested as unsuccessful defibrillation of ventricular fibrillation with immediate battery depletion. This report adds weight to existing concerns over narrow caliber leads, it draws attention to the possibility of lead malfunction despite unremarkable interrogation, and lastly it highlights the potential role of routine defibrillator threshold testing, particularly at elective generator change (an issue that remains sparingly addressed in the existing literature). PMID:22309386

  12. Insulation Failure of the Linox Defibrillator Lead: A Case Report and Retrospective Review of a Single Center Experience.

    PubMed

    Howe, Andrew J; McKeag, Nicholas A; Wilson, Carol M; Ashfield, Kyle P; Roberts, Michael J

    2015-06-01

    Implantable cardioverter defibrillator (ICD) lead insulation failure and conductor externalization have been increasingly reported. The 7.8F silicon-insulated Linox SD and Linox S ICD leads (Biotronik, Berlin, Germany) were released in 2006 and 2007, respectively, with an estimated 85,000 implantations worldwide. A 39-year-old female suffered an out-of-hospital ventricular fibrillation (VF) arrest with successful resuscitation. An ICD was implanted utilizing a single coil active fixation Linox(Smart) S lead (Biotronik, Berlin, Germany). A device-triggered alert approximately 3 years after implantation confirmed nonphysiological high rate sensing leading to VF detection. A chest X-ray showed an abnormality of the ICD lead and fluoroscopic screening confirmed conductor externalization proximal to the defibrillator coil. In view of the combined electrical and fluoroscopic abnormalities, urgent lead extraction and replacement were performed. A review of Linox (Biotronik) and Vigila (Sorin Group, Milan, Italy) lead implantations within our center (n = 98) identified 3 additional patients presenting with premature lead failure, 2 associated with nonphysiological sensed events and one associated with a significant decrease in lead impedance. All leads were subsequently removed and replaced. This case provides a striking example of insulation failure affecting the Linox ICD lead and, we believe, is the first to demonstrate conductor externalization manifesting both electrical and fluoroscopic abnormalities. PMID:25711237

  13. Study Ties Implanted Defibrillators to Long-Term Complications

    MedlinePlus

    ... by the devices outweigh the risks. ICDs are battery-powered devices placed in a "pocket" under the ... and quadruple the risk for procedures such as battery replacement and upgrades, the researchers determined. "This is ...

  14. Pacemakers and Implantable Defibrillators - Multiple Languages: MedlinePlus

    MedlinePlus

    ... العربية) Pacemaker (Arabic) العربية Bilingual PDF Health Information Translations Chinese - Simplified (简体中文) Pacemaker 心脏起搏器 - 简体中文 (Chinese - Simplified) Bilingual PDF Health Information Translations Chinese - Traditional (繁體中文) Pacemaker 心臟起搏器 - 繁體中文 (Chinese - Traditional) ...

  15. Many People with Implantable Defibrillators Can Participate in Vigorous Sports

    MedlinePlus

    ... M.D.; Barry J. Maron, M.D.; Frank Marcus, M.D.; Melvin Scheinman, M.D.; Bruce L. ... primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and ...

  16. Sexual Health for Patients with an Implantable Cardioverter Defibrillator

    MedlinePlus

    ... LIBRARY Hello, Guest! My alerts Sign In Join Facebook Twitter Home About this Journal Editorial Board General Statistics Circulation Cover Doodle → Blip the Doodle Go Red For Women's Issue Information for Advertisers Author Reprints Commercial Reprints Customer Service and Ordering ...

  17. How to Respond to an Implantable Cardioverter-Defibrillator Recall

    MedlinePlus

    ... American Heart Association Facebook Twitter Hello, Guest! My alerts Sign In Join Institution: NATIONAL INST HEALTH LIBRARY ... Institution: NATIONAL INST HEALTH LIBRARY Hello, Guest! My alerts Sign In Join Facebook Twitter Home About this ...

  18. Cellular phone interference testing of implantable cardiac defibrillators in vitro.

    PubMed

    Bassen, H I; Moore, H J; Ruggera, P S

    1998-09-01

    An in vitro study was undertaken to investigate the potential for cellular telephones to interfere with representative models of presently used ICDs. Digital cellular phones (DCPs) generate strong, amplitude modulated fields with pulse repetition rates near the physiological range sensed by the ICD as an arrhythmia. DCPs with Time Division Multiple Access (TDMA) pulsed amplitude modulation caused the most pronounced effect--high voltage firing or inhibition of pacing output of the ICDs. This electromagnetic interference (EMI) occurred only when the phones were within 2.3-5.8 cm of the ICD pulse generator that was submerged 0.5 cm in 0.18% saline. ICD performance always reverted to baseline when the cellular phones were removed from the immediate proximity of the ICD. Three models of ICDs were subjected to EMI susceptibility testing using two types of digital phones and one analog cellular phone, each operating at their respective maximum output power. EMI was observed in varying degrees from all DCPs. Inhibition of pacer output occurred in one ICD, and high voltage firing occurred in the two other ICDs, when a TDMA-11 Hz DCP was placed within 2.3 cm of the ICD. For the ICD that was most sensitive to delivering unintended therapy, inhibition followed by firing occurred at distances up to 5.8 cm. When a TDMA-50 Hz phone was placed at the minimum test distance of 2.3 cm, inhibition followed by firing was observed in one of the ICDs. EMI occurred most frequently when the lower portion of the monopole antenna of the cellular phone was placed over the ICD header. PMID:9744432

  19. How Will Having an Implantable Cardioverter Defibrillator Affect My Lifestyle?

    MedlinePlus

    ... High-tension wires Metal detectors Industrial welders Electrical generators These devices can disrupt the electrical signaling of ... 2 feet away from industrial welders or electrical generators. Rarely, ICDs have caused unnecessary shocks during long, ...

  20. Maintenance of defibrillators in a state of readiness.

    PubMed

    White, R D

    1993-02-01

    Since 1984, the US Food and Drug Administration (FDA) has utilized the Medical Device Reporting system as a mechanism for reporting adverse incidents associated with the use of medical devices, including external defibrillators. The frequency and content of these reports prompted an FDA-conducted five-state study of defibrillator-user training and maintenance practices for both devices and batteries. The study also included inspection and testing of defibrillators and batteries to assess their state of maintenance. A detailed review of the reports and of the five-state data confirmed that in the majority of cases, adverse incidents were related to improper defibrillator operation and maintenance, prompting the FDA Center for Devices and Radiological Health to launch an educational effort directed toward those who operate and maintain defibrillators. Proper maintenance of batteries (both nickel-cadmium and sealed lead-acid) was a major component of the educational thrust, because battery failure was identified as a recurrent and preventable problem. In an effort to correct the diverse types of incidents being reported, checklists were developed by the FDA for both manual and automated defibrillators. The checklists are designed to cover the spectrum of reported problems related to both device and user. The advent of more stringent FDA adverse incident-reporting regulations, coupled with increased use of defibrillators in diverse settings with varying usage frequencies, would seem to give a major impetus to the regular use of these checklists wherever defibrillators are employed. PMID:8434829

  1. Public access to defibrillation (PAD): implementing a church program.

    PubMed

    Gilchrist, Jody

    2012-01-01

    For every minute without cardiopulmonary resuscitation and defibrillation, the odds of surviving cardiac arrest decrease by 7% to 10%. Churches can implement a public access to defibrillation (PAD) program and help save lives. This article outlines steps and resources for setting up a PAD program. PMID:22480085

  2. Numerical analysis of electrical defibrillation. The parallel approach.

    PubMed

    Ng, K T; Hutchinson, S A; Gao, S

    1995-01-01

    Numerical modeling offers a viable tool for studying electrical defibrillation, allowing the behavior of field quantities to be observed easily as the different system parameters are varied. One numerical technique, namely the finite-element method, has been found particularly effective for modeling complex thoracic anatomies. However, an accurate finite-element model of the thorax often requires a large number of elements and nodes, leading to a large set of equations that cannot be solved effectively with the computational power of conventional computers. This is especially true if many finite-element solutions need to be achieved within a reasonable time period (eg, electrode configuration optimization). In this study, the use of massively parallel computers to provide the memory and reduction in solution time for solving these large finite-element problems is discussed. Both the uniform and unstructured grid approaches are considered. Algorithms that allow efficient mapping of uniform and unstructured grids to data-parallel and message-passing parallel computers are discussed. An automatic iterative procedure for electrode configuration optimization is presented. The procedure is based on the minimization of an objective function using the parallel direct search technique. Computational performance results are presented together with simulation results. PMID:8656104

  3. Too Many Public Defibrillators Out of Reach When Needed

    MedlinePlus

    ... News) -- Automated external defibrillators (AEDs) placed in public spaces can save the lives of people in cardiac ... in New York City. More AEDs in public spaces, along with timely access, is imperative, he said, ...

  4. 21 CFR 870.5310 - Automated external defibrillator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... shock of a maximum of 360 joules of energy used for defibrillating (restoring normal heart rhythm) the atria or ventricles of the heart. An AED analyzes the patient's electrocardiogram, interprets...

  5. 21 CFR 870.5310 - Automated external defibrillator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... shock of a maximum of 360 joules of energy used for defibrillating (restoring normal heart rhythm) the atria or ventricles of the heart. An AED analyzes the patient's electrocardiogram, interprets...

  6. Development of a current-controlled defibrillator for clinical tests.

    PubMed

    Fischer, M; Schönegg, M; Schöchlin, J; Bolz, A

    2002-01-01

    The work presented here is only a part of the development for a new current-controlled defibrillator. In the diploma thesis "Development and construction of a current-controlled defibrillator for clinical tests" the most important part was the control and safety of the defibrillator. To ensure a safe circuit design, a risk-analysis and a Failure Mode and Effects Analysis (FMEA) were necessary. Another major part was the programming of a microcontroller in embedded C and a programmable logic device in Very High Speed Integrated Circuit Description Language (VHDL). The circuit had to be constructed, and the defibrillator was optically decoupled from the laptop for safety reasons. The waveform-data can be transmitted to the microcontroller from the laptop, and the logged data is then transmitted back. PMID:12465307

  7. 21 CFR 870.5300 - DC-defibrillator (including paddles).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... heart or to terminate other cardiac arrhythmias. This generic type of device includes low energy... defibrillating the atria or ventricles of the heart or to terminate other cardiac arrhythmias. The device...

  8. Experience With the Wearable Cardioverter-Defibrillator in Patients at High Risk for Sudden Cardiac Death

    PubMed Central

    Günther, Michael; Quick, Silvio; Pfluecke, Christian; Rottstädt, Fabian; Szymkiewicz, Steven J.; Ringquist, Steven; Strasser, Ruth H.; Speiser, Uwe

    2016-01-01

    Background: This study evaluated the wearable cardioverter-defibrillator (WCD) for use and effectiveness in preventing sudden death caused by ventricular tachyarrhythmia or fibrillation. Methods: From April 2010 through October 2013, 6043 German WCD patients (median age, 57 years; male, 78.5%) were recruited from 404 German centers. Deidentified German patient data were used for a retrospective, nonrandomized analysis. Results: Ninety-four patients (1.6%) were treated by the WCD in response to ventricular tachyarrhythmia/fibrillation. The incidence rate was 8.4 (95% confidence interval, 6.8–10.2) per 100 patient-years. Patients with implantable cardioverter-defibrillator explantation had an incidence rate of 19.3 (95% confidence interval, 12.2–29.0) per 100 patient-years. In contrast, an incidence rate of 8.2 (95% confidence interval, 6.4–10.3) was observed in the remaining cardiac diagnosis groups, including dilated cardiomyopathy, myocarditis, and ischemic and nonischemic cardiomyopathies. Among 120 shocked patients, 112 (93%) survived 24 hours after treatment, whereas asystole was observed in 2 patients (0.03%) with 1 resulting death. ConclusionS: This large cohort represents the first nationwide evaluation of WCD use in patients outside the US healthcare system and confirms the overall value of the WCD in German treatment pathways. PMID:27458236

  9. Combined use of non-thoracotomy cardioverter defibrillators and endocardial pacemakers.

    PubMed Central

    Noguera, H. H.; Peralta, A. O.; John, R. M.; Venditti, F. J.; Martin, D. T.

    1997-01-01

    OBJECTIVE: To study the potential interactions in patients with endocardial permanent pacemakers and non-thoracotomy implantable cardioverter defibrillator (ICD) systems. DESIGN: Case series and cohort study. SETTING: Tertiary referral centre. PATIENTS: Fifteen consecutive patients with both endocardial pacemakers (12 dual chamber and three single chamber) and non-thoracotomy ICD systems. MAIN OUTCOME MEASURES: Detection inhibition of induced ventricular fibrillation; double counting; and pacemaker function after shocks. In the evaluation of detection inhibition, 124 VF inductions were analysed for detection duration compared with induced VF episodes in controls with an ICD but without a pacemaker. RESULTS: Two patients (13%) showed detection inhibition of VF and required pacemaker system change at the time of the ICD implant. With the final lead position, despite frequent pacemaker undersensing of VF, ICD detection of VF was not inhibited during any induction, and neither initial detection nor redetection times for VF were different from controls. Double/triple counting of pacemaker artefact and evoked electrogram was noted in three patients (20%). In two, this was remedied during the implantation procedure, and in the other it was abolished when amiodarone treatment was discontinued. Pacemaker function was affected by ICD discharges in two patients, one who showed postshock atrial undersensing and loss of capture, and another whose pacemaker reverted to VVI mode. CONCLUSIONS: When careful testing is performed at implantation to detect and remedy device interactions, non-thoracotomy ICD treatment and endocardial pacemakers can be used safely in combination. Images PMID:9290402

  10. Models of defibrillation of cardiac tissue

    NASA Astrophysics Data System (ADS)

    Krinsky, V.; Pumir, A.

    1998-03-01

    Heterogeneities, such as gap junctions, defects in periodical cellular lattices, intercellular clefts and fiber curvature allow one to understand the effect of an electric field in cardiac tissue. They induce membrane potential variations even in the bulk of the myocardium, with a characteristic sawtooth shape. The sawtooth potential, induced by heterogeneities at large scales (tissue strands) can be more easily observed, and lead to stronger effects than the one induced at the cellular level. In the generic model of propagation in cardiac tissue (FitzHugh), 4 mechanisms of defibrillation were found, two mechanisms based on excitation (EA,EM), and two—on de-excitation (DA,DM). The lowest electric field is required by an EM mechanism. In the Beeler-Reuter ionic model, mechanism DM is impossible. We critically review the experimental basis of the theory and propose new experiments.

  11. Switchable Faraday shielding with application to reducing the pain of internal cardiac defibrillation while permitting external defibrillation.

    PubMed

    Kolandaivelu, Aravindan; Jayanti, Venku; Halperin, Henry R; Berger, Ronald D

    2012-02-01

    Switchable Faraday shielding is desirable in situations where electric field shielding is required at certain times and undesirable at other times. In this study, electrostatic finite element modeling was used to assess the effect of different shield geometries on the leakage of an internally applied field and penetration of an externally applied field. "Switching OFF" the shield by electrically disconnecting shield faces from each other was shown to significantly increase external field penetration. Applying this model to defibrillation, we looked at the effect of spacing and size of shield panels to maximize the ability to deliver an external defibrillation shock to the heart when shield panels are disconnected while providing acceptably low leakage of internal defibrillation shocks to avoid painful skeletal muscle capture when shield panels are connected. This analysis may be useful for designing internal defibrillator electrodes that preserve the efficacy of internal and external defibrillation while avoiding the significant morbidity associated with painful defibrillator shocks. Similar analysis could also guide optimizing the switchable Faraday shielding concept for other applications. PMID:22042127

  12. Wearable 'Defibrillator-In-A-Vest' May Help Some Heart Patients

    MedlinePlus

    ... nlm.nih.gov/medlineplus/news/fullstory_158001.html Wearable 'Defibrillator-in-a-Vest' May Help Some Heart ... what the relative benefit is," he added. The wearable defibrillator is worn under clothes looks like a " ...

  13. [Implantation of a biventricular ICD in a patient with dextrocardia with situs inversus].

    PubMed

    Vurgun, Veysel Kutay; Gerede, Menekşe; Altın, Ali Timuçin; Candemir, Başar; Akyürek, Ömer

    2015-01-01

    In order to reduce sudden cardiac death and heart failure symptoms, biventricular implantable cardioverter defibrillator (ICD) implantation is a treatment method commonly used in selected patients with cardiomyopathy. The frequency of dextrocardia in congenital heart defects is approximately 0.4/10000. In this group, the frequency of cardiomyopathy development is rare. In this case report we present a patient with dextrocardia undergoing implantation of biventricular ICD. PMID:25655858

  14. European clinical experience with a dual chamber single pass sensing and pacing defibrillation lead.

    PubMed

    Gradaus, Rainer; Gonska, Bernd D; Stellbrink, Christoph; Cron, Thomas; Tebbenjohanns, Jürgen; Blomström-Lundqvist, Carina; Himmrich, Ewald; Salerno, Jorge A; Osswald, Stefan; Gommer, Erik D; Van Veen, Benno K; Böcker, Dirk

    2002-07-01

    Dual chamber ICDs are increasingly implanted nowadays, mainly to improve discrimination between supraventricular and ventricular arrhythmias but also to maintain AV synchrony in patients with bradycardia. The aim of this study was to investigate a new single pass right ventricular defibrillation lead capable of true bipolar sensing and pacing in the right atrium and integrated bipolar sensing and pacing in the right ventricle. The performance of the lead was evaluated in 57 patients (age 61 +/- 12 years; New York Heart Association 1.9 +/- 0.6, left ventricular ejection fraction 0.38 +/- 0.15) at implant, at prehospital discharge, and during a 1-year follow-up. Sensing and pacing behavior of the lead was evaluated in six different body positions. In four patients, no stable position of the atrial electrode could intraoperatively be found. The intraoperative atrial sensing was 2.3 +/- 1.6 mV and the atrial pacing threshold 0.8 +/- 0.5 V at 0.5 ms. At follow-up, the atrial sensing ranged from 1.5 mV to 2.2 mV and the atrial pacing threshold product from 0.8 to 1.7 V/ms. In 11 patients, an intermittent atrial sensing problem and in 24 patients an atrial pacing dysfunction were observed in at least one body position. In 565 episodes, a sensitivity of 100% and a specificity of 96.5% were found for ventricular arrhythmias. In conclusion, this single pass defibrillation lead performed well as a VDD lead and for dual chamber arrhythmia discrimination. However, loss of atrial capture in 45% of patients preclude its use in patients depending on atrial pacing. PMID:12164450

  15. Adhoc electromagnetic compatibility testing of non-implantable medical devices and radio frequency identification

    PubMed Central

    2013-01-01

    Background The use of radiofrequency identification (RFID) in healthcare is increasing and concerns for electromagnetic compatibility (EMC) pose one of the biggest obstacles for widespread adoption. Numerous studies have documented that RFID can interfere with medical devices. The majority of past studies have concentrated on implantable medical devices such as implantable pacemakers and implantable cardioverter defibrillators (ICDs). This study examined EMC between RFID systems and non-implantable medical devices. Methods Medical devices were exposed to 19 different RFID readers and one RFID active tag. The RFID systems used covered 5 different frequency bands: 125–134 kHz (low frequency (LF)); 13.56 MHz (high frequency (HF)); 433 MHz; 915 MHz (ultra high frequency (UHF])) and 2.4 GHz. We tested three syringe pumps, three infusion pumps, four automatic external defibrillators (AEDs), and one ventilator. The testing procedure is modified from American National Standards Institute (ANSI) C63.18, Recommended Practice for an On-Site, Ad Hoc Test Method for Estimating Radiated Electromagnetic Immunity of Medical Devices to Specific Radio-Frequency Transmitters. Results For syringe pumps, we observed electromagnetic interference (EMI) during 13 of 60 experiments (22%) at a maximum distance of 59 cm. For infusion pumps, we observed EMI during 10 of 60 experiments (17%) at a maximum distance of 136 cm. For AEDs, we observed EMI during 18 of 75 experiments (24%) at a maximum distance of 51 cm. The majority of the EMI observed was classified as probably clinically significant or left the device inoperable. No EMI was observed for all medical devices tested during exposure to 433 MHz (two readers, one active tag) or 2.4 GHz RFID (two readers). Conclusion Testing confirms that RFID has the ability to interfere with critical medical equipment. Hospital staff should be aware of the potential for medical device EMI caused by RFID systems and should be encouraged to

  16. Safety of nerve conduction studies in patients with implanted cardiac devices.

    PubMed

    Schoeck, Andreas P; Mellion, Michelle L; Gilchrist, James M; Christian, Fredric V

    2007-04-01

    Patients with implanted cardiac devices and their physicians may defer important electrodiagnostic testing because of anxiety about potential negative effects on the device. To determine the safety of routine nerve conduction studies (NCS) in this population, 10 patients with permanent dual-chamber pacemakers of various types and five patients with implanted cardiac defibrillators (ICD) underwent nerve stimulation at sites commonly used during NCS. The implanted cardiac device was interrogated before and after the study and there was continuous monitoring of the surface electrocardiogram (ECG) and atrial and ventricular electrograms. Electrical impulses generated during routine NCS were never detected by the sensing amplifier and did not affect the programmed settings of the implanted cardiac device. We conclude that routine NCS is safe in patients with implanted cardiac pacemakers with bipolar sensing configurations and defibrillators. PMID:17094099

  17. A new approach to optimization-based defibrillation.

    PubMed

    Muzdeka, S; Barbieri, E

    2001-01-01

    The purpose of this paper is to develop a new model for optimal cardiac defibrillation, based on simultaneous minimization of energy consumption and defibrillation time requirements. In order to generate optimal defibrillation waveforms that will accomplish the objective stated above, one parameter rho has been introduced as a part of the performance measure to weigh the relative importance of time and energy. All the results of this theoretical study have been obtained for the proposed model, under the assumption that cardiac tissue can be represented by a simple parallel resistor-capacitor circuit. It is well known from modern control theory that the selection of a numerical value of the weight factor is the matter of subjective judgment of a designer. However, it has been shown that defining a cost function can help in selecting a value for rho. Some results of the mathematical development of the algorithm and computer simulations will be included in the paper. PMID:11347410

  18. Breast calcifications following electrical defibrillation: An unusual mammographic appearance.

    PubMed

    Westphal, Steven M; Jani, Manish; Badve, Sunil

    2010-01-01

    We present a case of a 57-year-old woman with a past medical history of end-stage renal disease and a recent history of electrical defibrillation who arrived for her annual mammogram with no breast-related complaints. The mammogram showed interval development of unusual clusters of heterogeneous calcifications. The patient underwent stereotactic core-needle biopsy for definitive diagnosis. The pathologic evaluation revealed fibrosis, abnormal adipocytes, and calcifications with no evidence of malignancy. The constellation of findings was consistent with fat necrosis and fibrosis related to tissue damage sustained during the recent defibrillation. PMID:27307857

  19. Electronic article surveillance systems and interactions with implantable cardiac devices: risk of adverse interactions in public and commercial spaces.

    PubMed

    Gimbel, J Rod; Cox, James W

    2007-03-01

    Electronic article surveillance (EAS) systems are widely implemented in public spaces and can adversely affect the performance of pacemakers and implantable cardioverter defibrillators. The interaction between implantable devices and EAS systems is a serious problem that can be minimized through appropriate facility design. Careful facility design and employee education along with patient vigilance remain imperative in avoiding potentially life-threatening EAS system-implantable device interactions. PMID:17352368

  20. An unusual etiological agent of implantable cardioverter device endocarditis: Corynebacterium mucifaciens.

    PubMed

    Kaya, Adnan; Tekkesin, Ahmet Ilker; Kalenderoglu, Koray; Alper, Ahmet Taha

    2016-01-01

    Cardiac pacing devices and implantable cardioverter defibrillator (ICD) are becoming the mainstay of therapy in cardiology and infective endocarditis (IE) and pocket infection; however, these devices require careful monitoring. Here, we describe a case of a 68-year-old female with an ICD presenting with a previously unknown etiological agent of IE, Corynebacterium mucifaciens. PMID:27133333

  1. 21 CFR 870.5300 - DC-defibrillator (including paddles).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... of energy used for defibrillating (restoring normal heart rhythm) the atria or ventricles of the heart or to terminate other cardiac arrhythmias. This generic type of device includes low energy... either directly across the heart or on the surface of the body. (2) Classification. Class II...

