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Single and dual coil shock efficacy and predictors of shock failure in patients with modern implantable cardioverter defibrillators—a single-center paired randomized study. J Interv Card Electrophysiol 2019; 54:65-72. [DOI: 10.1007/s10840-018-0443-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
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Ishigaki D, Kutsuzawa D, Arimoto T, Iwayama T, Hashimoto N, Kumagai Y, Nishiyama S, Takahashi H, Shishido T, Miyamoto T, Nitobe J, Fukui A, Watanabe T, Kubota I. The association between defibrillation shock energy and acute cardiac damage in patients with implantable cardioverter defibrillators. J Arrhythm 2016; 32:481-485. [PMID: 27920833 PMCID: PMC5129114 DOI: 10.1016/j.joa.2016.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/12/2016] [Accepted: 03/31/2016] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The aim of this study was to establish a minimally invasive defibrillation testing (DT) protocol for patients with implantable cardioverter defibrillators (ICDs). METHODS Two different energy DTs were performed, immediately after (15 J-DT) and 7 days after (≤10 J-DT) device implantation, in 20 consecutive ICD implantation patients. Cardiac-troponin T (c-TNT) and heart-type fatty acid binding protein (H-FABP) levels were measured before implantation, 2 h after implantation, and 1 day after each DT. For an additional 122 patients with ICD, we retrospectively analyzed 203 DTs immediately and 7 days after device implantation. RESULTS Serum c-TNT levels were significantly elevated 2 h after 15 J-DT [0.008 (0.004-0.019) vs. 0.053 (0.037-0.068) ng/mL, p<0.001], but not ≤10 J-DT [0.007 (0.004-0.018) ng/mL]. Similarly, serum H-FABP levels were significantly elevated 2 h after 15 J-DT (2.9±1.5 vs. 6.4±3.4 ng/mL, p<0.001), but not ≤10 J-DT (2.7±1.5 ng/mL). The changes in c-TNT and H-FABP levels between baseline and 2 h after DT were significantly greater for 15 J-DT compared with ≤10 J-DT [c-TnT: 0.039 (0.029-0.060) vs. 0 (0-0.003) ng/mL, p<0.001; H-FABP: 3.6±2.8 vs. -0.16±1.1 ng/mL, p<0.001]. The success rates of the initial shocks delivered for ventricular fibrillation were no different between ≤10 J-DT (85% [78/92]) and ≥15 J-DT (92% [103/111]). CONCLUSIONS Elevated levels of myocardial damage markers such as c-TNT and H-FABP were not found after ≤10 J-DT. In addition, an acceptable success rate was confirmed in ≤10 J-DT.
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Affiliation(s)
- Daisuke Ishigaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Daisuke Kutsuzawa
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Takanori Arimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Tadateru Iwayama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Naoaki Hashimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Yu Kumagai
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Satoshi Nishiyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Hiroki Takahashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Tetsuro Shishido
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Takuya Miyamoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Joji Nitobe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Akio Fukui
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
| | - Isao Kubota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
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Defibrillation Threshold Testing: Who Doesn't Get It? Card Electrophysiol Clin 2016; 4:135-41. [PMID: 26939810 DOI: 10.1016/j.ccep.2012.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Defibrillation testing has been routinely performed as part of the implantable cardioverter-defibrillator (ICD) implantation procedure, and is currently supported by practice guidelines; however, more recently, this practice has been called into question. Such testing is safe, and serious complications are rare. With modern ICD systems, physicians will rarely encounter a patient in whom defibrillation will fail. This article reviews the literature regarding the utility, necessity, complications, and cost of routine operative and follow-up defibrillation testing, and, it is hoped, clarifies the issue of "Who doesn't get it?"
