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Le T, Neuenschwander J, Cordial P, Sankoe M, Parekh A, Hiestand B, Peacock WF. Assessing the safety of interrogating cardiac-implantable electronic devices with brand-mismatched remote interrogators: a pilot study. Clin Exp Emerg Med 2022; 9:24-28. [PMID: 35354231 PMCID: PMC8995514 DOI: 10.15441/ceem.21.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/27/2021] [Indexed: 12/03/2022] Open
Abstract
Objective Remote cardiac implantable electronic device (CIED) interrogators, originally developed for home use, have been proven to be efficacious in clinical settings, especially emergency departments. Concern exists that attempting to interrogate a CIED with the remote interrogator of a different brand, i.e., a brand-mismatched interrogator, may cause device malfunction. The aim of this study was to determine if intentionally attempting to interrogate a CIED with a brand-mismatched remote interrogator resulted in device malfunction. Methods A total of 75 ex vivo CIEDs manufactured by various companies underwent attempted interrogation by a brand-mismatched remote interrogator. CIED settings were compared before and after attempted mismatch interrogation. A total of 30 in vivo CIEDs were then randomized for an attempted 2-minute mismatched remote interrogation by one of the two possible mismatched remote interrogators. CIED settings were compared before and after attempted mismatch interrogation. Results Of 150 ex vivo brand-mismatched interrogations, no device setting changes or malfunctions occurred; no remote interrogators connected to a mismatched CIED, and no devices were turned off. In the 30 patients undergoing brand-mismatched interrogations, the mean (standard deviation) age was 71.6 ( ± 14.7) years, 16 (53%) were male, with 24 pacemakers (80%), four pacemaker/implantable cardioverter defibrillators (13%), and two implantable cardioverter defibrillators (7%). Of the 30 mismatched interrogations performed, no device setting changes or malfunctions occurred; no remote interrogators connected to a mismatched CIED, and no devices turned off. Conclusion In a total 180 attempted brand-mismatched CIED interrogations, no CIED malfunctions occurred. This suggests that the use of remote CIED interrogators when device manufacturer is unknown is unlikely to result in adverse CIED-related events.
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2
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Boriani G, Vitolo M, Svennberg E, Casado-Arroyo R, Merino JL, Leclercq C. Performance-based risk-sharing arrangements for devices and procedures in cardiac electrophysiology: an innovative perspective. Europace 2022; 24:1541-1547. [PMID: 35531864 DOI: 10.1093/europace/euac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/15/2022] [Indexed: 11/14/2022] Open
Abstract
There is an increasing pressure on demonstrating the value of medical interventions and medical technologies resulting in the proposal of new approaches for implementation in the daily practice of innovative treatments that might carry a substantial cost. While originally mainly adopted by pharmaceutical companies, in recent years medical technology companies have initiated novel value-based arrangements for using medical devices, in the form of 'outcomes-based contracts', 'performance-based contracts', or 'risk-sharing agreements'. These are all characterized by linking coverage, reimbursement, or payment for the innovative treatment to the attainment of pre-specified clinical outcomes. Risk-sharing agreements have been promoted also in the field of electrophysiology and offer the possibility to demonstrate the value of specific innovative technologies proposed in this rapidly advancing field, while relieving hospitals from taking on the whole financial risk themselves. Physicians deeply involved in the field of devices and technologies for arrhythmia management and invasive electrophysiology need to be prepared for involvement as stakeholders. This may imply engagement in the evaluation of risk-sharing agreements and specifically, in the process of assessment of technology performances or patient outcomes. Scientific Associations may have an important role in promoting the basis for value-based assessments, in promoting educational initiatives to help assess the determinants of the learning curve for innovative treatments, and in promoting large-scale registries for a precise assessment of patient outcomes and of specific technologies' performance.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,EHRA mHEALTH and Health Economics Section, European Heart Rhythm Association, Biot, France
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Emma Svennberg
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ruben Casado-Arroyo
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Josè L Merino
- Arrhythmia & Robotic EP Unit, University Hospital La Paz, Autonoma University, IdiPaz, Clinica Viamed-Santa Elena, Madrid, Spain
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3
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Boriani G, Imberti JF, Bonini N, Vitolo M. Cardiac resynchronization therapy: variations across Europe in implant rates and types of implanted devices. J Cardiovasc Med (Hagerstown) 2021; 22:90-93. [PMID: 32925392 DOI: 10.2459/jcm.0000000000001109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena University Hospital, Modena, Italy
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4
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Golzio PG, Magnano S Lio M, Bongiorni MG. Occult bacteraemia in cardiac implantable electronic device patients: a review of diagnostic workflow and mandatory therapy. J Cardiovasc Med (Hagerstown) 2019; 20:271-277. [PMID: 30624298 DOI: 10.2459/jcm.0000000000000754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
: Cardiac implantable electronic device (CIED) implantation has greatly increased, with an associated exponential increase in CIED infections (CDIs). Cardiac device related infective endocarditis (CDRIE) has high morbidity and mortality: approximately 10-21%. Therefore, a prompt diagnosis and radical treatment of CDRIE are needed; transvenous lead extraction (TLE) is the mainstay for the complete healing, even if associated with wide logistic problems, high therapeutic costs and high mortality risk for patients. Some criticisms about the value of Duke criteria and their limitations for the diagnosis of CDRIE are known. The significance of classic laboratory data, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), considered in the Duke score, are reviewed and critically discussed in this article, with regard to the specific field of the diagnosis of CDI. The need for new techniques for achieving the diagnostic reliability has been well perceived by physicians, and additional techniques have been introduced in the new European Society of Cardiology (ESC) and British Heart Rhythm Society (BHRS) guidelines on infective endocarditis. These suggested techniques, such as 18-Fluorodeoxyglucose PET/computed tomography (FDG-PET/CT), white blood cell PET (WBC PET) and lung multislice CT (MSCT), are also discussed in the study. This short review is intended as an extensive summary of the diagnostic workflow in cases of CDI and will be useful for readers who want to know more about this issue.