  2. Advantage of four-electrode over two-electrode defibrillators.

    PubMed

    Bragard, J; Šimić, A; Laroze, D; Elorza, J

    2015-12-01

    Defibrillation is the standard clinical treatment used to stop ventricular fibrillation. An electrical device delivers a controlled amount of electrical energy via a pair of electrodes in order to reestablish a normal heart rate. We propose a technique that is a combination of biphasic shocks applied with a four-electrode system rather than the standard two-electrode system. We use a numerical model of a one-dimensional ring of cardiac tissue in order to test and evaluate the benefit of this technique. We compare three different shock protocols, namely a monophasic and two types of biphasic shocks. The results obtained by using a four-electrode system are compared quantitatively with those obtained with the standard two-electrode system. We find that a huge reduction in defibrillation threshold is achieved with the four-electrode system. For the most efficient protocol (asymmetric biphasic), we obtain a reduction in excess of 80% in the energy required for a defibrillation success rate of 90%. The mechanisms of successful defibrillation are also analyzed. This reveals that the advantage of asymmetric biphasic shocks with four electrodes lies in the duration of the cathodal and anodal phase of the shock. PMID:26764786

  3. Advantage of four-electrode over two-electrode defibrillators

    NASA Astrophysics Data System (ADS)

    Bragard, J.; Šimić, A.; Laroze, D.; Elorza, J.

    2015-12-01

    Defibrillation is the standard clinical treatment used to stop ventricular fibrillation. An electrical device delivers a controlled amount of electrical energy via a pair of electrodes in order to reestablish a normal heart rate. We propose a technique that is a combination of biphasic shocks applied with a four-electrode system rather than the standard two-electrode system. We use a numerical model of a one-dimensional ring of cardiac tissue in order to test and evaluate the benefit of this technique. We compare three different shock protocols, namely a monophasic and two types of biphasic shocks. The results obtained by using a four-electrode system are compared quantitatively with those obtained with the standard two-electrode system. We find that a huge reduction in defibrillation threshold is achieved with the four-electrode system. For the most efficient protocol (asymmetric biphasic), we obtain a reduction in excess of 80% in the energy required for a defibrillation success rate of 90%. The mechanisms of successful defibrillation are also analyzed. This reveals that the advantage of asymmetric biphasic shocks with four electrodes lies in the duration of the cathodal and anodal phase of the shock.

  4. 21 CFR 870.5310 - Automated external defibrillator.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Automated external defibrillator. 870.5310 Section 870.5310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Therapeutic Devices § 870.5310...

  5. 21 CFR 870.5310 - Automated external defibrillator.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Automated external defibrillator. 870.5310 Section 870.5310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Therapeutic Devices § 870.5310...

  6. 21 CFR 870.5310 - Automated external defibrillator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Automated external defibrillator. 870.5310 Section 870.5310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Therapeutic Devices § 870.5310...

  7. Where Does It Lead? Imaging Features of Cardiovascular Implantable Electronic Devices on Chest Radiograph and CT

    PubMed Central

    Lanzman, Rotem S.; Winter, Joachim; Blondin, Dirk; Fürst, Günter; Scherer, Axel; Miese, Falk R; Abbara, Suhny

    2011-01-01

    Pacemakers and implantable cardioverter defibrillators (ICDs) are being increasingly employed in patients suffering from cardiac rhythm disturbances. The principal objective of this article is to familiarize radiologists with pacemakers and ICDs on chest radiographs and CT scans. Therefore, the preferred lead positions according to pacemaker types and anatomic variants are introduced in this study. Additionally, the imaging features of incorrect lead positions and defects, as well as complications subsequent to pacemaker implantation are demonstrated herein. PMID:21927563

  8. Incidence of Defibrillator Shocks After Elective Generator Exchange Following Uneventful First Battery Life

    PubMed Central

    Merchant, Faisal M.; Jones, Paul; Wehrenberg, Scott; Lloyd, Michael S.; Saxon, Leslie A.

    2014-01-01

    Background A significant number of implantable cardioverter‐defibrillator (ICD) patients do not experience shocks after ICD implant. Elective generator exchange (GE) has been associated with increased risk of infection and ICD lead failure. There is a paucity of contemporary data reporting on shock incidence with replacement devices. Methods and Results Patients undergoing elective GE (n=24 203) who transmit data remotely via a remote monitoring system were analyzed to determine the incidence of ICD shocks after GE. A total of 16 230 patients (67%) did not experience a shock with the first ICD (group A), and 7973 (33%) received at least 1 shock (group B). Patients in group A were older (71.3 versus 68.8 years, P<0.001) and more often female (71% versus 77% male, P<0.001). Over an average follow‐up of 1.9±1.2 years after GE, the proportion of patients with shocks and risk of ICD shocks was lower for those who did not receive a shock during the first battery life (group A: 9.9% versus 27.7%, hazard ratio 0.36, 95% CI 0.34 to 0.38, P<0.001). The cumulative rate of ICD shocks at 5 years after GE was 25.7% in group A and 51.1% in group B. Conclusions In this large cohort of ICD patients implanted across the United States, two thirds did not receive ICD shock therapy prior to GE. The occurrence of ICD shocks prior to GE is an important predictor of shocks after GE; however, even among those without shocks during first battery life, the incidence of shocks at 5 years following GE is >25%. These data should support informed decision making for patients and physicians at the time of ICD generator end of service. PMID:25385346

  9. Potential value of automated daily screening of cardiac resynchronization therapy defibrillator diagnostics for prediction of major cardiovascular events: results from Home-CARE (Home Monitoring in Cardiac Resynchronization Therapy) study

    PubMed Central

    Sack, Stefan; Wende, Christian Michael; Nägele, Herbert; Katz, Amos; Bauer, Wolfgang Rudolf; Barr, Craig Scott; Malinowski, Klaus; Schwacke, Harald; Leyva, Francisco; Proff, Jochen; Berdyshev, Sergey; Paul, Vincent

    2011-01-01

    Aim To investigate whether diagnostic data from implanted cardiac resynchronization therapy defibrillators (CRT-Ds) retrieved automatically at 24 h intervals via a Home Monitoring function can enable dynamic prediction of cardiovascular hospitalization and death. Methods and results Three hundred and seventy-seven heart failure patients received CRT-Ds with Home Monitoring option. Data on all deaths and hospitalizations due to cardiovascular reasons and Home Monitoring data were collected prospectively during 1-year follow-up to develop a predictive algorithm with a predefined specificity of 99.5%. Seven parameters were included in the algorithm: mean heart rate over 24 h, heart rate at rest, patient activity, frequency of ventricular extrasystoles, atrial–atrial intervals (heart rate variability), right ventricular pacing impedance, and painless shock impedance. The algorithm was developed using a 25-day monitoring window ending 3 days before hospitalization or death. While the retrospective sensitivities of the individual parameters ranged from 23.6 to 50.0%, the combination of all parameters was 65.4% sensitive in detecting cardiovascular hospitalizations and deaths with 99.5% specificity (corresponding to 1.83 false-positive detections per patient-year of follow-up). The estimated relative risk of an event was 7.15-fold higher after a positive predictor finding than after a negative predictor finding. Conclusion We developed an automated algorithm for dynamic prediction of cardiovascular events in patients treated with CRT-D devices capable of daily transmission of their diagnostic data via Home Monitoring. This tool may increase patients’ quality of life and reduce morbidity, mortality, and health economic burden, it now warrants prospective studies. ClinicalTrials.gov  NCT00376116. PMID:21852311

  10. Automatic Imitation

    ERIC Educational Resources Information Center

    Heyes, Cecilia

    2011-01-01

    "Automatic imitation" is a type of stimulus-response compatibility effect in which the topographical features of task-irrelevant action stimuli facilitate similar, and interfere with dissimilar, responses. This article reviews behavioral, neurophysiological, and neuroimaging research on automatic imitation, asking in what sense it is "automatic"…

  11. Skeletal muscle grids for assessing current distributions from defibrillation shocks.

    PubMed

    Schmidt, J; Gatlin, B; Eason, J; Koomullil, G; Pilkington, T

    1992-01-01

    This paper utilizes a structured and an unstructured grid representation of a torso with an anisotropic skeletal muscle to assess current distributions from defibrillation shocks. The results show that a finite-element solution on an unstructured grid of 400,000 elements (60,000 nodes) achieves comparable current distributions with a finite-difference solution on a structured grid that uses approximately the same number of nodes. Moreover, a finite-element solution on a 65,000-element (10,500 nodes) unstructured grid yielded fractional percent current results within 5% of the finer grids. The structured and unstructured grid models are used to investigate recent interpretations of experimental data that concluded that more than 80% of the total defibrillation current is shunted by the anisotropic skeletal muscle thoracic cage. It is concluded that these interpretations, which were based on a one-dimensional resistive network representation of the three-dimensional defibrillation situation, overestimate by 25% the current shunted by the anisotropic thoracic cage. PMID:1424684

  12. Why We Need Postmortem Analysis of Cardiac Implantable Electronic Devices.

    PubMed

    Mauf, Sabrina; Jentzsch, Thorsten; Laberke, Patrick J; Thali, Michael J; Bartsch, Christine

    2016-07-01

    The prevalence of cardiac implantable electronic devices (CIEDs), pacemakers and implantable cardioverter defibrillators (ICDs) is increasing. However, postmortem analysis of CIEDs is not performed routinely. Fourteen consecutive CIEDs were analyzed. The indication for and date of implantation, technical data, CIED reprogramming, heart rhythm disturbances, patient demographics and medical consultations were investigated. Death during the first year after implantation was seen in 54%, whereof 71% consulted a physician within 10 days before death. The time of death was attributed to a particular day in 29%. There was a relationship between CIEDs and cause/manner of death in 50%. Although limited by a small sample size, this study advocates the routine postmortem CIED analysis for forensic and clinical purposes in selected cases. Patients with CIEDs seem to show an increased risk of death during the first year after implantation. The analysis of CIEDs can be helpful in evaluating the time/cause/manner of death. PMID:27364278

  13. Pediatric defibrillation after cardiac arrest: initial response and outcome

    PubMed Central

    Rodríguez-Núñez, Antonio; López-Herce, Jesús; García, Cristina; Domínguez, Pedro; Carrillo, Angel; Bellón, Jose María

    2006-01-01

    Introduction Shockable rhythms are rare in pediatric cardiac arrest and the results of defibrillation are uncertain. The objective of this study was to analyze the results of cardiopulmonary resuscitation that included defibrillation in children. Methods Forty-four out of 241 children (18.2%) who were resuscitated from inhospital or out-of-hospital cardiac arrest had been treated with manual defibrillation. Data were recorded according to the Utstein style. Outcome variables were a sustained return of spontaneous circulation (ROSC) and one-year survival. Characteristics of patients and of resuscitation were evaluated. Results Cardiac disease was the major cause of arrest in this group. Ventricular fibrillation (VF) or pulseless ventricular tachycardia (PVT) was the first documented electrocardiogram rhythm in 19 patients (43.2%). A shockable rhythm developed during resuscitation in 25 patients (56.8%). The first shock (dose, 2 J/kg) terminated VF or PVT in eight patients (18.1%). Seventeen children (38.6%) needed more than three shocks to solve VF or PVT. ROSC was achieved in 28 cases (63.6%) and it was sustained in 19 patients (43.2%). Only three patients (6.8%), however, survived at 1-year follow-up. Children with VF or PVT as the first documented rhythm had better ROSC, better initial survival and better final survival than children with subsequent VF or PVT. Children who survived were older than the finally dead patients. No significant differences in response rate were observed when first and second shocks were compared. The survival rate was higher in patients treated with a second shock dose of 2 J/kg than in those who received higher doses. Outcome was not related to the cause or the location of arrest. The survival rate was inversely related to the duration of cardiopulmonary resuscitation. Conclusion Defibrillation is necessary in 18% of children who suffer cardiac arrest. Termination of VF or PVT after the first defibrillation dose is achieved in a low

  14. Introduction of new industry standards for cardiac implantable electronic devices: balancing benefits and unexpected risks

    PubMed Central

    Sticherling, Christian; Burri, Haran

    2012-01-01

    The DF-4 connector is a novel industry standard for the connection of a defibrillator lead to the generator. It aims at reducing the bulk created by two or three pins at the proximal end of the defibrillator lead and its corresponding ports at the header of the device. Having only one connection port between the lead and the device reduces the material in the pocket, the risk of lead-to-port mismatch, may lower the risk of lead abrasion, and probably makes the implantation procedure a little easier since only one set screw is required. However, all these conceived benefits are related to convenience rather than to a medical need. After the recent experiences with the possible negative clinical impact of ‘minor’ changes like simply downsizing a defibrillator lead, a word of caution is warranted. The lead is the weakest part of the defibrillator system, complex in design and undergoing constant stress through movement. It is very hard to predict which issues may evolve over time with the changes in lead design. Does the perceived benefit really outweigh an unpredictable risk in a sensitive medical product like a defibrillator? This article tries to address the possible issues of the new spring contacts instead of set screws, the proximity of the low- and high-voltage connections as well as the inability of adding a pace/sense or an additional shock lead without a special adaptor, and advocates a measured speed in the introduction of this technology. PMID:22389420

  15. Introduction of new industry standards for cardiac implantable electronic devices: balancing benefits and unexpected risks.

    PubMed

    Sticherling, Christian; Burri, Haran

    2012-08-01

    The DF-4 connector is a novel industry standard for the connection of a defibrillator lead to the generator. It aims at reducing the bulk created by two or three pins at the proximal end of the defibrillator lead and its corresponding ports at the header of the device. Having only one connection port between the lead and the device reduces the material in the pocket, the risk of lead-to-port mismatch, may lower the risk of lead abrasion, and probably makes the implantation procedure a little easier since only one set screw is required. However, all these conceived benefits are related to convenience rather than to a medical need. After the recent experiences with the possible negative clinical impact of 'minor' changes like simply downsizing a defibrillator lead, a word of caution is warranted. The lead is the weakest part of the defibrillator system, complex in design and undergoing constant stress through movement. It is very hard to predict which issues may evolve over time with the changes in lead design. Does the perceived benefit really outweigh an unpredictable risk in a sensitive medical product like a defibrillator? This article tries to address the possible issues of the new spring contacts instead of set screws, the proximity of the low- and high-voltage connections as well as the inability of adding a pace/sense or an additional shock lead without a special adaptor, and advocates a measured speed in the introduction of this technology. PMID:22389420

  16. Considerations in Patients With Cardiac Implantable Electronic Devices at End of Life.

    PubMed

    Gura, Melanie T

    2015-01-01

    Since the introduction of implantable cardiac pacemakers in 1958 and implantable cardioverter-defibrillators in 1980, these devices have been proven to save and prolong lives. Pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy are deemed life-sustaining therapies. Despite these life-saving technologies, all patients ultimately will reach the end of their lives from either their heart disease or development of a terminal illness. Clinicians may be faced with patient and family requests to withdraw these life-sustaining therapies. The purpose of this article is to educate clinicians about the legal and ethical principles that underlie withdrawal of life-sustaining therapies such as device deactivation and to highlight the importance of proactive communication with patients and families in these situations. PMID:26484996

  17. Low-Energy Defibrillation Failure Correction is Possible Through Nonlinear Analysis of Spatiotemporal Arrhythmia Data

    NASA Astrophysics Data System (ADS)

    Simonotto, Jennifer; Furman, Michael; Beaver, Thomas; Spano, Mark; Kavanagh, Katherine; Iden, Jason; Hu, Gang; Ditto, William

    2004-03-01

    Explanted Porcine hearts were Langendorff-perfused, administered a voltage-sensitive fluorescent dye (Di-4-ANEPPS) and illuminated with a ND:Yag laser (532 nm); the change in fluorescence resulting from electrical activity on the heart surface was recorded with an 80 x 80 pixel CCD camera at 1000 frames per second. The heart was put into fibrillation with rapid ventricular pacing and shocks were administered close to the defibrillation threshold. Defibrillation failure data was analyzed using synchronization, space-time volume plots and recurrence quantification. Preliminary spatiotemporal synchronization results reveal a short window of time ( 1 second) after defibrillation failure in which the disordered electrical activity becomes ordered; this ordered period occurs 4-5 seconds after the defibrillation shock. Recurrence analysis of a single time series confirmed these results, thus opening the avenue for dynamic defibrillators that can detect an optimal window for cardioversion.

  18. Cochlear Implants.

    ERIC Educational Resources Information Center

    Clark, Catherine; Scott, Larry

    This brochure explains what a cochlear implant is, lists the types of individuals with deafness who may be helped by a cochlear implant, describes the process of evaluating people for cochlear implants, discusses the surgical process for implanting the aid, traces the path of sound through the cochlear implant to the brain, notes the costs of…

  19. Management of Patients With Cardiovascular Implantable Electronic Devices in Dental, Oral, and Maxillofacial Surgery.

    PubMed

    Tom, James

    2016-01-01

    The prevalence of cardiovascular implantable electronic devices as life-prolonging and life-saving devices has evolved from a treatment of last resort to a first-line therapy for an increasing number of patients. As these devices become more and more popular in the general population, dental providers utilizing instruments and medications should be aware of dental equipment and medications that may affect these devices and understand the management of patients with these devices. This review article will discuss the various types and indications for pacemakers and implantable cardioverter-defibrillators, common drugs and instruments affecting these devices, and management of patients with these devices implanted for cardiac dysrhythmias. PMID:27269668

  20. Cardiovascular implantable electronic devices: patient education, information and ethical issues.

    PubMed

    Manaouil, Cécile; Gignon, Maxime; Traulle, Sarah

    2012-09-01

    Cardiovascular implantable electronic devices (CIED) are implanted increasingly frequently. CIEDs are indicated for the treatment of bradycardia, tachycardia and heart failure and therefore improve quality of life and life expectancy. CIED can treat ventricular arrhythmias that would be fatal without immediate care. However, CIEDs raise several patient education, medico-legal, and ethical questions that will be addressed in this article. Information is a patient's right, and necessary for informed consent. When implanting a CIED, the patient must be educated about the need for the device, the function of the device, any restrictions that apply postimplant, and postimplant follow-up methods and schedules. This transfer of information to the patient makes the patient responsible. The occupational physician can determine whether a patient wearing a CIED is able to work. Under current French law, patients are not prohibited from working while wearing a CIED. However, access to certain job categories remains limited, such as jobs involving mechanical stress to the chest, exposure to electromagnetic fields, or jobs requiring permanent vigilance. Pacemakers and defibrillators are medical treatments and are subject to the same ethical and clinical considerations as any other treatment. However, stopping a pacemaker or a defibrillator raises different ethical issues. Implantable Cardioverter Defibrillator shocks can be considered to be equivalent to resuscitation efforts and can be interpreted as being unreasonable in an end-of-life patient. Pacing is painless and it is unlikely to unnecessarily prolong the life of a patient with a terminal disease. Patients with a CIED should live as normally as possible, but must also be informed about the constraints related to the device and must inform each caregiver about the presence of the device. The forensic and ethical implications must be assessed in relation to current legislation. PMID:23248837

  1. The Effect of Compressor-administered Defibrillation on Peri-shock Pauses in a Simulated Cardiac Arrest Scenario

    PubMed Central

    Glick, Joshua; Lehman, Erik; Terndrup, Thomas

    2014-01-01

    Introduction Coordination of the tasks of performing chest compressions and defibrillation can lead to communication challenges that may prolong time spent off the chest. The purpose of this study was to determine whether defibrillation provided by the provider performing chest compressions led to a decrease in peri-shock pauses as compared to defibrillation administered by a second provider, in a simulated cardiac arrest scenario. Methods This was a randomized, controlled study measuring pauses in chest compressions for defibrillation in a simulated cardiac arrest model. We approached hospital providers with current CPR certification for participation between July, 2011 and October, 2011. Volunteers were randomized to control (facilitator-administered defibrillation) or experimental (compressor-administered defibrillation) groups. All participants completed one minute of chest compressions on a mannequin in a shockable rhythm prior to administration of defibrillation. We measured and compared pauses for defibrillation in both groups. Results Out of 200 total participants, we analyzed data from 197 defibrillations. Compressor-initiated defibrillation resulted in a significantly lower pre-shock hands-off time (0.57 s; 95% CI: 0.47–0.67) compared to facilitator-initiated defibrillation (1.49 s; 95% CI: 1.35–1.64). Furthermore, compressor-initiated defibrillation resulted in a significantly lower peri-shock hands-off time (2.77 s; 95% CI: 2.58–2.95) compared to facilitator-initiated defibrillation (4.25 s; 95% CI: 4.08–4.43). Conclusion Assigning the responsibility for shock delivery to the provider performing compressions encourages continuous compressions throughout the charging period and decreases total time spent off the chest. However, as this was a simulation-based study, clinical implementation is necessary to further evaluate these potential benefits. PMID:24672620

  2. Regaining venous access for implantation of a new lead

    PubMed Central

    Syska, Paweł; Maciąg, Aleksander; Oręziak, Artur; Kuśmierczyk, Mariusz; Przybylski, Andrzej

    2013-01-01

    Introduction Venous occlusion is a relatively common complication of endocardial lead implantation. It may cause a critical problem when implantation of a new lead is needed. Traditional methods result in leaving abandoned leads. The optimal approach seems to be the extraction of the damaged or abandoned lead, regaining venous access and implantation of a new lead. Aim To assess the efficacy and safety of new lead implantation by the method of lead extraction. Material and methods All transvenous lead extraction procedures (203 patients) between 1 August 2008 and 15 October 2012 were assessed. The analysis included cases with leads implanted for at least 6 months prior to extraction. Results Regaining venous access was the main indication for lead extraction in 5 patients (4.9%). The reason for new lead implantation was lead damage (n = 7) and system up-grade to cardiac resynchronization therapy (CRT) (n = 3). In total, 23 leads were extracted (9 defibrillation leads, 12 pacing leads and 2 left ventricular leads). The mean time from the implantation was 92.2 ±43.2 (48-152) months. In all cases Cook mechanical sheaths were applied. The use of the Evolution system was necessary to extract 3 leads. In all cases the new leads were successfully implanted as planned. No serious complications occurred. Conclusions Diagnosis of venous occlusion should not be a contraindication for ipsilateral implantation of the new lead, because the techniques of transvenous lead extraction enable successful regaining of venous access. PMID:24570688

  3. A patient with commotio cordis successfully resuscitated by bystander cardiopulmonary resuscitation and automated external defibrillator.