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PATEL MEHULB, PANDYA KHYATI, THAKUR RANJANK. Assessment of Adequate Safety Margin Using Single Coupling Interval-Upper Limit of Vulnerability Test. Pacing Clin Electrophysiol 2014; 37:95-103. [DOI: 10.1111/pace.12251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 07/05/2013] [Accepted: 07/09/2013] [Indexed: 11/28/2022]
Affiliation(s)
- MEHUL B. PATEL
- Sparrow Thoracic and Cardiovascular Institute, Division of Cardiology; Michigan State University; Lansing Michigan
| | - KHYATI PANDYA
- Sparrow Thoracic and Cardiovascular Institute, Division of Cardiology; Michigan State University; Lansing Michigan
| | - RANJAN K. THAKUR
- Sparrow Thoracic and Cardiovascular Institute, Division of Cardiology; Michigan State University; Lansing Michigan
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Sadoul N, Defaye P, Mouton E, Bizeau O, Dupuis JM, Blangy H, Delarche N, Blanc JJ, Lazarus A. Defibrillation testing in everyday medical practice during implantable cardioverter defibrillator implantation in France: Analysis from the LEADER registry. Arch Cardiovasc Dis 2013; 106:562-9. [DOI: 10.1016/j.acvd.2013.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 07/01/2013] [Accepted: 07/16/2013] [Indexed: 11/15/2022]
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Smits K, Virag N, Swerdlow CD. Impact of defibrillation testing on predicted ICD shock efficacy: Implications for clinical practice. Heart Rhythm 2013; 10:709-17. [DOI: 10.1016/j.hrthm.2013.01.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Indexed: 12/25/2022]
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Gabriels J, Budzikowski AS, Kassotis JT. Defibrillation Waveform Duration Adjustment Increases the Proportion of Acceptable Defibrillation Thresholds in Patients Implanted with Single-Coil Defibrillation Leads. Cardiology 2013; 124:71-5. [DOI: 10.1159/000345776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 10/31/2012] [Indexed: 11/19/2022]
Abstract
The aim of this study was to determine whether defibrillation waveform duration adjustment with single-coil defibrillation leads can be used to increase the proportion of patients with satisfactory defibrillation thresholds (DFTs). A retrospective analysis of the DFT levels for 105 patients with implantable cardioverter-defibrillator devices and a single-coil defibrillation lead was performed. Two groups of patients were compared: 34 patients who had undergone waveform tuning (group A) and 71 patients with a fixed-tilt waveform (group B). Additional data including demographics, etiology, New York Heart Association functional class, left ventricular ejection fraction, high-voltage lead impedance and medications were gathered to determine what effect these variables had on the DFT levels. Of the 34 patients who had undergone waveform adjustment (group A), 27 (79%) were found to have satisfactory DFTs, while 41 (58%) of the 71 patients with fixed-tilt devices (group B) had satisfactory DFTs. Waveform duration adjustment was found to significantly increase the proportion of patients with satisfactory DFTs (p = 0.03).
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A protocol for patients with cardiovascular implantable devices undergoing magnetic resonance imaging (MRI): should defibrillation threshold testing be performed post-(MRI). J Interv Card Electrophysiol 2010; 28:59-66. [DOI: 10.1007/s10840-009-9463-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 12/07/2009] [Indexed: 10/19/2022]
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Ching CK, Elayi CS, Di Biase L, Barrett CD, Martin DO, Saliba WI, Wazni O, Kanj M, Burkhardt DJ, Schweikert RA, Wilkoff BL. Transiliac ICD implantation: Defibrillation vector flexibility produces consistent success. Heart Rhythm 2009; 6:978-83. [DOI: 10.1016/j.hrthm.2009.03.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Accepted: 03/18/2009] [Indexed: 11/25/2022]
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CORBISIERO RAFFAELE, ARMBRUSTER REBECCA. Does Size Really Matter? A Comparison of the Riata Lead Family Based on Size and Its Relation to Performance. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:722-6. [DOI: 10.1111/j.1540-8159.2008.01076.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sandstedt B, Gottfridsson C, Nyström B, Edvardsson N. Testing the Implantable Cardioverter-Defibrillator After Implantation?Is It Necessary? Pacing Clin Electrophysiol 2007; 30:985-91. [PMID: 17669081 DOI: 10.1111/j.1540-8159.2007.00796.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The results of intraoperative and postoperative predischarge implantable cardioverter-defibrillator (ICD) testing of 211 consecutive patients, starting at 15 J and requiring two successful terminations of induced VT/VF with a relative defibrillation safety margin (DSM) of >10 J, were reviewed. The aim was to define the type of intraoperative response that would make postoperative predischarge testing unnecessary. The intraoperative responses were divided into three types: A, a DSM > or =10 J and an absolute energy level of < or =20 J; B, a DSM of > or =10 J and an absolute energy level of >20 J; and C, a DSM <10 J and an absolute energy level of >20 J. At operation, the responses to defibrillation were A, 88.6%; B, 7.1%; and C, 4.3%. Accepting an A response only would leave 11.4% of the patients for postoperative testing. The positive and negative predictive values for diagnosing a postoperative C response were 0.78 and 0.97, respectively. Similarly, the predictive values for diagnosing a postoperative B or C response were 0.71 and 0.97, respectively. The postoperative testing responses were A, 89.1%; B, 4.3%; and C, 6.6%. In summary, an intraoperative A response was sufficient to make a postoperative defibrillation testing unnecessary, while it was found that intraoperative B and C responders should undergo postoperative testing. Applying these criteria, approximately 90% of the patients could be discharged without any postoperative induction test.