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Affiliation(s)
- Pier Giorgio Golzio
- Division of Cardiology, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and University of Turin, Turin
| | - Massimo Magnano S Lio
- Division of Cardiology, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and University of Turin, Turin
| | - Maria Grazia Bongiorni
- Second Division of Cardiovascular Diseases, Cardiac and Thoracic Department, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
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5
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Boriani G, Diemberger I. Cardiac resynchronization therapy in the real world: need to focus on implant rates, patient selection, co-morbidities, type of devices, and complications. Eur Heart J 2019; 38:2129-2131. [PMID: 28430905 DOI: 10.1093/eurheartj/ehx137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division. Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
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6
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Banks H, Torbica A, Valzania C, Varabyova Y, Prevolnik Rupel V, Taylor RS, Hunger T, Walker S, Boriani G, Fattore G. Five year trends (2008-2012) in cardiac implantable electrical device utilization in five European nations: a case study in cross-country comparisons using administrative databases. Europace 2019; 20:643-653. [PMID: 29016747 DOI: 10.1093/europace/eux123] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/12/2017] [Indexed: 11/13/2022] Open
Abstract
Aims Common methodologies for analysis of analogous data sets are needed for international comparisons of treatment and outcomes. This study tests using administrative hospital discharge (HD) databases in five European countries to investigate variation/trends in pacemaker (PM) and implantable cardioverter defibrillator (ICD) implant rates in terms of patient characteristics/management, device subtype, and initial implantation vs. replacement, and compares findings with existing literature and European Heart Rhythm Association (EHRA) reports. Methods and results HD databases from 2008 to 2012 in Austria, England, Germany, Italy and Slovenia were interrogated to extract admissions (without patient identification) associated with PM and ICD implants and replacements, using direct cross-referencing of procedure codes and common methodology to compare aggregate data. 1 338 199 records revealed 212 952 PM and 62 567 ICD procedures/year on average for a 204.4 million combined population, a crude implant rate of about 104/100 000 inhabitants for PMs and 30.6 for ICDs. The first implant/replacement rate ratios were 81/24 (PMs) and 25/7 (ICDs). Rates have increased, with cardiac resynchronization therapy (CRT) subtypes for both devices rising dramatically. Significant between- and within-country variation persists in lengths of stay and rates (Germany highest, Slovenia lowest). Adjusting for age lessened differences for PM rates, scarcely affected ICDs. Male/female ratios remained stable at 56/44% (PMs) and 79/21% (ICDs). About 90% of patients were discharged to home; 85-100% were inpatient admissions. Conclusion To aid in policymaking and track outcomes, HD administrative data provides a reliable, relatively cheap, methodology for tracking implant rates for PMs and ICDs across countries, as comparisons to EHRA data and the literature indicated.
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Affiliation(s)
- Helen Banks
- Centre for Research on Health and Social Care Management, Bocconi University, Via Roentgen, 1, 20136 Milan, Italy
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management, Bocconi University, Via Roentgen, 1, 20136 Milan, Italy
| | - Cinzia Valzania
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Via Albertoni, 15, 40138 Bologna, Italy
| | - Yauheniya Varabyova
- Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, 20354 Hamburg, Germany
| | | | - Rod S Taylor
- Evidence Synthesis & Modelling for Health Improvement, Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1?2LU, Exeter, UK
| | - Theresa Hunger
- Department of Public Health, Health Services Research and Health Technology Assessment, The University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center I, 6060 Hall in Tyrol, Austria
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK YO1?6EN, UK
| | - Giuseppe Boriani
- Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Via Del Pozzo 71, 41124 Modena, Italy
| | - Giovanni Fattore
- Centre for Research on Health and Social Care Management, Bocconi University, Via Roentgen, 1, 20136 Milan, Italy.,Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
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7
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Blanch B, Lago LP, Sy R, Harris PJ, Semsarian C, Ingles J. Implantable cardioverter–defibrillator therapy in Australia, 2002–2015. Med J Aust 2018; 209:123-129. [DOI: 10.5694/mja17.01183] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/02/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Bianca Blanch
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, NSW
| | - Luise P Lago
- Centre for Health Research, University of Wollongong, Wollongong, NSW
| | - Raymond Sy
- Sydney Medical School, University of Sydney, Sydney, NSW
| | | | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, NSW
- Sydney Medical School, University of Sydney, Sydney, NSW
- Royal Prince Alfred Hospital, Sydney, NSW
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, NSW
- Sydney Medical School, University of Sydney, Sydney, NSW
- Royal Prince Alfred Hospital, Sydney, NSW
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8
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Raatikainen MJP, Arnar DO, Merkely B, Nielsen JC, Hindricks G, Heidbuchel H, Camm J. A Decade of Information on the Use of Cardiac Implantable Electronic Devices and Interventional Electrophysiological Procedures in the European Society of Cardiology Countries: 2017 Report from the European Heart Rhythm Association. Europace 2018; 19:ii1-ii90. [PMID: 28903470 DOI: 10.1093/europace/eux258] [Citation(s) in RCA: 194] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 12/19/2022] Open
Abstract
Aims The aim of this analysis was to provide comprehensive information on invasive cardiac arrhythmia therapies in the European Society of Cardiology (ESC) area over the past 10 years. Methods and results The European Heart Rhythm Association (EHRA) has collected data on invasive arrhythmia therapies since 2008. This year 53 of the 56 ESC member countries provided data for the EHRA White Book. Here we present updated data on procedure rates together with information on demographics, economy, vital statistics, local healthcare systems and training activities. Considerable heterogeneity in the access to invasive arrhythmia therapies still exists across the five geographical ESC regions. In 2016, the device implantation rates per million population were 3-6 times higher in the Western region than in the non-European and Eastern ESC member countries. Catheter ablation activity was highest in the Western countries followed by the Northern and Southern areas. In the non-European countries, atrial fibrillation ablation rate was more than tenfold lower than in the European countries. On the other hand, the growth rate over the past ten years was highest in the non-European and Eastern countries. In some Eastern European countries with relative low gross domestic product the procedure rates exceeded the average values. Conclusion It was encouraging to note that during the past decade the growth in invasive arrhythmia therapies was greatest in the areas historically with relatively low activity. Nevertheless, there is substantial disparity and continued efforts are needed to improve harmonization of cardiac arrhythmia therapies in the ESC area.
