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Wang J, Chu J, Song J, Li Z. The application of impantable sensors in the musculoskeletal system: a review. Front Bioeng Biotechnol 2024; 12:1270237. [PMID: 38328442 PMCID: PMC10847584 DOI: 10.3389/fbioe.2024.1270237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
As the population ages and the incidence of traumatic events rises, there is a growing trend toward the implantation of devices to replace damaged or degenerated tissues in the body. In orthopedic applications, some implants are equipped with sensors to measure internal data and monitor the status of the implant. In recent years, several multi-functional implants have been developed that the clinician can externally control using a smart device. Experts anticipate that these versatile implants could pave the way for the next-generation of technological advancements. This paper provides an introduction to implantable sensors and is structured into three parts. The first section categorizes existing implantable sensors based on their working principles and provides detailed illustrations with examples. The second section introduces the most common materials used in implantable sensors, divided into rigid and flexible materials according to their properties. The third section is the focal point of this article, with implantable orthopedic sensors being classified as joint, spine, or fracture, based on different practical scenarios. The aim of this review is to introduce various implantable orthopedic sensors, compare their different characteristics, and outline the future direction of their development and application.
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Affiliation(s)
- Jinzuo Wang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, Liaoning, China
| | - Jian Chu
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Jinhui Song
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Zhonghai Li
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, Liaoning, China
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Pascual D, Brauns L, Domes R, Tisler M, Kögel M, Stumpf A, Kirschniak A, Rolinger J, Kraushaar U, Jones PD. A flexible implant for acute intrapancreatic electrophysiology. Biomed Microdevices 2023; 25:35. [PMID: 37646842 DOI: 10.1007/s10544-023-00662-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 09/01/2023]
Abstract
Microelectrode arrays (MEAs) have proven to be a powerful tool to study electrophysiological processes over the last decades with most technology developed for investigation of the heart or brain. Other targets in the field of bioelectronic medicine are the peripheral nervous system and its innervation of various organs. Beyond the heart and nervous systems, the beta cells of the pancreatic islets of Langerhans generate action potentials during the production of insulin. In vitro experiments have demonstrated that their activity is a biomarker for blood glucose levels, suggesting that recording their activity in vivo could support patients suffering from diabetes mellitus with long-term automated read-out of blood glucose concentrations. Here, we present a flexible polymer-based implant having 64 low impedance microelectrodes designed to be implanted to a depth of 10 mm into the pancreas. As a first step, the implant will be used in acute experiments in pigs to explore the electrophysiological processes of the pancreas in vivo. Beyond use in the pancreas, our flexible implant and simple implantation method may also be used in other organs such as the brain.
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Affiliation(s)
- Domenic Pascual
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Lisa Brauns
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Ruth Domes
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | | | - Marco Kögel
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Angelika Stumpf
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Andreas Kirschniak
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
- Department of General and Visceral Surgery, Maria Hilf Hospital Mönchengladbach, Mönchengladbach, Germany
| | - Jens Rolinger
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
- Department of General and Visceral Surgery, Maria Hilf Hospital Mönchengladbach, Mönchengladbach, Germany
| | - Udo Kraushaar
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Peter D Jones
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany.
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McColgan G, Villarroel M, Gehmlich K. Should young athletes be screened for cardiomyopathies to reduce the burden of sudden cardiac death in athletes? Biophys Rev 2023; 15:321-327. [PMID: 37396442 PMCID: PMC10310562 DOI: 10.1007/s12551-023-01085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/21/2023] [Indexed: 07/04/2023] Open
Abstract
In this correspondence, we highlight the risk of sudden cardiac death associated with undiagnosed cardiomyopathies. Life-threatening arrhythmias, which underlie sudden cardiac death, can be triggered by high-intensity exercise. It raises the question whether, and if so, how athletes should be screened for cardiomyopathies. The example of practice from Italy is discussed. We also briefly discuss novel developments, such as wearable biosensors and machine learning, which could be applied to screening for cardiomyopathies in future.
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Affiliation(s)
- Grace McColgan
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Mauricio Villarroel
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, OX3 7DQ UK
| | - Katja Gehmlich
- Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, and British Heart Foundation Centre of Research Excellence Oxford, University of Oxford, Oxford, OX3 9DU UK
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Qian X, Chen X, Zhu L, Zhang QM. Fluoropolymer ferroelectrics: Multifunctional platform for polar-structured energy conversion. Science 2023; 380:eadg0902. [PMID: 37167372 DOI: 10.1126/science.adg0902] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Ferroelectric materials are currently some of the most widely applied material systems and are constantly generating improved functions with higher efficiencies. Advancements in poly(vinylidene fluoride) (PVDF)-based polymer ferroelectrics provide flexural, coupling-efficient, and multifunctional material platforms for applications that demand portable, lightweight, wearable, and durable features. We highlight the recent advances in fluoropolymer ferroelectrics, their energetic cross-coupling effects, and emerging technologies, including wearable, highly efficient electromechanical actuators and sensors, electrocaloric refrigeration, and dielectric devices. These developments reveal that the molecular and nanostructure manipulations of the polarization-field interactions, through facile defect biasing, could introduce enhancements in the physical effects that would enable the realization of multisensory and multifunctional wearables for the emerging immersive virtual world and smart systems for a sustainable future.
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Affiliation(s)
- Xiaoshi Qian
- State Key Laboratory of Mechanical System and Vibration, Interdisciplinary Research Centre, and MOE Key Laboratory for Power Machinery and Engineering, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Xin Chen
- Materials Research Institute and Department of Materials Science and Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - Lei Zhu
- Department of Macromolecular Science and Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Q M Zhang
- Materials Research Institute and Department of Materials Science and Engineering, The Pennsylvania State University, University Park, PA 16802, USA
- School of Electrical Engineering and Computer Science, The Pennsylvania State University, University Park, PA 16802, USA
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Courtney AM, Chandler JK, Anderson J, Shrestha A, Noheria A, Pimentel R, Dendi R, Ramirez R, Reddy YM, Sheldon SH. UltraSound Axillary Vein Access (USAA): Learning curve and randomized comparison to traditional venous access for cardiac device implantation. Pacing Clin Electrophysiol 2022; 45:1364-1371. [PMID: 36270271 DOI: 10.1111/pace.14611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/13/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Many techniques exist for venous access (VA) during cardiac implantable electronic device (CIED) implantation. OBJECTIVE We sought to evaluate the learning curve with ultrasound (US) guided axillary vein access (USAA). METHODS Single-center prospective randomized controlled trial of patients undergoing CIED implantation. Patients were randomized in a 2:1 fashion to USAA versus conventional VA techniques. The primary outcomes were the success rates, VA times and 30-day complication rates. RESULTS The study included 100 patients (age 68 ± 14 years, BMI 27 ± 4 kg/m2 ). USAA was successful in 66/70 implants (94%). Initial attempts at conventional VA included 47% axillary (n = 14), 30% (n = 9) cephalic, and 23% (n = 7) subclavian. The median access time was longer for USAA than conventional access (8.3 IQR 4.2-15.3 min vs. 5.2 IQR 3.4-8.6 min, p = .009). Among the five inexperienced USAA implanters, there was a significant improvement in median access time from first to last tertile of USAA implants (17.0 IQR 7.0-21.0 min to 8.6 IQR 4.5-10.8 min, p = .038). The experienced USAA implanter had similar access times with USAA compared with conventional access (4.0 IQR 3.3-4.7 min vs. 5.2 IQR 3.4-8.6 min, p = .15). Venograms were less common with USAA than conventional access (2% vs. 33%, p < .0001). The 30-day complication rate was similar with USAA (n = 4/70, 6%) versus conventional (n = 3/30, 10%, p = .44). CONCLUSION Although the success rate with USAA was high, there was a significant learning curve. Once experienced with the USAA technique, there is the potential for reduced complications without adding to the procedure duration.
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Affiliation(s)
- Alex M Courtney
- School of Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Jonathan K Chandler
- Department of Internal Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - John Anderson
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Amit Shrestha
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Rhea Pimentel
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Raghuveer Dendi
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Rigoberto Ramirez
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Y Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
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De Filippo P, Malanchini G, Ferrari P. Implantable cardioverted defibrillators: 40 years of history and beyond. Expert Rev Cardiovasc Ther 2022; 20:593-596. [PMID: 35799448 DOI: 10.1080/14779072.2022.2098116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Paolo De Filippo
- Cardiac Electrophysiology and Pacing Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giovanni Malanchini
- Cardiac Electrophysiology and Pacing Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paola Ferrari
- Cardiac Electrophysiology and Pacing Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
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Hu L, Peng K, Huang X, Wang Z, Wu Y, Zhu H, Ma J, Chen C. A novel strategy sequentially linking mechanical cardiopulmonary resuscitation with extracorporeal cardiopulmonary resuscitation optimizes prognosis of refractory cardiac arrest: an illustrative case series. Eur J Med Res 2022; 27:77. [PMID: 35643583 PMCID: PMC9145112 DOI: 10.1186/s40001-022-00711-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) to support cardiopulmonary resuscitation (CPR), also known as extracorporeal cardiopulmonary resuscitation (ECPR), has shown encouraging results in refractory cardiac arrest (RCA) resuscitation. However, its therapeutic benefits are linked to instant and uninterrupted chest compression (CC), besides early implementation. Mechanical CC can overcome the shortcomings of conventional manual CC, including fatigue and labor consumption, and ensure adequate blood perfusion. A strategy sequentially linking mechanical CPR with ECPR may earn extra favorable outcomes. Case series We present a four-case series with ages ranging from 8 to 94 years who presented with prolonged absences of return of spontaneous circulation (ROSC) after CA associated with acute fulminant myocarditis (AFM) and myocardial infarction (MI). All the cases received VA-ECMO (ROTAFLOW, Maquet) assisted ECPR, with intra-aortic balloon pump (IABP) or continuous renal replacement treatment (CRRT) appended if persistently low mean blood pressure (MAP) or ischemic kidney injury occurred. All patients have successfully weaned off ECMO and the assistant life support devices with complete neurological recovery. Three patients were discharged, except the 94-year-old patient who died of irreversible sepsis 20 days after ECMO weaning-off. These encouraging results will hopefully lead to more consideration of this lifesaving therapy model that sequentially integrates mechanical CPR with ECPR to rescue RCA related to reversible cardiac causes. Conclusions This successful case series should lead to more consideration of an integrated lifesaving strategy sequentially linking mechanical cardiopulmonary resuscitation with ECPR, as an extra favorable prognosis of refractory cardiac arrest related to this approach can be achieved. Supplementary Information The online version contains supplementary material available at 10.1186/s40001-022-00711-1.
