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Termination of Ventricular Tachycardia with Antitachycardia Pacing after Ineffective Shock Therapy in an ICD Recipient with Hypertrophic Cardiomyopathy  [cached]
Panagiotis N. Margos,Rolf Schomburg,Jorg Kynast,Ahmed A. Khattab
Indian Pacing and Electrophysiology Journal , 2009,
Abstract: Implantable Cardioverter Defibrillator (ICD) implantation is the only established therapy for primary or secondary prevention of sudden cardiac death in patients with Hypertrophic Cardiomyopathy (HCM). Ineffectiveness of shock therapy for the termination of potentially fatal ventricular arrhythmias in ICD recipients is rare in the presence of appropriate arrhythmia detection by the device. We report the case of a 48-year-old woman with HCM and a single chamber ICD, who received five inefficient high-energy (35 Joules) shocks for the termination of an appropriately detected episode of Ventricular Tachycardia (VT). The episode was safely terminated with a subsequent application of Antitachycardia Pacing (ATP) by the device. At the following ICD control, an acceptable defibrillation threshold was detected.
Effect of Induced Ventricular Fibrillation and Shock Delivery on Brain Natriuretic Peptide Measured Serially Following a Predischarge ICD Test
Marco Budeus,Emanuel Salibassoglu,Anna Maria Schymura,Nico Reinsch
Indian Pacing and Electrophysiology Journal , 2007,
Abstract: Objectives: Brain natriuretic peptide (BNP) was a marker for heart failure and cardiac wall tension. We analysed the trend of BNP after predischarge testing in order to get non-invasive details about the cardiac stress during predischarge testing.Methods: 4-5 days after ICD implant we measured BNP, myoglobin, cardiac troponin I and creatine kinase in 20 patients before and 1, 5, 10, 20, 40, 60, 80, 100, 120 minutes and at the next day after predischarge testing. We evaluated actual values and percentage alterations of BNP. Results: BNP significantly increased with a maximum after 5 minutes (804.0 ± 803.4 vs. 475.7 ± 629.5 pg/ml, P < 0.0001) and in terms of the percentage values (100 vs. 199.4 ± 61.4 %, P < 0.0001) compared with baseline BNP. BNP decreased after that with the last significantly increased BNP value after 20 minutes (540.2 ± 604.9 vs. 475.7 ± 629.5 pg/ml, P = 0.017). We excluded a cardiac necrosis during predischarge testing because of similar values of myoglobin, cardiac troponin I and creatine kinase during the 2-hour follow-up. Conclusions: Our data showed a great increase with a doubling of BNP after 5 minutes as a result of induced ventricular fibrillation during predischarge test. This increase was not generated by myocardial necrosis but rather caused by an acute cardiac failure as a consequence of induced ventricular fibrillation in predischarge testing.
Inappropriate Shock Delivered By Implantable Cardioverter Defibrillator - Cardiac Resynchronization Therapy (ICD-CRT) Due To Myopotential Oversensing
Hamid Barakpour,Zahra Emkanjoo,Abolfath Alizadeh,Mohammad Ali Sadr-Ameli
Indian Pacing and Electrophysiology Journal , 2009,
Abstract: The clinical efficacy of ICD-CRT therapy depends on accurate sensing of intracardiac signals and sensing algorithms. We report the occurrence of sensing abnormality in a patient with ICD-CRT. In this patient, oversensing of myopotentials during strenuous muscular activity resulted in an inappropriate ICD-CRT discharge. Although modern ICDs are highly effective in detecting and terminating malignant tachyarrhythmias, their detection specificity must be improved. It is possible to find the mechanism of arrhythmia by EGM. Simple device reprogramming make it possible to avoid the oversensing of myopotentials.