    PubMed

    Ngai, K Y; Chan, H Y; Ng, F

    2010-10-01

    Sudden deaths of children and adolescents during competitive sports are usually due to congenital heart diseases. Ventricular fibrillation, however, may also occur in individuals with no underlying cardiac disease who have sustained a low-impact chest wall blow. This phenomenon is described as commotio cordis, and the overall survival rate is poor. Successful resuscitation can be achieved by prompt cardiopulmonary resuscitation and early defibrillation. We report a teenager who sustained a chest wall blow that resulted in a cardiac arrest during a rugby competition. Cardiopulmonary resuscitation was given by bystanders. The ambulance crew arrived with an automated external defibrillator. Ventricular fibrillation was detected and responded to defibrillation. Subsequent investigations including imaging and electrophysiological studies did not reveal any cardiac or brain abnormality, and the patient recovered well neurologically. Accessible cardiopulmonary resuscitation-trained personnel and automated external defibrillators should be present at all organised sporting events. PMID:20890008

  4. Cardiac Implantable Electronic Devices and End-of-Life Care: An Australian Perspective.

    PubMed

    Alhammad, Nasser J; O'Donnell, Mark; O'Donnell, David; Mariani, Justin A; Gould, Paul A; McGavigan, Andrew D

    2016-08-01

    Cardiac implantable electronic devices (pacemakers and defibrillators) are increasingly common in modern cardiology practice, and health professionals from a variety of specialties will encounter patients with such devices on a frequent basis. This article will focus on the subset of patients who may request, or be appropriate for, device deactivation and discuss the issues surrounding end-of-life decisions, along with the ethical and legal implications of device deactivation. PMID:27320854

  5. Central venous access resulting in selective failure of ICD defibrillation capacity.

    PubMed

    Varma, N; Cunningham, D; Falk, R

    2001-03-01

    In a patient with a defibrillator system incorporating a lead with integrated bipolar sensing, physical contact between a guidewire (inserted for venous access) and the right ventricular defibrillation coil created sensing artefacts that triggered an inappropriate discharge. The presence of the guidewire in the heart during the discharge resulted in an electrical short with irreversible damage to the generator and rendered it incapable of delivering further high voltage therapy. PMID:11310314

  6. Impedance-gradient electrode reduces skin irritation induced by transthoracic defibrillation.

    PubMed

    Meyer, P F; Gadsby, P D; Van Sickle, D; Schoenlein, W E; Foster, K S; Graber, G P

    2005-03-01

    A new type of disposable external defibrillation electrode has been developed to reduce the skin irritation commonly associated with defibrillation and synchronised cardioversion. This design employs an impedance gradient to reduce the proportion of current delivered to the electrode periphery. The temperature distribution under the new electrode was compared with that of four other types of commercially available electrodes after repeated high-energy biphasic defibrillation discharges to domestic swine. Skin temperature distributions were acquired using non-invasive thermography. Measurements of the maximum temperature rise at each electrode site, taken 3.6s after the fifth defibrillation discharge, demonstrated that the new impedance-gradient electrode produced 50-60% less skin heating than two of the three uniform-impedance electrode designs. Histological examination of erythematous sites excised 24 h after defibrillation quantified the associated skin damage using a scoring protocol developed for this study. In contrast to previous studies, histological examinations demonstrated second-degree skin burns following defibrillation. The new electrode design, however, induced 44-46% less skin damage than two of the traditional uniform-impedance electrodes. PMID:15865132

  7. Automated external defibrillator use for in-hospital emergency management.

    PubMed

    Huschak, G; Dünnebier, A; Kaisers, U X; Huschens, B; Bercker, S

    2016-05-01

    The in-hospital spread of automated external defibrillators (AEDs) is aimed to allow for a shock-delivery within three minutes. However, it has to be questioned if the implementation of AED alone really contributes to a 'heart-safe hospital'. We performed a cohort study of 1008 in-hospital emergency calls in a university tertiary care hospital, analysing cardiopulmonary resuscitation (CPR) cases with and without AED use. In total, 484 patients (48%) had cardiac arrest and received CPR. Response time of the emergency team was 4.3 ± 4.0 minutes. Only 8% percent of the CPR cases had a shockable rhythm. In three of 43 placements a shock was delivered by the AED. There were no differences in survival between patients with CPR only and CPR with AED use. Our data do not support the use of an AED for in-hospital CPR if a professional response team is rapidly available. PMID:27246934

  8. Cochlear Implants

    MedlinePlus

    ... electrodes are inserted. The electronic device at the base of the electrode array is then placed under ... FDA approval for implants The Food and Drug Administration (FDA) regulates cochlear implant devices for both adults ...

  9. Goserelin Implant

    MedlinePlus

    Goserelin implant is used in combination with radiation therapy and other medications to treat localized prostate cancer and is ... treatment of abnormal bleeding of the uterus. Goserelin implant is in a class of medications called gonadotropin- ...

  10. Cochlear Implants

    MedlinePlus

    A cochlear implant is a small, complex electronic device that can help to provide a sense of sound. People who are ... of-hearing can get help from them. The implant consists of two parts. One part sits on ...

  11. Carmustine Implant

    MedlinePlus

    Carmustine implant is used along with surgery and sometimes radiation therapy to treat malignant glioma (a certain type of ... Carmustine implant comes as a small wafer that is placed in the brain by a doctor during surgery to ...

  12. Cochlear implant

    MedlinePlus

    ... antenna. This part of the implant receives the sound, converts the sound into an electrical signal, and sends it to ... implants allow deaf people to receive and process sounds and speech. However, these devices do not restore ...

  13. Breast Implants

    MedlinePlus

    ... Updated Safety Information (Consumer Article) FDA Provides Updated Safety Data on Silicone Gel-Filled Breast Implants (Press Announcement) [ARCHIVED] Breast Implant Guidance for Industry (2006) Post Approval Studies Webpage Freedom of Information ...

  14. Home Monitoring for Cardiovascular Implantable Electronic Devices: Benefits to Patients and to Their Follow-up Clinic.

    PubMed

    Leahy, Robin A; Davenport, Elizabeth E

    2015-01-01

    Recent technological advances in the management of patients with cardiovascular implantable electronic devices (CIEDs) have expanded clinicians' ability to remotely monitor patients with CIEDs. Remote monitoring, in addition to periodic in-person device evaluation, provides many advantages to patients and clinicians. Aside from the therapeutic and diagnostic benefits of pacemakers, implantable cardioverter-defibrillators, cardiac resynchronization therapy devices, and implantable loop recorders, improvement in clinical outcomes, clinical efficiencies, and patient experience can be realized with the adoption of remote CIED monitoring. These advantages create significant value to both patients and CIED follow-up centers. PMID:26484995

  15. Surgical Management of the Patient with an Implanted Cardiac Device

    PubMed Central

    Madigan, John D.; Choudhri, Asim F.; Chen, Jonathan; Spotnitz, Henry M.; Oz, Mehmet C.; Edwards, Niloo

    1999-01-01

    Objective To identify the sources of electromagnetic interference (EMI) that may alter the performance of implanted cardiac devices and develop strategies to minimize their effects on patient hemodynamic status. Summary Background Data Since the development of the sensing demand pacemaker, EMI in the clinical setting has concerned physicians treating patients with such devices. Implanted cardiovertor defibrillators (ICDs) and ventricular assist devices (VADs) can also be affected by EMI. Methods All known sources of interference to pacemakers, ICDs, and VADs were evaluated and preventative strategies were devised. Results All devices should be thoroughly evaluated before and after surgery to make sure that its function has not been permanently damaged or changed. If electrocautery is to be used, pacemakers should be placed in a triggered or asynchronous mode; ICDs should have arrhythmia detection suspended before surgery. If defibrillation is to be used, the current flow between the paddles should be kept as far away from and perpendicular to the lead system as possible. Both pacemakers and ICDs should be properly shielded if magnetic resonance imaging, positron emission tomography, or radiation therapy is to be used. The effect of EMI on VADs depends on the model. Magnetic resonance imaging adversely affects all VADs except the Abiomed VAD, and therefore its use should be avoided in this population of patients. Conclusions The patient with an implanted cardiac device can safely undergo surgery as long as certain precautions are taken. PMID:10561087

  16. Automatic Stabilization

    NASA Technical Reports Server (NTRS)

    Haus, FR

    1936-01-01

    This report lays more stress on the principles underlying automatic piloting than on the means of applications. Mechanical details of servomotors and the mechanical release device necessary to assure instantaneous return of the controls to the pilot in case of malfunction are not included. Descriptions are provided of various commercial systems.

  17. Automatic warranties.

    PubMed

    Decker, R

    1987-10-01

    In addition to express warranties (those specifically made by the supplier in the contract) and implied warranties (those resulting from circumstances of the sale), there is one other classification of warranties that needs to be understood by hospital materials managers. These are sometimes known as automatic warranties. In the following dialogue, Doctor Decker develops these legal concepts. PMID:10284977

  18. The effect of time on CPR and automated external defibrillator skills in the Public Access Defibrillation Trial

    PubMed Central

    Christenson, Jim; Nafziger, Sarah; Compton, Scott; Vijayaraghavan, Kris; Slater, Brian; Ledingham, Robert; Powell, Judy; McBurnie, Mary Ann

    2009-01-01

    Background The time to skill deterioration between primary training/retraining and further retraining in Cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED) for lay-persons is unclear. The Public Access Defibrillation (PAD) Trial was a multi-center randomized controlled trial evaluating survival after CPR-only vs. CPR+AED delivered by onsite non-medical volunteer responders in out-of-hospital cardiac arrest. Aims This sub-study evaluated the relationship of time between primary training/retraining and further retraining on volunteer performance during pretest AED and CPR skill evaluation. Methods Volunteers at 1260 facilities in 24 North American regions underwent training/retraining according to facility randomization, which included an initial session and a refresher session at approximately 6 months. Before the next retraining, a CPR and AED skill test was completed for 2729 volunteers. Primary outcome for the study was assessment of global competence of CPR or AED performance (adequate vs not adequate) using Chi-square tests for trends by time interval (3, 6, 9, and 12 months). Confirmatory (GEE) logistic regression analysis, adjusted for site and potential confounders. Results The proportion of volunteers judged to be competent did not diminish by interval (3,6,9,12 months) for either CPR or AED skills. After adjusting for site and potential confounders, longer intervals before to further retraining was associated with a slightly lower likelihood of performing adequate CPR but not with AED scores. Conclusions After primary training/retraining, the CPR skills of targeted lay responders deteriorate nominally but 80% remain competent up to one year. AED skills do not significantly deteriorate and 90% of volunteers remain competent up to one year. PMID:17303309

  19. Left main coronary artery occlusion after percutaneous aortic valve implantation.

    PubMed

    Bartorelli, Antonio L; Andreini, Daniele; Sisillo, Erminio; Tamborini, Gloria; Fusari, Melissa; Biglioli, Paolo

    2010-03-01

    Left main coronary artery occlusion occurred immediately after transfemoral aortic valve implantation in an 87-year-old woman, which resulted in ventricular fibrillation and hemodynamic collapse. This life-threatening complication was promptly diagnosed with transesophageal echocardiography, which showed the disappearance of diastolic left main coronary artery jet flow and was confirmed with aortic root angiography. After prompt defibrillation, hemodynamic support was obtained with intra-aortic balloon pump and inotropic drugs. Functional recovery and survival were achieved with coronary stenting. This report highlights the importance of an integrated team approach of highly skilled specialists for these novel interventions. PMID:20172163

  20. 41 CFR 102-79.115 - What guidelines must an agency follow if it elects to establish a public access defibrillation...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... agency follow if it elects to establish a public access defibrillation program in a Federal facility? 102... SPACE Assignment and Utilization of Space Public Access Defibrillation Programs § 102-79.115 What guidelines must an agency follow if it elects to establish a public access defibrillation program in...

  1. 41 CFR 102-79.115 - What guidelines must an agency follow if it elects to establish a public access defibrillation...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... agency follow if it elects to establish a public access defibrillation program in a Federal facility? 102... SPACE Assignment and Utilization of Space Public Access Defibrillation Programs § 102-79.115 What guidelines must an agency follow if it elects to establish a public access defibrillation program in...

  2. 41 CFR 102-79.115 - What guidelines must an agency follow if it elects to establish a public access defibrillation...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... agency follow if it elects to establish a public access defibrillation program in a Federal facility? 102... SPACE Assignment and Utilization of Space Public Access Defibrillation Programs § 102-79.115 What guidelines must an agency follow if it elects to establish a public access defibrillation program in...

  3. 41 CFR 102-79.115 - What guidelines must an agency follow if it elects to establish a public access defibrillation...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... agency follow if it elects to establish a public access defibrillation program in a Federal facility? 102... SPACE Assignment and Utilization of Space Public Access Defibrillation Programs § 102-79.115 What guidelines must an agency follow if it elects to establish a public access defibrillation program in...

  4. Telecardiology and Remote Monitoring of Implanted Electrical Devices: The Potential for Fresh Clinical Care Perspectives

    PubMed Central

    Diemberger, Igor; Martignani, Cristian; Biffi, Mauro; Valzania, Cinzia; Bertini, Matteo; Domenichini, Giulia; Saporito, Davide; Ziacchi, Matteo; Branzi, Angelo

    2007-01-01

    Telecardiology may help confront the growing burden of monitoring the reliability of implantable defibrillators/pacemakers. Herein, we suggest that the evolving capabilities of implanted devices to monitor patients’ status (heart rhythm, fluid overload, right ventricular pressure, oximetry, etc.) may imply a shift from strictly device-centered follow-up to perspectives centered on the patient (and patient-device interactions). Such approaches could provide improvements in health care delivery and clinical outcomes, especially in the field of heart failure. Major professional, policy, and ethical issues will have to be overcome to enable real-world implementation. This challenge may be relevant for the evolution of our health care systems. PMID:18095049

  5. Exercise Rehabilitation for Chronic Heart Failure Patients with Cardiac Device Implants

    PubMed Central

    Haennel, Robert G.

    2012-01-01

    In the past decade a significant development in the management and rehabilitation of people with chronic heart failure (CHF) has been the utilization of cardiac devices. The use of biventricular pacemakers, referred to as Cardiac Resynchronization Therapy (CRT) can yield improvements in functional abilities for a select group of CHF patients and the inclusion of implantable cardiac defibrillators (ICDs) may reduce the risk of sudden death. This review provides physical therapists with a basic understanding of how to prescribe exercise for people with CHF who have these device implants. PMID:22993499

  6. My Child Needs or Has an Implantable Cardioverter-Defibrillator: What Should I Do?

    MedlinePlus

    ... Association . Circulation . 2011 ; 123 : 1454 – 1485 . OpenUrl FREE Full Text 5. ↵ Brown RT DeMaso DR . Pediatric heart disease . ... shock . Circulation . 2005 ; 111 : e380 – e382 . OpenUrl FREE Full Text 8. ↵ MedTees . http://www.cafepress.com/medtees/s_icd . ...

  7. Coping with Trauma and Stressful Events As a Patient with an Implantable Cardioverter-Defibrillator

    MedlinePlus

    ... 29, 2013 Jessica Ford From the Departments of Psychology (J.F., S.F.S.) and Department of Cardiovascular Sciences (S. ... site Samuel F. Sears From the Departments of Psychology (J.F., S.F.S.) and Department of Cardiovascular Sciences (S. ...

  8. 77 FR 20873 - Qualification of Drivers; Application for Exemptions; Implantable Cardioverter Defibrillators

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-06

    ... on January 17, 2008 (73 FR 3316), or you may visit http://edocket.access.gpo.gov/2008/pdf/E8-785.pdf... final rule implementing section 4007 (69 FR 51589). Under this rule, FMCSA must publish a notice of each... person has no current clinical diagnosis of myocardial infarction, angina pectoris,...

  9. AUTOMATIC COUNTER

    DOEpatents

    Robinson, H.P.

    1960-06-01

    An automatic counter of alpha particle tracks recorded by a sensitive emulsion of a photographic plate is described. The counter includes a source of mcdulated dark-field illumination for developing light flashes from the recorded particle tracks as the photographic plate is automatically scanned in narrow strips. Photoelectric means convert the light flashes to proportional current pulses for application to an electronic counting circuit. Photoelectric means are further provided for developing a phase reference signal from the photographic plate in such a manner that signals arising from particle tracks not parallel to the edge of the plate are out of phase with the reference signal. The counting circuit includes provision for rejecting the out-of-phase signals resulting from unoriented tracks as well as signals resulting from spurious marks on the plate such as scratches, dust or grain clumpings, etc. The output of the circuit is hence indicative only of the tracks that would be counted by a human operator.

  10. How are arrhythmias detected by implanted cardiac devices managed in Europe? Results of the European Heart Rhythm Association Survey.

    PubMed

    Todd, Derick; Hernandez-Madrid, Antonio; Proclemer, Alessandro; Bongiorni, Maria Grazia; Estner, Heidi; Blomström-Lundqvist, Carina

    2015-09-01

    The management of arrhythmias detected by implantable cardiac devices can be challenging. There are no formal international guidelines to inform decision-making. The purpose of this European Heart Rhythm Association (EHRA) survey was to assess the management of various clinical scenarios among members of the EHRA electrophysiology research network. There were 49 responses to the questionnaire. The survey responses were mainly (81%) from medium-high volume device implanting centres, performing more than 200 total device implants per year. Clinical scenarios were described focusing on four key areas: the implantation of pacemakers for bradyarrhythmia detected on an implantable loop recorder (ILR), the management of patients with ventricular arrhythmia detected by an ILR or pacemaker, the management of atrial fibrillation in patients with pacemakers and cardiac resynchronization therapy devices and the management of ventricular tachycardia in patients with implantable cardioverter-defibrillators. PMID:26443791

  11. Management of malfunctioning and recalled pacemaker and defibrillator leads: results of the European Heart Rhythm Association survey.

    PubMed

    Grazia Bongiorni, Maria; Dagres, Nikolaos; Estner, Heidi; Pison, Laurent; Todd, Derick; Blomstrom-Lundqvist, Carina

    2014-11-01

    The aim of this survey was to describe the different strategies regarding the management of malfunctioning and recalled pacemaker and defibrillator leads across Europe. A questionnaire has been designed to assess the current practice and physician's approach to the management of leads which are faulty, unnecessary, and/or recalled. Responses to the questionnaire were received from 34 hospitals-members of the European Heart Rhythm Association (EHRA) electrophysiology (EP) research network. The survey involved both very high and low volume implanting centres, with 85% of the responding centres performing lead extraction. The survey provides a panoramic view of operator's decision making in the field of malfunctioning, recalled, and redundant leads and outlines a common point of view on lead abandonment and factors influencing the decision about lead extraction. The main factors strongly influencing the decision making were patient's age (59%), the presence of the damaged leads (44%), and the lead dwelling time (44%). Regarding the lead abandonment, the main concern (61%) was the potential greater difficulty associated with lead extraction in the future. High volume extracting centres showed a greater propensity to removing the malfunctioning or recalled leads compared with low volume or non-extracting centres. This EP Wire survey gives a snapshot of the operators' approaches and options regarding redundant, malfunctioning, and recalled lead management and may form the basis for future prospective research on this topic. PMID:25344962

  12. High Productivity Implantation ''PARTIAL IMPLANT''

    SciTech Connect

    Hino, Masayoshi; Miyamoto, Naoki; Sakai, Shigeki; Matsumoto, Takao

    2008-11-03

    The patterned ion implantation 'PARTIAL IMPLANT' has been developed as a productivity improvement tool. The Partial Implant can form several different ion dose areas on the wafer surface by controlling the speed of wafer moving and the stepwise rotation of twist axis. The Partial Implant system contains two implant methods. One method is 'DIVIDE PARTIAL IMPLANT', that is aimed at reducing the consumption of the wafer. The Divide Partial Implant evenly divides dose area on one wafer surface into two or three different dose part. Any dose can be selected in each area. So the consumption of the wafer for experimental implantation can be reduced. The second method is 'RING PARTIAL IMPLANT' that is aimed at improving yield by correcting electrical characteristic of devices. The Ring Partial Implant can form concentric ion dose areas. The dose of wafer external area can be selected to be within plus or minus 30% of dose of wafer central area. So the electrical characteristic of devices can be corrected by controlling dose at edge side on the wafer.

  13. Should we use automated external defibrillators in hospital wards?

    PubMed

    De Regge, M; Monsieurs, K G; Vandewoude, K; Calle, P A

    2012-01-01

    Automated external defibrillators (AEDs) have shown to improve survival after cardiopulmonary arrest (CPA) in many, but not all clinical settings. A recent study reported that the use of AEDs in-hospital did not improve survival. The current retrospective study reports the results of an in-hospital AED programme in a university hospital, and focuses on the quality of AED use. At Ghent University Hospital 30 AEDs were placed in non-monitored hospital wards and outpatient clinics treating patients with non-cardiac problems. Nurses were trained to use these devices. From November 2006 until March 2011, the AEDs were used in 23 of 39 CPA cases, in only one patient the presenting heart rhythm was ventricular fibrillation and this patient survived. Pulseless electrical activity was present in 14 patients (four survived) and asystole in eight patients (one survived). AEDs were attached to eight patients without CPA, and in 16 patients with CPA AED was not used. The quality of AED use was often suboptimal as illustrated by external artifacts during the first rhythm analysis by the AED in 30% (7/23) and more than 20 seconds delay before restart of chest compressions after the AED rhythm analysis in 50% (9/18). The literature data, supported by our results, indicate that in-hospital AED programmes are unlikely to improve survival after CPA. Moreover, their use is often suboptimal. Therefore, if AEDs are introduced in a hospital, initial training, frequent retraining and close follow-up are essential. PMID:23019797

  14. Subpectoral implantation of ICD generators: long-term follow-up.

    PubMed

    Thakur, R K; Ip, J H; Mehta, D; Jung, J Y; Collar, A; Camunas, J; Gomes, J A

    1995-01-01

    A nonthoracotomy surgical approach using an endocardial electrode and combined implantation of a subcutaneous patch and the implantable cardioverter defibrillator (ICD) generator in a subpectoral pocket has been described. We report the long-term follow-up results in patients undergoing implantation using this approach. The patient population consisted of 28 patients (22 men and 6 women) with a mean age of 59 +/- 12 years. The underlying heart disease consisted of coronary artery disease in 20 patients and dilated cardiomyopathy in 8 patients. Sustained ventricular tachycardia was the mode of presentation in 16 patients and sudden cardiac death in 12 patients. The mean left ventricular ejection fraction was 31% +/- 6%. The lead system consisted of an 8 French bipolar passive fixation rate sensing lead positioned at the right ventricular apex, an 11 French spring coil electrode positioned at the superior vena cava-right atrial junction (surface area 700 mm2), and submuscular placement of a large patch (surface area 28 cm2) on the anterolateral chest wall near the cardiac apex via a submammary incision. A defibrillation threshold of < or = 15 joules (J) was required for implantation. This criterion was not satisfied in five patients; thus, a limited thoracotomy was performed via the submammary incision, and the large patch was placed epicardially. The mean R wave amplitude was 12 +/- 3 mV, the mean pacing threshold was 1.0 +/- 0.5 V at 0.5 msec, and the mean defibrillation threshold was 12.6 +/- 3 J. ICD generators implanted were the Ventak-P in 17, PCD-7217 in 5, and the Cadence V-100 in 6 patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7724391

  15. Automatic stabilization

    NASA Technical Reports Server (NTRS)

    Haus, FR

    1936-01-01

    This report concerns the study of automatic stabilizers and extends it to include the control of the three-control system of the airplane instead of just altitude control. Some of the topics discussed include lateral disturbed motion, static stability, the mathematical theory of lateral motion, and large angles of incidence. Various mechanisms and stabilizers are also discussed. The feeding of Diesel engines by injection pumps actuated by engine compression, achieves the required high speeds of injection readily and permits rigorous control of the combustible charge introduced into each cylinder and of the peak pressure in the resultant cycle.

  16. Defibrillation in the movies: a missed opportunity for public health education

    PubMed Central

    Mgbako, Ofole U.; Ha, Yoonhee P.; Ranard, Benjamin L.; Hypolite, Kendra A.; Sellers, Allison M.; Nadkarni, Lindsay D.; Becker, Lance B.; Asch, David A.; Merchant, Raina M.