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Affiliation(s)
| | - David O Arnar
- Division of Cardiology, Department of Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Bela Merkely
- Semmelweis University of Budapest, Heart and Vascular Center, Budapest, Hungary
| | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Centre, University of Leipzig, Leipzig
| | - Hein Heidbuchel
- Cardiology - Electrophysiology, Antwerp University and University Hospital, Antwerp, Belgium
| | - John Camm
- Division of Cardiovascular Sciences, St George's University of London, London, United Kingdom; ICMS, Imperial College, London, United Kingdom
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9
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New-onset pericardial effusion during transvenous lead extraction: incidence, causative mechanisms, and associated factors. J Interv Card Electrophysiol 2018; 51:253-261. [DOI: 10.1007/s10840-018-0327-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 02/06/2018] [Indexed: 12/22/2022]
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10
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Deharo JC, Sciaraffia E, Leclercq C, Amara W, Doering M, Bongiorni MG, Chen J, Dagres N, Estner H, Larsen TB, Johansen JB, Potpara TS, Proclemer A, Pison L, Brunet C, Blomström-Lundqvist C. Perioperative management of antithrombotic treatment during implantation or revision of cardiac implantable electronic devices: the European Snapshot Survey on Procedural Routines for Electronic Device Implantation (ESS-PREDI). Europace 2017; 18:778-84. [PMID: 27226497 DOI: 10.1093/europace/euw127] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 11/14/2022] Open
Abstract
The European Snapshot Survey on Procedural Routines for Electronic Device Implantation (ESS-PREDI) was a prospective European survey of consecutive adults who had undergone implantation/surgical revision of a cardiac implantable electronic device (CIED) on chronic antithrombotic therapy (enrolment March-June 2015). The aim of the survey was to investigate perioperative treatment with oral anticoagulants and antiplatelets in CIED implantation or surgical revision and to determine the incidence of complications, including clinically significant pocket haematomas. Information on antithrombotic therapy before and after surgery and bleeding and thromboembolic complications occurring after the intervention was collected at first follow-up. The study population comprised 723 patients (66.7% men, 76.9% aged ≥66 years). Antithrombotic treatment was continued during surgery in 489 (67.6%) patients; 6 (0.8%) had their treatment definitively stopped; 46 (6.4%) were switched to another antithrombotic therapy. Heparin bridging was used in 55 out of 154 (35.8%) patients when interrupting vitamin K antagonist (VKA) treatment. Non-vitamin K oral anticoagulant (NOAC) treatment was interrupted in 88.7% of patients, with heparin bridging in 25.6%, but accounted for only 25.3% of the oral anticoagulants used. A total of 108 complications were observed in 98 patients. No intracranial haemorrhage or embolic events were observed. Chronic NOAC treatment before surgery was associated with lower rates of minor pocket haematoma (1.4%; P= 0.042) vs. dual antiplatelet therapy (13.0%), VKA (11.4%), VKA + antiplatelet (9.2%), or NOAC + antiplatelet (7.7%). Similar results were observed for bleeding complications (P= 0.028). Perioperative management of patients undergoing CIED implantation/surgical revision while on chronic antithrombotic therapy varies, with evidence of a disparity between guideline recommendations and practice patterns in Europe. Haemorrhagic complications were significantly less frequent in patients treated with NOACs. Despite this, the incidence of severe pocket haematomas was low.
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Affiliation(s)
- Jean-Claude Deharo
- Department of Cardiology, University Hospital La Timone, Marseilles, France
| | - Elena Sciaraffia
- Department of Cardiology, Institution of Medical Science, Uppsala University, Uppsala, Sweden
| | - Christophe Leclercq
- Department of Cardiology, University Hospital Pontchaillou, CIC-IT 804, INSERM 1099, Rennes, France
| | - Walid Amara
- Department of Cardiology, GHI Le Raincy-Montfermeil, Montfermeil, France
| | - Michael Doering
- Department of Electrophysiology, University Leipzig - Heart Center, Leipzig, Germany
| | | | - Jian Chen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Nicolaus Dagres
- Department of Electrophysiology, University Leipzig - Heart Center, Leipzig, Germany
| | - Heidi Estner
- Department of Cardiology, MedizinischeKlinik I, Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistrasse 15, München 81377, Germany
| | - Torben B Larsen
- Department of Cardiology, AF Study group, Aalborg University Hospital, Aalborg, Denmark
| | - Jens B Johansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Tatjana S Potpara
- School of Medicine, Belgrade University, Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Alessandro Proclemer
- Division of Cardiology, University Hospital S. Maria della Misericordia, IRCAB Foundation Udine, Udine, Italy
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute, Maastricht PO Box 5800, The Netherlands
| | - Caroline Brunet
- Department of Cardiology, University Hospital La Timone, Marseilles, France
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11
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Validation of Algorithms to Identify Invasive Electrophysiology Procedures Using Administrative Data in Ontario, Canada. Med Care 2017; 55:e44-e50. [PMID: 25415560 DOI: 10.1097/mlr.0000000000000274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Administrative database research can provide insight into the real-world effectiveness of invasive electrophysiology procedures. However, no validated algorithm to identify these procedures within administrative data currently exists. OBJECTIVE To develop and validate algorithms to identify atrial fibrillation (AF), atrial flutter (AFL), supraventricular tachycardia (SVT) catheter ablation procedures, and diagnostic electrophysiology studies (EPS) within administrative data. METHODS Algorithms consisting of physician procedural billing codes and their associated most responsible hospital diagnosis codes were used to identify potential AF, AFL, SVT catheter ablation procedures and diagnostic EPS within large administrative databases in Ontario, Canada. The potential procedures were then limited to those performed between October 1, 2011 and March 31, 2013 at a single large regional cardiac center (Sunnybrook Health Sciences Center) in Ontario, Canada. These procedures were compared with a gold-standard cohort of patients known to have undergone invasive electrophysiology procedures during the same time period at the same institution. The sensitivity, specificity, positive and negative predictive values of each algorithm was determined. RESULTS Algorithms specific to each of AF, AFL, and SVT ablation were associated with a moderate sensitivity (75%-86%), high specificity (95%-98%), positive (95%-98%), and negative (99%) predictive values. The best algorithm to identify diagnostic EPS was less optimal with a sensitivity of 61% and positive predictive value of 88%. CONCLUSIONS Algorithms using a combination of physician procedural billing codes and accompanying most responsible hospital diagnosis may identify catheter ablation procedures within administrative data with a high degree of accuracy. Diagnostic EPS may be identified with reduced accuracy.
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12
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Abstract
Cardiac resynchronization therapy (CRT) is included in international consensus guidelines as a treatment with proven efficacy in well-selected patients on top of optimal medical therapy. Although all the guidelines strongly recommend CRT for LBBB with QRS duration greater than 150 milliseconds, lower strength of recommendation is reported for QRS duration of 120 to 150 milliseconds, especially if not associated with LBBB. CRT is not recommended for a QRS of less than 120 milliseconds. No indication emerges for guiding the implant based on echocardiographic evaluation of dyssynchrony. Many data indicate that CRT is underused and there is heterogeneity in its implementation.
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13
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Guerra F, Bonelli P, Flori M, Cipolletta L, Carbucicchio C, Izquierdo M, Kozluk E, Shivkumar K, Vaseghi M, Patani F, Cupido C, Pala S, Ruiz-Granell R, Ferrero A, Tondo C, Capucci A. Temporal Trends and Temperature-Related Incidence of Electrical Storm. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004634. [DOI: 10.1161/circep.116.004634] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/27/2016] [Indexed: 01/28/2023]
Abstract
Background—
The occurrence of ventricular tachyarrhythmias seems to follow circadian, daily, and seasonal distributions. Our aim is to identify potential temporal patterns of electrical storm (ES), in which a cluster of ventricular tachycardias or ventricular fibrillation, negatively affects short- and long-term survival.