Frequent Home Monitoring of ICD Is Effective to Prevent Inappropriate Defibrillator Shock Delivery  [PDF]
Paolo Bifulco,Luigi Argenziano,Maria Romano,Mario Cesarelli,Mario Sansone,Stefano Casella,Stefano Nardi
Case Reports in Medicine , 2014, DOI: 10.1155/2014/579526
Abstract: Recently, in the context of telemedicine, telemonitoring services are gaining attention. They are offered, for example, to patients with implantable cardioverter defibrillators (ICDs). A major problem associated with ICD therapy is the occurrence of inappropriate shocks which impair patients’ quality of life and may also be arrhythmogenic. The telemonitoring can provide a valid support to intensify followup visits, in order to improve the prevention of inappropriate defibrillator shock, thus enhancing patient safety. Inappropriate shock generally depends on atrial fibrillation, supraventricular tachycardia, and abnormal sensing (such as those caused by electromagnetic interferences). As a practical example, an unusual case of an ICD patient who risked an inappropriate shock while taking a shower is reported. Continuous remote telemonitoring was able to timely warn cardiologist via GSM-SMS, who were able to detect improper sensing examining the intracardiac electrogram via Web. Patient was promptly contacted and warned to not further come in contact with the hydraulic system and any electrical appliance to prevent an inappropriate defibrillator shock. This demonstrates the effectiveness and usefulness of continuous remote telemonitoring in supporting ICD patients. 1. Introduction In the last decades, the advances in information and communication technology have permitted that telehealth supports are diffusing rapidly into all aspects of healthcare. Integration of traditional medical practices with computerized supports and Internet functionalities may improve quality of life and solve problems of access health disparities for some patient categories [1–3]. Home-care is a term often used to describe telemedicine applications in which medical services are delivered to patients at their homes. Home-care is especially important for a specific group of patients with long-term chronic conditions, such as chronic cardiac diseases. Recently, there is a growing interest also in the remote monitoring and followup of implantable cardioverter defibrillators (ICDs). The number of patients with implantable devices has been growing steadily, mainly because indications for ICD shifted from secondary to primary prevention of sudden death [4] (for more details refer to Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) [5]). According to current guidelines (issued by AHA, ACC, etc.), patients with an ICD should be followed up every 3–6 months (increasing frequency as the battery approaches elective replacement) to ensure proper device function. However,
Integrated approach for smart implantable cardioverter defibrillator (ICD) device with real time ECG monitoring: use of flexible sensors for localized arrhythmia sensing and stimulation  [PDF]
Munish Puri,Kalyan C. Chapalamadugu,Aimon C. Miranda,Shyam Gelot,Srinivas M. Tipparaju
Frontiers in Physiology , 2013, DOI: 10.3389/fphys.2013.00300
Abstract: Arrhythmias are the most common cause of death associated with sudden death and are common in US and worldwide. Cardiac resynchronization therapy (CRT), evolving from pacemakers and development of implantable cardioverter defibrillator (ICD), has been adopted for therapeutic use and demonstrated benefits in patients over the years due to its design and intricate functionality. Recent research has been focused on significant design improvement and efforts are dedicated toward device size reduction, weight and functionality in commercially available ICD's since its invention in the 1960's. Commercially available CRT-D has shown advancement on both clinical and technical side. However, improved focus is required on the device miniaturization, technologically supported and integrated wireless based system for real time heart monitoring electrocardiogram (ECG). In the present report a concise overview for the state-of-the art technology in ICDs and avenues for future development are presented. A unique perspective is also included for ICD device miniaturization and integration of flexible sensing array. Sensor array integration along with its capabilities for identifying localized arrhythmia detection and targeted stimulation for enhancing ICD device capabilities is reviewed.