    2014-01-01

    Aim To characterise defibrillation and cardiac arrest survival outcomes in movies. Methods Movies from 2003–2012 with defibrillation scenes were reviewed for patient and rescuer characteristics, scene characteristics, defibrillation characteristics, additional interventions, and cardiac arrest survival outcomes. Resuscitation actions were compared with chain of survival actions and the American Heart Association (AHA) Emergency Cardiovascular Care (ECC) 2020 Impact Goals. Cardiac arrest survival outcomes were compared with survival rates reported in the literature and targeted by the AHA ECC 2020 Impact Goals. Results Thirty-five scenes were identified in 32 movies. Twenty-five (71%) patients were male, and 29 (83%) rescuers were male. Intent of defibrillation was resuscitation in 29 (83%) scenes and harm in 6 (17%) scenes. Cardiac arrest was the indication for use in 23 (66%) scenes, and the heart rhythm was made known in 18 scenes (51%). When the heart rhythm was known, defibrillation was appropriately used for ventricular tachycardia or ventricular fibrillation in 5 (28%) scenes and inappropriately used for asystole in 7 (39%) scenes. In 8 scenes with in-hospital cardiac arrest, 7 (88%) patients survived, compared to survival rates of 23.9% reported in the literature and 38% targeted by an AHA ECC 2020 Impact Goal. In 12 movie scenes with out-of-hospital cardiac arrest, 8 (67%) patients survived, compared to survival rates of 7.9–9.5% reported in peer-reviewed literature and 15.8% targeted by an AHA ECC 2020 Impact Goal. Conclusion In movies, defibrillation and cardiac arrest survival outcomes are often portrayed inaccurately, representing missed opportunities for public health education. PMID:25241344

  17. [Implant allergies].

    PubMed

    Thomas, P; Thomsen, M

    2010-03-01

    An increasing number of patients receive and benefit from osteosynthesis materials or artificial joint replacement. The most common complications are mechanical problems or infection. Metals like nickel, chromium and cobalt as well as bone cement components like acrylates and gentamicin are potential contact allergens which can cause intolerance reactions to implants. Eczema, delayed wound/bone healing, recurrent effusions, pain and implant loosening all have been described as manifestation of implant allergy. In contrast to the high incidence of cutaneous metal allergy, allergies associated with implants are rare. Diagnosis of metal implant allergy is still difficult. Thus differential diagnoses--in particular infection--have to be excluded and a combined approach of allergologic diagnostics by patch test and histopathology of peri-implant tissue is recommended. It is still unknown which conditions induce allergic sensitization to implants or trigger peri-implant allergic reactions in the case of preexisting cutaneous metal allergy. Despite the risk of developing complications being unclear, titanium based osteosynthesis materials are recommended for metal allergic patients and the use of metal-metal couplings in arthroplasty is not recommended for such patients. If the regular CoCr-polyethylene articulation is employed, the patient should give informed written consent. PMID:20204719

  18. Increased defibrillator therapies during influenza season in patients without influenza vaccines

    PubMed Central

    Singh, Sheldon M.; de Souza, Russell J.; Kumareswaran, Ramanan

    2015-01-01

    Background The association between influenza vaccination and implantable cardiac defibrillator (ICD) therapies during influenza season is not known and is described in this study. Understanding this association is important since reduction in ICD therapies during influenza season via use of influenza vaccination would benefit patients physically and psychologically. Methods Patients presenting to the Sunnybrook Health Sciences Center ICD clinic between September 1st, 2011 and November 31st, 2011 were asked to complete a survey evaluating their use of the influenza vaccine. The number of patients with any ICD therapy and the total number of ICD therapies in the six months before and the three months during the 2010–2011 influenza season were determined. Poisson regression analysis was employed to assess differences in the average number of ICD therapies received during the influenza season based on vaccine status (vaccinated vs. unvaccinated). The analysis was repeated after limiting the cohort to patients with a left ventricular ejection fraction ≤35%. Results A total of 229 patients completed the survey, 78% of whom received the influenza vaccine. Four patients had more than one ICD shock during the study period. Electrical storm was rare (n=2). A trend toward more ICD therapies (unadjusted incident rate ratio (IRR)=3.2; P=0.07) and appropriate ICD shocks (unadjusted IRR=9.0; P=0.17) was noted for unvaccinated compared to vaccinated patients. This association persisted when analysis was limited to patients with a left ventricular ejection fraction ≤35% (all ICD therapies: unadjusted IRR=5.8; P=0.045; adjusted IRR=2.6; P=0.33). No patient who received the influenza vaccine, and had a reduced ejection fraction, received an approprite ICD shock during influenza season (unadjusted P<0.002). Conclusion A trend toward more ICD therapies during influenza season was observed in patients who did not receive the influenza vaccine compared to those who did. The

  19. Patient Report and Review of Rapidly Growing Mycobacterial Infection after Cardiac Device Implantation

    PubMed Central

    Hirsh, David S.; Goswami, Neela D.

    2016-01-01

    Mycobacterial infections resulting from cardiac implantable electronic devices are rare, but as more devices are implanted, these organisms are increasingly emerging as causes of early-onset infections. We report a patient with an implantable cardioverter-defibrillator pocket and associated bloodstream infection caused by an organism of the Mycobacterium fortuitum group, and we review the literature regarding mycobacterial infections resulting from cardiac device implantations. Thirty-two such infections have been previously described; most (70%) were caused by rapidly growing species, of which M. fortuitum group species were predominant. When managing such infections, clinicians should consider the potential need for extended incubation of routine cultures or dedicated mycobacterial cultures for accurate diagnosis; combination antimicrobial drug therapy, even for isolates that appear to be macrolide susceptible, because of the potential for inducible resistance to this drug class; and the arrhythmogenicity of the antimicrobial drugs traditionally recommended for infections caused by these organisms. PMID:26890060

  20. Implantable Smart Technologies (IST): Defining the 'Sting' in Data and Device.

    PubMed

    Haddow, Gill; Harmon, Shawn H E; Gilman, Leah

    2016-09-01

    In a world surrounded by smart objects from sensors to automated medical devices, the ubiquity of 'smart' seems matched only by its lack of clarity. In this article, we use our discussions with expert stakeholders working in areas of implantable medical devices such as cochlear implants, implantable cardiac defibrillators, deep brain stimulators and in vivo biosensors to interrogate the difference facets of smart in 'implantable smart technologies', considering also whether regulation needs to respond to the autonomy that such artefacts carry within them. We discover that when smart technology is deconstructed it is a slippery and multi-layered concept. A device's ability to sense and transmit data and automate medicine can be associated with the 'sting' of autonomy being disassociated from human control as well as affecting individual, group, and social environments. PMID:26646672

  1. Preferred tools and techniques for implantation of cardiac electronic devices in Europe: results of the European Heart Rhythm Association survey.

    PubMed

    Bongiorni, Maria Grazia; Proclemer, Alessandro; Dobreanu, Dan; Marinskis, Germanas; Pison, Laurent; Blomstrom-Lundqvist, Carina

    2013-11-01

    The aim of this European Heart Rhythm Association (EHRA) survey was to assess clinical practice in relation to the tools and techniques used for cardiac implantable electronic devices procedures in the European countries. Responses to the questionnaire were received from 62 members of the EHRA research network. The survey involved high-, medium-, and low-volume implanting centres, performing, respectively, more than 200, 100-199 and under 100 implants per year. The following topics were explored: the side approach for implantation, surgical techniques for pocket incision, first venous access for lead implantation, preference of lead fixation, preferred coil number for implantable cardioverter-defibrillator (ICD) leads, right ventricular pacing site, generator placement site, subcutaneous ICD implantation, specific tools and techniques for cardiac resynchronization therapy (CRT), lead implantation sequence in CRT, coronary sinus cannulation technique, target site for left ventricular lead placement, strategy in left ventricular lead implant failure, mean CRT implantation time, optimization of the atrioventricular (AV) and ventriculo-ventricular intervals, CRT implants in patients with permanent atrial fibrillation, AV node ablation in patients with permanent AF. This panoramic view allows us to find out the operator preferences regarding the techniques and tools for device implantation in Europe. The results showed different practices in all the fields we investigated, nevertheless the survey also outlines a good adherence to the common standards and recommendations. PMID:24170423

  2. Implantable rhythm devices and electromagnetic interference: myth or reality?

    PubMed

    Dyrda, Katia; Khairy, Paul

    2008-07-01

    Current medical guidelines have prompted implementation of increasing numbers of implantable rhythm devices, be they pacemakers, internal cardioverter-defibrillators or loop recorders. These devices rely on complex microcircuitry and use electromagnetic waves for communication. They are, therefore, susceptible to interference from surrounding electromagnetic radiation and magnetic energy. Hermetic shielding in metallic cases, filters, interference rejection circuits and bipolar sensing have contributed to their relative resistance to electromagnetic interference (EMI) in household and workplace environments. Device interactions have occurred in hospitals where EMI sources are ubiquitous, including radiation, electrocautery and MRI exposures. However, with rapidly evolving technology, devices and potential sources of EMI continue to change. This review provides a contemporary overview of the current state of knowledge regarding risks attributable to EMI; highlights current limitations of implantable rhythm devices; and attempts to distinguish myths from realities. PMID:18570620

  3. Cardiac or Other Implantable Electronic Devices and Sleep-disordered Breathing – Implications for Diagnosis and Therapy

    PubMed Central

    Bitter, Thomas; Gutleben, Klaus-Jürgen; Horstkotte, Dieter; Oldenburg, Olaf

    2014-01-01

    Sleep-disordered breathing (SDB) is of growing interest in cardiology because SDB is a highly prevalent comorbidity in patients with a variety of cardiovascular diseases. The prevalence of SDB is particularly high in patients with cardiac dysrhythmias and/or heart failure. In this setting, many patients now have implantable cardiac devices, such as pacemakers, implantable cardioverter-defibrillators or implanted cardiac resynchronisation therapy devices (CRT). Treatment of SDB using implantable cardiac devices has been studied previously, with atrial pacing and CRT being shown not to bring about satisfactory results in SDB care. The latest generations of these devices have the capacity to determine transthoracic impedance, to detect and quantify breathing efforts and to identify SDB. The capability of implantable cardiac devices to detect SDB is of potential importance for patients with cardiovascular disease, allowing screening for SDB, monitoring of the course of SDB in relation to cardiac status, and documenting of the effects of treatment. PMID:26835077

  4. The cardiac implantable electronic device power source: evolution and revolution.

    PubMed

    Mond, Harry G; Freitag, Gary

    2014-12-01

    Although the first power source for an implantable pacemaker was a rechargeable nickel-cadmium battery, it was rapidly replaced by an unreliable short-life zinc-mercury cell. This sustained the small pacemaker industry until the early 1970s, when the lithium-iodine cell became the dominant power source for low voltage, microampere current, single- and dual-chamber pacemakers. By the early 2000s, a number of significant advances were occurring with pacemaker technology which necessitated that the power source should now provide milliampere current for data logging, telemetric communication, and programming, as well as powering more complicated pacing devices such as biventricular pacemakers, treatment or prevention of atrial tachyarrhythmias, and the integration of innovative physiologic sensors. Because the current delivery of the lithium-iodine battery was inadequate for these functions, other lithium anode chemistries that can provide medium power were introduced. These include lithium-carbon monofluoride, lithium-manganese dioxide, and lithium-silver vanadium oxide/carbon mono-fluoride hybrids. In the early 1980s, the first implantable defibrillators for high voltage therapy used a lithium-vanadium pentoxide battery. With the introduction of the implantable cardioverter defibrillator, the reliable lithium-silver vanadium oxide became the power source. More recently, because of the demands of biventricular pacing, data logging, and telemetry, lithium-manganese dioxide and the hybrid lithium-silver vanadium oxide/carbon mono-fluoride laminate have also been used. Today all cardiac implantable electronic devices are powered by lithium anode batteries. PMID:25387600

  5. Battery drain in daily practice and medium-term projections on longevity of cardioverter-defibrillators: an analysis from a remote monitoring database

    PubMed Central

    Boriani, Giuseppe; Ritter, Philippe; Biffi, Mauro; Ziacchi, Matteo; Diemberger, Igor; Martignani, Cristian; Valzania, Cinzia; Valsecchi, Sergio; Padeletti, Luigi; Gadler, Fredrik

    2016-01-01

    Aims The longevity of generators is a crucial determinant of the cost-effectiveness of therapy with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-D). We evaluated the trend of device-measured residual battery capacity and longevity projections over 5-year follow-up. We also investigated possible factors associated with battery drain. Methods and results Data from 4851 patients in the European LATITUDE® database who were followed up for a minimum of 3 years were analysed. The factors associated with battery drain (i.e. year-to-year decrease in residual battery capacity), and thus potentially impacting on device longevity, were mainly the pacing parameters in CRT-D devices and the number of shocks delivered and diverted in both ICD and CRT-D (all P < 0.01 on linear regression analysis). Over the first 5 years, the longevity estimates provided by devices showed low intra-patient variability and increased with time. The estimates exceeded 10 years for CRT-D and 13 and 12 years for single- and dual-chamber ICDs, respectively. In CRT-D patients, the expected patient age on replacement was 80 ± 12 years, and the expected probability of undergoing device replacement was 63 ± 13% for New York Heart Association (NYHA) II patients and 37 ± 16% for NYHA III patients. For comparison, the probabilities of replacing a CRT-D lasting 5 years were 78 ± 8 and 59 ± 13%, respectively (both P < 0.001). Conclusion Battery drain was mainly associated with pacing output in CRT-D devices and with the number of capacitor charges in both ICD and CRT-D devices. The longevity estimates provided by the devices were consistent and conservative. According to these estimates, among CRT-D recipients a low proportion of patients should require device replacement. PMID:26847076

  6. Effect of body hypothermia on transventricular simple-capacitor-discharge defibrillation thresholds.

    PubMed

    Arredondo, M T; Armayor, M R; Clavin, O E; Valentinuzzi, M E; Scidá, E E

    1980-05-01

    In 260 successful transventricular simple capacitor-discharge defibrillations performed on 20 mongrel dogs under conditions of body hypothermia, an overall average peak current threshold of 69.5 mA/g of heart (SD 30.4) was found. This value, when compared by means of the unpaired t test with previous data obtained under conditions of relative normothermia (89.5 mA/g of heart, SD 32.8, 346 defibrillations, 20 dogs) yielded a highly significant difference (P less than 0.1%). When comparing the deviation of the regression equation (current vs. temperature) from the horizontal line, the Snedecor F test gave also a high level of significance (P less than 1%). These results led to the conclusion that body hypothermia significantly reduces transventricular defibrillation thresholds. After normalizing the regression equations, this reduction was found to be on the average equal to 4.1%/degrees C (SD 1.4) for current and to 5.9%/degrees C (SD 1.4) for energy over the 20 dogs. In all animals, the coefficient of variation was greater for energy than for current (about twice as much), suggesting that current is a better descriptor of what is needed for electrical defibrillation. The transventricular impedance was rather constant, yielding an overall average of 28.5 omega (SD 6.0). PMID:7377363

  7. Purkinje Activation Precedes Myocardial Activation After Defibrillation Following Long Duration Ventricular Fibrillation

    PubMed Central

    Dosdall, Derek J.; Osorio, Jose; Robichaux, Robert P.; Huang, Jian; Li, Li; Ideker, Raymond E.

    2010-01-01

    Background While reentry within the ventricular myocardium (VM) is responsible for the maintenance of short duration ventricular fibrillation (SDVF, VF duration < 1 min), Purkinje fibers (PFs) are important in the maintenance of long duration ventricular fibrillation (LDVF, VF duration > 1 min). Objective We hypothesized that the mechanisms of defibrillation may also be different for SDVF and LDVF. Methods A multielectrode basket catheter was deployed in the left ventricle of 8 beagles. External defibrillation shocks were delivered with a ramp-up protocol following SDVF (20 s) and LDVF (150 s). Earliest VM and PF activations were identified following the highest energy shock that failed to terminate VF and the successful shock. Results Defibrillation was successful after 36±12 s and 181±14 s for SDVF and LDVF, respectively. The time after shock delivery until earliest activation was detected for failed shocks and was significantly longer following LDVF (138.7±24.1 ms) than SDVF (75.6±8.7 ms). Earliest postshock activation following SDVF typically initiated in the VM (14 of 16 episodes) while it always initiated in the PF (16 of 16 episodes) following LDVF. Sites of earliest activity during sinus rhythm correlated with sites of earliest postshock activation for PF-led cycles but not VM-led cycles. Conclusion Earliest recorded postshock activation is in the Purkinje system following LDVF but not SDVF. This difference raises the possibility that the optimal defibrillation strategy is different for SDVF and LDVF. PMID:20061187

  8. Cellular mechanism of reentry induced by a strong electrical stimulus: implications for fibrillation and defibrillation.

    PubMed

    Karagueuzian, H S; Chen, P S

    2001-05-01

    The objective of this review article is to describe the graded response hypothesis of reentry induced by a strong single electrical stimulus in the normal canine ventricular myocardium. It is shown that the graded responses (subthreshold depolarization during phase 3 of the action potential) induced at a site distant (S2) from the regular S1--S1 pacing site, propagate slowly over short distances (approximately 5 mm) and initiate a regenerative action potentials in recovered cells near the S1 site. Activation wave then blocks near the S2 site (unidirectional block) but reenters when the S2 site recovers it excitability. Super strong S2 currents do not induce reentry (upper limit of vulnerability). Since similar activation sequence and properties are shown to exist in intact canine hearts during induction of ventricular fibrillation with a similar S2 stimulus, the graded response hypothesis may have relevance to vulnerability to fibrillation. Furthermore, since the upper limit of vulnerability is closely related to defibrillation threshold, the graded response hypothesis might also be relevant to defibrillation mechanism. Other proposed mechanisms of fibrillation and defibrillation (critical point hypothesis, the progressive depolarization hypothesis and the hypothesis of phase singularity of defibrillation failure) are also discussed in this review paper and compared to the graded response hypothesis. PMID:11334829

  9. Cardiac Arrest During Medically-Supervised Exercise Training: A Report of Fifteen Successful Defibrillations.

    ERIC Educational Resources Information Center

    Pyfer, Howard R.; And Others

    The Cardio-Pulmonary Research Institute conducted an exercise program for men with a history of coronary heart disease. Over 7 years, there were 15 cases of cardiac arrest during exercise (one for every 6,000 man-hours of exercise). Trained medical personnel were present in all cases, and all were resuscitated by electrical defibrillation with no…

  10. Cochlear Implants

    MedlinePlus

    ... additional visits are needed for activating, adjusting, and programming the various electrodes that have been implanted. Also, ... to the center for checkups once the final programming is made to the speech processor. Both children ...

  11. Histrelin Implant

    MedlinePlus

    ... bone growth and development of sexual characteristics) in girls usually between 2 and 8 years of age ... MRI scans (radiology techniques designed to show the images of body structures) to find the implant when ...

  12. Goserelin Implant

    MedlinePlus

    ... which the type of tissue that lines the uterus [womb] grows in other areas of the body ... with the treatment of abnormal bleeding of the uterus. Goserelin implant is in a class of medications ...

  13. Ion Implantation

    NASA Astrophysics Data System (ADS)

    Langouche, G.; Yoshida, Y.

    In this tutorial we describe the basic principles of the ion implantation technique and we demonstrate that emission Mössbauer spectroscopy is an extremely powerful technique to investigate the atomic and electronic configuration around implanted atoms. The physics of dilute atoms in materials, the final lattice sites and their chemical state as well as diffusion phenomena can be studied. We focus on the latest developments of implantation Mössbauer spectroscopy, where three accelerator facilities, i.e., Hahn-Meitner Institute Berlin, ISOLDE-CERN and RIKEN, have intensively been used for materials research in in-beam and on-line Mössbauer experiments immediately after implantation of the nuclear probes.

  14. Dental Implants

    MedlinePlus Videos and Cool Tools

    ... facts so you can make an informed decision as to whether dental implants are right for your ... the jaw bone. It’s obviously not the same as the original connection , but functions just the same. ...

  15. Automatic transmission

    SciTech Connect

    Miura, M.; Inuzuka, T.

    1986-08-26

    1. An automatic transmission with four forward speeds and one reverse position, is described which consists of: an input shaft; an output member; first and second planetary gear sets each having a sun gear, a ring gear and a carrier supporting a pinion in mesh with the sun gear and ring gear; the carrier of the first gear set, the ring gear of the second gear set and the output member all being connected; the ring gear of the first gear set connected to the carrier of the second gear set; a first clutch means for selectively connecting the input shaft to the sun gear of the first gear set, including friction elements, a piston selectively engaging the friction elements and a fluid servo in which hydraulic fluid is selectively supplied to the piston; a second clutch means for selectively connecting the input shaft to the sun gear of the second gear set a third clutch means for selectively connecting the input shaft to the carrier of the second gear set including friction elements, a piston selectively engaging the friction elements and a fluid servo in which hydraulic fluid is selectively supplied to the piston; a first drive-establishing means for selectively preventing rotation of the ring gear of the first gear set and the carrier of the second gear set in only one direction and, alternatively, in any direction; a second drive-establishing means for selectively preventing rotation of the sun gear of the second gear set; and a drum being open to the first planetary gear set, with a cylindrical intermediate wall, an inner peripheral wall and outer peripheral wall and forming the hydraulic servos of the first and third clutch means between the intermediate wall and the inner peripheral wall and between the intermediate wall and the outer peripheral wall respectively.

  16. Infection control in implantation of cardiac implantable electronic devices: current evidence, controversial points, and unresolved issues.