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Pallikadavath S, Vali Z, Patel R, Mavilakandy A, Peckham N, Clegg M, Sandilands AJ, Ng GA. The Influence of Environmental Air Pollution on Ventricular Arrhythmias: A Scoping Review. Curr Cardiol Rev 2022; 18:e160422203685. [PMID: 35430968 PMCID: PMC9893149 DOI: 10.2174/1573403x18666220416203716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/07/2021] [Accepted: 01/16/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Exposure to air pollution is a recognised risk factor for cardiovascular disease and has been associated with supraventricular arrhythmias. The effect of air pollution on ventricular arrhythmias is less clear. This scoping review assessed the effects of particulate and gaseous air pollutants on the incidence of ventricular arrhythmias. METHODS MEDLINE and EMBASE databases were searched for studies assessing the effects of air pollutants on ventricular tachycardia and ventricular fibrillation. These pollutants were particulate matter (PM) 2.5, PM10, Nitrogen Dioxide (NO2), Carbon Monoxide (CO), Sulphur Dioxide (SO2), and Ozone (O3). RESULTS This review identified 27 studies: nine in individuals with implantable cardioverter defibrillators, five in those with ischaemic heart disease, and 13 in the general population. Those with ischaemic heart disease appear to have the strongest association with ventricular arrhythmias in both gaseous and particulate pollution, with all three studies assessing the effects of PM2.5 demonstrating some association with ventricular arrythmia. Results in the general and ICD population were less consistent. CONCLUSION Individuals with ischaemic heart disease may be at an increased risk of ventricular arrhythmias following exposure to air pollution.
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Affiliation(s)
- Susil Pallikadavath
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Zakariyya Vali
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Roshan Patel
- Leicester Medical School, College of Life Sciences, University of Leicester, UK
| | - Akash Mavilakandy
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Nicholas Peckham
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Matt Clegg
- Department of Geography, University of Birmingham, Birmingham, UK
| | - Alastair J. Sandilands
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - G. André Ng
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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Syed MK, Sheikh HI, McKay B, Tseng N, Pakosh M, Caterini JE, Sharma A, Colella TJ, Konieczny KM, Connelly KA, Graham MM, McDonald M, Banks L, Randhawa VK. Sex, Race, and Age Differences in Cardiovascular Outcomes in Implantable Cardioverter–Defibrillator Randomized Controlled Trials: A Systematic Review and Meta-analysis. CJC Open 2021; 3:S209-S217. [PMID: 34993451 PMCID: PMC8712708 DOI: 10.1016/j.cjco.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/16/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Mohammad K. Syed
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Hassan I. Sheikh
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Bradley McKay
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Nicholas Tseng
- Faculty of Biomedical Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto, Ontario, Canada
| | | | - Abhinav Sharma
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tracey J.F. Colella
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, Faculty of Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Kaja M. Konieczny
- Department of Cardiology, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Kim A. Connelly
- Department of Cardiology, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Michelle M. Graham
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michael McDonald
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Laura Banks
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Corresponding author: Dr Laura Banks, Affiliate Scientist, University Health Network, Assistant Teaching Professor, Faculty of Health Sciences, Ontario Tech University, KITE, Toronto Rehabilitation Institute, Cardiovascular Prevention & Rehabilitation Program, 347 Rumsey Rd, Toronto, Ontario M4G 1R7, Canada. Tel.: +1-416-597-3422; fax: +1-416-425-0301.
| | - Varinder Kaur Randhawa
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Hosur S, Sriramdas R, Karan SK, Liu N, Priya S, Kiani M. A Comprehensive Study on Magnetoelectric Transducers for Wireless Power Transfer Using Low-Frequency Magnetic Fields. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2021; 15:1079-1092. [PMID: 34623276 DOI: 10.1109/tbcas.2021.3118981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Magnetoelectric (ME) transducers, comprising of layered magnetostrictive and piezoelectric materials, are more efficient than inductive coils in converting low-frequency magnetic fields into electric fields, particularly in applications that require miniaturized devices such as biomedical implants. Therefore, ME transducers are an attractive candidate for wireless power transfer (WPT) using low-frequency magnetic fields, which are less harmful to the human body and can penetrate easily through different lossy media. The literature lacks a comprehensive study on the ME transducer as a power receiver in a WPT link. This paper studies the impact of different ME design parameters on the WPT link performance. An accurate analytical model of the ME transducer, operating in the longitudinal-transverse mode, is presented, describing both temporal and spatial deformations. Nine ME transducers with different sizes (ME volume: 5-150 mm3) were fabricated with Galfenol and PZT-5A as magnetostrictive and piezoelectric layers, respectively. Through the modeling and measurement of these ME transducers, the effects of the ME transducer dimension, DC bias magnetic field, loading (RL), and operation frequency on the resonance frequency, quality factor, and received power (PL) of the ME transducer are determined. In measurements, a 150 mm3 ME transducer achieved > 10-fold higher PL for a wide RL range of 500 Ω to 1 MΩ at 95.5 kHz, compared to an optimized coil with comparable size and operation frequency.
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Surendran PJ, Jacob P, Selvamani D, Papasavvas T, Swaminathan N, Mathew G, Praveen R. Upper extremity dysfunctions in patients with cardiac implantable electronic devices: a systematic review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background/Aims The prevalence of cardiac implantable electronic devices has risen considerably during recent years. This has revolutionised the treatment of cardiac arrhythmias, which in turn reduced the incidence of sudden cardiac death. There are several complications associated with cardiac implantable electronic device implantation. Upper extremity dysfunction is one of the complications associated with this procedure and it should be addressed, since it can affect activities of daily living. This systematic review analysed the prevailing evidence pertaining to the common upper extremity dysfunctions associated with receiving a cardiac implantable electronic device. Methods A comprehensive literature search was conducted using PubMed, Cochrane Central Register of Controlled Trials, EMBASE (through Cochrane) and Google Scholar for original research published in the English language. The Rayyan QCRI web application was used for study selection and the decision-making process. PRISMA guidelines were used to conduct and report this review. The methodological quality of the included studies was appraised using the Newcastle–Ottawa Scale and Joanna Briggs Institute critical appraisal tool for analytic cross-sectional studies and case reports. Results This systematic review included eight studies with a total of 696 participants. The most common upper extremity dysfunctions associated with receiving a cardiac implantable electronic device were pain and limitation of shoulder range of motion. Limitation of range of motion could be persisted even in the long term after having a cardiac implantable electronic device implanted. Conclusions Contributing factors of upper extremity dysfunctions included size of the device, pectoral site of implantation and upper extremity immobilisation practices. Upper extremity dysfunction is an overlooked complication, as it received a relatively low priority, although it may negatively impact quality of life.
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Affiliation(s)
| | - Prasobh Jacob
- Department of Cardiac Rehabilitation, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Dineshkumar Selvamani
- Department of Cardiac Rehabilitation, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Theodoros Papasavvas
- Department of Cardiac Rehabilitation, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Narasimman Swaminathan
- Faculty of Allied health sciences and Physiotherapy, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Gigi Mathew
- Department of Cardiac Rehabilitation, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Reshma Praveen
- Department of Physiotherapy, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Richardson CJ, Prempeh J, Gordon KS, Poyser TA, Tiesenga F. Surgical Techniques, Complications, and Long-Term Health Effects of Cardiac Implantable Electronic Devices. Cureus 2021; 13:e13001. [PMID: 33659133 PMCID: PMC7920239 DOI: 10.7759/cureus.13001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Cardiovascular implantable electronic device (CIED) has helped with advanced technological improvement in the cardiac field and has been a long-term alternative to medical management. There are different forms of CIEDs such as pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy. These devices are efficient in establishing near-normal hemodynamics and circulation that ultimately aid physicians to improve the quality of life for their patients. However, there are risk factors that can result in postoperative complications, including infection, lead and pulse generator complications, heart complications, medication-related complications, and psychosocial complications. To ensure optimal outcome of CIED placement, preprocedural measures need to be in place such as matching the right candidate and using appropriate devices. This review aims to highlight the surgical techniques for CIEDs, the associated postoperative complications, and long-term health effects.