Methods and Results—
The TEMPEST study (Circannual Pattern and Temperature-Related Incidence of Electrical Storm) is a patient-level, pooled analysis of previously published data sets. Study selection criteria included diagnosis of ES, absence of acute coronary syndrome as the arrhythmic trigger, and ≥10 patients included. At the end of the selection and collection processes, 5 centers had the data set from their article pooled into the present registry. Temperature data and sunrise and sunset hours were retrieved from Weather Underground, the largest weather database available online. Total sample included 246 patients presenting with ES (221 men; age: 65±9 years). Each ES episode included a median of 7 ventricular tachycardia/ventricular fibrillation episodes. Fifty-nine percent of patients experienced ES during daytime hours (
P
<0.001). The prevalence of ES was significantly higher during workdays, with Saturdays and Sundays registering the lowest rates of ES (10.4% and 7.2%, respectively, versus 16.5% daily mean from Monday to Friday;
P
<0.001). ES occurrence was significantly associated with increased monthly temperature range when compared with the month before (
P
=0.003).
Conclusions—
ES incidence is not homogenous over time but seems to have a clustered pattern, with a higher incidence during daytime hours and working days. ES is associated with an increase in monthly temperature variation.
Clinical Trial Registration—
https://www.crd.york.ac.uk
. Unique identifier: CRD42013003744.
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Affiliation(s)
- Federico Guerra
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Paolo Bonelli
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Marco Flori
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Laura Cipolletta
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Corrado Carbucicchio
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Maite Izquierdo
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Edward Kozluk
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Kalyanam Shivkumar
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Marmar Vaseghi
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Francesca Patani
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Claudio Cupido
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Salvatore Pala
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Ricardo Ruiz-Granell
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Angel Ferrero
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Claudio Tondo
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
| | - Alessandro Capucci
- From the Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti”, Ancona (F.G., P.B., M.F., L.C., F.P., C. Cupido, A.C.); Cardiology Center Monzino IRCCS, Milan, Italy (C. Carbucicchio, S.P., C.T.); University Hospital Clinic of Valencia, Spain (M.I., R.R.-G., A.F.); Medical University of Warsaw, Poland (E.K.); and Cardiac Arrhythmia Center, University of California, Los Angeles (K.S., M.V.)
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14
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Boczar K, Zabek A, Haberka K, Debski M, Rydlewska A, Musial R, Lelakowski J, Malecka B. Venous stenosis and occlusion in the presence of endocardial leads in patients referred for transvenous lead extraction. Acta Cardiol 2017; 72:61-67. [PMID: 28597736 DOI: 10.1080/00015385.2017.1281545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective The aim of this study was to evaluate the incidence of venous stenosis and occlusion (VSO) in patients referred for transvenous lead extraction (TLE) with regard to the indications for this treatment and to analyse the influence of VSO on efficacy, complications and technical challenges of TLE procedures. Methods The material consists of 133 consecutive TLE procedure records. The contrast venography examination of the ipsilateral access vein was performed prior to the operation. The whole study population was divided into two subgroups, based on the presence (subgroup I) or absence (subgroup II) of VSO. Results Phlebography was performed in 133 patients with age ranging from 25.7 to 86.1 years, 44 female (33.1%). The VSO was confirmed in 48 (36.1%) patients - subgroup I. Most of the patients were referred to TLE due to non-infectious reasons (100 pts-75.2%). The absence of VSO was observed substantially more frequently in patients with diabetes (P = 0.02). Procedural success rate reached 93.3% in subgroup I and 98.8% in subgroup II (P = 0.1). There was no significant difference in the use of advanced tools and alternative access sites. Conclusion The presence of VSO can be expected in one third of patients referred for lead extraction. There is no association between indication for TLE (infected or noninfected lead extraction) and the incidence of VSO. Diabetes proved to have a protective effect on venous patency in the previously mentioned group. VSO does not influence the effectiveness, safety, and the use of additional tools during TLE procedures.
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Affiliation(s)
- Krzysztof Boczar
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Andrzej Zabek
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Kazimierz Haberka
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Maciej Debski
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Anna Rydlewska
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Robert Musial
- Department of Medical Intensive Care Unit, John Paul II Hospital, Cracow, Poland
| | - Jacek Lelakowski
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Barbara Malecka
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
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15
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Hatz MHM, Schreyögg J, Torbica A, Boriani G, Blankart CRB. Adoption Decisions for Medical Devices in the Field of Cardiology: Results from a European Survey. HEALTH ECONOMICS 2017; 26 Suppl 1:124-144. [PMID: 28139093 DOI: 10.1002/hec.3472] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 07/29/2016] [Accepted: 11/23/2016] [Indexed: 06/06/2023]
Abstract
Decisions to adopt medical devices at the hospital level have consequences for health technology assessment (HTA) on system level and are therefore important to decision makers. Our aim was to investigate the characteristics of organizations and individuals that are more inclined to adopt and utilize cardiovascular devices based on a comprehensive analysis of environmental, organizational, individual, and technological factors and to identify corresponding implications for HTA. Seven random intercept hurdle models were estimated using the data obtained from 1249 surveys completed by members of the European Society of Cardiology. The major findings were that better manufacturer support increased the adoption probability of 'new' devices (i.e. in terms of CE mark approval dates), and that budget pressure increased the adoption probability of 'old' devices. Based on our findings, we suggest investigating the role of manufacturer support in more detail to identify diffusion patterns relevant to HTA on system level, to verify whether it functions as a substitute for medical evidence of new devices, and to receive new insights about its relationship with clinical effectiveness and cost-effectiveness. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Jonas Schreyögg
- Hamburg Center for Health Economics, University of Hamburg, Germany
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Department, University of Modena and Reggio Emilia, Modena University Hospital, Modena, Italy
- European Society of Cardiology, Sophia Antipolis, France
| | - Carl R B Blankart
- Hamburg Center for Health Economics, University of Hamburg, Germany
- Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, RI, USA
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16
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Torbica A, Banks H, Valzania C, Boriani G, Fattore G. Investigating Regional Variation of Cardiac Implantable Electrical Device Implant Rates in European Healthcare Systems: What Drives Differences? HEALTH ECONOMICS 2017; 26 Suppl 1:30-45. [PMID: 28139088 DOI: 10.1002/hec.3470] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 09/27/2016] [Accepted: 11/23/2016] [Indexed: 06/06/2023]
Abstract
Despite established efficacy for cardiac implantable electrical devices (CIEDs), large differences in CIED implant rates have been documented across and within countries. The aim of this paper is to investigate the influence of socio-economic, epidemiological and supply side factors on CIED implant rates across 57 Regions in 5 EU countries and to assess the feasibility of using administrative data for this purpose. A total of 1 330 098 hospitalizations for CIED procedures extracted from hospital discharge databases in Austria, England, Germany, Italy and Slovenia from 2008 to 2012 was used in the analysis. Higher levels of tertiary education among the labour force and percent of aged population are positively associated with implant rates of CIED. Regional per capita GDP and number of implanting centres appear to have no significant effect. Institutional factors are shown to be important for the diffusion of CIED. Wide variation in CIED implant rates across and within five EU countries is undeniable. However, regional factors play a limited part in explaining these differences with few exceptions. Administrative databases are a valuable source of data for investigating the diffusion of medical technologies, while the choice of appropriate modelling strategy is crucial in identifying the drivers for variation across countries. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Aleksandra Torbica