    PubMed

    Korantzopoulos, Panagiotis; Sideris, Skevos; Dilaveris, Polychronis; Gatzoulis, Konstantinos; Goudevenos, John A

    2016-04-01

    A significant increase in the implantation of cardiac implantable electronic devices (CIEDs) is evident over the past years, while there is evidence for a disproportionate increase in CIED-related infections. The cumulative probability of device infection seems to be higher in implantable cardioverter defibrillator and in cardiac resynchronization therapy patients compared with permanent pacemaker patients. Given that more than a half of CIED infections are possibly related to the operative procedure, there is a need for effective periprocedural infection control. However, many of the current recommendations are empirical and not evidence-based, while questions, unresolved issues, and conflicting evidence arise. The perioperative systemic use of antibiotics confers significant benefit in prevention of CIED infections. However, there are no conclusive data regarding the specific value of each agent in different clinical settings, the value of post-operative antibiotic treatment as well as the optimal duration of therapy. The merit of local pocket irrigation with antibiotic and/or antiseptic agents remains unproved. Of note, recent evidence indicates that the application of antibacterial envelopes into the device pocket markedly decreases the infection risk. In addition, limited reports on strict integrated infection control protocols show a dramatic reduction in infection rates in this setting and therefore deserve further attention. Finally, the relative impact of particular factors on the infection risk, including the type of the CIED, patients' individual characteristics and comorbidities, should be further examined since it may facilitate the development of tailored prophylactic interventions for each patient. PMID:26516219

  17. Integration of Attributes from Non-Linear Characterization of Cardiovascular Time-Series for Prediction of Defibrillation Outcomes

    PubMed Central

    Shandilya, Sharad; Kurz, Michael C.; Ward, Kevin R.; Najarian, Kayvan

    2016-01-01

    Objective The timing of defibrillation is mostly at arbitrary intervals during cardio-pulmonary resuscitation (CPR), rather than during intervals when the out-of-hospital cardiac arrest (OOH-CA) patient is physiologically primed for successful countershock. Interruptions to CPR may negatively impact defibrillation success. Multiple defibrillations can be associated with decreased post-resuscitation myocardial function. We hypothesize that a more complete picture of the cardiovascular system can be gained through non-linear dynamics and integration of multiple physiologic measures from biomedical signals. Materials and Methods Retrospective analysis of 153 anonymized OOH-CA patients who received at least one defibrillation for ventricular fibrillation (VF) was undertaken. A machine learning model, termed Multiple Domain Integrative (MDI) model, was developed to predict defibrillation success. We explore the rationale for non-linear dynamics and statistically validate heuristics involved in feature extraction for model development. Performance of MDI is then compared to the amplitude spectrum area (AMSA) technique. Results 358 defibrillations were evaluated (218 unsuccessful and 140 successful). Non-linear properties (Lyapunov exponent > 0) of the ECG signals indicate a chaotic nature and validate the use of novel non-linear dynamic methods for feature extraction. Classification using MDI yielded ROC-AUC of 83.2% and accuracy of 78.8%, for the model built with ECG data only. Utilizing 10-fold cross-validation, at 80% specificity level, MDI (74% sensitivity) outperformed AMSA (53.6% sensitivity). At 90% specificity level, MDI had 68.4% sensitivity while AMSA had 43.3% sensitivity. Integrating available end-tidal carbon dioxide features into MDI, for the available 48 defibrillations, boosted ROC-AUC to 93.8% and accuracy to 83.3% at 80% sensitivity. Conclusion At clinically relevant sensitivity thresholds, the MDI provides improved performance as compared to AMSA

  18. A Study to Improve Communication Between Clinicians and Patients With Advanced Heart Failure: Methods and Challenges Behind the Working to Improve diScussions about DefibrillatOr Management (WISDOM) Trial

    PubMed Central

    Goldstein, Nathan E.; Kalman, Jill; Kutner, Jean S.; Fromme, Erik K.; Hutchinson, Mathew D.; Lipman, Hannah I.; Matlock, Daniel D.; Swetz, Keith M.; Lampert, Rachel; Herasme, Omarys; Morrison, R. Sean

    2014-01-01

    We report the challenges of the Working to Improve diScussions about DefibrillatOr Management (WISDOM) Trial, our novel, multicenter trial aimed at improving communication between cardiology clinicians and their patients with advanced heart failure (HF) who have implantable cardioverter defibrillators (ICDs). The study objectives are to: 1) increase ICD deactivation conversations; 2) increase the number of ICDs deactivated; and 3) improve psychological outcomes in bereaved caregivers. The unit of randomization is the hospital, the intervention is aimed at HF clinicians, and the patient and caregiver are the units of analysis. Three hospitals were randomized to usual care and three to intervention. The intervention consists of an interactive educational session, clinician reminders, and individualized feedback. We enroll patients with advanced HF and their caregivers, and then we regularly survey them to evaluate whether the intervention has improved communication between them and their heart failure providers. We encountered three implementation barriers. First, there were Institutional Review Board (IRB) concerns at two sites because of the palliative nature of the study. Second, we had difficulty in creating entry criteria that accurately identified a HF population at high risk of dying. Third, we had to adapt our entry criteria to the changing landscape of ventricular assist devices and cardiac transplant eligibility. Here we present our novel solutions to the difficulties we encountered. Our work has the ability to enhance conduct of future studies focusing on improving care for patients with advanced illness. PMID:24768595

  19. Tachyarrhythmia Cycle Length in Appropriate versus Inappropriate Defibrillator Shocks in Brugada Syndrome, Early Repolarization Syndrome, or Idiopathic Ventricular Fibrillation

    PubMed Central

    Lee, Woo Seok; Kwon, Chang-Hee; Choi, Jin Hee; Jo, Uk; Kim, Yoo Ri; Nam, Gi-Byoung; Choi, Kee-Joon; Kim, You-Ho

    2016-01-01

    Background and Objectives Implantable cardioverter–defibrillators (ICDs) are indicated in patients with Brugada syndrome (BS), early repolarization syndrome (ERS), or idiopathic ventricular fibrillation (IVF) who are at high risk for sudden cardiac death. The optimal ICD programming for reducing inappropriate shocks in these patients remains to be determined. We investigated the difference in the mean cycle length of tachyarrhythmias that activated either appropriate or inappropriate ICD shocks in these three patient groups to determine the optimal ventricular fibrillation (VF) zone for minimizing inappropriate ICD shocks. Subjects and Methods We selected 41 patients (35 men) (mean age±standard deviation=42.6±13.0 year) who received ICD shocks between April 1996 and April 2014 to treat BS (n=24), ERS (n=9), or IVF (n=8). Clinical and ICD interrogation data were retrospectively collected and analyzed for all events with ICD shocks. Results Of the 244 episodes, 180 (73.8%) shocks were appropriate and 64 (26.2%) were inappropriate. The mean cycle lengths of the tachyarrhythmias that activated appropriate and inappropriate shocks were 178.9±28.7 ms and 284.8±24.4 ms, respectively (p<0.001). The cutoff value with the highest sensitivity and specificity for discriminating between appropriate and inappropriate shocks was 235 ms (sensitivity, 98.4%; specificity, 95.6%). When we programmed a single VF zone of ≤270 ms, inappropriate ICD shocks were reduced by 70.5% and appropriate shocks were missed in 1.7% of these patients. Conclusion Programming of a single VF zone of ≤270 ms in patients with BS, ERS, or IVF could reduce inappropriate ICD shocks, with a low risk of missing appropriate shocks. PMID:27014348

  20. The use of wearable cardioverter-defibrillators in Europe: results of the European Heart Rhythm Association survey.

    PubMed

    Lenarczyk, Radosław; Potpara, Tatjana S; Haugaa, Kristina H; Hernández-Madrid, Antonio; Sciaraffia, Elena; Dagres, Nikolaos

    2016-01-01

    The aim of this European Heart Rhythm Association (EHRA) survey was to collect data on the use of wearable cardioverter-defibrillators (WCDs) among members of the EHRA electrophysiology research network. Of the 50 responding centres, 23 (47%) reported WCD use. Devices were fully reimbursed in 17 (43.6%) of 39 respondents, and partially reimbursed in 3 centres (7.7%). Eleven out of 20 centres (55%) reported acceptable patients' compliance (WCD worn for >90% of time). The most common indications for WCD (8 out of 10 centres; 80%) were covering the period until re-implantation of ICD explanted due to infection, in patients with left ventricular impairment due to myocarditis or recent myocardial infarction and those awaiting heart transplantation. Patient life expectancy of <12 months and poor compliance were the most commonly reported contraindications for WCD (24 of 46 centres, 52.2%). The major problems encountered by physicians managing patients with WCD were costs (8 of 18 centres, 44.4%), non-compliance, and incorrect use of WCD. Four of 17 centres (23.5%) reported inappropriate WCD activations in <5% of patients. The first shock success rate in terminating ventricular arrhythmias was 95-100% in 6 of 15 centres (40%), 85-95% in 4 (26.7%), 75-85% in 2 (13.3%), and <75% in 3 centres (20%). The survey has shown that the use of WCD in Europe is still restricted and depends on reimbursement. Patients' compliance remains low. Heterogeneity of indications for WCD among centres underscores the need for further research and a better definition of indications for WCD in specific patient groups. PMID:26842735

  1. Defibrillation time intervals and outcomes of cardiac arrest in hospital: retrospective cohort study from Get With The Guidelines-Resuscitation registry

    PubMed Central

    Liu, Wenhui; Chan, Paul S; Nallamothu, Brahmajee K; Grunwald, Gary K; Self, Alyssa; Sasson, Comilla; Varosy, Paul D; Anderson, Monique L; Schneider, Preston M; Ho, P Michael

    2016-01-01

    Objective To describe temporal trends in the time interval between first and second attempts at defibrillation and the association between this time interval and outcomes in patients with persistent ventricular tachycardia or ventricular fibrillation (VT/VF) arrest in hospital. Design Retrospective cohort study Setting 172 hospitals in the United States participating in the Get With The Guidelines-Resuscitation registry, 2004-12. Participants Adults who received a second defibrillation attempt for persistent VT/VF arrest within three minutes of a first attempt. Interventions Second defibrillation attempts categorized as early (time interval of up to and including one minute between first and second defibrillation attempts) or deferred (time interval of more than one minute between first and second defibrillation attempts). Main outcome measure Survival to hospital discharge. Results Among 2733 patients with persistent VT/VF after the first defibrillation attempt, 1121 (41%) received a deferred second attempt. Deferred second defibrillation for persistent VT/VF increased from 26% in 2004 to 57% in 2012 (P<0.001 for trend). Compared with early second defibrillation, unadjusted patient outcomes were significantly worse with deferred second defibrillation (57.4% v 62.5% for return of spontaneous circulation, 38.4% v 43.6% for survival to 24 hours, and 24.7% v 30.8% for survival to hospital discharge; P<0.01 for all comparisons). After risk adjustment, deferred second defibrillation was not associated with survival to hospital discharge (propensity weighting adjusted risk ratio 0.89, 95% confidence interval 0.78 to 1.01; P=0.08; hierarchical regression adjusted 0.92, 0.83 to 1.02; P=0.1). Conclusions Since 2004, the use of deferred second defibrillation for persistent VT/VF in hospital has doubled. Deferred second defibrillation was not associated with improved survival. PMID:27052620

  2. Are patients with cardiac implants protected against electromagnetic interference in daily life and occupational environment?

    PubMed

    Napp, Andreas; Stunder, Dominik; Maytin, Melanie; Kraus, Thomas; Marx, Nikolaus; Driessen, Sarah

    2015-07-21

    Utilization of cardiac implants such as pacemakers and implantable cardioverter defibrillators is now commonplace among heart disease patients. The ever-increasing technological complexity of these devices is matched by the near omnipresent exposure to electric, magnetic, and electromagnetic fields (EMFs), both in everyday life and the occupational environment. Given that electromagnetic interferences (EMIs) are associated with potential risk in device patients, physicians are increasingly confronted with managing device patients with intermittent EMI and chronic occupational exposure. The current review aims to provide a contemporary overview of cardiovascular implantable electronic devices, their function and susceptibility of non-medical EMFs and provide recommendations for physicians caring for cardiac device patients presenting with EMI. PMID:25908772

  3. Cochlear Implants

    MedlinePlus

    ... outside of the body, behind the ear. A second part is surgically placed under the skin. An implant does not restore normal hearing. It can help a person understand speech. Children and adults can benefit from them. National Institute on Deafness and Other Communication Disorders

  4. Cochlear implant

    MedlinePlus

    ... are sent along the auditory nerve to the brain. A deaf person does not have a functioning inner ear. A cochlear implant tries to replace the function of the inner ear by ... signals to the brain. Sound is picked up by a microphone worn ...

  5. Comparison of mechanism of break up and cycle length in defibrillation success

    NASA Astrophysics Data System (ADS)

    Melkus, Natalya; Puwal, Steffan

    2012-10-01

    Heart fibrillation is an often fatal condition which can be modeled by chaotic electrical activity; spiral waves of electrical activity rotate, break-up, and meander on tissue. As they do, they produce a chaotic distribution of electrical activity, negatively affecting physical contraction (blood pumping). Fenton, et al. studied several mechanisms of this wave breakup, including ``far from tip'' and ``Doppler shift.'' We used Fenton et al.'s mathematical model and the different modes of breakup proposed by Fenton to simulate fibrillation and to determine if the cycle length of the activity or the type of mechanism was more significant in defibrillation. Our data supports the conclusion that the cycle length is the more important factor in defibrillation.

  6. Effective date of requirement for premarket approval for automated external defibrillator systems. Final rule.

    PubMed

    2015-01-29

    The Food and Drug Administration (FDA or the Agency) is issuing a final order to require the filing of premarket approval applications (PMA) for automated external defibrillator (AED) systems, which consist of an AED and those AED accessories necessary for the AED to detect and interpret an electrocardiogram and deliver an electrical shock (e.g., pad electrodes, batteries, adapters, and hardware keys for pediatric use). PMID:25730922

  7. Implantation of Total Artificial Heart in Congenital Heart Disease

    PubMed Central

    Adachi, Iki; Morales, David S. L.

    2014-01-01

    In patients with end-stage heart failure (HF), a total artificial heart (TAH) may be implanted as a bridge to cardiac transplant. However, in congenital heart disease (CHD), the malformed heart presents a challenge to TAH implantation. In the case presented here, a 17 year-old patient with congenital transposition of the great arteries (CCTGA) experienced progressively worsening HF due to his congenital condition. He was hospitalized multiple times and received an implantable cardioverter defibrillator (ICD). However, his condition soon deteriorated to end-stage HF with multisystem organ failure. Due to the patient's grave clinical condition and the presence of complex cardiac lesions, the decision was made to proceed with a TAH. The abnormal arrangement of the patient's ventricles and great arteries required modifications to the TAH during implantation. With the TAH in place, the patient was able to return home and regain strength and physical well-being while awaiting a donor heart. He was successfully bridged to heart transplantation 5 months after receiving the device. This report highlights the TAH is feasible even in patients with structurally abnormal hearts, with technical modification. PMID:25078059

  8. [When do you implant a pacemaker in myotonic dystrophy?].

    PubMed

    Babuty, Dominique; Lallemand, Bénédicte; Laurent, Valérie; Clémenty, Nicolas; Pierre, Bertrand; Fauchier, Laurent; Raynaud, Martine; Pellieux, Sybille

    2011-01-01

    Myotonic dystrophy is the most frequent adult form of hereditary muscular dystrophy caused by a mutation on the DMPK gene. Myotonic dystrophy leads to multiple systemic complications related to weakness, respiratory failure, cardiac arrhythmias and cardiac conduction disturbances. Age of death is earlier in myotonic dystrophy patients than in general population with a high frequency of sudden death. Several mechanisms are involved in sudden death: atrio-ventricular block, severe ventricular arrhythmias or non-cardiac mechanism. The high degree of atrio-ventricular block is a well-recognized indication of pacemaker implantation but the prophylactic implantation of pacemaker should be considered to prevent sudden death in asymptomatic myotonic dystrophy patients. A careful clinical evaluation needs to be done for the identification of patients at high risk of sudden death. The resting ECG and SA ECG are non-invasive tools useful to select the patients who need an electrophysiologic study. In presence of prolonged HV interval more than or equal to 70 ms one can discuss the implantation of a prophylactic pacemaker. The choice of an implantable cardiac defibrillator is preferred in presence of spontaneous ventricular tachycardia or an alteration of the left ventricular ejection fraction. PMID:21549556

  9. Characterization of available automated external defibrillators in the market based on the product manuals in 2014

    PubMed Central

    Ho, Chik Leung; Cheng, Ka Wai; Ma, Tze Hang; Wong, Yau Hang; Cheng, Ka Lok; Kam, Chak Wah

    2016-01-01

    BACKGROUND: To popularize the wide-spread use of automated external defibrillator (AED) to save life in sudden cardiac arrest, we compared the strength and weakness of different types of AEDs to enable a sound selection based on regional requirement. METHODS: This was a retrospective descriptive study. Different types of AEDs were compared according to the information of AEDs from manuals and brochures provided by the manufacturers. Fifteen types of AEDs were divided into 3 groups, basic, intermediate and advanced. RESULTS: Lifeline™ AUTO AED had the best performance in price, portability and user-friendly among AEDs of basic level. It required less time for shock charging. Samaritan PAD defibrillator was superior in price, portability, durability and characteristic among AEDs of intermediate level. It had the longest warranty and highest protection against water and dust. Lifeline™ PRO AED had the best performance in most of the criteria among AEDs of advanced level and offered CPR video and manual mode for laypersons and clinicians respectively. CONCLUSION: Lifeline™ AUTO AED, Samaritan PAD defibrillator, Lifeline™ PRO AED are superior in AEDs of basic, intermediate and advanced levels, respectively. A feasible AED may be chosen by users according to the regional requirement and the current information about the best available products. PMID:27313810

  10. Hidden in Plain Sight: A Crowdsourced Public Art Contest to Make Automated External Defibrillators More Visible

    PubMed Central

    Griffis, Heather M.; Kilaru, Austin S.; Sellers, Allison M.; Hershey, John C.; Hill, Shawndra S.; Kramer-Golinkoff, Emily; Nadkarni, Lindsay; Debski, Margaret M.; Padrez, Kevin A.; Becker, Lance B.; Asch, David A.

    2014-01-01

    Objectives. We sought to explore the feasibility of using a crowdsourcing study to promote awareness about automated external defibrillators (AEDs) and their locations. Methods. The Defibrillator Design Challenge was an online initiative that asked the public to create educational designs that would enhance AED visibility, which took place over 8 weeks, from February 6, 2014, to April 6, 2014. Participants were encouraged to vote for AED designs and share designs on social media for points. Using a mixed-methods study design, we measured participant demographics and motivations, design characteristics, dissemination, and Web site engagement. Results. Over 8 weeks, there were 13 992 unique Web site visitors; 119 submitted designs and 2140 voted. The designs were shared 48 254 times on Facebook and Twitter. Most designers–voters reported that they participated to contribute to an important cause (44%) rather than to win money (0.8%). Design themes included: empowerment, location awareness, objects (e.g., wings, lightning, batteries, lifebuoys), and others. Conclusions. The Defibrillator Design Challenge engaged a broad audience to generate AED designs and foster awareness. This project provides a framework for using design and contest architecture to promote health messages. PMID:25320902

  11. Computer methods for automating preoperative dental implant planning: implant positioning and size assignment.

    PubMed

    Galanis, Christos C; Sfantsikopoulos, Michael M; Koidis, Petros T; Kafantaris, Nikolaos M; Mpikos, Pavlos G

    2007-04-01

    The paper presents computer-aided methods that allocate a dental implant and suggest its size, during the pre-operative planning stage, in conformance with introduced optimization criteria and established clinical requirements. Based on computed tomography data of the jaw and prosthesis anatomy, single tooth cases are planned for the best-suited implant insertion at a user-defined region. An optimum implantation axis line is produced and cylindrical implants of various candidate sizes are then automatically positioned, while their occlusal end is leveled to bone ridge, and evaluated. Radial safety margins are used for the assessment of the implant safety distance from neighboring anatomical structures and bone quantity and quality are estimated and taken into consideration. A case study demonstrates the concept and allows for its discussion. PMID:17267066

  12. del Nido versus St. Thomas Cardioplegia Solutions: A Single-Center Retrospective Analysis of Post Cross-Clamp Defibrillation Rates.

    PubMed

    Buel, Shane T; Striker, Carrie Whittaker; O'Brien, James E

    2016-06-01

    There are many cardioplegia solutions currently in use for pediatric cardiopulmonary bypass (CPB). The most common being del Nido solution. Another common cardioplegia solution used for pediatric CPB is St. Thomas. In October 2014, Children's Mercy Kansas City changed from the use of modified St. Thomas to del Nido. This study compared rates of post cross-clamp fibrillation requiring defibrillation between del Nido solution and modified St. Thomas solution stratified by weight at Children's Mercy Kansas City. This retrospective study consisted of 394 patients who underwent cardiac surgery requiring cardioplegia between January 1, 2014 and July 31, 2015. The outcome measured was defibrillation upon cross-clamp removal. Statistical significance was determined using Fishers exact test with a two-sided significance level of .05. Incidence of defibrillation post cross-clamp removal was 4.4% in the del Nido group and 26.8% in the St. Thomas group (p < .0001). Analysis by weight stratifications displays a reduction in post cross-clamp defibrillation rates in groups using the del Nido solution. The 0- to 6-kg category had an incidence of fibrillation of 1.23% in the del Nido group and 17.5% in the St. Thomas group (p < .0003). The 6- to 15-kg category had an incidence of defibrillation of 1.82% in the del Nido group and 14% in the St. Thomas group (p < .0198). The 15- to 60-kg category had an incidence of defibrillation of 8.9% in the del Nido group and 61% in the St. Thomas group (p < .0001). The >60-kg category had an incidence of defibrillation of 16.7% in the del Nido group and 63% in the St. Thomas group (p < .0623). This study demonstrates a 6-fold decrease in the overall rate of defibrillation post cross-clamp removal between St. Thomas and del Nido cardioplegia solutions. Analyses of weight stratifications demonstrate a decrease in the rate of defibrillation post cross-clamp removal in all categories within the del Nido group. PMID:27578896

  13. Thin-film rechargeable lithium batteries for implantable devices

    SciTech Connect

    Bates, J.b.; Dudney, N.J.

    1997-05-01

    Thin films of LiCoO{sub 2} have been synthesized in which the strongest x-ray reflection is either weak or missing, indicating a high degree of preferred orientation. Thin-film solid state batteries with these textured cathode films can deliver practical capacities at high current densities. For example, for one of the cells 70% of the maximum capacity between 4.2 V and 3 V ({approximately}0.2 mAh/cm{sup 2}) was delivered at a current of 2 mA/cm{sup 2}. When cycled at rates of 0.1 mA/cm{sup 2}, the capacity loss was 0.001 %/cycle or less. The reliability and performance of Li-LiCoO{sub 2} thin-film batteries make them attractive for application in implantable devices such as neural stimulators, pacemakers, and defibrillators.

  14. Thin-film Rechargeable Lithium Batteries for Implantable Devices

    DOE R&D Accomplishments Database

    Bates, J. B.; Dudney, N. J.

    1997-05-01

    Thin films of LiCoO{sub 2} have been synthesized in which the strongest x ray reflection is either weak or missing, indicating a high degree of preferred orientation. Thin film solid state batteries with these textured cathode films can deliver practical capacities at high current densities. For example, for one of the cells 70% of the maximum capacity between 4.2 V and 3 V ({approximately}0.2 mAh/cm{sup 2}) was delivered at a current of 2 mA/cm{sup 2}. When cycled at rates of 0.1 mA/cm{sup 2}, the capacity loss was 0.001%/cycle or less. The reliability and performance of Li LiCoO{sub 2} thin film batteries make them attractive for application in implantable devices such as neural stimulators, pacemakers, and defibrillators.

  15. Malfunctions of Implantable Cardiac Devices in Patients Receiving Proton Beam Therapy: Incidence and Predictors

    SciTech Connect

    Gomez, Daniel R.; Poenisch, Falk; Pinnix, Chelsea C.; Sheu, Tommy; Chang, Joe Y.; Memon, Nada; Mohan, Radhe; Rozner, Marc A.; Dougherty, Anne H.

    2013-11-01

    Purpose: Photon therapy has been reported to induce resets of implanted cardiac devices, but the clinical sequelae of treating patients with such devices with proton beam therapy (PBT) are not well known. We reviewed the incidence of device malfunctions among patients undergoing PBT. Methods and Materials: From March 2009 through July 2012, 42 patients with implanted cardiac implantable electronic devices (CIED; 28 pacemakers and 14 cardioverter-defibrillators) underwent 42 courses of PBT for thoracic (23, 55%), prostate (15, 36%), liver (3, 7%), or base of skull (1, 2%) tumors at a single institution. The median prescribed dose was 74 Gy (relative biological effectiveness; range 46.8-87.5 Gy), and the median distance from the treatment field to the CIED was 10 cm (range 0.8-40 cm). Maximum proton and neutron doses were estimated for each treatment course. All CIEDs were checked before radiation delivery and monitored throughout treatment. Results: Median estimated peak proton and neutron doses to the CIED in all patients were 0.8 Gy (range 0.13-21 Gy) and 346 Sv (range 11-1100 mSv). Six CIED malfunctions occurred in 5 patients (2 pacemakers and 3 defibrillators). Five of these malfunctions were CIED resets, and 1 patient with a defibrillator (in a patient with a liver tumor) had an elective replacement indicator after therapy that was not influenced by radiation. The mean distance from the proton beam to the CIED among devices that reset was 7.0 cm (range 0.9-8 cm), and the mean maximum neutron dose was 655 mSv (range 330-1100 mSv). All resets occurred in patients receiving thoracic PBT and were corrected without clinical incident. The generator for the defibrillator with the elective replacement indicator message was replaced uneventfully after treatment. Conclusions: The incidence of CIED resets was about 20% among patients receiving PBT to the thorax. We recommend that PBT be avoided in pacing-dependent patients and that patients with any type of CIED receiving

  16. Implanted near-infrared spectroscopy for cardiac monitoring

    NASA Astrophysics Data System (ADS)

    Bhunia, Sourav K.; Cinbis, Can

    2011-02-01

    Implanted Cardioverter Defibrillator (ICD) provides one of the most effective therapies for the prevention of sudden cardiac death, but also delivers some high voltage shocks inappropriately, causing morbidity and mortality. Implanted near-infrared spectroscopy (NIRS) may augment ICD arrhythmia detection by monitoring skeletal muscle perfusion. A two-wavelength, single-distance, continuous-wave implanted NIRS has been evaluated in-vivo. A weighted difference of the changes in attenuation at two wavelengths, across the isobestic point of the hemoglobin spectra, was taken to be the microvascular oxygenation trend indicator (O2 Index). Although the exact weight depends on the local vascular distribution and their oxygen levels, the hypothesis that a constant weight may be adequate for hemodynamic trending during short arrhythmic episodes, was tested. The sensor was implanted subcutaneously both on fresh tissue and inside scar tissue that formed around a pre-existing implant, in 3 animals each. Attenuations were recorded at 660 and 890 nm during normal sinus rhythm (NSR) and induced ventricular fibrillation (VF). The slope of the O2 Index over 10 seconds was computed for 7 NSR and 8 VF episodes in fresh and 13 NSR and 15 VF episodes in scar tissue pockets. The mean O2 Index slope was significantly different (p<0.0001) between NSR and VF rhythms for both the fresh and scar tissue pockets. Therefore implanted NIRS may be useful for preventing inappropriate detection of VF during electromagnetic interference, double counting of ECG T-wave as an R-wave, ICD lead failure, electrocardiographic aberrancy etc.