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Affiliation(s)
| | - John Prempeh
- Internal Medicine, Saint James School of Medicine, The Quarter, AIA
| | - Kyle S Gordon
- Internal Medicine, American University of Antigua, Osburn, ATG
| | - Tracy-Ann Poyser
- Internal Medicine, Windsor University School of Medicine, Cayon, KNA
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Chandler JK, Apte N, Ranka S, Mohammed M, Noheria A, Emert M, Pimentel R, Dendi R, Reddy M, Sheldon SH. Ultrasound guided axillary vein access: An alternative approach to venous access for cardiac device implantation. J Cardiovasc Electrophysiol 2021; 32:458-465. [PMID: 33337570 DOI: 10.1111/jce.14846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/21/2020] [Accepted: 11/05/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Ultrasound guided axillary vein access (UGAVA) is an emerging approach for cardiac implantable electronic device (CIED) implantation not widely utilized. METHODS AND RESULTS This is a retrospective, age and sex-matched cohort study of CIED implantation from January 2017 to July 2019 comparing UGAVA before incision to venous access obtained after incision without ultrasound (conventional). The study population included 561 patients (187 with attempted UGAVA, 68 ± 13 years old, 43% women, body mass index (BMI) 30 ± 8 kg/m2 , 15% right-sided, 43% implantable cardioverter-defibrillator, 15% upgrades). UGAVA was successful in 178/187 patients (95%). In nine patients where UGAVA was abandoned, the vein was too deep for access before incision. BMI was higher in abandoned patients than successful UGAVA (38 ± 6 vs. 28 ± 6 kg/m2 , p < .0001). Median time from local anesthetic to completion of UGAVA was 7 min (interquartile range [IQR]: 4-10) and median procedure time 61 min (IQR: 50-92). UGAVA changed implant laterality in two patients (avoiding an extra incision in both) and could have prevented unnecessary incision in four conventional patients. Excluding device upgrades, there was reduced fluoroscopy time in UGAVA versus conventional (4 vs. 6 min; IQR: 2-5 vs. 4-9; p < .001). Thirty-day complications were similar in UGAVA versus conventional (n = 7 vs. 26, 4 vs. 7%; p = .13, p = .41 adjusting for upgrades), partly driven by a trend towards reduced pneumothorax (n = 0 vs. 3, 0 vs. 1%; p = .22). CONCLUSIONS UGAVA is a safe approach for CIED implantation and helps prevent an extra incision if a barrier is identified changing laterality preincision.
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Affiliation(s)
- Jonathan K Chandler
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Nachiket Apte
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Sagar Ranka
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Moghniuddin Mohammed
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Martin Emert
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Rhea Pimentel
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Raghuveer Dendi
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
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Niaz T, Bos JM, Sorensen KB, Moir C, Ackerman MJ. Left Cardiac Sympathetic Denervation Monotherapy in Patients With Congenital Long QT Syndrome. Circ Arrhythm Electrophysiol 2020; 13:e008830. [DOI: 10.1161/circep.120.008830] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Videoscopic left cardiac sympathetic denervation (LCSD) is an effective antifibrillatory, minimally invasive therapy for patients with potentially life-threatening arrhythmia syndromes like long QT syndrome (LQTS). Although initially used primarily for treatment intensification following documented LQTS-associated breakthrough cardiac events while on beta-blockers, LCSD as 1-time monotherapy for certain patients with LQTS requires further evaluation. We are presenting our early experience with LCSD monotherapy for carefully selected patients with LQTS.
Methods:
Among the 1400 patients evaluated and treated for LQTS, a retrospective review was performed on the 204 patients with LQTS who underwent LCSD at our institution since 2005 to identify the patients where the LCSD served as stand-alone, monotherapy. Clinical data on symptomatic status before diagnosis, clinical, and genetic diagnosis, and breakthrough cardiac events after diagnosis were analyzed to determine efficacy of LCSD monotherapy.
Result:
Overall, 64 of 204 patients (31%) were treated with LCSD alone (37 [58%] female, mean QTc 466±30 ms, 16 [25%] patients were symptomatic before diagnosis with a mean age at diagnosis 17.3±11.8 years, 5 had [8%] ≥1 breakthrough cardiac event after diagnosis, and mean age at LCSD was 21.1±11.4 years). The primary motivation for LCSD monotherapy was an unacceptable quality of life stemming from beta-blocker related side effects (ie, beta-blocker intolerance) in 56/64 patients (88%). The underlying LQTS genotype was LQT1 in 36 (56%) and LQT2 in 20 (31%). There were no significant LCSD-related surgical complications. With a mean follow-up of 2.7±2.4 years so far, only 3 patients have experienced a nonlethal, post-LCSD breakthrough cardiac event in 180 patient-years.
Conclusions:
LCSD may be a safe and effective stand-alone therapy for select patients who do not tolerate beta-blockers. However, LCSD is not curative and patient selection will be critical when potentially considering LCSD as monotherapy.
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Affiliation(s)
- Talha Niaz
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Windland Smith Rice Genetic Heart Rhythm Clinic (T.N., J.M.B., M.J.A.), Mayo Clinic, Rochester, MN
| | - J. Martijn Bos
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Windland Smith Rice Genetic Heart Rhythm Clinic (T.N., J.M.B., M.J.A.), Mayo Clinic, Rochester, MN
- Department of Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory) (J.M.B., K.B.S., M.J.A.), Mayo Clinic, Rochester, MN
| | - Katrina B. Sorensen
- Department of Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory) (J.M.B., K.B.S., M.J.A.), Mayo Clinic, Rochester, MN
| | - Christopher Moir
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine (J.M.B., K.B.S., M.J.A.), Mayo Clinic, Rochester, MN
| | - Michael J. Ackerman
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Windland Smith Rice Genetic Heart Rhythm Clinic (T.N., J.M.B., M.J.A.), Mayo Clinic, Rochester, MN
- Department of Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory) (J.M.B., K.B.S., M.J.A.), Mayo Clinic, Rochester, MN
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15
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Zhao J, Ghannam R, Htet KO, Liu Y, Law M, Roy VAL, Michel B, Imran MA, Heidari H. Self-Powered Implantable Medical Devices: Photovoltaic Energy Harvesting Review. Adv Healthc Mater 2020; 9:e2000779. [PMID: 32729228 DOI: 10.1002/adhm.202000779] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/09/2020] [Indexed: 12/21/2022]
Abstract
Implantable technologies are becoming more widespread for biomedical applications that include physical identification, health diagnosis, monitoring, recording, and treatment of human physiological traits. However, energy harvesting and power generation beneath the human tissue are still a major challenge. In this regard, self-powered implantable devices that scavenge energy from the human body are attractive for long-term monitoring of human physiological traits. Thanks to advancements in material science and nanotechnology, energy harvesting techniques that rely on piezoelectricity, thermoelectricity, biofuel, and radio frequency power transfer are emerging. However, all these techniques suffer from limitations that include low power output, bulky size, or low efficiency. Photovoltaic (PV) energy conversion is one of the most promising candidates for implantable applications due to their higher-power conversion efficiencies and small footprint. Herein, the latest implantable energy harvesting technologies are surveyed. A comparison between the different state-of-the-art power harvesting methods is also provided. Finally, recommendations are provided regarding the feasibility of PV cells as an in vivo energy harvester, with an emphasis on skin penetration, fabrication, encapsulation, durability, biocompatibility, and power management.
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Affiliation(s)
- Jinwei Zhao
- James Watts school of Engineering University of Glasgow Glasgow G12 8QQ UK
| | - Rami Ghannam
- James Watts school of Engineering University of Glasgow Glasgow G12 8QQ UK
| | - Kaung Oo Htet
- James Watts school of Engineering University of Glasgow Glasgow G12 8QQ UK
| | - Yuchi Liu
- James Watts school of Engineering University of Glasgow Glasgow G12 8QQ UK
| | - Man‐kay Law
- State Key Laboratory of Analog and Mixed‐Signal VLSI AMSV University of Macao Macao China
| | | | - Bruno Michel
- Smart System Integration IBM Research GmbH Rueschlikon CH‐8803 Switzerland
| | - Muhammad Ali Imran
- James Watts school of Engineering University of Glasgow Glasgow G12 8QQ UK
| | - Hadi Heidari
- James Watts school of Engineering University of Glasgow Glasgow G12 8QQ UK
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16
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Ahmed AS, Gilge JL, Clark BA, Shah A, Bagga S, Padanilam MS, Prystowsky EN, Joshi SA, Nair GV, Patel PJ. Predictors of successful ultrasound‐guided lead implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:217-222. [DOI: 10.1111/pace.13855] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/12/2019] [Accepted: 12/02/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Asim S. Ahmed
- St. Vincent Medical GroupSt. Vincent Hospital Indianapolis Indiana
| | - Jasen L. Gilge
- St. Vincent Medical GroupSt. Vincent Hospital Indianapolis Indiana
| | - Brad A. Clark
- St. Vincent Medical GroupSt. Vincent Hospital Indianapolis Indiana
| | - Ankur Shah
- Doctors Hospital—OhioHealth Columbus Ohio
| | - Shiv Bagga
- St. Vincent Medical GroupSt. Vincent Hospital Indianapolis Indiana
| | | | | | - Sandeep A. Joshi
- St. Vincent Medical GroupSt. Vincent Hospital Indianapolis Indiana
| | - Girish V. Nair
- St. Vincent Medical GroupSt. Vincent Hospital Indianapolis Indiana
| | - Parin J. Patel
- St. Vincent Medical GroupSt. Vincent Hospital Indianapolis Indiana
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17
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Kazmi SHA, Datta S, Chi G, Nafee T, Yee M, Kalia A, Sharfaei S, Shojaei F, Mirwais S, Gibson CM. The AngelMed Guardian ® System in the Detection of Coronary Artery Occlusion: Current Perspectives. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:1-12. [PMID: 32021496 PMCID: PMC6954830 DOI: 10.2147/mder.s219865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/13/2019] [Indexed: 11/23/2022] Open
Abstract
Total ischemic time, which specifies the time from the onset of chest pain to initiation of reperfusion during percutaneous coronary intervention, consists of two intervals: symptom to door time and door to balloon time. A door to balloon time of 90 mins or less has become a quality-of-care metric in the management of ST elevation myocardial infarction (STEMI). While national efforts made by the American College of Cardiology (ACC) and American Heart Association (AHA) have curtailed in-hospital door to balloon time over the years, a reduction in pre-hospital symptoms to door time presents a challenge in modern interventional Cardiology. Early and complete revascularization has been associated with improved clinical outcomes in MI and strategies that may help reduce symptom to door time, and thus the total ischemic time, are crucial. Rapidly evolving ST-segment changes commonly develop prior to ischemia-related symptom onset, and are detectable even in patients with clinically unrecognized silent MIs. Therefore, a highly intelligent ischemia detection system that alerts patients of ST segment deviation may allow for rapid identification of acute coronary occlusion. The AngelMed Guardian® System is a cardiac activity monitoring and alerting system designed for rapid identification of intracardiac ST-segment changes among patients at a high risk for recurrent ACS events. This article reviews the clinical studies evaluating the design, safety and efficacy of the AngelMed Guardian System and discusses the clinical implications of the device.