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Helen Banks
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | - Cinzia Valzania
- Universita degli Studi di Bologna Azienda Ospedaliera Sant\'Orsola-Malpighi, Bologna, Italy
| | - Giuseppe Boriani
- Modena University Hospital, Universita degli Studi di Modena e Reggio Emilia Facolta di Medicina e Chirurgia, Modena, Italy
| | - Giovanni Fattore
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
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17
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Dilaveris P, Tousoulis D. Long-term follow-up of patients with implantable cardioverter defibrillators in Greece: The Cretan Registry. Hellenic J Cardiol 2016; 57:S1109-9666(16)30189-0. [PMID: 27751657 DOI: 10.1016/j.hjc.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Polychronis Dilaveris
- From the First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
| | - Dimitris Tousoulis
- From the First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece
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18
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Boczar K, Ząbek A, Dębski M, Haberka K, Rydlewska A, Lelakowski J, Małecka B. The utility of a CHA2DS2-VASc score in predicting the presence of significant stenosis and occlusion of veins with indwelling endocardial leads. Int J Cardiol 2016; 218:164-169. [PMID: 27236109 DOI: 10.1016/j.ijcard.2016.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/12/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Currently, there are no studies in which a CHA2DS2-VASc score has been used to predict the risk of venous stenosis and occlusion (VSO) in patients after the implantation of a cardiac implantable electronic device (CIED). METHODS The material consists of the records of 223 consecutive patients qualified for transvenous lead extraction, generator change and system revisions or upgrades in whom we assessed the utility of a CHA2DS2-VASc score in the prediction of VSO. The CHA2DS2-VASc score was calculated retrospectively based on the clinical data. The whole study population was divided into two groups, based on the presence (group I) or absence (group II) of VSO. Using the receiver operating characteristic (ROC) curve, we identified the optimal cut-off point for the CHA2DS2-VASc score that allowed the prediction of the absence of VSO. RESULTS The venography was performed in 223 consecutive patients aged on average 68.2years (25.7-95.3), 77 females (34.5%). The presence of VSO was detected in 79 (35.4%) patients aged 68.3±14.1years, 30 female (40%) patients-group I. The level of the cut-off point for the CHA2DS2-VASc score that allowed the prediction of the absence of VSO was 3.0. CONCLUSION In the whole population the incidence of VSO amounted to 35.4%. The result of the CHA2DS2-VASc score was a destimulant of VSO occurrence and was characterized by moderate sensitivity (73.4%) and specificity (42.4%) in predicting the absence of VSO. The most significant factor, which prevented VSO development was diabetes.
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Affiliation(s)
- Krzysztof Boczar
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland.
| | - Andrzej Ząbek
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Maciej Dębski
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Kazimierz Haberka
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Anna Rydlewska
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland
| | - Jacek Lelakowski
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland; Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Barbara Małecka
- Department of Electrocardiology, John Paul II Hospital, Cracow, Poland; Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
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Raatikainen MP, Arnar DO, Merkely B, Camm AJ, Hindricks G. Access to and clinical use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology Countries: 2016 Report from the European Heart Rhythm Association. Europace 2016; 18 Suppl 3:iii1-iii79. [DOI: 10.1093/europace/euw244] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 11/13/2022] Open
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20
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Corzani A, Ziacchi M, Biffi M, Allaria L, Diemberger I, Martignani C, Bratten T, Gardini B, Boriani G. Clinical management of electromagnetic interferences in patients with pacemakers and implantable cardioverter-defibrillators: review of the literature and focus on magnetic resonance conditional devices. J Cardiovasc Med (Hagerstown) 2016; 16:704-13. [PMID: 26313816 DOI: 10.2459/jcm.0000000000000301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The number of cardiac implantable electronic devices (CIEDs) has greatly increased in the last 10 years. Many electronic devices used in daily activities generate electromagnetic interferences (EMIs) that can interact with CIEDs. In clinical practice, it is very important to know the potential sources of EMIs and their effect on CIEDs in order to understand how to manage or mitigate them. A very important source of EMI is magnetic resonance (MR), which is considered nowadays the diagnostic gold standard for different anatomical districts. In this review, we focused on the effects of EMI on CIEDs and on the clinical management. Moreover, we made a clarification about MR and CIEDs.In patients with CIEDs, EMIs may cause potentially serious and even life-threatening complications (inappropriate shocks, device malfunctions, inhibition of pacing in pacemaker-dependent patients) and may rarely dictate device replacement. The association of inappropriate shocks with increased mortality highlights the importance of minimizing the occurrence of EMI. Adequate advice and recommendations about the correct management of EMIs in patients with CIEDs are required to avoid all complications during hospitalization and in daily life. Furthermore, the article focused on actual management about MR and CIEDs.
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Affiliation(s)
- Alessandro Corzani
- aDepartment of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S.Orsola Malpighi University Hospital, Bologna, Italy bMedtronic Inc, Minneapolis, Minnesota, USA *These authors contributed equally to this work
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21
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Cubbon RM, Witte KK, Kearney LC, Gierula J, Byrom R, Paton M, Sengupta A, Patel PA, Mn Walker A, Cairns DA, Rajwani A, Hall AS, Sapsford RJ, Kearney MT. Performance of 2014 NICE defibrillator implantation guidelines in heart failure risk stratification. Heart 2016; 102:735-40. [PMID: 26857212 PMCID: PMC4853639 DOI: 10.1136/heartjnl-2015-308939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/03/2016] [Indexed: 01/14/2023] Open
Abstract
Objective Define the real-world performance of recently updated National Institute for Health and Care Excellence guidelines (TA314) on implantable cardioverter-defibrillator (ICD) use in people with chronic heart failure. Methods Multicentre prospective cohort study of 1026 patients with stable chronic heart failure, associated with left ventricular ejection fraction (LVEF) ≤45% recruited in cardiology outpatient departments of four UK hospitals. We assessed the capacity of TA314 to identify patients at increased risk of sudden cardiac death (SCD) or appropriate ICD shock. Results The overall risk of SCD or appropriate ICD shock was 2.1 events per 100 patient-years (95% CI 1.7 to 2.6). Patients meeting TA314 ICD criteria (31.1%) were 2.5-fold (95% CI 1.6 to 3.9) more likely to suffer SCD or appropriate ICD shock; they were also 1.5-fold (95% CI 1.1 to 2.2) more likely to die from non-cardiovascular causes and 1.6-fold (95% CI 1.1 to 2.3) more likely to die from progressive heart failure. Patients with diabetes not meeting TA314 criteria experienced comparable absolute risk of SCD or appropriate ICD shock to patients without diabetes who met TA314 criteria. Patients with ischaemic cardiomyopathy not meeting TA314 criteria experienced comparable absolute risk of SCD or appropriate ICD shock to patients with non-ischaemic cardiomyopathy who met TA314 criteria. Conclusions TA314 can identify patients with reduced LVEF who are at increased relative risk of sudden death. Clinicians should also consider clinical context and the absolute risk of SCD when advising patients about the potential risks and benefits of ICD therapy.