  17. Critical appraisal of cardiac implantable electronic devices: complications and management

    PubMed Central

    Padeletti, Luigi; Mascioli, Giosuè; Perini, Alessandro Paoletti; Grifoni, Gino; Perrotta, Laura; Marchese, Procolo; Bontempi, Luca; Curnis, Antonio

    2011-01-01

    Population aging and broader indications for the implant of cardiac implantable electronic devices (CIEDs) are the main reasons for the continuous increase in the use of pacemakers (PMs), implantable cardioverter-defibrillators (ICDs) and devices for cardiac resynchronization therapy (CRT-P, CRT-D). The growing burden of comorbidities in CIED patients, the greater complexity of the devices, and the increased duration of procedures have led to an augmented risk of infections, which is out of proportion to the increase in implantation rate. CIED infections are an ominous condition, which often implies the necessity of hospitalization and carries an augmented risk of in-hospital death. Their clinical presentation may be either at pocket or at endocardial level, but they can also manifest themselves with lone bacteremia. The management of these infections requires the complete removal of the device and subsequent, specific, antibiotic therapy. CIED failures are monitored by competent public authorities, that require physicians to alert them to any failures, and that suggest the opportune strategies for their management. Although the replacement of all potentially affected devices is often suggested, common practice indicates the replacement of only a minority of devices, as close follow-up of the patients involved may be a safer strategy. Implantation of a PM or an ICD may cause problems in the patients’ psychosocial adaptation and quality of life, and may contribute to the development of affective disorders. Clinicians are usually unaware of the psychosocial impact of implanted PMs and ICDs. The main difference between PM and ICD patients is the latter’s dramatic experience of receiving a shock. Technological improvements and new clinical evidences may help reduce the total burden of shocks. A specific supporting team, providing psychosocial help, may contribute to improving patient quality of life. PMID:22915942

  18. Activation during ventricular defibrillation in open-chest dogs. Evidence of complete cessation and regeneration of ventricular fibrillation after unsuccessful shocks.

    PubMed Central

    Chen, P S; Shibata, N; Dixon, E G; Wolf, P D; Danieley, N D; Sweeney, M B; Smith, W M; Ideker, R E

    1986-01-01

    To test the hypothesis that a defibrillation shock is unsuccessful because it fails to annihilate activation fronts within a critical mass of myocardium, we recorded epicardial and transmural activation in 11 open-chest dogs during electrically induced ventricular fibrillation (VF). Shocks of 1-30 J were delivered through defibrillation electrodes on the left ventricular apex and right atrium. Simultaneous recordings were made from septal, intramural, and epicardial electrodes in various combinations. Immediately after all 104 unsuccessful and 116 successful defibrillation shocks, an isoelectric interval much longer than that observed during preshock VF occurred. During this time no epicardial, septal, or intramural activations were observed. This isoelectric window averaged 64 +/- 22 ms after unsuccessful defibrillation and 339 +/- 292 ms after successful defibrillation (P less than 0.02). After the isoelectric window of unsuccessful shocks, earliest activation was recorded from the base of the ventricles, which was the area farthest from the apical defibrillation electrode. Activation was synchronized for one or two cycles following unsuccessful shocks, after which VF regenerated. Thus, after both successful and unsuccessful defibrillation with epicardial shocks of greater than or equal to 1 J, an isoelectric window occurs during which no activation fronts are present; the postshock isoelectric window is shorter for unsuccessful than for successful defibrillation; unsuccessful shocks transiently synchronize activation before fibrillation regenerates; activation leading to the regeneration of VF after the isoelectric window for unsuccessful shocks originates in areas away from the defibrillation electrodes. The isoelectric window does not support the hypothesis that defibrillation fails solely because activation fronts are not halted within a critical mass of myocardium. Rather, unsuccessful epicardial shocks of greater than or equal to 1 J halt all activation

  19. Automatic patient respiration failure detection system with wireless transmission

    NASA Technical Reports Server (NTRS)

    Dimeff, J.; Pope, J. M.

    1968-01-01

    Automatic respiration failure detection system detects respiration failure in patients with a surgically implanted tracheostomy tube, and actuates an audible and/or visual alarm. The system incorporates a miniature radio transmitter so that the patient is unencumbered by wires yet can be monitored from a remote location.

  20. Electromagnetic interference of implantable cardiac devices from a shoulder massage machine.

    PubMed

    Yoshida, Saeko; Fujiwara, Kousaku; Kohira, Satoshi; Hirose, Minoru

    2014-09-01

    Shoulder massage machines have two pads that are driven by solenoid coils to perform a per cussive massage on the shoulders. There have been concerns that such machines might create electromagnetic interference (EMI) in implantable cardiac devices because of the time-varying magnetic fields produced by the alternating current in the solenoid coils. The objective of this study was to investigate the potential EMI from one such shoulder massage machine on implantable cardiac devices. We measured the distribution profile of the magnetic field intensity around the massage machine. Furthermore, we performed an inhibition test and an asynchronous test on an implantable cardiac pacemaker using the standardized Irnich human body model. We examined the events on an implantable cardioverter-defibrillator (ICD) using a pacemaker programmer while the massage machine was in operation. The magnetic field distribution profile exhibited a peak intensity of 212 (A/m) in one of the solenoid coils. The maximal interference distance between the massage machine and the implantable cardiac pacemaker was 28 cm. Ventricular fibrillation was induced when the massage machine was brought near the electrode of the ICD and touched the Irnich human body model. It is necessary to provide a "don't use" warning on the box or the exterior of the massage machines or in the user manuals and to caution patients with implanted pacemakers about the dangers and appropriate usage of massage machines. PMID:24710851

  1. DEGRO/DGK guideline for radiotherapy in patients with cardiac implantable electronic devices.

    PubMed

    Gauter-Fleckenstein, Benjamin; Israel, Carsten W; Dorenkamp, Marc; Dunst, Jürgen; Roser, Mattias; Schimpf, Rainer; Steil, Volker; Schäfer, Jörg; Höller, Ulrike; Wenz, Frederik

    2015-05-01

    An increasing number of patients undergoing radiotherapy (RT) have cardiac implantable electronic devices [CIEDs, cardiac pacemakers (PMs) and implanted cardioverters/defibrillators (ICDs)]. Ionizing radiation can cause latent and permanent damage to CIEDs, which may result in loss of function in patients with asystole or ventricular fibrillation. Reviewing the current literature, the interdisciplinary German guideline (DEGRO/DGK) was developed reflecting patient risk according to type of CIED, cardiac condition, and estimated radiation dose to the CIED. Planning for RT should consider the CIED specifications as well as patient-related characteristics (pacing-dependent, previous ventricular tachycardia/fibrillation). Antitachyarrhythmia therapy should be suspended in patients with ICDs, who should be under electrocardiographic monitoring with an external defibrillator on stand-by. The beam energy should be limited to 6 (to 10) MV CIEDs should never be located in the beam, and the cumulative scatter radiation dose should be limited to 2 Gy. Personnel must be able to respond adequately in the case of a cardiac emergency and initiate basic life support, while an emergency team capable of advanced life support should be available within 5 min. CIEDs need to be interrogated 1, 3, and 6 months after the last RT due to the risk of latent damage. PMID:25739476

  2. The evolution of the cardiac implantable electronic device connector.

    PubMed

    Mond, Harry G; Helland, John R; Fischer, Avi

    2013-11-01

    Cardiac implantable electronic devices (CIEDs) play a vital role in the management of cardiac rhythm disturbances. The devices are comprised of two primary components: a generator and lead joined by a connector. Original pacemaker lead connectors were created de novo at the time of implantation or replacement and were very unreliable. With the development of new lead designs, creation of a standard connector configuration, the IS-1 connector became mandatory. Similar connector development also occurred with the advent of the implantable cardioverter defibrillator (ICD), resulting in creation of the high voltage standard: the DF-1 connector. Differing from a pacemaker lead, the ICD lead connector requires one IS-1 connector and one or two DF-1 connectors, resulting in a large cumbersome lead connector and generator header block. Recently, a revolutionary quad pole single plug connector standard has been approved for market release. These are the single-pin DF4 and IS4 lead connectors that carry low- and high-voltage poles or all low-voltage poles, respectively. These connectors, together with new labeling guidelines, have simplified operative procedures and reduced errors, when mating lead connectors into the generator's connector block. PMID:23808816

  3. Successful Treatment of Refractory Electrical Storm With Landiolol After More Than 100 Electrical Defibrillations.

    PubMed

    Kanamori, Kenta; Aoyagi, Takashi; Mikamo, Takashi; Tsutsui, Kenta; Kunishima, Tomoyuki; Inaba, Hideko; Hayami, Noriyuki; Murakawa, Yuji

    2015-01-01

    Electrical storm (ES) was observed in an 82-year-old man with recent myocardial infarction. Conventional therapy, including amiodarone, could not suppress the ES. After more than 100 electrical defibrillations, we were finally able to control the ES with the administration of landiolol. It is known that landiolol can inhibit ES. However, we hesitate to use landiolol in patients with low cardiac output. We would like to emphasize that careful use of landiolol should be considered in patients with refractory ES after myocardial infarction, although cardiac output is severely reduced. PMID:26346519

  4. An anatomy of automatism.

    PubMed

    Mackay, R D

    2015-07-01

    The automatism defence has been described as a quagmire of law and as presenting an intractable problem. Why is this so? This paper will analyse and explore the current legal position on automatism. In so doing, it will identify the problems which the case law has created, including the distinction between sane and insane automatism and the status of the 'external factor doctrine', and comment briefly on recent reform proposals. PMID:26378105

  5. Automatic crack propagation tracking

    NASA Technical Reports Server (NTRS)

    Shephard, M. S.; Weidner, T. J.; Yehia, N. A. B.; Burd, G. S.

    1985-01-01

    A finite element based approach to fully automatic crack propagation tracking is presented. The procedure presented combines fully automatic mesh generation with linear fracture mechanics techniques in a geometrically based finite element code capable of automatically tracking cracks in two-dimensional domains. The automatic mesh generator employs the modified-quadtree technique. Crack propagation increment and direction are predicted using a modified maximum dilatational strain energy density criterion employing the numerical results obtained by meshes of quadratic displacement and singular crack tip finite elements. Example problems are included to demonstrate the procedure.

  6. Automatic differentiation bibliography

    SciTech Connect

    Corliss, G.F.

    1992-07-01

    This is a bibliography of work related to automatic differentiation. Automatic differentiation is a technique for the fast, accurate propagation of derivative values using the chain rule. It is neither symbolic nor numeric. Automatic differentiation is a fundamental tool for scientific computation, with applications in optimization, nonlinear equations, nonlinear least squares approximation, stiff ordinary differential equation, partial differential equations, continuation methods, and sensitivity analysis. This report is an updated version of the bibliography which originally appeared in Automatic Differentiation of Algorithms: Theory, Implementation, and Application.

  7. Health Care Utilization and Expenditures Associated With Remote Monitoring in Patients With Implantable Cardiac Devices.

    PubMed

    Ladapo, Joseph A; Turakhia, Mintu P; Ryan, Michael P; Mollenkopf, Sarah A; Reynolds, Matthew R

    2016-05-01

    Several randomized trials and decision analysis models have found that remote monitoring may reduce health care utilization and expenditures in patients with cardiac implantable electronic devices (CIEDs), compared with in-office monitoring. However, little is known about the generalizability of these findings to unselected populations in clinical practice. To compare health care utilization and expenditures associated with remote monitoring and in-office monitoring in patients with CIEDs, we used Truven Health MarketScan Commercial Claims and Medicare Supplemental Databases. We selected patients newly implanted with an implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy defibrillator (CRT-D), or permanent pacemaker (PPM), in 2009, who had continuous health plan enrollment 2 years after implantation. Generalized linear models and propensity score matching were used to adjust for confounders and estimate differences in health care utilization and expenditures in patients with remote or in-office monitoring. We identified 1,127; 427; and 1,295 pairs of patients with a similar propensity for receiving an ICD, CRT-D, or PPM, respectively. Remotely monitored patients with ICDs experienced fewer emergency department visits resulting in discharge (p = 0.050). Remote monitoring was associated with lower health care expenditures in office visits among patients with PPMs (p = 0.025) and CRT-Ds (p = 0.006) and lower total inpatient and outpatient expenditures in patients with ICDs (p <0.0001). In conclusion, remote monitoring of patients with CIEDs may be associated with reductions in health care utilization and expenditures compared with exclusive in-office care. PMID:26996767

  8. Wireless microsensor network solutions for neurological implantable devices

    NASA Astrophysics Data System (ADS)

    Abraham, Jose K.; Whitchurch, Ashwin; Varadan, Vijay K.

    2005-05-01

    trigger the feed back system or contact a point-of-care office that can remotely control the implantable system. The remote monitoring technology can be adaptable to EEG monitoring of children with epilepsy, implantable cardioverters/defibrillators, pacemakers, chronic pain management systems, treatment for sleep disorders, patients with implantable devices for diabetes. In addition, the development of a wireless neural electronics interface to detect, transmit and analyze neural signals could help patients with spinal injuries to regain some semblance of mobile activity.

  9. Electromagnetic interference from lasers and intense light sources in the treatment of patients with artificial pacemakers and other implantable cardiac devices.

    PubMed

    Lister, Tom; Grant, Lindsay; Lee, Siu-Man; Cole, Richard P; Jones, Anthony; Taylor, Timothy; Mayo, Angela; Wright, Philip A

    2015-07-01

    Measurements of the electric and magnetic field strengths surrounding six laser systems and one intense pulsed light system were carried out. The results were compared to exposure limits published by cardiac device manufacturers to assess the risk of electromagnetic interference to implantable cardiac devices such as pacemakers or implantable cardioverter defibrillators. The majority of lasers assessed in this study were found to produce electric and magnetic field strengths below the published exposure limits for cardiac devices. However, the low-frequency electric field and static magnetic field of both the CO2 laser and the ruby laser were found to exceed these limits. Ensuring that a small separation is maintained at all times between the laser unit and any patient with a pacemaker or implantable cardioverter defibrillator appears to be a sensible expedient in avoiding overexposure of an implantable cardiac device to electromagnetic interference. Due to the single-shot fast discharge nature of the intense pulsed light system, changes in electromagnetic field strength were too fast for some of the measuring equipment used in this study to register accurate readings during operation. PMID:24162308

  10. Retrograde peri-implantitis.

    PubMed

    Mohamed, Jumshad B; Shivakumar, B; Sudarsan, Sabitha; Arun, K V; Kumar, T S S

    2010-01-01

    Retrograde peri-implantitis constitutes an important cause for implant failure. Retrograde peri-implantitis may sometimes prove difficult to identify and hence institution of early treatment may not be possible. This paper presents a report of four cases of (the implant placed developing to) retrograde peri-implantitis. Three of these implants were successfully restored to their fully functional state while one was lost due to extensive damage. The paper highlights the importance of recognizing the etiopathogenic mechanisms, preoperative assessment, and a strong postoperative maintenance protocol to avoid retrograde peri-implant inflammation. PMID:20922082

  11. Automatic Mode Switch (AMS) Causes Less Synchronization

    PubMed Central

    Jorat, Mohammadvahid; Nikoo, Mohammadhossein

    2016-01-01

    Introduction: Cardiac resynchronization devices are part of modern heart failure management. After implantation, we analyze and program devices in an attempt to ensure their success. Biventricular pacing should be 98% or more for the lowest mortality and best symptom improvement. Case Presentation: In this case series, we present a combination of far field sensing and automatic mode switching (AMS) in six patients. It is found that this combination causes ventricular sensing (VS) episodes with wide QRS and no synchronization. We turn off the AMS and alleviate the problem. Conclusions: Switching AMS off may increase biventricular pacing in some patients. PMID:26949695

  12. Defibrillation efficacy of different electrode placements in a human thorax model.

    PubMed

    de Jongh, A L; Entcheva, E G; Replogle, J A; Booker, R S; Kenknight, B H; Claydon, F J

    1999-01-01

    The objective of this study was to measure the defibrillation threshold (DFT) associated with different electrode placements using a three-dimensional anatomically realistic finite element model of the human thorax. Coil electrodes (Endotak DSP, model 125, Guidant/CPI) were placed in the RV apex along the lateral wall (RV), withdrawn 10 mm away from the RV apex along the lateral wall (RVprox), in the RV apex along the anterior septum (RVseptal), and in the SVC. An active pulse generator (can) was placed in the subcutaneous prepectoral space. Five electrode configurations were studied: RV-->SVC, RVprox-->SVC, RVSEPTAL-->SVC, RV-->Can, and RV-->SVC + Can. DFTs are defined as the energy required to produce a potential gradient of at least 5 V/cm in 95% of the ventricular myocardium. DFTs for RV-->SVC, RVprox-->SVC, RVseptal-->SVC, RV-->Can, and RV-->SVC + Can were 10, 16, 7, 9, and 6 J, respectively. The DFTs measured at each configuration fell within one standard deviation of the mean DFTs reported in clinical studies using the Endotak leads. The relative changes in DFT among electrode configurations also compared favorably. This computer model allows measurements of DFT or other defibrillation parameters with several different electrode configurations saving time and cost of clinical studies. PMID:9990621

  13. Walnut extract inhibits the fibrillization of amyloid beta-protein, and also defibrillizes its preformed fibrils.

    PubMed

    Chauhan, Neha; Wang, K C; Wegiel, Jerzy; Malik, Mazhar N

    2004-08-01

    Fibrillar amyloid beta-protein (Abeta) is the principal component of amyloid plaques in the brains of patients with Alzheimer's disease. We have studied the effect of walnut extract on Abeta fibrillization by Thioflavin T fluorescence spectroscopy and electron microscopy. The walnut extract not only inhibited Abeta fibril formation in a concentration and time- dependent manner but it was also able to defibrillize Abeta preformed fibrils. Over 90% inhibition of Abeta fibrillization was observed with 5 microl of methanolic extract of walnut (MEOW) both after 2 and 3 days of incubation. The maximum defibrillization (91.6%) was observed when preformed Abeta fibrils were incubated with 10 microl of MEOW for 2 days. These results suggest that walnuts may reduce the risk or delay the onset of Alzheimer's disease by maintaining Abeta in the soluble form. Further studies showed that anti-amyloidogenic compound in walnut is an organic compound of molecular weight less than 10 kDa, which is neither a lipid nor a protein. Chloroform extract of walnut had no effect on Abeta fibrillization while MEOW and its 10 kDa filtrate inhibited Abeta fibrillization equally. It is proposed that polyphenolic compounds (such as flavonoids) present in walnuts may be responsible for its anti-amyloidogenic activity. PMID:15975066

  14. A Comparison of the Effect of Square and Circular Electrodes During Defibrillation

    NASA Astrophysics Data System (ADS)

    Langrill Beaudoin, Deborah M.; Roth, Bradley J.

    2004-10-01

    The mechanism by which defibrillation-strength electric fields affect the heart has been studied extensively. Widely cited experiments designed to look at this effect incorporated plunge electrodes, made up of insulated, 21-gauge needles, to record the transmural, extracellular potential. In a previous paper (Langrill and Roth, IEEE Trans. Biomed. Eng. 48:1207-1211, 2001), we looked at the effect of a single circular plunge electrode in a passive, two-dimensional model of cardiac tissue under the influence of a defibrillation-strength electric field. In a more recent paper, we looked at 9 square plunge electrodes. It is our hypothesis that the shape of the electrode does not make a significant difference in the response of the tissue to the electric field. We perform the same simulations as in the circular plunge electrode paper and compare the two sets of data. We find that although there are some quantitative differences between the two shapes, the overall response is nearly identical.

  15. Hospital-wide first-responder automated external defibrillator programme: 1 year experience.

    PubMed

    Hanefeld, Christoph; Lichte, Carolin; Mentges-Schröter, Ina; Sirtl, Clemens; Mügge, Andreas

    2005-08-01

    The first year experience with a hospital-wide first-responder automated external defibrillator (AED) programme implemented in a 683-bed University Hospital is reported. Throughout the hospital, 14 "AED access spots" were identified which could be easily reached from all wards and diagnostic rooms within 30s. AEDs were installed (Lifepak 500; Medtronik PhysioControl Corp., Redmond, USA, equipped with a Biolog 3000i portable ECG monitor; Micromedical Industries Ltd., Labrador, Australia). Within 3 months, 120 medical officers, 750 nurses, and 50 administrative or technical staff underwent a 2h training programme. An AED was applied and activated by nurses/medical staff before the cardiac arrest team arrived in 27 of 33 cases (81.8%) of witnessed cardiac arrest. The median time from onset of the emergency call to the activation of the AED (record of ECG) was on average 2.1 min (range 1.0--4.5 min). In 18 of 27 cases in which the AED was installed promptly, the primary arrest rhythm was either VT or VF, and the AED delivered a shock. For this subgroup, the rate of return of spontaneous circulation and the rate of discharge at home were 88.9 and 55.6%, respectively. This encourages us to extend the concept of first-responder AED-defibrillation throughout our hospital. PMID:16053941

  16. Digital automatic gain control

    NASA Technical Reports Server (NTRS)

    Uzdy, Z.

    1980-01-01

    Performance analysis, used to evaluated fitness of several circuits to digital automatic gain control (AGC), indicates that digital integrator employing coherent amplitude detector (CAD) is best device suited for application. Circuit reduces gain error to half that of conventional analog AGC while making it possible to automatically modify response of receiver to match incoming signal conditions.

  17. Automatic Differentiation Package

    Energy Science and Technology Software Center (ESTSC)

    2007-03-01

    Sacado is an automatic differentiation package for C++ codes using operator overloading and C++ templating. Sacado provide forward, reverse, and Taylor polynomial automatic differentiation classes and utilities for incorporating these classes into C++ codes. Users can compute derivatives of computations arising in engineering and scientific applications, including nonlinear equation solving, time integration, sensitivity analysis, stability analysis, optimization and uncertainity quantification.