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Affiliation(s)
- Syed Hassan Abbas Kazmi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sudarshana Datta
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Gerald Chi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tarek Nafee
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Megan Yee
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Akshun Kalia
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sadaf Sharfaei
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Fahimehalsadat Shojaei
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sabawoon Mirwais
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - C Michael Gibson
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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18
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Chatterjee S, Saxena M, Padmanabhan D, Jayachandra M, Pandya HJ. Futuristic medical implants using bioresorbable materials and devices. Biosens Bioelectron 2019; 142:111489. [DOI: 10.1016/j.bios.2019.111489] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/19/2019] [Accepted: 06/29/2019] [Indexed: 12/16/2022]
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Méndez-Flórez J, Agudelo-Zapata Y, Torres Villarreal MC, Paola-León L, Guarín-Loaiza G, Torres-Saavedra F, Burgos-Cárdenas Á, Mora-Pabón G. Uso de desfibriladores implantables y terapia de resincronización cardiaca en ancianos mayores de 70 a 80 años: controversias y evidencia. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2019.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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A Clinical Review of Common Medications Used in Emergency Dermatological Situations. Dermatol Surg 2019; 45:652-657. [PMID: 31034446 DOI: 10.1097/dss.0000000000001789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medical emergencies can occur in any environment, including dermatologic and procedural surgical settings. There are many options available to dermatologic surgeons, which they should consider having easily accessible in the office in case an emergency arises. OBJECTIVE To summarize the current understanding about major medications that should be on-hand during dermatological surgeries. To review their mechanism of action, examine their general use, and dermatological use during surgical emergencies. METHODS AND MATERIALS A comprehensive review using PubMed was performed, searching for studies using these various medications in relation to cutaneous surgeries. RESULTS Distinct items such as hyaluronidase, nitroglycerin paste, aspirin, injectable epinephrine, and defibrillators are potential options to address various emergencies and should be readily accessible to dermatologic surgeons. CONCLUSION Dermatologic surgeons' knowledge of key medications and options to have in the office allow for a proper response in the event an emergency arises.
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21
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Palese A, Cracina A, Purino M, Urli N, Fabris S, Danielis M. The experiences of patients electrically shocked by an implantable cardioverter defibrillator: Findings from a descriptive qualitative study. Nurs Crit Care 2019; 25:229-237. [DOI: 10.1111/nicc.12424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Alvisa Palese
- Department of Medical SciencesUdine University Udine Italy
| | | | - Michela Purino
- Neonatal Intensive Care UnitAzienda Sanitaria Universitaria Integrata di Udine Udine Italy
| | - Nadia Urli
- Pediatric UnitAzienda per l'Assistenza Sanitaria Udine Italy
| | - Stefano Fabris
- Department of Medical SciencesUdine University Udine Italy
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22
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Godino C, Giannattasio A, Scotti A, Baldetti L, Pivato CA, Munafò A, Cappelletti A, Beneduce A, Melillo F, Chiarito M, Biondi Zoccai G, Frati G, Fragasso G, Azzalini L, Carlino M, Montorfano M, Margonato A, Colombo A. Risk of cardiac and sudden death with and without revascularisation of a coronary chronic total occlusion. Heart 2019; 105:1096-1102. [PMID: 30792237 DOI: 10.1136/heartjnl-2018-314076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/28/2018] [Accepted: 01/14/2019] [Indexed: 02/05/2023] Open
Abstract
ObjectiveThe aim of this study is to evaluate the long-term risk of cardiac death and sudden cardiac death (SCD) and/or sustained ventricular arrhythmias (SVAs) in patients with coronary chronic total occlusions (CTO) revascularised versus those with CTO not revascularised by percutaneous coronary intervention (PCI).MethodsFrom a cohort of 1357 CTO-PCI patients, 1162 patients who underwent CTO PCI attempt were included in this long-term analysis: 837 patients were revascularised by PCI (CTO-R group) and 325 were not revascularised (CTO-NR group). Primary adverse endpoint was the incidence of cardiac death; secondary endpoint was the cumulative incidence of SCD/SVAs.ResultsUp to 12-year follow-up (median 6 year), compared with CTO-R patients, those with CTO-NR had significantly higher rate of cardiac death (13%[43/325]vs6%[48/837]; p<0.001) and SCD/SVAs (7.5%[24/325]vs2.5%[20/837]; p<0.001). The risk of cardiac death and SCD/SVAs was mainly driven by the subgroup of infarct-related artery (IRA) CTO patients and was significantly higher only in IRA CTO-NR patients (18%vs7%, p<0.001, 14%vs5%, p=0.001; IRA CTO-NR vs IRA CTO-R, respectively). At multivariable Cox hazards regression analysis, CTO-NR remains one of the strongest independent predictors of higher risk of cardiac death and of SCD/SVAs in the overall population and in IRA CTO patients.ConclusionsAt long-term follow-up, patients with CTO not revascularised by PCI had worse outcomes compared with those with CTO revascularised, with >2-fold risk of cardiac death and threefold risk of SCD/SVAs. The presence of an infarct-related artery (IRA CTO) not revascularised identified the category of patients with the highest rate of adverse events .
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Affiliation(s)
- Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessia Giannattasio
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luca Baldetti
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Andrea Munafò
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Cappelletti
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Melillo
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Chiarito
- Interventional Cardiology Unit, Istituto Clinico Humanitas, Milan, Italy
| | - Giuseppe Biondi Zoccai
- Division of Cardiology, IRCCS Neuromed, Pozzilli, Italy
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Giacomo Frati
- Division of Cardiology, IRCCS Neuromed, Pozzilli, Italy
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Gabriele Fragasso
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Azzalini
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
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Abstract
Biodegradable batteries play an important role in fully degradable biomedical or environmental systems. The development of biodegradable batteries faces many challenges including power content, device compactness, performance stability, shelf and functional lifetime. In particular, a key driver in the lifetime and overall size of microfabricated biodegradable batteries is the liquid electrolyte volume. Harnessing liquid from the environment to serve as the battery electrolyte may, therefore, be desirable; however, for stable operation, maintaining a constant electrochemical environment inside the cell is required even in the presence of changing body or environmental conditions. We report a biodegradable battery featuring a solid electrolyte of sodium chloride and polycaprolactone. This approach harnesses the body fluid that diffuses into the cell as an element of the electrolyte; however, the large excess of sodium chloride suspended in the polycaprolactone holds intracell ionic conditions constant. A constant discharge profile can then be achieved even in the presence of varying external aqueous conditions, enabling compact, stable-performing cells. This design also features easy integration and automatic activation, providing a simplified strategy to fabricate batteries with long shelf life and desirable functional life span. In addition, the polymeric skeleton of the solid electrolyte system acts as an insulating layer between electrodes, preventing the metallic structure from short-circuit during discharge.
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24
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Khera R, Pandey A, Link MS, Sulistio MS. Managing Implantable Cardioverter-Defibrillators at End-of-Life: Practical Challenges and Care Considerations. Am J Med Sci 2018; 357:143-150. [PMID: 30665495 DOI: 10.1016/j.amjms.2018.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 11/18/2018] [Accepted: 11/26/2018] [Indexed: 01/11/2023]
Abstract
Implantable cardioverter-defibrillators (ICDs) monitor for and terminate malignant arrhythmias. Given their potential as a life-saving therapy, an increasing number of people receive an ICD every year, and a growing number are currently living with ICDs. However, cardiopulmonary arrest serves as the final common pathway of natural death, and the appropriate management of an ICD near the end-of-life is crucial to ensure that a patient's death is not marked by further suffering due to ICD shocks. The tenets of palliative care at the end-of-life include addressing any medical intervention that may preclude dying with dignity; thus, management of ICDs during this phase is necessary. Internists are at the forefront of discussions about end-of-life care, and are likely to find discussions about ICD care at the end-of-life particularly challenging. The present review addresses issues pertaining to ICDs near the end of a patient's life and their potential impact on dying patients and their families. A multidisciplinary, patient-centered approach can ensure that patients receive the maximum benefit from ICDs, without any unintended pain or suffering.
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Affiliation(s)
- Rohan Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mark S Link
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Melanie S Sulistio
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
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25
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Ibrahim A, Meng M, Kiani M. A Comprehensive Comparative Study on Inductive and Ultrasonic Wireless Power Transmission to Biomedical Implants. IEEE SENSORS JOURNAL 2018; 18:3813-3826. [PMID: 30344453 PMCID: PMC6192045 DOI: 10.1109/jsen.2018.2812420] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This paper presents a comprehensive comparison between inductive coupling and ultrasound for wireless power transmission (WPT) to biomedical implants. Several sets of inductive and ultrasonic links for different powering distances (d 12) and receiver dimensions have been optimized, and their key parameters, including power transmission efficiency (PTE) and power delivered to the load (PDL) within safety constraints, have been compared to find out which method is optimal for any given condition. Two design procedures have been presented for maximizing the PTE of inductive and ultrasonic links by finding the optimal geometry for the transmitter (Tx) and receiver (Rx) coils and ultrasonic transducers as well as the optimal operation frequency (fp ). Our simulation and measurement results showed that the ultrasonic link transcends the inductive link in PTE and somewhat in PDL for a small Rx of 1.1 mm3 (diameter of 1.2 mm), particularly when the Rx was deeply implanted inside the tissue (d 12 ≥ 10 mm). However, for a larger 20 mm3 Rx (diameter of 5 mm), the inductive link achieved higher PTE and PDL, particularly at shorter distances (d 12 < 30 mm). The optimal loading condition is shown to be quite different in inductive and ultrasonic links. Despite higher performance for small Rx and large d 12, the ultrasonic link is more sensitive to Rx misalignments and orientations. This led us to propose a new design procedure based on the worst-case misalignment scenario. The simulation results have been validated by measurements. The inductive and ultrasonic links, operating at 30 MHz and 1.1 MHz, achieved measured PTEs of 0.05% and 0.65% for the 1.1 mm3 Rx located 30 mm inside tissue and oil environments with optimal load resistances of 295 Ω and 3.8 kΩ, respectively.