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Affiliation(s)
- Richard M Cubbon
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Leeds, UK
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Leeds, UK
| | - Lorraine C Kearney
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Leeds, UK
| | - Rowenna Byrom
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Leeds, UK
| | - Maria Paton
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Leeds, UK
| | - Anshuman Sengupta
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Leeds, UK
| | - Peysh A Patel
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Leeds, UK
| | - Andrew Mn Walker
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Leeds, UK
| | - David A Cairns
- Leeds Institute of Clinical Trials Research, The University of Leeds, Leeds, UK
| | - Adil Rajwani
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Alistair S Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Leeds, UK
| | | | - Mark T Kearney
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Leeds, UK
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22
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Ziacchi M, Corzani A, Diemberger I, Martignani C, Marziali A, Mazzotti A, Massaro G, Rapezzi C, Biffi M, Boriani G. Electrocardiographic Eligibility for Subcutaneous Implantable Cardioverter Defibrillator: Evaluation during Bicycle Exercise. Heart Lung Circ 2016; 25:476-83. [DOI: 10.1016/j.hlc.2015.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/08/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
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23
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Ozenne V, Toupin S, Bour P, de Senneville BD, Lepetit-Coiffé M, Boissenin M, Benois-Pineau J, Hansen MS, Inati SJ, Govari A, Jaïs P, Quesson B. Improved cardiac magnetic resonance thermometry and dosimetry for monitoring lesion formation during catheter ablation. Magn Reson Med 2016; 77:673-683. [PMID: 26899165 DOI: 10.1002/mrm.26158] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/14/2016] [Accepted: 01/18/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE A new real-time MR-thermometry pipeline was developed to measure multiple temperature images per heartbeat with 1.6×1.6×3 mm3 spatial resolution. The method was evaluated on 10 healthy volunteers and during radiofrequency ablation (RFA) in sheep. METHODS Multislice, electrocardiogram-triggered, echo-planar imaging was combined with parallel imaging, under free breathing conditions. In-plane respiratory motion was corrected on magnitude images by an optical flow algorithm. Motion-related susceptibility artifacts were compensated on phase images by an algorithm based on Principal Component Analysis. Correction of phase drift and temporal filter were included in the pipeline implemented in the Gadgetron framework. Contact electrograms were recorded simultaneously with MR thermometry by an MR-compatible ablation catheter. RESULTS The temporal standard deviation of temperature in the left ventricle remained below 2 °C on each volunteer. In sheep, focal heated regions near the catheter tip were observed on temperature images (maximal temperature increase of 38 °C) during RFA, with contact electrograms of acceptable quality. Thermal lesion dimensions at gross pathology were in agreement with those observed on thermal dose images. CONCLUSION This fully automated MR thermometry pipeline (five images/heartbeat) provides direct assessment of lesion formation in the heart during catheter-based RFA, which may improve treatment of cardiac arrhythmia by ablation. Magn Reson Med 77:673-683, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Valéry Ozenne
- Institut Hospitalo-Universitaire, Liryc Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France.,Inserm U1045 Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Solenn Toupin
- Institut Hospitalo-Universitaire, Liryc Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France.,Inserm U1045 Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France.,Siemens Healthcare France, Saint Denis, France
| | - Pierre Bour
- Institut Hospitalo-Universitaire, Liryc Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France.,Inserm U1045 Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France
| | | | | | - Manuel Boissenin
- Institut Hospitalo-Universitaire, Liryc Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France.,Inserm U1045 Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France
| | | | - Michael S Hansen
- Magnetic Resonance Technology Program, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Souheil J Inati
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Pierre Jaïs
- Institut Hospitalo-Universitaire, Liryc Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Bruno Quesson
- Institut Hospitalo-Universitaire, Liryc Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France.,Inserm U1045 Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France
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Fontenla A, Martínez-Ferrer JB, Alzueta J, Viñolas X, García-Alberola A, Brugada J, Peinado R, Sancho-Tello MJ, Cano A, Fernández-Lozano I. Incidence of arrhythmias in a large cohort of patients with current implantable cardioverter-defibrillators in Spain: results from the UMBRELLA Registry. Europace 2015; 18:1726-1734. [PMID: 26705555 DOI: 10.1093/europace/euv393] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/31/2015] [Indexed: 01/06/2023] Open
Abstract
AIMS The benefit of implantable cardioverter-defibrillators (ICDs) in patients at risk of sudden death has been established in randomized clinical trials (RCTs) using the ICD models available at the time. However, observational large-scale data on the incidence of arrhythmias in up-to-date ICDs implanted according to the current guidelines are scarce. The aim was to assess the incidence of arrhythmias in a large, current ICD population based on a blinded peer review of the detected episodes. METHODS AND RESULTS UMBRELLA is a multicentre, observational registry of ICD patients followed by remote monitoring. Stored episodes were classified by a blinded committee of experts. Subgroup analyses were based on clinical profiles established by previous pivotal RCTs of ICDs. Of 1514 enrolled patients, 605 (39.9%) patients had 5951 episodes after 26 ± 17 months follow-up, being 3353 of them (56.3%) sustained ventricular arrhythmias (SVA), and 13.2% of SVA were self-terminated. Appropriate and inappropriate shocks occurred in 11.6 and 5% of patients, respectively. The 3 years cumulative incidence of SVA was 25% (95% CI: 21-28%) in primary prevention patients and 41% (95% CI: 36-47%) in secondary prevention patients (P < 0.001). Male gender, secondary prevention, and atrial fibrillation as basal rhythm were significantly related to a higher incidence of SVA. CONCLUSION This real-world analysis suggests that modern ICD patients have a low rate of appropriate and inappropriate shocks. The risk of SVA in secondary prevention patients is less than what has been reported in RCTs.