  18. Inappropriate Shock Delivered By Implantable Cardioverter Defibrillator - Cardiac Resynchronization Therapy (ICD-CRT) Due To Myopotential Oversensing

    PubMed Central

    Barakpour, Hamid; Emkanjoo, Zahra; Alizadeh, Abolfath; Sadr-Ameli, Mohammad Ali

    2009-01-01

    The clinical efficacy of ICD-CRT therapy depends on accurate sensing of intracardiac signals and sensing algorithms. We report the occurrence of sensing abnormality in a patient with ICD-CRT. In this patient, oversensing of myopotentials during strenuous muscular activity resulted in an inappropriate ICD-CRT discharge. Although modern ICDs are highly effective in detecting and terminating malignant tachyarrhythmias, their detection specificity must be improved. It is possible to find the mechanism of arrhythmia by EGM. Simple device reprogramming make it possible to avoid the oversensing of myopotentials. PMID:19165363

  19. Initial experience in the extraction of chronically implanted pacemaker leads using the Excimer laser sheath

    PubMed Central

    Levy, T; Walker, S; Paul, V

    1999-01-01

    OBJECTIVE—To assess the safety and efficiency of the Excimer laser sheath in extracting chronically implanted pacemaker leads.
PATIENTS—Eight patients were studied (one female, mean age 62 years, range 34 to 77) with 17 pacemaker leads (five atrial, 10 ventricular, two implantable defibrillator). The mean implantation time was 65 months (range 23 to 188). The indications for lead extraction were chronic infection (7), superior vena cava obstruction (4), lead malfunction (4), and pain (2).
METHODS—A prospective analysis of the use of the Excimer laser sheath in extracting chronically implanted pacemaker leads. Laser sheath extraction was undertaken if conventional extraction techniques with simple traction or traction with a locking stylet had failed. If laser sheath extraction was unsuccessful, basket retrieval of the lead from the groin was performed.
RESULTS—Complete lead removal was achieved in 16 leads (94%). In one case the electrode tip was left behind without complication. Extraction was achieved with the laser sheath alone in 16 leads. Basket retrieval was required in one case after laser failure. There were no complications.
CONCLUSIONS—The Excimer laser sheath appears to be an effective and safe technique for extracting chronically implanted pacemaker leads. It can be used in combination with the currently available techniques for successful lead extraction.


Keywords: Excimer laser sheath; lead extraction; pacing PMID:10377320

  20. Utilization of YouTube as a Tool to Assess Patient Perception Regarding Implanted Cardiac Devices

    PubMed Central

    Hayes, Kevin; Mainali, Prajeena; Deshmukh, Abhishek; Pant, Sadip; Badheka, Apurva O; Paydak, Hakan

    2014-01-01

    Background: The outreach of YouTube may have a dramatic role in the widespread dissemination of knowledge on implantable cardioverter devices (ICD). Aims: This study was designed to review and analyze the information available on YouTube pertaining to implantable cardiac devices such as implantable cardioverter defibrillators (ICDs) and pacemakers. Materials and Methods: YouTube was queried for the terms “ICD”, “Implantable Cardioverter Defibrillator”, and “Pacemaker”. The videos were reviewed and categorized as according to content; number of views and “likes” or “dislikes” was recorded by two separate observers. Results: Of the 55 videos reviewed, 18 of the videos were categorized as patient education, 12 were advertisements, 8 were intraoperative videos documenting the device implantation procedures, 7 of the videos were produced to document personal patient experiences, and 4 were categorized as documentation of a public event. 3 were intended to educate health care workers. The remaining 3 were intended to raise public awareness about sudden cardiac death. The videos portraying intraoperative procedures generated the most “likes” or “dislikes” per view. Conclusion: While YouTube provides a logical platform for delivery of health information, the information on this platform is not regulated. Initiative by reputed authorities and posting accurate information in such platform can be a great aid in public education regarding device therapy. PMID:25077075

  1. Safety of anticoagulation with uninterrupted warfarin vs. interrupted dabigatran in patients requiring an implantable cardiac device

    PubMed Central

    Madan, Shivanshu; Muthusamy, Purushothaman; Mowers, Katie L.; Elmouchi, Darryl A.; Finta, Bohuslav; Gauri, Andre J.; Woelfel, Alan K.; Fritz, Timothy D.; Davis, Alan T.

    2016-01-01

    Background The optimal strategy of peri-procedural anticoagulation in patients undergoing permanent cardiac device implantation is controversial. Our objective was to compare the major bleeding and thromboembolic complications in patients managed with uninterrupted warfarin (UW) vs. interrupted dabigatran (ID) during permanent pacemaker (PPM) or implantable cardioverter defibrillators (ICD) implantation. Methods A retrospective cohort study of all eligible patients from July 2011 through January 2012 was performed. UW was defined as patients who had maintained a therapeutic international normalized ratio (INR) on the day of the procedure. ID was defined as stopping dabigatran ≥12 hours prior to the procedure and then resuming after implantation. Major bleeding events included hemothorax, hemopericardium, intracranial hemorrhage, gastrointestinal bleed, epistaxis, or pocket hematoma requiring surgical intervention. Thromboembolic complications included stroke, transient ischemic attack, deep venous thrombosis, pulmonary embolism, or arterial embolism. Results Of the 133 patients (73.4±11.0 years; 91 males) in the study, 86 received UW and 47 received ID. One (1.2%) patient in the UW group sustained hemopericardium perioperatively and died. In comparison, the ID patients had no complications. As compared to the ID group, the UW group had a higher median CHADS2 score (2 vs. 3, P=0.04) and incidence of Grade 1 pocket hematoma (0% vs. 7%, P=0.09). Neither group developed any thromboembolic complications. Conclusions Major bleeding rates were similar among UW and ID groups. Perioperative ID appears to be a safe anticoagulation strategy for patients undergoing PPM or ICD implantation. PMID:26885486

  2. Computer-aided recognition of dental implants in X-ray images

    NASA Astrophysics Data System (ADS)

    Morais, Pedro; Queirós, Sandro; Moreira, António H. J.; Ferreira, Adriano; Ferreira, Ernesto; Duque, Duarte; Rodrigues, Nuno F.; Vilaça, João. L.

    2015-03-01

    Dental implant recognition in patients without available records is a time-consuming and not straightforward task. The traditional method is a complete user-dependent process, where the expert compares a 2D X-ray image of the dental implant with a generic database. Due to the high number of implants available and the similarity between them, automatic/semi-automatic frameworks to aide implant model detection are essential. In this study, a novel computer-aided framework for dental implant recognition is suggested. The proposed method relies on image processing concepts, namely: (i) a segmentation strategy for semi-automatic implant delineation; and (ii) a machine learning approach for implant model recognition. Although the segmentation technique is the main focus of the current study, preliminary details of the machine learning approach are also reported. Two different scenarios are used to validate the framework: (1) comparison of the semi-automatic contours against implant's manual contours of 125 X-ray images; and (2) classification of 11 known implants using a large reference database of 601 implants. Regarding experiment 1, 0.97±0.01, 2.24±0.85 pixels and 11.12±6 pixels of dice metric, mean absolute distance and Hausdorff distance were obtained, respectively. In experiment 2, 91% of the implants were successfully recognized while reducing the reference database to 5% of its original size. Overall, the segmentation technique achieved accurate implant contours. Although the preliminary classification results prove the concept of the current work, more features and an extended database should be used in a future work.

  3. Prevention of inappropriate ICD shocks due to lead insulation failure by continuous monitoring and automatic alert.

    PubMed

    Gelder, Robert N; Gunderson, Bruce D

    2012-06-01

    Patients with implantable cardioverter defibrillator lead insulation failures may present with oversensing and/or abnormal impedance. The Lead Integrity Alert (LIA) monitors right ventricular pace/sense leads using both continuous oversensing and daily impedance measurementd. Oversensing consists of isolated short R-R intervals and nonsustained runs of short R-R intervals. The LIA algorithm has been studied for Sprint Fidelis conductor fractures, but not for lead insulation failures. We report on a patient with a failed St. Jude Riata™ ST lead (St. Jude Medical, St. Paul, MN, USA) connected to a Medtronic Virtuoso DR (Medtronic Inc., Minneapolis, MN, USA) with the LIA. Oversensing triggered the LIA, while the impedance trend was normal. PMID:22309317

  4. Dosimetric review of cardiac implantable electronic device patients receiving radiotherapy.

    PubMed

    Prisciandaro, Joann I; Makkar, Akash; Fox, Colleen J; Hayman, James A; Horwood, Laura; Pelosi, Frank; Moran, Jean M

    2015-01-01

    A formal communication process was established and evaluated for the management of patients with cardiac implantable electronic devices (CIEDs) receiving radiation therapy (RT). Methods to estimate dose to the CIED were evaluated for their appropriateness in the management of these patients. A retrospective, institutional review board (IRB) approved study of 69 patients with CIEDs treated with RT between 2005 and 2011 was performed. The treatment sites, techniques, and the estimated doses to the CIEDs were analyzed and compared to estimates from published peripheral dose (PD) data and three treatment planning systems(TPSs) - UMPlan, Eclipse's AAA and Acuros algorithms. When measurements were indicated, radiation doses to the CIEDs ranged from 0.01-5.06 Gy. Total peripheral dose estimates based on publications differed from TLD measurements by an average of 0.94 Gy (0.05-4.49 Gy) and 0.51 Gy (0-2.74 Gy) for CIEDs within 2.5 cm and between 2.5 and 10 cm of the treatment field edge, respectively. Total peripheral dose estimates based on three TPSs differed from measurements by an average of 0.69 Gy (0.02-3.72 Gy) for CIEDs within 2.5 cm of the field edge. Of the 69 patients evaluated in this study, only two with defibrillators experienced a partial reset of their device during treatment. Based on this study, few CIED-related events were observed during RT. The only noted correlation with treatment parameters for these two events was beam energy, as both patients were treated with high-energy photon beams (16 MV). Differences in estimated and measured CIED doses were observed when using published PD data and TPS calculations. As such, we continue to follow conservative guidelines and measure CIED doses when the device is within 10 cm of the field or the estimated dose is greater than 2 Gy for pacemakers or 1 Gy for defibrillators. PMID:25679176

  5. Radiated radiofrequency immunity testing of automated external defibrillators - modifications of applicable standards are needed

    PubMed Central

    2011-01-01

    Background We studied the worst-case radiated radiofrequency (RF) susceptibility of automated external defibrillators (AEDs) based on the electromagnetic compatibility (EMC) requirements of a current standard for cardiac defibrillators, IEC 60601-2-4. Square wave modulation was used to mimic cardiac physiological frequencies of 1 - 3 Hz. Deviations from the IEC standard were a lower frequency limit of 30 MHz to explore frequencies where the patient-connected leads could resonate. Also testing up to 20 V/m was performed. We tested AEDs with ventricular fibrillation (V-Fib) and normal sinus rhythm signals on the patient leads to enable testing for false negatives (inappropriate "no shock advised" by the AED). Methods We performed radiated exposures in a 10 meter anechoic chamber using two broadband antennas to generate E fields in the 30 - 2500 MHz frequency range at 1% frequency steps. An AED patient simulator was housed in a shielded box and delivered normal and fibrillation waveforms to the AED's patient leads. We developed a technique to screen ECG waveforms stored in each AED for electromagnetic interference at all frequencies without waiting for the long cycle times between analyses (normally 20 to over 200 s). Results Five of the seven AEDs tested were susceptible to RF interference, primarily at frequencies below 80 MHz. Some induced errors could cause AEDs to malfunction and effectively inhibit operator prompts to deliver a shock to a patient experiencing lethal fibrillation. Failures occurred in some AEDs exposed to E fields between 3 V/m and 20 V/m, in the 38 - 50 MHz range. These occurred when the patient simulator was delivering a V-Fib waveform to the AED. Also, we found it is not possible to test modern battery-only-operated AEDs for EMI using a patient simulator if the IEC 60601-2-4 defibrillator standard's simulated patient load is used. Conclusions AEDs experienced potentially life-threatening false-negative failures from radiated RF, primarily

  6. Automatic amino acid analyzer

    NASA Technical Reports Server (NTRS)

    Berdahl, B. J.; Carle, G. C.; Oyama, V. I.

    1971-01-01

    Analyzer operates unattended or up to 15 hours. It has an automatic sample injection system and can be programmed. All fluid-flow valve switching is accomplished pneumatically from miniature three-way solenoid pilot valves.

  7. Automatic Payroll Deposit System.

    ERIC Educational Resources Information Center

    Davidson, D. B.

    1979-01-01

    The Automatic Payroll Deposit System in Yakima, Washington's Public School District No. 7, directly transmits each employee's salary amount for each pay period to a bank or other financial institution. (Author/MLF)

  8. Automatic switching matrix

    DOEpatents

    Schlecht, Martin F.; Kassakian, John G.; Caloggero, Anthony J.; Rhodes, Bruce; Otten, David; Rasmussen, Neil

    1982-01-01

    An automatic switching matrix that includes an apertured matrix board containing a matrix of wires that can be interconnected at each aperture. Each aperture has associated therewith a conductive pin which, when fully inserted into the associated aperture, effects electrical connection between the wires within that particular aperture. Means is provided for automatically inserting the pins in a determined pattern and for removing all the pins to permit other interconnecting patterns.

  9. Relation between detection rate and inappropriate shocks in single versus dual chamber cardioverter-defibrillator - an analysis from the OPTION trial.

    PubMed

    Kolb, Christof; Sturmer, Marcio; Babuty, Dominique; Sick, Peter; Davy, Jean Marc; Molon, Giulio; Schwab, Jörg Otto; Mantovani, Giuseppe; Wickliffe, Andrew; Lennerz, Carsten; Semmler, Verena; Siot, Pierre-Henri; Reif, Sebastian

    2016-01-01

    The programming of implantable cardioverter-defibrillators (ICDs) influences inappropriate shock rates. The aim of the study is to analyse rates of patients with appropriate and inappropriate shocks according to detection zones in the OPTION trial. All patients received dual chamber (DC) ICDs randomly assigned to be programmed either to single chamber (SC) or to DC settings including PARAD+ algorithm. In a post-hoc analysis, rates of patients with inappropriate and appropriate shocks were calculated for shocks triggered at heart rates ≥170 bpm (ventricular tachycardia zone) and at rates ≥200 bpm (ventricular fibrillation zone). In the SC group, higher rates of patients with total and inappropriate shocks were delivered at heart rates ≥170 bpm than at rates ≥200 bpm (total shocks: 21.1% vs. 16.6%; p = 0.002; inappropriate shocks: 7.6% vs. 4.5%, p = 0.016; appropriate shocks: 15.2% vs. 13.5%; p = n.s.). No such differences were observed in the DC group (total shocks: 14.3% vs. 12.6%; p = n.s.; inappropriate shocks: 3.9% vs. 3.6%; p = n.s.; appropriate shocks: 12.2% vs. 10.4%; p = n.s.). The higher frequency of patients with total shocks with SC settings than with DC settings that benefit from PARAD+ was driven by a higher percentage of patients with inappropriate shocks in the VT zone (170-200 bpm) in the SC population. PMID:26892534

  10. Relation between detection rate and inappropriate shocks in single versus dual chamber cardioverter-defibrillator – an analysis from the OPTION trial

    PubMed Central

    Kolb, Christof; Sturmer, Marcio; Babuty, Dominique; Sick, Peter; Davy, Jean Marc; Molon, Giulio; Schwab, Jörg Otto; Mantovani, Giuseppe; Wickliffe, Andrew; Lennerz, Carsten; Semmler, Verena; Siot, Pierre-Henri; Reif , Sebastian

    2016-01-01

    The programming of implantable cardioverter-defibrillators (ICDs) influences inappropriate shock rates. The aim of the study is to analyse rates of patients with appropriate and inappropriate shocks according to detection zones in the OPTION trial. All patients received dual chamber (DC) ICDs randomly assigned to be programmed either to single chamber (SC) or to DC settings including PARAD+ algorithm. In a post-hoc analysis, rates of patients with inappropriate and appropriate shocks were calculated for shocks triggered at heart rates ≥170 bpm (ventricular tachycardia zone) and at rates ≥200 bpm (ventricular fibrillation zone). In the SC group, higher rates of patients with total and inappropriate shocks were delivered at heart rates ≥170 bpm than at rates ≥200 bpm (total shocks: 21.1% vs. 16.6%; p = 0.002; inappropriate shocks: 7.6% vs. 4.5%, p = 0.016; appropriate shocks: 15.2% vs. 13.5%; p = n.s.). No such differences were observed in the DC group (total shocks: 14.3% vs. 12.6%; p = n.s.; inappropriate shocks: 3.9% vs. 3.6%; p = n.s.; appropriate shocks: 12.2% vs. 10.4%; p = n.s.). The higher frequency of patients with total shocks with SC settings than with DC settings that benefit from PARAD+ was driven by a higher percentage of patients with inappropriate shocks in the VT zone (170–200 bpm) in the SC population. PMID:26892534

  11. Endoscopic Electrosurgery in Patients with Cardiac Implantable Electronic Devices

    PubMed Central

    Baeg, Myong Ki; Kim, Sang-Woo; Ko, Sun-Hye; Lee, Yoon Bum; Hwang, Seawon; Lee, Bong-Woo; Choi, Hye Jin; Park, Jae Myung; Lee, In-Seok; Oh, Yong-Seog; Choi, Myung-Gyu

    2016-01-01

    Background/Aims: Patients with cardiac implantable electronic devices (CIEDs) undergoing endoscopic electrosurgery (EE) are at a risk of electromagnetic interference (EMI). We aimed to analyze the effects of EE in CIED patients. Methods: Patients with CIED who underwent EE procedures such as snare polypectomy, endoscopic submucosal dissection (ESD), and endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) were retrospectively analyzed. Postprocedural symptoms as well as demographic and outpatient follow-up data were reviewed through medical records. Electrical data, including preprocedural and postprocedural arrhythmia records, were reviewed through pacemaker interrogation, 24-hour Holter monitoring, or electrocardiogram. Results: Fifty-nine procedures in 49 patients were analyzed. Fifty procedures were performed in 43 patients with a pacemaker, and nine were performed in six patients with an implantable cardioverter-defibrillator. There were one gastric and 44 colon snare polypectomies, five gastric and one colon ESDs, and eight ERCPs with EST. Fifty-five cases of electrical follow-up were noted, with two postprocedural changes not caused by EE. Thirty-one pacemaker interrogations had procedure recordings, with two cases of asymptomatic tachycardia. All patients were asymptomatic with no adverse events. Conclusions: Our study reports no adverse events from EE in patients with CIED, suggesting that this procedure is safe. However, because of the possibility of EMI, recommendations on EE should be followed. PMID:26867552

  12. Arrhythmic death and ICD implantation after myocardial infarction

    PubMed Central

    LOMBARDI, FEDERICO

    2006-01-01

    Arrhythmic death remains one of the most important causes of mortality after an acute myocardial infarction also in the revascularization era. As a consequence, identification of patients at risk should be performed before discharge. Unfortunately, in the clinical practice, this evaluation is mainly based on detection of a depressed left ventricular ejection. This approach, however, cannot adequately distinguish arrhythmic versus non-arrhythmic risk. This issue is of critical relevance when considering that arrhythmic death can be significantly reduced by appropriate interventions of implantable cardioverter defibrillator. Available evidence, however, indicates that in the first month after myocardial infarction, device implantation does not significantly reduce cardiac mortality: it seems that the reduction of arrhythmic death is counterbalanced by an increase in rate of death from non arrhythmic cause. It is therefore to be hoped that, in the future, arrhythmic risk evaluation will be based not only on the extent of left ventricular dysfunction but also on the analysis of other risk markers such as those reflecting autonomic dysfunction, cardiac electrical instability and presence of subclinical inflammation. PMID:21977246

  13. Urinary incontinence - injectable implant

    MedlinePlus

    Injectable implants are injections of material into the urethra to help control urine leakage ( urinary incontinence ) caused by a ... into the tissue next to the sphincter. The implant procedure is usually done in the hospital. Or ...

  14. PDE constrained optimization of electrical defibrillation in a 3D ventricular slice geometry.

    PubMed

    Chamakuri, Nagaiah; Kunisch, Karl; Plank, Gernot

    2016-04-01

    A computational study of an optimal control approach for cardiac defibrillation in a 3D geometry is presented. The cardiac bioelectric activity at the tissue and bath volumes is modeled by the bidomain model equations. The model includes intramural fiber rotation, axially symmetric around the fiber direction, and anisotropic conductivity coefficients, which are extracted from a histological image. The dynamics of the ionic currents are based on the regularized Mitchell-Schaeffer model. The controls enter in the form of electrodes, which are placed at the boundary of the bath volume with the goal of dampening undesired arrhythmias. The numerical optimization is based on Newton techniques. We demonstrated the parallel architecture environment for the computation of potentials on multidomains and for the higher order optimization techniques. Copyright © 2015 John Wiley & Sons, Ltd. PMID:26249168

  15. Cardiac Resynchronization Therapy Defibrillator Treatment in a Child with Heart Failure and Ventricular Arrhythmia

    PubMed Central

    Kim, Hak Ju; Cho, Sungkyu; Kim, Woong-Han

    2016-01-01

    Cardiac resynchronization therapy (CRT) is a new treatment for refractory heart failure. However, most patients with heart failure treated with CRT are adults, middle-aged or older with idiopathic or ischemic dilated cardiomyopathy. We treated a 12-year-old boy, who was transferred after cardiac arrest, with dilated cardiomyopathy, left bundle-branch block, and ventricular tachycardia. We performed cardiac resynchronization therapy with a defibrillator (CRT-D). After CRT-D, left ventricular ejection fraction improved from 22% to 44% assessed by echocardiogram 1 year postoperatively. On electrocardiogram, QRS duration was shortened from 206 to 144 ms. The patient’s clinical symptoms also improved. For pediatric patients with refractory heart failure and ventricular arrhythmia, CRT-D could be indicated as an effective therapeutic option. PMID:27525239

  16. Cardiac Resynchronization Therapy Defibrillator Treatment in a Child with Heart Failure and Ventricular Arrhythmia.

    PubMed

    Kim, Hak Ju; Cho, Sungkyu; Kim, Woong-Han

    2016-08-01

    Cardiac resynchronization therapy (CRT) is a new treatment for refractory heart failure. However, most patients with heart failure treated with CRT are adults, middle-aged or older with idiopathic or ischemic dilated cardiomyopathy. We treated a 12-year-old boy, who was transferred after cardiac arrest, with dilated cardiomyopathy, left bundle-branch block, and ventricular tachycardia. We performed cardiac resynchronization therapy with a defibrillator (CRT-D). After CRT-D, left ventricular ejection fraction improved from 22% to 44% assessed by echocardiogram 1 year postoperatively. On electrocardiogram, QRS duration was shortened from 206 to 144 ms. The patient's clinical symptoms also improved. For pediatric patients with refractory heart failure and ventricular arrhythmia, CRT-D could be indicated as an effective therapeutic option. PMID:27525239

  17. Hair implant complications.

    PubMed

    Hanke, C W; Norins, A L; Pantzer, J G; Bennett, J E

    1981-04-01

    Four men who underwent hair implantation for pattern baldness were treated for complications such as infection, foreign-body reaction, pruritus, and scarring. The complications were similar to those reported with synthetic modacrylic fiber implants that have been used for the same purpose. Although we believe this is the first article to report complications from hair implants, the illogical basis of the procedure suggests that complications will occur in many unsuspecting patients who undergo hair implantation. PMID:7009899

  18. How Can Death Due to Sudden Cardiac Arrest Be Prevented?

    MedlinePlus

    ... heartbeats that can trigger the ICD. Implantable Cardioverter Defibrillator The illustration shows the location of an implantable cardioverter defibrillator in the upper chest. The electrodes are inserted ...