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Affiliation(s)
- Ahmed Ibrahim
- Electrical Engineering Department at the Pennsylvania State University, University Park, PA 16802, USA
| | - Miao Meng
- Electrical Engineering Department at the Pennsylvania State University, University Park, PA 16802, USA
| | - Mehdi Kiani
- Electrical Engineering Department at the Pennsylvania State University, University Park, PA 16802, USA
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26
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Advances in Materials for Recent Low-Profile Implantable Bioelectronics. MATERIALS 2018; 11:ma11040522. [PMID: 29596359 PMCID: PMC5951368 DOI: 10.3390/ma11040522] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 03/20/2018] [Accepted: 03/26/2018] [Indexed: 12/28/2022]
Abstract
The rapid development of micro/nanofabrication technologies to engineer a variety of materials has enabled new types of bioelectronics for health monitoring and disease diagnostics. In this review, we summarize widely used electronic materials in recent low-profile implantable systems, including traditional metals and semiconductors, soft polymers, biodegradable metals, and organic materials. Silicon-based compounds have represented the traditional materials in medical devices, due to the fully established fabrication processes. Examples include miniaturized sensors for monitoring intraocular pressure and blood pressure, which are designed in an ultra-thin diaphragm to react with the applied pressure. These sensors are integrated into rigid circuits and multiple modules; this brings challenges regarding the fundamental material’s property mismatch with the targeted human tissues, which are intrinsically soft. Therefore, many polymeric materials have been investigated for hybrid integration with well-characterized functional materials such as silicon membranes and metal interconnects, which enable soft implantable bioelectronics. The most recent trend in implantable systems uses transient materials that naturally dissolve in body fluid after a programmed lifetime. Such biodegradable metallic materials are advantageous in the design of electronics due to their proven electrical properties. Collectively, this review delivers the development history of materials in implantable devices, while introducing new bioelectronics based on bioresorbable materials with multiple functionalities.
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27
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AlTurki A, Proietti R, Alturki H, Essebag V, Huynh T. Implantable cardioverter-defibrillator use in elderly patients receiving cardiac resynchronization: A meta-analysis. Hellenic J Cardiol 2018; 60:276-281. [PMID: 29292244 DOI: 10.1016/j.hjc.2017.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/09/2017] [Accepted: 12/07/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) reduce sudden cardiac death and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). Current guidelines do not suggest any upper age limit for ICD and CRT but recommend avoidance of ICD and CRT in frail patients with a life expectancy of less than 1 year. It remains unclear whether elderly patients undergoing CRT derive the same additional benefit from ICDs as younger patients. We aimed to assess the use of ICDs in elderly compared to younger patients receiving CRT. METHODS We searched electronic databases, up to April 11, 2016, for all studies reporting on ICD use stratified by age in patients who received CRT. We used random-effects meta-analysis models to calculate the summarized baseline characteristics and rates of implantation of ICD among patients enrolled in the studies. RESULTS We retained six observational studies enrolling 613 patients ≥75 years old and 2810 patients <75 years old. The aggregate mean age was 82.7 years for the elderly patients compared to 66.3 years in the younger patients. There was a significantly lower use of ICDs in elderly patients compared to that in younger patients (37.9% versus 64.3%) (odds ratio: 0.26; 95% confidence intervals: 0.14-0.46; p < 0.0001). CONCLUSIONS In conclusion, ICD was less frequently used in patients ≥75 years old receiving CRT compared to younger patients receiving CRT. Future studies that evaluate the efficacy and effectiveness of ICDs in elderly patients with indications for CRT are needed to guide management of this increasing population.
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Affiliation(s)
- Ahmed AlTurki
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Cardiology, McGill University Health Center, Quebec, Canada.
| | - Riccardo Proietti
- Cardiology Department, Morriston Hospital, Swansea University, Swansea, UK
| | - Hasan Alturki
- University College Dublin. School of Medicine, Dublin, Ireland
| | - Vidal Essebag
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Cardiology, McGill University Health Center, Quebec, Canada
| | - Thao Huynh
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Cardiology, McGill University Health Center, Quebec, Canada
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Klosterhoff BS, Tsang M, She D, Ong KG, Allen MG, Willett NJ, Guldberg RE. Implantable Sensors for Regenerative Medicine. J Biomech Eng 2017; 139:2594421. [PMID: 27987300 DOI: 10.1115/1.4035436] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Indexed: 01/05/2023]
Abstract
The translation of many tissue engineering/regenerative medicine (TE/RM) therapies that demonstrate promise in vitro are delayed or abandoned due to reduced and inconsistent efficacy when implemented in more complex and clinically relevant preclinical in vivo models. Determining mechanistic reasons for impaired treatment efficacy is challenging after a regenerative therapy is implanted due to technical limitations in longitudinally measuring the progression of key environmental cues in vivo. The ability to acquire real-time measurements of environmental parameters of interest including strain, pressure, pH, temperature, oxygen tension, and specific biomarkers within the regenerative niche in situ would significantly enhance the information available to tissue engineers to monitor and evaluate mechanisms of functional healing or lack thereof. Continued advancements in material and fabrication technologies utilized by microelectromechanical systems (MEMSs) and the unique physical characteristics of passive magnetoelastic sensor platforms have created an opportunity to implant small, flexible, low-power sensors into preclinical in vivo models, and quantitatively measure environmental cues throughout healing. In this perspective article, we discuss the need for longitudinal measurements in TE/RM research, technical progress in MEMS and magnetoelastic approaches to implantable sensors, the potential application of implantable sensors to benefit preclinical TE/RM research, and the future directions of collaborative efforts at the intersection of these two important fields.
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Affiliation(s)
- Brett S Klosterhoff
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332;Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
| | - Melissa Tsang
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332
| | - Didi She
- Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104
| | - Keat Ghee Ong
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931
| | - Mark G Allen
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332;Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104
| | - Nick J Willett
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332;Department of Orthopaedics, Emory University, Atlanta, GA 30303;Atlanta Veteran's Affairs Medical Center, Decatur, GA 30033;Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332
| | - Robert E Guldberg
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332;Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
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Amiaz R, Asher E, Rozen G, Czerniak E, Levi L, Weiser M, Glikson M. Reduction in depressive symptoms in primary prevention ICD scheduled patients - One year prospective study. Gen Hosp Psychiatry 2017; 48:37-41. [PMID: 28917393 DOI: 10.1016/j.genhosppsych.2017.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/16/2017] [Accepted: 06/29/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Implantable Cardioverter Defibrillators (ICDs), have previously been associated with the onset of depression and anxiety. The aim of this one-year prospective study was to evaluate the rate of new onset psychopathological symptoms after elective ICD implantation. METHODS A total of 158 consecutive outpatients who were scheduled for an elective ICD implantation were diagnosed and screened based on the Mini International Neuropsychiatric Interview (MINI). Depression and anxiety were evaluated using the Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A). Patient's attitude toward the ICD device was evaluated using a Visual Analog Scale (VAS). RESULTS Patients' mean age was 64±12.4years; 134 (85%) were men, with the majority of patients performing the procedure for reasons of 'primary prevention'. According to the MINI diagnosis at baseline, three (2%) patients suffered from major depressive disorder and ten (6%) from dysthymia. Significant improvement in HAM-D mean scores was found between baseline, three months and one year after implantation (6.50±6.4; 4.10±5.3 and 2.7±4.6, respectively F(2100)=16.42; p<0.001). There was a significantly more positive attitude toward the device over time based on the VAS score [F(2122)=53.31, p<0.001]. CONCLUSIONS ICD implantation significantly contributes to the reduction of depressive symptoms, while the overall mindset toward the ICD device was positive and improved during the one-year follow-up.
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Affiliation(s)
- Revital Amiaz
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Elad Asher
- Davidai Arrhythmia Center, Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Rozen
- Davidai Arrhythmia Center, Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Czerniak
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Linda Levi
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mark Weiser
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Glikson
- Davidai Arrhythmia Center, Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Salman MM, Kemp HI, Cauldwell MR, Dob DP, Sutton R. Anaesthetic management of pregnant patients with cardiac implantable electronic devices: case reports and review. Int J Obstet Anesth 2017; 33:57-66. [PMID: 28899734 DOI: 10.1016/j.ijoa.2017.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/03/2017] [Accepted: 07/29/2017] [Indexed: 10/19/2022]
Abstract
Heart disease is a leading cause of maternal mortality and morbidity. Pregnant women with structural, conduction or degenerative cardiac disease who require rhythm control or who are at high risk of sudden cardiac death may carry a cardiac implantable electronic device or may occasionally require the insertion of one during their pregnancy. These women are now encountered more frequently in clinical practice, and it is essential that a multidisciplinary approach, beginning from the early antenatal phase, be adopted in their counselling and management. Contemporary cardiac rhythm control devices are a constantly evolving technology with increasingly sophisticated features; anaesthetists should therefore have an adequate understanding of the principles of their operation and the special considerations for their use, in order to enable their safe management in the peripartum period. Of particular importance is the potential adverse effect of electromagnetic interference, which may cause device malfunction or damage, and the precautions required to reduce this risk. The ultimate goal in the management of this patient subgroup is to minimise the disruption to cardiovascular physiology that may occur near the time of labour and delivery and to control the factors that impact on device integrity and function. We present the ante- and peripartum management of two pregnant women with an implantable cardioverter-defibrillator, followed by a review and update of the anaesthetic management of parturients with cardiac implantable electronic devices.