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Affiliation(s)
- Bengt Sandstedt
- Division of Cardiology, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
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Swerdlow CD, Russo AM, Degroot PJ. The dilemma of ICD implant testing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:675-700. [PMID: 17461879 DOI: 10.1111/j.1540-8159.2007.00730.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ventricular fibrillation (VF) has been induced at implantable cardioverter defibrillator (ICD) implant to ensure reliable sensing, detection, and defibrillation. Despite its risks, the value was self-evident for early ICDs: failure of defibrillation was common, recipients had a high risk of ventricular tachycardia (VT) or VF, and the only therapy for rapid VT or VF was a shock. Today, failure of defibrillation is rare, the risk of VT/VF is lower in some recipients, antitachycardia pacing is applied for fast VT, and vulnerability testing permits assessment of defibrillation efficacy without inducing VF in most patients. This review reappraises ICD implant testing. At implant, defibrillation success is influenced by both predictable and unpredictable factors, including those related to the patient, ICD system, drugs, and complications. For left pectoral implants of high-output ICDs, the probability of passing a 10 J safety margin is approximately 95%, the probability that a maximum output shock will defibrillate is approximately 99%, and the incidence of system revision based on testing is < or = 5%. Bayes' Theorem predicts that implant testing identifies < or = 50% of patients at high risk for unsuccessful defibrillation. Most patients who fail implant criteria have false negative tests and may undergo unnecessary revision of their ICD systems. The first-shock success rate for spontaneous VT/VF ranges from 83% to 93%, lower than that for induced VF. Thus, shocks for spontaneous VT/VF fail for reasons that are not evaluated at implant. Whether system revision based on implant testing improves this success rate is unknown. The risks of implant testing include those related to VF and those related to shocks alone. The former may be due to circulatory arrest alone or the combination of circulatory arrest and shocks. Vulnerability testing reduces risks related to VF, but not those related to shocks. Mortality from implant testing probably is 0.1-0.2%. Overall, VF should be induced to assess sensing in approximately 5% of ICD recipients. Defibrillation or vulnerability testing is indicated in 20-40% of recipients who can be identified as having a higher-than-usual probability of an inadequate defibrillation safety margin based on patient-specific factors. However, implant testing is too risky in approximately 5% of recipients and may not be worth the risks in 10-30%. In 25-50% of ICD recipients, testing cannot be identified as either critical or contraindicated.
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Affiliation(s)
- Charles D Swerdlow
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, and the David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
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Day JD, Doshi RN, Belott P, Birgersdotter-Green U, Behboodikhah M, Ott P, Glatter KA, Tobias S, Frumin H, Lee BK, Merillat J, Wiener I, Wang S, Grogin H, Chun S, Patrawalla R, Crandall B, Osborn JS, Weiss JP, Lappe DL, Neuman S. Inductionless or Limited Shock Testing Is Possible in Most Patients With Implantable Cardioverter- Defibrillators/Cardiac Resynchronization Therapy Defibrillators. Circulation 2007; 115:2382-9. [PMID: 17470697 DOI: 10.1161/circulationaha.106.663112] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Implantable cardioverter-defibrillators and cardiac resynchronization therapy defibrillators have relied on multiple ventricular fibrillation (VF) induction/defibrillation tests at implantation to ensure that the device can reliably sense, detect, and convert VF. The ASSURE Study (Arrhythmia Single Shock Defibrillation Threshold Testing Versus Upper Limit of Vulnerability: Risk Reduction Evaluation With Implantable Cardioverter-Defibrillator Implantations) is the first large, multicenter, prospective trial comparing vulnerability safety margin testing versus defibrillation safety margin testing with a single VF induction/defibrillation.