  19. Ventricular defibrillation combining DC electrical field and electrical pacing: an optical mapping study

    NASA Astrophysics Data System (ADS)

    Musunuri, Sai Shruthi; Tang, Liang; Joung, Boyoung; Berbari, Edward J.; Lin, Shien-Fong

    2009-02-01

    Although high voltage direct current (DC) shock is a standard technique to terminate ventricular fibrillation (VF), it can cause severe pain and tissue damage. The exact effect of the DC electric field, which can depolarize the heart during VF is still unknown. We hypothesized that low-energy DC field in combination with pacing (pacing+DC) could terminate VF by affecting the ventricular propagation pattern. In six Langendorff-perfused isolated rabbit hearts with the ablated sinoatrial (SA) node, the DC field was delivered to the left ventricle (cathode) and right ventricle (anode). We designed a timed protocol using LabVIEW programming that delivers pacing, DC and pacing+DC stimuli for two seconds time intervals each. The pacing pulse (with varying pacing cycle length: 300ms-30ms) was delivered to the apex. Transmembrane voltage was recorded with optical mapping technique for 16 seconds at a sampling rate of 2ms/frame. We crushed the sinoatrial node to reduce the heart rate. The baseline activation appeared to have endocardial origins with a mean escape ventricular rate of 60 +/- 5bpm at baseline. The DC field (30mA-60mA) alone increased the mean heart rate to 120+/-5bpm. Although DC alone terminated VF in a few cases, the rate of termination was very low (6.2%). However, when pacing+DC was applied, it was possible to terminate VF in 34 of 130 episodes in six rabbits. The rate of successful defibrillation of VF with pacing+DC was significantly higher than that with DC alone (20% vs 6.2%, p<0.01). Pacing alone never terminated the VF. In conclusion, DC field may affect the conduction velocity in normal condition. Pacing+DC intervention could lead to regularization of VF propagation and eventually to termination. Further improvement of this approach may offer a higher success rate of defibrillation with lower energy requirements.

  20. Malfunctions of implantable cardiac devices in patients receiving proton beam therapy: incidence and predictors

    PubMed Central

    Gomez, Daniel R.; Poenisch, Falk; Pinnix, Chelsea C.; Sheu, Tommy; Chang, Joe Y.; Memon, Nada; Mohan, Radhe; Rozner, Marc A.; Dougherty, Anne H.

    2014-01-01

    Purpose Photon therapy has been reported to induce resets of implanted cardiac devices, but the clinical sequelae of treating patients with such devices with proton beam therapy (PBT) are not well known. We reviewed the incidence of device malfunctions among patients undergoing PBT. Methods From March 2009 through July 2012, 42 patients with implanted cardiac implantable electronic devices (CIEDs) (28 pacemakers and 14 cardioverter-defillibrators) underwent 42 courses of PBT for thoracic (23 [55%]), prostate (15 [36%]), liver (3[7%]), or base of skull (1 [2%]) tumors at a single institution. The median prescribed dose was 74 Gy(RBE) [range 46.8–87.5 Gy(RBE)], and the median distance from the treatment field to the CIED was 10 cm (range 0.8–40 cm). Maximum proton and neutron doses were estimated for each treatment course. All CIEDs were checked before radiation delivery and monitored throughout treatment. Results Median estimated peak proton and neutron doses to the CIED in all patients were 0.8 Gy (range 0.13–21 Gy) and 346 Sv (range 11–1100 mSv). Six CIED malfunctions occurred in five patients (2 pacemakers and 3 defibrillators). Five of these malfunctions were CIED resets, and one patient with a defibrillator (in a patient with a liver tumor) had an elective replacement indicator (ERI) after therapy that was not influenced by radiation. The mean distance from the proton beam to the CIED among devices that reset was 7.0 cm (range 0.9–8 cm), and the mean maximum neutron dose was 655 mSv (range 330–1100 mSv). All resets occurred in patients receiving thoracic PBT and were corrected without clinical incident. The generator for the defibrillator with the ERI message was replaced uneventfully after treatment. Conclusions The incidence of CIED resets was about 20% among patients receiving PBT to the thorax. We recommend that PBT be avoided in pacing-dependent patients and that patients with any type of CIED receiving thoracic PBT be followed closely. PMID

  1. Candida and cardiovascular implantable electronic devices: a case of lead and native aortic valve endocarditis and literature review.

    PubMed

    Glavis-Bloom, Justin; Vasher, Scott; Marmor, Meghan; Fine, Antonella B; Chan, Philip A; Tashima, Karen T; Lonks, John R; Kojic, Erna M

    2015-11-01

    Use of cardiovascular implantable electronic devices (CIED), including permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD), has increased dramatically over the past two decades. Most CIED infections are caused by staphylococci. Fungal causes are rare and their prognosis is poor. To our knowledge, there has not been a previously reported case of multifocal Candida endocarditis involving both a native left-sided heart valve and a CIED lead. Here, we report the case of a 70-year-old patient who presented with nausea, vomiting, and generalised fatigue, and was found to have Candida glabrata endocarditis involving both a native aortic valve and right atrial ICD lead. We review the literature and summarise four additional cases of CIED-associated Candida endocarditis published from 2009 to 2014, updating a previously published review of cases prior to 2009. We additionally review treatment guidelines and discuss management of CIED-associated Candida endocarditis. PMID:26403965

  2. Spontaneous defibrillation after cessation of resuscitation in out-of-hospital cardiac arrest: a case of Lazarus phenomenon.

    PubMed

    Kämäräinen, Antti; Virkkunen, Ilkka; Holopainen, Leevi; Erkkilä, Elja-Pekka; Yli-Hankala, Arvi; Tenhunen, Jyrki

    2007-12-01

    This report describes a case of out-of-hospital cardiac arrest with spontaneous defibrillation and subsequent return of circulation after cessation of resuscitative efforts. A 47-year-old man was found in cardiac arrest and resuscitation was initiated. As no response was achieved, the efforts were withdrawn and final registered cardiac rhythm was ventricular fibrillation. Fifteen minutes later the patient was found to be normotensive and breathing spontaneously. The patient made a poor neurological recovery and died 3 months after the arrest. The authors are unable to give an explanation to the event, but suspect the effect of adrenaline combined with mild hypothermia to have contributed to the self-defibrillation of the myocardium. PMID:17629389

  3. Active implantable medical device EMI assessment for wireless power transfer operating in LF and HF bands.

    PubMed

    Hikage, Takashi; Nojima, Toshio; Fujimoto, Hiroshi

    2016-06-21

    The electromagnetic interference (EMI) imposed on active implantable medical devices by wireless power transfer systems (WPTSs) is discussed based upon results of in vitro experiments. The purpose of this study is to present comprehensive EMI test results gathered from implantable-cardiac pacemakers and implantable cardioverter defibrillators exposed to the electromagnetic field generated by several WPTSs operating in low-frequency (70 kHz-460 kHz) and high-frequency (6.78 MHz) bands. The constructed in vitro experimental test system based upon an Irnich's flat torso phantom was applied. EMI test experiments are conducted on 14 types of WPTSs including Qi-compliant system and EV-charging WPT system mounted on current production EVs. In addition, a numerical simulation model for active implantable medical device (AIMD) EMI estimation based on the experimental test system is newly proposed. The experimental results demonstrate the risk of WPTSs emitting intermittent signal to affect the correct behavior of AIMDs when operating at very short distances. The proposed numerical simulation model is applicable to obtain basically the EMI characteristics of various types of WPTSs. PMID:27224201

  4. Interference of implanted cardiac pacemakers with TASER X26 dart mode application.

    PubMed

    Leitgeb, Norbert; Niedermayr, Florian; Neubauer, Robert

    2012-06-01

    The prevalence of pacemaker patients among the general population and of conducted energy devices for law enforcement and self-defence is increasing. Consequently, the question on whether cardiac pacemaker patients are at particular risk becomes increasingly important, in particular, as the widespread use of such devices is planned in Europe. The risk of pacemaker patients has been investigated by numerical simulation at detailed anatomical models of patients with cardiac pacemakers implanted in left pectoral, right pectoral, and abdominal positions, with the monopolar electrode placed at the ventricular apex. The induced cardiac pacemaker interference voltages have been assessed for distant application of TASER X26 devices with dart electrodes propelled towards a subject. It could be shown that interference voltages are highest in abdominal pacemaker implantation, while they are about 20% lower in left or right pectoral sites. They remain below the immunity threshold level as defined by safety standards of implanted cardiac pacemakers and of implanted cardioverter defibrillators to prevent persisting malfunction or damage. However, induced voltages are high enough to be sensed by the pacemaker and to capture pacemaker function in case of hits at thorax and abdomen, frontal as well as dorsal. PMID:22691428

  5. Active implantable medical device EMI assessment for wireless power transfer operating in LF and HF bands

    NASA Astrophysics Data System (ADS)

    Hikage, Takashi; Nojima, Toshio; Fujimoto, Hiroshi

    2016-06-01

    The electromagnetic interference (EMI) imposed on active implantable medical devices by wireless power transfer systems (WPTSs) is discussed based upon results of in vitro experiments. The purpose of this study is to present comprehensive EMI test results gathered from implantable-cardiac pacemakers and implantable cardioverter defibrillators exposed to the electromagnetic field generated by several WPTSs operating in low-frequency (70 kHz–460 kHz) and high-frequency (6.78 MHz) bands. The constructed in vitro experimental test system based upon an Irnich’s flat torso phantom was applied. EMI test experiments are conducted on 14 types of WPTSs including Qi-compliant system and EV-charging WPT system mounted on current production EVs. In addition, a numerical simulation model for active implantable medical device (AIMD) EMI estimation based on the experimental test system is newly proposed. The experimental results demonstrate the risk of WPTSs emitting intermittent signal to affect the correct behavior of AIMDs when operating at very short distances. The proposed numerical simulation model is applicable to obtain basically the EMI characteristics of various types of WPTSs.

  6. Effect of Continued Cardiac Resynchronization Therapy on Ventricular Arrhythmias After Left Ventricular Assist Device Implantation.

    PubMed

    Schleifer, John William; Mookadam, Farouk; Kransdorf, Evan P; Nanda, Udai; Adams, Jonathon C; Cha, Stephen; Pajaro, Octavio E; Steidley, David Eric; Scott, Robert L; Carvajal, Tomas; Saadiq, Rayya A; Srivathsan, Komandoor

    2016-08-15

    Cardiac resynchronization therapy (CRT) reduces ventricular arrhythmia (VA) burden in some patients with heart failure, but its effect after left ventricular assist device (LVAD) implantation is unknown. We compared VA burden in patients with CRT devices in situ who underwent LVAD implantation and continued CRT (n = 39) to those who had CRT turned off before discharge (n = 26). Implantable cardioverter-defibrillator (ICD) shocks were significantly reduced in patients with continued CRT (1.5 ± 2.7 shocks per patient vs 5.5 ± 9.3 with CRT off, p = 0.014). There was a nonsignificant reduction in cumulative VA episodes per patient with CRT continued at discharge (42 ± 105 VA per patient vs 82 ± 198 with CRT off, p = 0.29). On-treatment analysis by whether CRT was on or off identified a significantly lower burden of VA (17 ± 1 per patient-year CRT on vs 37 ± 1 per patient-year CRT off, p <0.0001) and ICD shocks (1.2 ± 0.3 per patient-year CRT on vs 1.7 ± 0.3 per patient-year CRT off, p = 0.018). In conclusion, continued CRT is associated with significantly reduced ICD shocks and VA burden after LVAD implantation. PMID:27328958

  7. Trends in Cochlear Implants

    PubMed Central

    Zeng, Fan-Gang

    2004-01-01

    More than 60,000 people worldwide use cochlear implants as a means to restore functional hearing. Although individual performance variability is still high, an average implant user can talk on the phone in a quiet environment. Cochlear-implant research has also matured as a field, as evidenced by the exponential growth in both the patient population and scientific publication. The present report examines current issues related to audiologic, clinical, engineering, anatomic, and physiologic aspects of cochlear implants, focusing on their psychophysical, speech, music, and cognitive performance. This report also forecasts clinical and research trends related to presurgical evaluation, fitting protocols, signal processing, and postsurgical rehabilitation in cochlear implants. Finally, a future landscape in amplification is presented that requires a unique, yet complementary, contribution from hearing aids, middle ear implants, and cochlear implants to achieve a total solution to the entire spectrum of hearing loss treatment and management. PMID:15247993

  8. Potential error in the use of an automated external defibrillator during an in-flight medical emergency.

    PubMed

    Katis, Peter G; Dias, Solange M

    2004-01-01

    In-flight medical emergencies are uncommon, generally non-lethal events. In fatal cases, the most common cause of death is a sudden cardiac event. This fact, and the awareness that early defibrillation is the most important determinant of successful cardiac resuscitation, have led to the increasing availability of automated external defibrillators (AEDs) aboard commercial airplanes. AEDs are sophisticated and extremely reliable devices that are designed to be used by trained laypersons in the hope of minimizing the crucial time to defibrillation. Although designed to be foolproof, both machine- and operator-dependent usage errors have been recognized. In this case study we report a unique operator-dependent error involving the misreading of an AED instruction window, briefly review the history of AED use in the airline industry, and underscore the need for a sound knowledge of basic life support skills when working with these devices. We conclude by making recommendations to prevent similar errors from occurring in the future. PMID:17433145

  9. Using a Combined Platform of Swarm Intelligence Algorithms and GIS to Provide Land Suitability Maps for Locating Cardiac Rehabilitation Defibrillators

    PubMed Central

    KAFFASH-CHARANDABI, Neda; SADEGHI-NIARAKI, Abolghasem; PARK, Dong-Kyun

    2015-01-01

    Background: Cardiac arrest is a condition in which the heart is completely stopped and is not pumping any blood. Although most cardiac arrest cases are reported from homes or hospitals, about 20% occur in public areas. Therefore, these areas need to be investigated in terms of cardiac arrest incidence so that places of high incidence can be identified and cardiac rehabilitation defibrillators installed there. Methods: In order to investigate a study area in Petersburg, Pennsylvania State, and to determine appropriate places for installing defibrillators with 5-year period data, swarm intelligence algorithms were used. Moreover, the location of the defibrillators was determined based on the following five evaluation criteria: land use, altitude of the area, economic conditions, distance from hospitals and approximate areas of reported cases of cardiac arrest for public places that were created in geospatial information system (GIS). Results: The A-P HADEL algorithm results were more precise about 27.36%. The validation results indicated a wider coverage of real values and the verification results confirmed the faster and more exact optimization of the cost function in the PSO method. Conclusion: The study findings emphasize the necessity of applying optimal optimization methods along with GIS and precise selection of criteria in the selection of optimal locations for installing medical facilities because the selected algorithm and criteria dramatically affect the final responses. Meanwhile, providing land suitability maps for installing facilities across hot and risky spots has the potential to save many lives. PMID:26587471

  10. A new automatic synchronizer

    SciTech Connect

    Malm, C.F.

    1995-12-31

    A phase lock loop automatic synchronizer, PLLS, matches generator speed starting from dead stop to bus frequency, and then locks the phase difference at zero, thereby maintaining zero slip frequency while the generator breaker is being closed to the bus. The significant difference between the PLLS and a conventional automatic synchronizer is that there is no slip frequency difference between generator and bus. The PLL synchronizer is most advantageous when the penstock pressure fluctuates the grid frequency fluctuates, or both. The PLL synchronizer is relatively inexpensive. Hydroplants with multiple units can economically be equipped with a synchronizer for each unit.

  11. Quantitative Assessment of Orbital Implant Position – A Proof of Concept

    PubMed Central

    Schreurs, Ruud; Dubois, Leander; Becking, Alfred G.; Maal, Thomas J. J.

    2016-01-01

    Introduction In orbital reconstruction, the optimal location of a predefined implant can be planned preoperatively. Surgical results can be assessed intraoperatively or postoperatively. A novel method for quantifying orbital implant position is introduced. The method measures predictability of implant placement: transformation parameters between planned and resulting implant position are quantified. Methods The method was tested on 3 human specimen heads. Computed Tomography scans were acquired at baseline with intact orbits (t0), after creation of the defect (t1) and postoperatively after reconstruction of the defect using a preformed implant (t2). Prior to reconstruction, the optimal implant position was planned on the t0 and t1 scans. Postoperatively, the planned and realized implant position were compared. The t0 and t2 scans were fused using iPlan software and the resulting implant was segmented in the fused t2 scan. An implant reference frame was created (Orbital Implant Positioning Frame); the planned implant was transformed to the reference position using an Iterative Closest Point approach. The segmentation of the resulting implant was also registered on the reference position, yielding rotational (pitch, yaw, roll) as well as translational parameters of implant position. Results Measurement with the Orbital Implant Positioning Frame proved feasible on all three specimen. The positional outcome provided more thorough and accurate insight in resulting implant position than could be gathered from distance measurements alone. Observer-related errors were abolished from the process, since the method is largely automatic. Conclusion A novel method of quantifying surgical outcome in orbital reconstructive surgery was presented. The presented Orbital Implant Positioning Frame assessed all parameters involved in implant displacement. The method proved to be viable on three human specimen heads. Clinically, the method could provide direct feedback intraoperatively

  12. Silicone breast implant materials.

    PubMed

    Daniels, A U

    2012-01-01

    This opinion article has been written on request because of the recent public controversy over silicone breast implants produced by a now-defunct company, Poly Implant Prosthese (PIP) in France. More than 300,000 PIP devices have been implanted. The purposes of my article are to (1.) provide a general overview of silicone breast implant materials, (2.) to describe the general safety of these materials as reported to date, and (3.) to summarise current publicly available information about these aspects of the PIP prostheses. The materials covered are the silicone rubber from which the implant shells are made and the silicone gel used to fill the shell. The materials safety issues are biocompatibility (especially of the gel) and biodurability of the shell. The literature reviewed indicates that biocompatibility is not an issue with other current generation implants. However, biodurability is. A rough estimate of implant shell rupture rate is ~10+% at 10 years. Information is still emerging about the PIP implants. Initial regulatory disclosures suggest the PIP implants may have both biocompatibility and biodurability problems. They also suggest that PIP implants may have been produced using silicone materials not certified as medical grade. Governmental health and regulatory agencies are just now in the process of deciding what actions should be taken to protect patients. PMID:22826101

  13. Implicit active contours for automatic brachytherapy seed segmentation in fluoroscopy

    NASA Astrophysics Data System (ADS)

    Moult, Eric; Burdette, Clif; Song, Danny; Fichtinger, Gabor; Fallavollita, Pascal

    2012-02-01

    Motivation: In prostate brachytherapy, intra-operative dosimetry would be ideal to allow for rapid evaluation of the implant quality while the patient is still in the treatment position. Such a mechanism, however, requires 3-D visualization of the currently deposited seeds relative to the prostate. Thus, accurate, robust, and fully-automatic seed segmentation is of critical importance in achieving intra-operative dosimetry. Methodology: Implanted brachytherapy seeds are segmented by utilizing a region-based implicit active contour approach. Overlapping seed clusters are then resolved using a simple yet effective declustering technique. Results: Ground-truth seed coordinates were obtained via a published segmentation technique. A total of 248 clinical C-arm images from 16 patients were used to validate the proposed algorithm resulting in a 98.4% automatic detection rate with a corresponding 2.5% false-positive rate. The overall mean centroid error between the ground-truth and automatic segmentations was measured to be 0.42 pixels, while the mean centroid error for overlapping seed clusters alone was measured to be 0.67 pixels. Conclusion: Based on clinical data evaluation and validation, robust, accurate, and fully-automatic brachytherapy seed segmentation can be achieved through the implicit active contour framework and subsequent seed declustering method.

  14. Automatic Program Synthesis Reports.

    ERIC Educational Resources Information Center

    Biermann, A. W.; And Others

    Some of the major results of future goals of an automatic program synthesis project are described in the two papers that comprise this document. The first paper gives a detailed algorithm for synthesizing a computer program from a trace of its behavior. Since the algorithm involves a search, the length of time required to do the synthesis of…

  15. Automaticity of Conceptual Magnitude.

    PubMed

    Gliksman, Yarden; Itamar, Shai; Leibovich, Tali; Melman, Yonatan; Henik, Avishai

    2016-01-01

    What is bigger, an elephant or a mouse? This question can be answered without seeing the two animals, since these objects elicit conceptual magnitude. How is an object's conceptual magnitude processed? It was suggested that conceptual magnitude is automatically processed; namely, irrelevant conceptual magnitude can affect performance when comparing physical magnitudes. The current study further examined this question and aimed to expand the understanding of automaticity of conceptual magnitude. Two different objects were presented and participants were asked to decide which object was larger on the screen (physical magnitude) or in the real world (conceptual magnitude), in separate blocks. By creating congruent (the conceptually larger object was physically larger) and incongruent (the conceptually larger object was physically smaller) pairs of stimuli it was possible to examine the automatic processing of each magnitude. A significant congruity effect was found for both magnitudes. Furthermore, quartile analysis revealed that the congruity was affected similarly by processing time for both magnitudes. These results suggest that the processing of conceptual and physical magnitudes is automatic to the same extent. The results support recent theories suggested that different types of magnitude processing and representation share the same core system. PMID:26879153

  16. Automaticity of Conceptual Magnitude

    PubMed Central

    Gliksman, Yarden; Itamar, Shai; Leibovich, Tali; Melman, Yonatan; Henik, Avishai

    2016-01-01

    What is bigger, an elephant or a mouse? This question can be answered without seeing the two animals, since these objects elicit conceptual magnitude. How is an object’s conceptual magnitude processed? It was suggested that conceptual magnitude is automatically processed; namely, irrelevant conceptual magnitude can affect performance when comparing physical magnitudes. The current study further examined this question and aimed to expand the understanding of automaticity of conceptual magnitude. Two different objects were presented and participants were asked to decide which object was larger on the screen (physical magnitude) or in the real world (conceptual magnitude), in separate blocks. By creating congruent (the conceptually larger object was physically larger) and incongruent (the conceptually larger object was physically smaller) pairs of stimuli it was possible to examine the automatic processing of each magnitude. A significant congruity effect was found for both magnitudes. Furthermore, quartile analysis revealed that the congruity was affected similarly by processing time for both magnitudes. These results suggest that the processing of conceptual and physical magnitudes is automatic to the same extent. The results support recent theories suggested that different types of magnitude processing and representation share the same core system. PMID:26879153

  17. AUTOmatic Message PACKing Facility

    Energy Science and Technology Software Center (ESTSC)

    2004-07-01

    AUTOPACK is a library that provides several useful features for programs using the Message Passing Interface (MPI). Features included are: 1. automatic message packing facility 2. management of send and receive requests. 3. management of message buffer memory. 4. determination of the number of anticipated messages from a set of arbitrary sends, and 5. deterministic message delivery for testing purposes.

  18. Automatic finite element generators

    NASA Technical Reports Server (NTRS)

    Wang, P. S.

    1984-01-01

    The design and implementation of a software system for generating finite elements and related computations are described. Exact symbolic computational techniques are employed to derive strain-displacement matrices and element stiffness matrices. Methods for dealing with the excessive growth of symbolic expressions are discussed. Automatic FORTRAN code generation is described with emphasis on improving the efficiency of the resultant code.

  19. Principles of Automatic Lemmatisation

    ERIC Educational Resources Information Center

    Hann, M. L.

    1974-01-01

    Introduces some algorithmic methods, for which no pre-editing is necessary, for automatically "lemmatising" raw text (changing raw text to an equivalent version in which all inflected words are artificially transformed to their dictionary look-up form). The results of a study of these methods, which used a German Text, are also given. (KM)

  20. Reactor component automatic grapple

    SciTech Connect

    Greenaway, P.R.

    1982-12-07

    A grapple for handling nuclear reactor components in a medium such as liquid sodium which, upon proper seating and alignment of the grapple with the component as sensed by a mechanical logic integral to the grapple, automatically seizes the component. The mechanical logic system also precludes seizure in the absence of proper seating and alignment.