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Affiliation(s)
- M M Salman
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - H I Kemp
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - M R Cauldwell
- Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
| | - D P Dob
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
| | - R Sutton
- National Heart & Lung Institute, Imperial College, Hammersmith Hospital, London W12 0NN, UK
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Sweeting J, Ball K, McGaughran J, Atherton J, Semsarian C, Ingles J. Impact of the implantable cardioverter defibrillator on confidence to undertake physical activity in inherited heart disease: A cross-sectional study. Eur J Cardiovasc Nurs 2017; 16:742-752. [PMID: 28613082 DOI: 10.1177/1474515117715760] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Physical activity is associated with improved quality of life. Patients with an implantable cardioverter defibrillator (ICD) face unique clinical and psychological challenges. Factors such as fear of ICD shock may negatively impact on physical activity, while a sense of protection gained from the ICD may instil confidence to be active. AIM We aimed to examine the impact of an ICD on physical activity levels and factors associated with amount of activity. METHODS Two cross-sectional studies were conducted. Accelerometer data (seven-day) was collected in March-November 2015 for 63 consecutively recruited hypertrophic cardiomyopathy patients, with or without an ICD, aged ⩾18 years. A survey study was conducted in July-August 2016 of 155 individuals aged ⩾18 years with an inherited heart disease and an ICD in situ. RESULTS Based on the International Physical Activity Questionnaire, mean leisure time physical activity was 239 ± 300 min/week with 51% meeting physical activity guidelines. Accelerometry showed that mean moderate-vigorous physical activity was the same for patients with and without an ICD (254 ± 139 min/week versus 300 ± 150 min/week, p=0.23). Nearly half of survey participants ( n=73) said their device made them more confident to exercise. Being anxious about ICD shocks was the only factor associated with not meeting physical activity guidelines. CONCLUSIONS Patients with inherited heart disease adjust differently to their ICD device, and for many it has no impact on physical activity. Discussion regarding the appropriate level of physical activity and potential barriers will ensure best possible outcomes in this unique patient group.
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Affiliation(s)
- Joanna Sweeting
- 1 Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia.,2 Sydney Medical School, University of Sydney, Australia
| | - Kylie Ball
- 3 Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Julie McGaughran
- 4 Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.,5 School of Medicine, University of Queensland, Brisbane, Australia
| | - John Atherton
- 5 School of Medicine, University of Queensland, Brisbane, Australia.,6 Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Christopher Semsarian
- 1 Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia.,2 Sydney Medical School, University of Sydney, Australia.,7 Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jodie Ingles
- 1 Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia.,2 Sydney Medical School, University of Sydney, Australia.,7 Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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Agarwal K, Jegadeesan R, Guo YX, Thakor NV. Wireless Power Transfer Strategies for Implantable Bioelectronics. IEEE Rev Biomed Eng 2017; 10:136-161. [PMID: 28328511 DOI: 10.1109/rbme.2017.2683520] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neural implants have emerged over the last decade as highly effective solutions for the treatment of dysfunctions and disorders of the nervous system. These implants establish a direct, often bidirectional, interface to the nervous system, both sensing neural signals and providing therapeutic treatments. As a result of the technological progress and successful clinical demonstrations, completely implantable solutions have become a reality and are now commercially available for the treatment of various functional disorders. Central to this development is the wireless power transfer (WPT) that has enabled implantable medical devices (IMDs) to function for extended durations in mobile subjects. In this review, we present the theory, link design, and challenges, along with their probable solutions for the traditional near-field resonant inductively coupled WPT, capacitively coupled short-ranged WPT, and more recently developed ultrasonic, mid-field, and far-field coupled WPT technologies for implantable applications. A comparison of various power transfer methods based on their power budgets and WPT range follows. Power requirements of specific implants like cochlear, retinal, cortical, and peripheral are also considered and currently available IMD solutions are discussed. Patient's safety concerns with respect to electrical, biological, physical, electromagnetic interference, and cyber security from an implanted neurotech device are also explored in this review. Finally, we discuss and anticipate future developments that will enhance the capabilities of current-day wirelessly powered implants and make them more efficient and integrable with other electronic components in IMDs.
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Chakravarthy M, Prabhakumar D, George A. Anaesthetic consideration in patients with cardiac implantable electronic devices scheduled for surgery. Indian J Anaesth 2017; 61:736-743. [PMID: 28970632 PMCID: PMC5613599 DOI: 10.4103/ija.ija_346_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
With advances in cardiology and cardiothoracic surgery, several newer implantable cardiac devices have become common in the surgical population. Multichamber pacemakers, implanted cardiac defibrillators and ventricular assist devices are frequent in current day practice. Many of the newer implantable cardiac electronic devices are targeted at managing heart failure. While managing such patients for non-cardiac surgeries, specific issues related to equipment characteristics and troubleshooting should be a priority for the anaesthesiologists. There is a possibility of malfunction of the devices resulting in catastrophic outcomes. Therefore, it is imperative to understand the pathophysiology, device characteristics and troubleshooting before embarking on anaesthetising patients with implantable cardiac electronic devices.
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Affiliation(s)
- Murali Chakravarthy
- Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India
| | - Dattatreya Prabhakumar
- Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India
| | - Antony George
- Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India
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Wilson D, Moehlis J. Toward a More Efficient Implementation of Antifibrillation Pacing. PLoS One 2016; 11:e0158239. [PMID: 27391010 PMCID: PMC4938213 DOI: 10.1371/journal.pone.0158239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/12/2016] [Indexed: 11/18/2022] Open
Abstract
We devise a methodology to determine an optimal pattern of inputs to synchronize firing patterns of cardiac cells which only requires the ability to measure action potential durations in individual cells. In numerical bidomain simulations, the resulting synchronizing inputs are shown to terminate spiral waves with a higher probability than comparable inputs that do not synchronize the cells as strongly. These results suggest that designing stimuli which promote synchronization in cardiac tissue could improve the success rate of defibrillation, and point towards novel strategies for optimizing antifibrillation pacing.
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Affiliation(s)
- Dan Wilson
- Department of Mechanical Engineering, University of California Santa Barbara, Santa Barbara, CA 93106, United States of America
- * E-mail:
| | - Jeff Moehlis
- Department of Mechanical Engineering, University of California Santa Barbara, Santa Barbara, CA 93106, United States of America
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Albarran JW, Tagney J, James J. Partners of ICD Patients—An Exploratory Study of Their Experiences. Eur J Cardiovasc Nurs 2016; 3:201-10. [PMID: 15350229 DOI: 10.1016/j.ejcnurse.2004.06.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2004] [Revised: 06/21/2004] [Accepted: 06/22/2004] [Indexed: 11/21/2022]
Abstract
BACKGROUND The experiences of partners who care for and support the needs of a loved one with an implantable cardiac defibrillator (ICD) remain largely unknown within Europe. AIMS This study explored the nature of partner's experiences from the pre-ICD implantation phase up until a maximum of 20 months at home. METHODS Eight partners cohabiting with a recipient of an ICD were interviewed using a semistructured schedule. All interviews were transcribed and content analysed for emerging categories and themes. FINDINGS Four themes representing 11 categories conceptualised the partners' experiences, these included: Acknowledging the patient's need for the device, reactions to the device, safeguarding the patient, and returning to normality. CONCLUSION This qualitative study suggests that partners of ICD recipients progress through various difficult and adaptive stages when learning how best to support the patient. A point is reached when most are able to assume control and normalise their lives. This transformation is slow; however, to improve this process and empower partners, nurses should provide relevant information and include them in decisions affecting the patient. Further research into the unique needs of partners, which includes international perspectives, would be significant in developing practice and theory in this area.
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Affiliation(s)
- John W Albarran
- Faculty of Health and Social Care, Critical Care Nursing, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK.
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Amiaz R, Asher E, Rozen G, Czerniak E, Glikson M, Weiser M. Do implantable cardioverter defibrillators contribute to new depression or anxiety symptoms? A retrospective study. Int J Psychiatry Clin Pract 2016; 20:101-5. [PMID: 27052573 DOI: 10.3109/13651501.2016.1161055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In this retrospective cross-sectional study, we evaluated the existence of psychiatric symptoms which appeared after implantation of an implantable cardioverter defibrillator (ICD). METHODS Patients with ICDs were diagnosed using the Mini International Neuropsychiatric Interview (MINI) and were excluded if they had any psychiatric diagnosis prior to ICD implantation. Depression and anxiety were evaluated using the HAM-D and HAM-A rating scales and their attitude towards the ICD using a visual analog scale (VAS). Ninety five ICD patients with mean age of 66 years (±11.5) were recruited, 80 (84%) were men. RESULTS Four (4%) patients were diagnosed with new-onset MDD and one patient (1%) with anxiety. Twenty seven (28%) were found to have significant depressive symptoms (HAM-D >8), without MDD diagnosis; half of them attributing these symptoms to the device. Seven (8%) patients experienced phantom shocks and had relatively higher depressive scores (HAM-D 10.3 vs. 5.8; F = 3.696; p = 0.058). The MDD rates in our study were rather consistent with those reported for cardiac patients. CONCLUSIONS We suggest that ICD contributed little, if any, additional depressive or anxiety symptoms after implantation. We found that the overall attitude towards the device was positive and that shocks and phantom shocks were related to depressive symptoms.