Methods and Results—
A total of 426 patients receiving an implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator underwent vulnerability safety margin or defibrillation safety margin screening at 14 J in a randomized order. After this, patients underwent confirmatory testing, which required 2 VF conversions without failure at ≤21 J. Patients who passed their first 14-J and confirmatory tests, irrespective of the results of their second 14-J test, had their devices programmed to a 21-J shock for ventricular tachycardia (VT) or VF ≥200 bpm and were followed up for 1 year. Of 420 patients who underwent 14-J vulnerability safety margin screening, 322 (76.7%) passed. Of these, 317 (98.4%) also passed 21-J confirmatory tests. Of 416 patients who underwent 14-J defibrillation safety margin screening, 343 (82.5%) passed, and 338 (98.5%) also passed 21-J confirmatory tests. Most clinical VT/VF episodes (32 of 37, or 86%) were terminated by the first shock, with no difference in first shock success. In all observed cases in which the first shock was unsuccessful, subsequent shocks terminated VT/VF without complication.
Conclusions—
Although spontaneous episodes of fast VT/VF were limited, there was no difference in the odds of first shock efficacy between groups. Screening with vulnerability safety margin or defibrillation safety margin may allow for inductionless or limited shock testing in most patients.
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Affiliation(s)
- John D Day
- Utah Heart Clinic Arrhythmia Service, LDS Hospital, 324 10th Ave, #206, Salt Lake City, UT 84103, USA.
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Pires LA, Johnson KM. Intraoperative testing of the implantable cardioverter-defibrillator: how much is enough? J Cardiovasc Electrophysiol 2006; 17:140-5. [PMID: 16533250 DOI: 10.1111/j.1540-8167.2005.00294.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Defibrillation testing of the implantable cardioverter-defibrillator (ICD) is considered a standard and required practice at the time of implantation. How much testing, if any in some cases, should be performed, however, remains unknown. METHODS AND RESULTS Included in this retrospective analysis were 835 patients (77% men; age 65 +/- 13 years) who received transvenous ICDs between January 1996 and December 2003. One hundred twenty-nine (15.5%) had intraoperative defibrillation threshold (DFT) testing, 503 (60.2%) had limited defibrillation safety margin testing, and 203 (24.3%) had no defibrillation testing. We compared the outcome (success of ICD therapies against spontaneous VT/VF events and survival) of the three groups of patients, who in some respects had important clinical differences. The success of the first delivered shocks against VT/VF was similar for DFT (91%), safety margin testing (91%), and no-testing (92%) groups; and the second shocks terminated the remaining episodes in all three groups. Sudden-death-free survival rates were similar in the three groups, however, the overall long-term survival rate was significantly lower in the no-testing group (58%) than in the DFT (74%) and safety margin testing (69%) groups (P < 0.0005). Multivariate analysis found no strong predictors of sudden death, but there were several independent predictors of overall mortality including lack of ICD testing (HR: 2.031, CI: 1.253-3.290, P = 0.004). CONCLUSION In this select patient cohort, success of ICD therapies and sudden-death-free survival were similar in patients who had DFT, safety margin testing, and no testing, but overall survival was significantly lower in the no-testing group. Thus in the absence of prospective mortality data, a minimum of safety margin ICD testing should remain standard practice.
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Affiliation(s)
- Luis A Pires
- Heart Rhythm Center and the Division of Cardiology, Department of Medicine, St. John Hospital and Medical Center, Detroit, Michigan 48236, USA.
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Barold SS, Herweg B, Curtis AB. The Defibrillation Safety Margin of Patients Receiving ICDs: A Matter of Definition. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:881-2. [PMID: 16176523 DOI: 10.1111/j.1540-8159.2005.00191.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Almquist AK, Montgomery JV, Haas TS, Maron BJ. Cardioverter-defibrillator implantation in high-risk patients with hypertrophic cardiomyopathy. Heart Rhythm 2005; 2:814-9. [PMID: 16051115 DOI: 10.1016/j.hrthm.2005.05.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 05/10/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) are used with increasing frequency in hypertrophic cardiomyopathy (HCM) patients of all ages for primary and secondary sudden death prevention. Concerns may arise regarding the safety of device implantation because of unique clinical and phenotypic expressions of HCM. OBJECTIVES The purpose of this study was to assess the efficacy and safety of ICD placement in high-risk patients with HCM. METHODS We analyzed the experience with ICDs and transvenous lead systems in 75 consecutive HCM patients at the Minneapolis Heart Institute from 1993 to 2004. RESULTS The age of the study group patients was 12 to 79 years (mean 36 +/- 16). Patients received ICDs for secondary (n = 4, after cardiac arrest) or primary prevention (n = 71, with > or = 1 risk factor). Thirty-one patients demonstrated disease features that potentially impacted methodology and safety of the implant procedure, most commonly massive left ventricular (LV) hypertrophy and outflow obstruction > or = 50 mmHg. There were no procedure-related deaths; defibrillator implants were successful and uneventful in 71 of 75 patients (95%). In 3 of the 75 patients (4%), defibrillation was unsuccessful because of high thresholds, associated with extreme hypertrophy (wall thickness > 45 mm) and/or ongoing amiodarone therapy. In two of these patients, thoracotomy with epicardial lead placement achieved successful defibrillation; ICD therapy was abandoned in the other patient. CONCLUSION ICD placement in children and adults with HCM is generally safe and effective. However, in some patients with massive LV hypertrophy and/or prior administration of amiodarone, transvenous defibrillation proved difficult, and epicardial lead placement was required. High-energy ICD devices and defibrillation threshold testing are recommended for most high-risk HCM patients.