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Affiliation(s)
- Adolfo Fontenla
- University Hospital 12 de Octubre, Av de Córodoba sn, 28041, Madrid, Spain
| | - Jose B Martínez-Ferrer
- University Hospital of Araba, Calle Jose itxotegi sn, 01009, Vitoria-Gasteiz, Alava, Spain
| | - Javier Alzueta
- University Hospital Virgen de las Victoria, Campus de Teatinos sn, 29010 Malaga, Spain
| | - Xavier Viñolas
- Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quinti, 89, 08026 Barcelona, Spain
| | | | - Josep Brugada
- Hospital Clìnic i Provincial, Carrer Villarroel, 170, 08036 Barcelona, Spain
| | - Rafael Peinado
- University Hospital La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | | | - Alicia Cano
- Cardiac and Vascular Group, Medtronic Iberica, Calle Maria de Portugal, 9, 28050 Madrid, Spain
| | - Ignacio Fernández-Lozano
- University Hospital Puerta de Hierro-Majadahonda, Calle Manuel de Falla, 1, 28222, Majadahonda, Madrid, Spain
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Boriani G, Nesti M, Ziacchi M, Padeletti L. Cardiac Resynchronization Therapy: An Overview on Guidelines. Card Electrophysiol Clin 2015; 7:673-693. [PMID: 26596811 DOI: 10.1016/j.ccep.2015.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cardiac resynchronization therapy (CRT) is included in international consensus guidelines as a treatment with proven efficacy in well-selected patients on top of optimal medical therapy. Although all the guidelines strongly recommend CRT for LBBB with QRS duration greater than 150 milliseconds, lower strength of recommendation is reported for QRS duration of 120 to 150 milliseconds, especially if not associated with LBBB. CRT is not recommended for a QRS of less than 120 milliseconds. No indication emerges for guiding the implant based on echocardiographic evaluation of dyssynchrony. Many data indicate that CRT is underused and there is heterogeneity in its implementation.
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Affiliation(s)
- Giuseppe Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Via Giuseppe Massarenti 9, Bologna 40138, Italy.
| | - Martina Nesti
- Electrophysiology and Pacing Centre, Heart and Vessels Department, University of Firenze, Largo Brambilla 3, Firenze 50134, Italy
| | - Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Via Giuseppe Massarenti 9, Bologna 40138, Italy
| | - Luigi Padeletti
- Specialty School in Cardiovascular Diseases, University of Firenze, Largo Brambilla 3, Firenze 50134, Italy
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Valzania C, Torbica A, Tarricone R, Leyva F, Boriani G. Implant rates of cardiac implantable electrical devices in Europe: A systematic literature review. Health Policy 2015; 120:1-15. [PMID: 26632502 DOI: 10.1016/j.healthpol.2015.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 10/02/2015] [Accepted: 11/02/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND In recent years, indications for cardiac implantable electrical devices (CIEDs) have broadened; however, budget constraints can significantly impact patient access to these life-saving health technologies. OBJECTIVE To perform a systematic literature review on the implant rates of pacemakers, cardioverter-defibrillators, and cardiac resynchronization therapy devices in Europe over the last decade to provide insight into the possible reasons for differences across regions or countries. METHODS Four electronic databases were searched to find studies describing CIED implant rates in Europe. Fifty-eight studies were included. RESULTS An overview showed a recent rise in CIED implants, with large geographic differences. The ratio between the regions with the highest and lowest implant rates within the same country ranged between 1.3 and 3.4 for pacemakers and between 1.7 and 44.0 for defibrillators. The ratio between the countries with the highest and lowest implant rates ranged between 2.3 and 87.5 for pacemakers, between 3.1 and 1548.0 for defibrillators, and between 4.1 and 221.0 for resynchronization therapy devices. Implant rate variability appears to be influenced by health care, economic, demographic, and cultural factors. CONCLUSION Publications on CIED implant rates in Europe show a wide variability within and across countries, the determinants of which are only partially investigated. Policy making should improve regarding equity of access to better care.
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Affiliation(s)
- Cinzia Valzania
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Aleksandra Torbica
- CERGAS, Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Rosanna Tarricone
- CERGAS, Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Francisco Leyva
- Aston Medical Research Institute, Aston University Medical School, Birmingham, United Kingdom
| | - Giuseppe Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy; Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena , Modena, Italy
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Raatikainen MP, Arnar DO, Zeppenfeld K, Merino JL, Kuck KH, Hindricks G. Current trends in the use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology member countries: 2015 report from the European Heart Rhythm Association. Europace 2015; 17 Suppl 4:iv1-72. [DOI: 10.1093/europace/euv265] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Boriani G, Savelieva I, Dan GA, Deharo JC, Ferro C, Israel CW, Lane DA, La Manna G, Morton J, Mitjans AM, Vos MA, Turakhia MP, Lip GY. Chronic kidney disease in patients with cardiac rhythm disturbances or implantable electrical devices: clinical significance and implications for decision making-a position paper of the European Heart Rhythm Association endorsed by the Heart Rhythm Society and the Asia Pacific Heart Rhythm Society. Europace 2015; 17:1169-96. [PMID: 26108808 PMCID: PMC6281310 DOI: 10.1093/europace/euv202] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Giuseppe Boriani
- Corresponding author. Giuseppe Boriani, Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy. Tel: +39 051 349858; fax: +39 051 344859. E-mail address:
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Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry. Am J Med 2015; 128:509-18.e2. [PMID: 25534423 DOI: 10.1016/j.amjmed.2014.11.026] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/18/2014] [Accepted: 11/18/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Atrial fibrillation is often asymptomatic, but outcomes require further characterization. The study objective was to investigate the clinical presentation, management, and outcomes in asymptomatic and symptomatic patients with atrial fibrillation who were prospectively enrolled in the EurObservational Research Programme - Atrial Fibrillation (EORP-AF) Pilot General Registry. METHODS A total of 3119 patients were enrolled, and 1237 (39.7%) were asymptomatic (European Heart Rhythm Association [EHRA] score I). Among symptomatic patients, 963 (51.2%) had mild symptoms (EHRA score II) and 919 (48.8%) had severe or disabling symptoms (EHRA III-IV). Permanent atrial fibrillation was 3-fold more common in asymptomatic patients than in symptomatic patients. RESULTS On multivariate analysis, male gender (odds ratio [OR], 1.630; 95% confidence interval [CI], 1.384-1.921), older age (OR, 1.019; 95% CI, 1.012-1.026), previous myocardial infarction (OR, 1.681; 95% CI, 1.350-2.093), and limited physical activity (OR, 1.757; 95% CI, 1.495-2.064) were associated significantly with asymptomatic (EHRA I) atrial fibrillation. Fully asymptomatic atrial fibrillation (absence of current and previous symptoms) was present in 520 patients (16.7%) and was associated independently with male gender, age, and previous myocardial infarction. Appropriate guideline-based prescription of oral anticoagulants was lower in these patients, and aspirin was prescribed more frequently. Mortality at 1 year was more than 2-fold higher in asymptomatic patients compared with symptomatic patients (9.4% vs 4.2%, P < .0001) and was associated independently with older age and comorbidities, including chronic kidney disease and chronic heart failure. CONCLUSIONS Asymptomatic atrial fibrillation is common in daily cardiology practice and is associated with elderly age, more comorbidities, and high thromboembolic risks. A higher 1-year mortality was found in asymptomatic patients compared with symptomatic patients.