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Affiliation(s)
- Revital Amiaz
- a Psychiatry Department , The Chaim Sheba Medical Center , Tel Hashomer , Israel ;,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Elad Asher
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel ;,c Davidai Arrhythmia Center, Leviev Heart Center, The Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Guy Rozen
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel ;,c Davidai Arrhythmia Center, Leviev Heart Center, The Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Efrat Czerniak
- a Psychiatry Department , The Chaim Sheba Medical Center , Tel Hashomer , Israel ;,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Michael Glikson
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel ;,c Davidai Arrhythmia Center, Leviev Heart Center, The Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Mark Weiser
- a Psychiatry Department , The Chaim Sheba Medical Center , Tel Hashomer , Israel ;,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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McNamara DA, Goldberger JJ, Berendsen MA, Huffman MD. Implantable defibrillators versus medical therapy for cardiac channelopathies. Cochrane Database Syst Rev 2015; 2015:CD011168. [PMID: 26445202 PMCID: PMC6599851 DOI: 10.1002/14651858.cd011168.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Sudden cardiac death is a significant cause of mortality in both the US and globally. However, 5% to 15% of people with sudden cardiac death have no structural abnormalities, and most of these events are attributed to underlying cardiac ion channelopathies. Rates of cardiac ion channelopathy diagnosis are increasing. However, the optimal treatment for such people is poorly understood and current guidelines rely primarily on expert opinion. OBJECTIVES To compare the effect of implantable cardioverter defibrillators (ICD) with antiarrhythmic drugs or usual care in reducing the risk of all-cause mortality, fatal and non-fatal cardiovascular events, and adverse events in people with cardiac ion channelopathies. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2015, Issue 6), EMBASE, MEDLINE, Conference Proceedings Citation Index - Science (CPCI-S), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) in July 2015. We applied no language restrictions. SELECTION CRITERIA We included all randomized controlled trials of people aged 18 years and older with ion channelopathies, including congenital long QT syndrome, congenital short QT syndrome, Brugada syndrome, or catecholaminergic polymorphic ventricular tachycardia. Participants must have been randomized to ICD implantation and compared to antiarrhythmic drug therapy or usual care. DATA COLLECTION AND ANALYSIS Two authors independently selected studies for inclusion and extracted the data. We included all-cause mortality, fatal and non-fatal cardiovascular events, and adverse events for our primary outcome analyses and non-fatal cardiovascular events, rates of inappropriate ICD firing, quality of life, and cost for our secondary outcome analyses. We calculated risk ratios (RR) and associated 95% confidence intervals (CIs) for dichotomous outcomes, both for independent and pooled study analyses. MAIN RESULTS From the 468 references identified after removing duplicates, we found two trials comprising 86 participants that met our inclusion criteria. Both trials included participants with Brugada syndrome who were randomized to ICD versus β-blocker therapy for secondary prevention for sudden cardiac death. Both studies were small, were performed by the same investigators, and exhibited a high risk of bias across multiple domains. In the group randomized to ICD therapy, there was a nine-fold lower risk of mortality compared with people randomized to medical therapy (0% with ICD versus 18% with medical therapy; RR 0.11, 95% CI 0.01 to 0.83; 2 trials, 86 participants). There was low quality evidence of a difference in the rates of combined fatal and non-fatal cardiovascular events, and the results were imprecise (26% with ICD versus 18% with medical therapy; RR 1.49, 95% CI 0.66 to 3.34; 2 trials, 86 participants). The rates of adverse events were higher in the ICD group, but these results were imprecise (28% with ICD versus 10% with medical therapy; RR 2.44, 95% CI 0.92 to 6.44; 2 trials, 86 participants). For secondary outcomes, the risk of non-fatal cardiovascular events was higher in the ICD group, but these results were imprecise and were driven entirely by appropriate ICD-termination of cardiac arrhythmias (26% with ICD versus 0% with medical therapy; RR 11.4, 95% CI 1.57 to 83.3; 2 trials, 86 participants). Approximately 25% of the ICD group experienced inappropriate ICD firing, all of which was corrected by device reprogramming. No data were available for quality of life or cost. We considered the quality of evidence low using the GRADE methodology, due to study limitations and imprecision of effects. AUTHORS' CONCLUSIONS Among people with Brugada syndrome who have survived a prior episode of sudden cardiac death, ICD therapy appeared to reduce mortality when compared to β-blocker therapy, but the true magnitude may be substantially different from the estimate of the effect because of study limitations and imprecision. Due to the large magnitude of effect, it is unlikely that there will be additional studies evaluating the role of ICDs for secondary prevention in this population. Further studies are necessary to determine the optimal treatment, if any, to prevent an initial episode of sudden cardiac death in people with cardiac ion channelopathies.
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Affiliation(s)
- David A McNamara
- Northwestern University Feinberg School of MedicineDepartment of MedicineGalter 3‐150251 East Huron StreetChicagoILUSA60611
| | - Jeffrey J Goldberger
- Northwestern University Feinberg School of MedicineDepartment of Medicine (Cardiology)251 E HuronFeinberg Pavilion 8?503ChicagoILUSAIL 60611
| | - Mark A Berendsen
- Northwestern UniversityGalter Health Sciences Library303 E. Chicago AvenueChicagoILUSA60611
| | - Mark D Huffman
- Northwestern University Feinberg School of MedicineDepartments of Preventive Medicine and Medicine (Cardiology)680 N. Lake Shore Drive, Suite 1400ChicagoILUSA60611
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Waks JW, Higgins AY, Mittleman MA, Buxton AE. Influence of renal function on mortality and ventricular arrhythmias in patients undergoing first implantable cardioverter-defibrillator generator replacement. J Cardiovasc Electrophysiol 2014; 26:282-90. [PMID: 25431143 DOI: 10.1111/jce.12589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 11/02/2014] [Accepted: 11/13/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Impaired renal function is associated with increased mortality among patients with implantable cardioverter-defibrillators (ICDs). The relationship between renal function at time of ICD generator replacement and subsequent appropriate ICD therapies is not known. METHODS AND RESULTS We identified 441 patients who underwent first ICD generator replacement between 2000 and 2011 and had serum creatinine measured within 30 days of their procedure. Patients were divided into tertiles based on estimated glomerular filtration rate (eGFR). Adjusted Cox proportional hazard and competing risk models were used to assess relationships between eGFR and subsequent mortality and appropriate ICD therapy. Median eGFR was 37.6, 59.3, and 84.8 mL/min/1.73 m(2) for tertiles 1-3, respectively. Five-year Kaplan-Meier survival probability was 34.8%, 61.4%, and 84.5% for tertiles 1-3, respectively (P < 0.001). After multivariable adjustment, compared to tertile 3, worse eGFR tertile was associated with increased mortality (HR 2.84, 95% CI [1.36-5.94] for tertile 2; HR 3.84, 95% CI [1.81-8.12] for tertile 1). At 5 years, 57.0%, 58.1%, and 60.2% of patients remained free of appropriate ICD therapy in tertiles 1-3, respectively (P = 0.82). After adjustment, eGFR tertile was not associated with future appropriate ICD therapy. Results were unchanged in an adjusted competing risk model accounting for death. CONCLUSIONS At time of first ICD generator replacement, lower eGFR is associated with higher mortality, but not with appropriate ICD therapies. The poorer survival of ICD patients with reduced eGFR does not appear to be influenced by arrhythmia status, and there is no clear proarrhythmic effect of renal dysfunction, even after accounting for the competing risk of death.
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Affiliation(s)
- Jonathan W Waks
- Harvard-Thorndike Electrophysiology Institute, Department of Cardiovascular Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Prognostic evaluation of the troponin I elevation after multiple spontaneous shocks of the implantable cardioverter/defibrillator. Am J Emerg Med 2014; 32:1085-8. [DOI: 10.1016/j.ajem.2014.04.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/21/2014] [Accepted: 04/23/2014] [Indexed: 01/21/2023] Open
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Rome BN, Kramer DB, Kesselheim AS. FDA approval of cardiac implantable electronic devices via original and supplement premarket approval pathways, 1979-2012. JAMA 2014; 311:385-91. [PMID: 24449317 PMCID: PMC4142419 DOI: 10.1001/jama.2013.284986] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The US Food and Drug Administration (FDA) evaluates high-risk medical devices such as cardiac implantable electronic devices (CIEDs), including pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy devices, via the premarket approval (PMA) process, during which manufacturers submit clinical data demonstrating safety and effectiveness. Subsequent changes to approved high-risk devices are implemented via "supplements," which may not require additional clinical testing. OBJECTIVE To characterize the prevalence and characteristics of changes to CIEDs made through the PMA supplement process. DESIGN Using the FDA's PMA database, we reviewed all CIEDs approved as original PMAs or supplements from 1979 through 2012. For each supplement, we collected the date approved, type of supplement (panel-track, 180-day, real-time, special, and 30-day notice), and the nature of the changes. We calculated the number of supplements approved per PMA and analyzed trends relating to different supplement regulatory categories over time. For supplements approved via the 180-day regulatory pathway, which often involve significant design changes, from 2010-2012, we identified how often additional clinical data were collected. RESULTS From 1979-2012, the FDA approved 77 original and 5829 supplement PMA applications for CIEDs, with a median of 50 supplements per original PMA (interquartile range [IQR], 23-87). Excluding manufacturing changes that do not alter device design, the number of supplements approved each year was stable around a mean (SD) of 2.6 (0.9) supplements per PMA per year. Premarket approvals remained active via successive supplements over a median period of 15 years (IQR, 8-20), and 79% of the 77 original PMAs approved during our study period were the subject of at least 1 supplement in 2012. Thirty-seven percent of approved supplements involved a change to the device's design. Among 180-day supplements approved from 2010-2012, 23% (15/64) included new clinical data to support safety and effectiveness. CONCLUSIONS AND RELEVANCE Many CIED models currently used by clinicians were approved via the PMA supplement process, not as original PMAs. Most new device models are deemed safe and effective without requiring new clinical data, reinforcing the importance of rigorous postapproval surveillance of these devices.