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Affiliation(s)
- Adrian K Almquist
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota 55407, USA
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Maruyama Y, Stenvinkel P, Lindholm B. Role of interleukin-1beta in the development of malnutrition in chronic renal failure patients. Blood Purif 2005; 23:275-81. [PMID: 15925866 DOI: 10.1159/000086012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2005] [Indexed: 01/04/2023]
Abstract
Protein-energy malnutrition and wasting are common among patients with end-stage renal disease (ESRD) and these complications are strongly associated with poor survival in these patients. Whereas both under- and overweight predict in increased mortality risk in the general population, a high body mass index is associated with better outcome in ESRD patients. Circulating levels of pro-inflammatory cytokines are markedly elevated in uremia and also predictor of a poor clinical outcome in ESRD patients. Interleukin-1beta (IL-1beta), which is a major pro-inflammatory cytokine, may further amplify inflammation and lead to malnutrition, through inducing anorexia, and muscle wasting due to increased protein breakdown. Several clinical studies have shown that the circulating level of IL-1beta may affect nutritional status, especially body composition. Several IL-1 gene cluster polymorphisms were reported, and they may affect the prevalence of cytokine-mediated diseases. Although a number of factors are related to malnutrition and wasting in ESRD, pro-inflammatory cytokines, such as IL-1beta, may play an important role. This could in part be due to genetic factors. Further research, especially regarding the IL-1 gene cluster polymorphisms, is necessary to determine this hypothesis.
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Affiliation(s)
- Yukio Maruyama
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
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Higgins S, Mann D, Calkins H, Estes NAM, Strickberger SA, Breiter D, Lang D, Hahn S. One conversion of ventricular fibrillation is adequate for implantable cardioverter-defibrillator implant: An analysis from the Low Energy Safety Study (LESS). Heart Rhythm 2005; 2:117-22. [PMID: 15851281 DOI: 10.1016/j.hrthm.2004.10.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Accepted: 10/26/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to analyze defibrillation conversion data from the Low Energy Safety Study (LESS) to determine how implant criteria that use fewer inductions of ventricular fibrillation (VF) correlate with outcome and, in particular, to assess the reliability of using a single VF induction and test shock at 14 J. BACKGROUND A safety margin of 10 J has become standard for implantation of an implantable cardioverter-defibrillator (ICD), but the specifics and rigor of the implant test sequence are not standardized. METHODS In LESS, 611 ICD recipients completed a rigorous VF induction test scheme that began at 14 J and continued until the energy that succeeded three times without a failure was determined (DFT++). The data were analyzed to determine how well the outcome of the first 14-J shock and various other combinations of first and/or second shocks predicted a rigorous gold standard of DFT++ < or =21 J (i.e., three successes at < or =21 J). RESULTS The positive predictive accuracy for the 91% of patients in whom the first 14-J shock succeeded was virtually identical to the positive predictive accuracy for the commonly used criteria of two successes at < or =17 J (99.1% vs 99.0%, P = .69), and slightly higher than the positive predictive accuracy for two successes at < or =21 J (98.8%, P = .51). A single success at 17 J or 21 J had a somewhat lower positive predictive accuracy of 98.2% (P = .17). Eliminating VF induction testing would have resulted in a significantly lower positive predictive accuracy of 97.1% (P = .01). CONCLUSIONS A single conversion success at 14 J on the first VF induction provides similar positive predictive accuracy as two successes at 17 J or 21 J. Using this criterion, 91% of patients meet implant criteria with a single induction of ventricular fibrillation.
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Affiliation(s)
- Steven Higgins
- Scripps Memorial Hospital, La Jolla, California. 92037, USA.
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