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Boriani G. Remote monitoring of cardiac implantable electrical devices in Europe: quo vadis? Europace 2015; 17:674-676. [DOI: 10.1093/europace/euv031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Bhagirath P, van der Graaf M, Karim R, Rhode K, Piorkowski C, Razavi R, Schwitter J, Götte M. Interventional cardiac magnetic resonance imaging in electrophysiology: advances toward clinical translation. Circ Arrhythm Electrophysiol 2015; 8:203-11. [PMID: 25691554 DOI: 10.1161/circep.114.002371] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Pranav Bhagirath
- From the Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.v.d.G., M.G.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom (R.K., K.R., R.R.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (C.P.); and Department of Cardiology, University Hospital Lausanne, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Switzerland (J.S.)
| | - Maurits van der Graaf
- From the Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.v.d.G., M.G.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom (R.K., K.R., R.R.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (C.P.); and Department of Cardiology, University Hospital Lausanne, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Switzerland (J.S.)
| | - Rashed Karim
- From the Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.v.d.G., M.G.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom (R.K., K.R., R.R.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (C.P.); and Department of Cardiology, University Hospital Lausanne, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Switzerland (J.S.)
| | - Kawal Rhode
- From the Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.v.d.G., M.G.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom (R.K., K.R., R.R.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (C.P.); and Department of Cardiology, University Hospital Lausanne, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Switzerland (J.S.)
| | - Christopher Piorkowski
- From the Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.v.d.G., M.G.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom (R.K., K.R., R.R.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (C.P.); and Department of Cardiology, University Hospital Lausanne, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Switzerland (J.S.)
| | - Reza Razavi
- From the Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.v.d.G., M.G.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom (R.K., K.R., R.R.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (C.P.); and Department of Cardiology, University Hospital Lausanne, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Switzerland (J.S.)
| | - Juerg Schwitter
- From the Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.v.d.G., M.G.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom (R.K., K.R., R.R.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (C.P.); and Department of Cardiology, University Hospital Lausanne, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Switzerland (J.S.)
| | - Marco Götte
- From the Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.v.d.G., M.G.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom (R.K., K.R., R.R.); Department of Electrophysiology, University of Dresden-Heart Center, Dresden, Germany (C.P.); and Department of Cardiology, University Hospital Lausanne, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Switzerland (J.S.).
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Schmidt M, Pedersen SB, Farkas DK, Hjortshøj SP, Bøtker HE, Nielsen JC, Sørensen HT. Thirteen-year nationwide trends in use of implantable cardioverter-defibrillators and subsequent long-term survival. Heart Rhythm 2015; 12:2018-27. [PMID: 25937527 DOI: 10.1016/j.hrthm.2015.04.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term trends in use of implantable cardioverter-defibrillators (ICDs) and outcomes are rare. OBJECTIVE We examined 13-year nationwide trends in ICD implantation and survival rates in Denmark. METHODS Using medical databases, we identified all first time ICD recipients in Denmark during 2000-2012 (N = 8460) and ascertained all-cause mortality. We computed standardized annual implantation rates and mortality rate ratios according to age, sex, comorbidity level, indication, and device type. RESULTS The standardized annual implantation rate increased from 42 per million persons in 2000 to 213 per million persons in 2012 (from 34 to 174 for men and from 8 to 39 for women). The increase was driven by secondary prophylactic ICDs until 2006 and primary prophylactic ICDs thereafter. The increase occurred particularly in older patients and those with a high level of comorbidity. Independent of indication, 76% of all patients with ICD were alive after 5 years. Men had a higher mortality rate compared with women (mortality rate ratio 1.28; 95% confidence interval 1.10-1.49). Compared with low comorbidity level, moderate, severe, and very severe comorbidity levels were associated with 1.6-, 2.5-, and 4.9-fold increased mortality rates, respectively. The most influential individual comorbidities were heart failure, diabetes, liver disease, and renal disease. CONCLUSION The annual implantation rate of ICDs increased 5-fold in Denmark between 2000 and 2012. The rate increase occurred for both men and women, but particularly in the elderly and patients with severe comorbidity. Five-year survival probability was high, but severe comorbidity and male sex were associated with shorter survival.
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Affiliation(s)
- Morten Schmidt
- Departments of Clinical Epidemiology; Cardiology, Aarhus University Hospital, Aarhus, Denmark.
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Sohaib SA, Finegold JA, Nijjer SS, Hossain R, Linde C, Levy WC, Sutton R, Kanagaratnam P, Francis DP, Whinnett ZI. Opportunity to Increase Life Span in Narrow QRS Cardiac Resynchronization Therapy Recipients by Deactivating Ventricular Pacing. JACC-HEART FAILURE 2015; 3:327-36. [DOI: 10.1016/j.jchf.2014.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/12/2014] [Accepted: 11/14/2014] [Indexed: 01/14/2023]
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Clinical utility of routine use of continuous transesophageal echocardiography monitoring during transvenous lead extraction procedure. Heart Rhythm 2015; 12:313-20. [DOI: 10.1016/j.hrthm.2014.10.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Indexed: 11/24/2022]
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Raatikainen MJP, Arnar DO, Zeppenfeld K, Merino JL, Levya F, Hindriks G, Kuck KH. Statistics on the use of cardiac electronic devices and electrophysiological procedures in the European Society of Cardiology countries: 2014 report from the European Heart Rhythm Association. Europace 2015; 17 Suppl 1:i1-75. [DOI: 10.1093/europace/euu300] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Coma Samartín R, Cano Pérez Ó, Pombo Jiménez M. Registro Español de Marcapasos. XI Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2013). Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Coma Samartín R, Cano Pérez Ó, Pombo Jiménez M. Spanish Pacemaker Registry. Eleventh official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2013). REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2014; 67:1024-1038. [PMID: 25455755 DOI: 10.1016/j.rec.2014.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/16/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES The present report summarizes the analysis of pacemaker implantation and replacement data sent to the Spanish Pacemaker Registry in 2013, with specific discussion of pacing mode selection. METHODS This study was based on information obtained from the European Pacemaker Patient Identification Card. RESULTS Information was received on 118 hospital centers, with a total of 12 831 cards, or 35% of the estimated activity. There were 755 and 58.1 conventional and resynchronization devices per million population, respectively. The mean age of patients receiving an implant was 77.4 years. Men received 59.5% of first implantations and 56.6% of replacements. Most implantations and generator replacements were performed in patients older than 80 years. Almost all endocardial leads used were bipolar, and 78.7% of leads had an active fixation mechanism. Despite being in sinus rhythm, 24% of patients with sick sinus syndrome and 25% of those with atrioventricular block were paced in VVIR mode. CONCLUSIONS The use of pacemaker generators and resynchronization devices per million population continues to increase in Spain. Active fixation mechanisms predominate for leads but just 20% of leads are compatible with magnetic resonance imaging. The factors influencing the correct selection of pacing mode were age and, to a lesser extent, the type of atrioventricular block, and sex. Implementation of home monitoring of pacemakers remains low.
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Affiliation(s)
- Raúl Coma Samartín
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Cuidados Críticos Cardiológicos, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Óscar Cano Pérez
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Marta Pombo Jiménez
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Estimulación Cardiaca, Hospital Costal de Sol, Marbella, Málaga, Spain
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