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Affiliation(s)
- Benjamin N Rome
- Harvard Medical School, Boston, Massachusetts2Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel B Kramer
- Harvard Medical School, Boston, Massachusetts2Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts3Beth Israel Deaconess Medical C
| | - Aaron S Kesselheim
- Harvard Medical School, Boston, Massachusetts2Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Costantino G, Solbiati M, Casazza G, Bonzi M, Vago T, Montano N, McDermott D, Quinn J, Furlan R. Usefulness of N-terminal pro-B-type natriuretic Peptide increase as a marker for cardiac arrhythmia in patients with syncope. Am J Cardiol 2014; 113:98-102. [PMID: 24169011 DOI: 10.1016/j.amjcard.2013.08.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/19/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Abstract
B-type natriuretic peptides (BNPs) have been investigated as biomarkers for risk stratification of patients with syncope. Their concentration can be influenced by age and co-morbidities. In the present study, we compared the change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels within 6 hours in patients with vasovagal and arrhythmic syncope to determine whether this change can predict arrhythmic syncope. Using a case-control design, 33 patients were enrolled. Of the 33 patients, 18 with arrhythmic syncope, as they underwent controlled ventricular tachycardia or ventricular fibrillation (VF) during device safety testing of an implantable cardioverter defibrillator implantation or battery replacement, were compared with 15 patients, who during a tilt-table test were diagnosed with vasovagal syncope (VS). For each patient, a blood sample for NT-proBNP evaluation was collected at baseline and 6 hours after the episode of ventricular tachycardia, VF, or VS. We calculated the percentage of increase in the 6-hour NT-proBNP concentration between the 2 groups using nonparametric techniques. We also calculated the area under a receiver operating characteristic curve with the 95% confidence intervals. The 6-hour change in the NT-proBNP concentrations between patients who had had an episode of ventricular tachycardia or VF and patients with VS was significantly different, with a median increase of 32% in the ventricular tachycardia or VF group versus 5% in the VS group (p <0.01). The area under a receiver operating characteristic curve to predict arrhythmic syncope was 0.8 (95% confidence interval 0.65 to 0.95). In conclusion, the results of the present study suggest that a 6-hour NT-proBNP increase might be able to predict arrhythmic syncope. Future work is needed to confirm these findings in undifferentiated emergency department patients who present with syncope.
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Obtaining rapid and effective hemostasis. J Am Acad Dermatol 2013; 69:677.e1-677.e9. [DOI: 10.1016/j.jaad.2013.07.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/02/2013] [Accepted: 07/09/2013] [Indexed: 11/19/2022]
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SAFAK ERDAL, SCHMITZ DIETMAR, KONORZA THOMAS, WENDE CHRISTIAN, DE ROS JOSEOLAGUE, SCHIRDEWAN ALEXANDER. Clinical Efficacy and Safety of an Implantable Cardioverter-Defibrillator Lead with a Floating Atrial Sensing Dipole. Pacing Clin Electrophysiol 2013; 36:952-62. [PMID: 23692262 DOI: 10.1111/pace.12171] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 03/04/2013] [Accepted: 03/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- ERDAL SAFAK
- Charité Campus Benjamin Franklin; Medical Clinic II; Berlin; Germany
| | - DIETMAR SCHMITZ
- Clinic for Cardiology and Angiology; Elisabeth Hospital; Essen; Germany
| | | | - CHRISTIAN WENDE
- Department of Cardiology; Marien Hospital; Papenburg; Germany
| | - JOSE OLAGUE DE ROS
- Department of Cardiology; Hospital University La FE Valencia; Arrhythmias Service; Spain
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Affiliation(s)
- Michael Mitar
- From the Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Ana C. Alba
- From the Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Jane MacIver
- From the Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Heather Ross
- From the Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
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von Känel R, Baumert J, Kolb C, Cho EYN, Ladwig KH. Chronic posttraumatic stress and its predictors in patients living with an implantable cardioverter defibrillator. J Affect Disord 2011; 131:344-52. [PMID: 21195483 DOI: 10.1016/j.jad.2010.12.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 12/01/2010] [Accepted: 12/01/2010] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Patients with an implantable cardioverter defibrillator (ICD) show clinically relevant depression and anxiety, but little is known about their levels of posttraumatic stress. We assessed chronic posttraumatic stress attributable to a traumatic cardiac event and its predictors in patients at two time points after ICD placement. METHODS We investigated 107 consecutively enrolled patients (57 ± 14 years, 62% men) on average 24 ± 21 months after ICD placement (baseline) and again 41 ± 18 months later (follow-up). All patients completed the Impact of Event Scale-Revised (IES-R) to self-rate the severity of posttraumatic stress (range 0-110). The 30% of patients with the highest IES-R scores (≥ 25) at baseline were defined as PTSD cases; the same threshold was applied to define PTSD caseness at follow-up. RESULTS Posttraumatic stress increased from baseline to follow-up (19 ± 22 vs. 25 ± 19, p < 0.001); 19% of patients had PTSD at both assessments, 12% at baseline only, and 18% at follow-up only. Female gender as well as greater peritraumatic dissociation and depression predicted greater posttraumatic stress at baseline (p-values ≤ 0.041). Greater baseline posttraumatic stress, helplessness, alexithymia, and ≥ 5 shocks during follow-up all predicted greater posttraumatic stress at follow-up (p-values ≤ 0.029). Female gender, helplessness, and depression predicted PTSD at baseline (p-values ≤ 0.022); low education and posttraumatic stress at baseline predicted PTSD at follow-up (p-values ≤ 0.003). CONCLUSIONS Between 2 and 5.5 years post-ICD placement chronic posttraumatic stress slightly increased and nearly one-fifth of patients had newly developed PTSD. The identified psychological predictors of long-term chronicity of posttraumatic stress might particularly inform behavioral interventions for ICD recipients.
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Affiliation(s)
- Roland von Känel
- Division of Psychosomatic Medicine, Department of General Internal Medicine, Inselspital, Bern University Hospital and University of Bern, Switzerland
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Palacios-Ceña D, Losa-Iglesias ME, Alvarez-López C, Cachón-Pérez M, Reyes RAR, Salvadores-Fuentes P, Fernández-de-Las-Peñas C. Patients, intimate partners and family experiences of implantable cardioverter defibrillators: qualitative systematic review. J Adv Nurs 2011; 67:2537-50. [PMID: 21615459 DOI: 10.1111/j.1365-2648.2011.05694.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This paper is a report of an interpretive review of qualitative research on how an implantable cardioverter defibrillator affects adult recipients and their significant others. BACKGROUND An implantable cardioverter defibrillator detects pathological cardiac rhythms and automatically converts the rhythm with electrical counter shocks. DATA SOURCES A systematic literature search was conducted for qualitative research papers published between January 1999 and January 2009. PubMed, Medline, ISI Web of Knowledge and CINAHL databases were searched with the following key words: internal defibrillator, implantable defibrillator and qualitative research. REVIEW METHODS Twenty-two papers were included. The critical appraisal skills programme and prompts were used to appraise studies. Thematic analysis and synthesis approaches were used to interpret evidence. FINDINGS People with an implantable cardioverter defibrillator were found to experience physical, psychological and social changes. Shocks produce fear and anxiety, affecting relationships and sexual relations. The use of support groups and the use of the Internet are important in helping adjustment to an implantable cardioverter defibrillator. Women's responses to an implantable cardioverter defibrillator appear different than men's responses and include concerns about physical appearance and relationship issues. Postdischarge follow-up and educational programmes are still underdeveloped. CONCLUSION Patients need additional education, support and follow-up care after hospital discharge. Patients and significant others benefit from collaboration between patient associations and healthcare professional societies. Future research is needed to identify the specific challenges that women recipients face.
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Droogan C, Patel C, Yan GX, Kowey PR. Role of Antiarrhythmic Drugs: Frequent Implantable Cardioverter-Defibrillator Shocks, Risk of Proarrhythmia, and New Drug Therapy. Heart Fail Clin 2011; 7:195-205, viii. [DOI: 10.1016/j.hfc.2010.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lambert P, Da Costa A, Marcy PY, Kreps S, Angellier G, Marcié S, Bondiau PY, Briand-Amoros C, Thariat J. [Pacemaker, implanted cardiac defibrillator and irradiation: Management proposal in 2010 depending on the type of cardiac stimulator and prognosis and location of cancer]. Cancer Radiother 2011; 15:238-49; quiz 257. [PMID: 21435931 DOI: 10.1016/j.canrad.2010.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Revised: 12/19/2010] [Accepted: 12/22/2010] [Indexed: 10/18/2022]
Abstract
Ionizing radiation may interfere with electric components of pacemakers or implantable cardioverter-defibrillators. The type, severity and extent of radiation damage to pacemakers, have previously been shown to depend on the total dose and dose rate. Over 300,000 new cancer cases are treated yearly in France, among which 60% are irradiated in the course of their disease. One among 400 of these patients has an implanted pacemaker or defibrillator. The incidence of pacemaker and implanted cardioverter defribillator increases in an ageing population. The oncologic prognosis must be weighted against the cardiologic prognosis in a multidisciplinary and transversal setting. Innovative irradiation techniques and technological sophistications of pacemakers and implantable cardioverter-defibrillators (with the introduction of more radiosensitive complementary metal-oxide-semiconductors since 1970) have potentially changed the tolerance profiles. This review of the literature studied the geometric, dosimetric and radiobiological characteristics of the radiation beams for high energy photons, stereotactic irradiation, protontherapy. Standardized protocols and radiotherapy optimization (particle, treatment fields, energy) are advisable in order to improve patient management during radiotherapy and prolonged monitoring is necessary following radiation therapy. The dose received at the pacemaker/heart should be calculated. The threshold for the cumulated dose to the pacemaker/implantable cardioverter-defibrillator (2 to 5 Gy depending on the brand), the necessity to remove/displace the device based on the dose-volume histogram on dosimetry, as well as the use of lead shielding and magnet are discussed.
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Affiliation(s)
- P Lambert
- Service d'anesthésie réanimation, hôpital Nord, centre hospitalier universitaire de Saint-Étienne, France
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Palacios-Ceña D, Losa ME, Fernández-de-las-Peñas C, Salvadores-Fuentes P. Living with life insurance: a qualitative analysis of the experience of male implantable defibrillator recipients in Spain. J Clin Nurs 2011; 20:2003-13. [DOI: 10.1111/j.1365-2702.2010.03508.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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van Welsenes GH, van Rees JB, Borleffs CJW, Cannegieter SC, Bax JJ, van Erven L, Schalij MJ. Long-term follow-up of primary and secondary prevention implantable cardioverter defibrillator patients. Europace 2011; 13:389-94. [DOI: 10.1093/europace/euq494] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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