Ventricular Arrhythmia-Free Survival Following Therapeutic Hypothermia in Patients with Sudden Cardiac Death Due to Ventricular Tachycardia or Fibrillation  [PDF]
Basil M. Saour, Yong H. Ji, Edward F. Philbin, Henry T. Tan, Duy T. Nguyen, James J. O’Brien, Mandeep S. Sidhu, David A. Steckman, Mikhail T. Torosoff
International Journal of Clinical Medicine (IJCM) , 2017, DOI: 10.4236/ijcm.2017.85028
Abstract: Background: The potential benefits of implantable cardioverter-defibrillator (ICD) therapy in patients with sudden cardiac death (SCD) treated with therapeutic hypothermia (TH) have not been well studied. Methods: Incidence of recurrent non-sustained ventricular arrhythmia, ICD therapy, and death were ascertained in 64 consecutive survivors of SCD due to ventricular fibrillation or tachycardia, who were treated with TH. Follow-up was 31.5 +/- 3.3 months in 41 ICD recipients and 36.3 +/- 3.9 months in 23 patients who did not receive an ICD due to the presence of a reversible cause of cardiac arrest, an acute myocardial infarction in 87%. Results: Combined incidence of ventricular arrhythmia, ICD therapy, or death in patients who underwent ICD placement (21.9%) were similar to overall mortality in the patients who did not receive an ICD (21.7%, p = 0.752). ICD placement was associated with a significant mortality benefit; 95.1% survival in ICD recipients vs. 78.3% in the no-ICD group (p = 0.038). Electrocardiographic findings of ST segment elevation on admission were associated with increased event rate in ICD recipients (p = 0.039) and increased mortality in SCD patients who did not receive an ICD (p < 0.001). Other studied variables had no significant effect on the investigated outcomes. Conclusions: SCD survivors treated with TH are at increased risk for recurrent arrhythmic events and derive significant mortality benefit from ICD implantation. Increased mortality in revascularized SCD patients with acute coronary syndrome, thought to have a reversible cause of cardiac arrest, calls for prospective trials investigating utility of ICD in this vulnerable patient population.
Atrial Fibrillation Due to Electric Shock  [cached]
Mustafa ??er,Umut Güla?t?,Recep Dursun
Akademik Acil T?p Olgu Sunumlar? Dergisi (AKATOS) , 2012,
Abstract: Rhythm disorders (transmission problems, tachycardia and arrhythmia) related to electric shock are frequently seen. One of these arrhythmias is atrial fibrillation (AF). A case of atrial fibrillation that occurred due to electric shock and returned to normal sinus rhythm following medical cardiovascular intervention is presented in this paper.
Junctional ectopic tachycardia following repair of congenital heart defects - experience in multimodal management from a West African Centre
Kow Entsua-Mensah, Ernest Aniteye, Lawrence Agyemang Sereboe, Mark Mawutor Tettey, Frank Edwin, Martin Tamatey, Ibrahim Delia, Kofi Bafoe Gyan
Pan African Medical Journal , 2012,
Abstract: Background: Postoperative junctional ectopic tachycardia (JET) is a rare and transient phenomenon occurring after repair of congenital heart defects. Report on this arrhythmia in the subregion is rare. We set out to determine the incidence of this arrhythmia and review the treatment and outcomes of treatment in our centre. Methods: Retrospective search of the records of all patients aged 18 years and below admitted into the intensive care unit (ICU) following repair or palliation of a congenital heart defect over 5 years, from January 1, 2006 to December 31, 2010. A review of clinical notes, operative records, anaesthetic charts, cardiopulmonary bypass (CPB) records, nursing observation charts, electrocardiograms (ECGs) and out-patient follow-up records was undertaken. Results: 510 children under 18 years were enlisted. 7 cases of postoperative JET were recorded, (1.37%). 184 (36.1%) of these were performed under CPB. All JET cases were from cases done under CPB, 3.8%. Median age was 3 years and median weight 11.3kg. No patient was febrile at diagnosis. 4 patients had amiodarone administration, 5 had magnesium sulphate infusion, 2 patients had direct current shock (DCS) whilst 3 patients had all three therapeutic modalities. All patients had control of the arrhythmia with conversion to sinus rhythm and no recurrence. Conclusion: We report a JET incidence of 1.37% among children undergoing CPB for repair of congenital heart defects. We demonstrate the therapeutic effectiveness of amiodarone, magnesium sulphate infusions and DCS alone or in combination in the management of JET on various substrates with good outcome. Pan African Medical Journal 2012; 12:18
Comparison of ICD code-based diagnosis of obesity with measured obesity in children and the implications for health care cost estimates
Stefan Kuhle, Sara FL Kirk, Arto Ohinmaa, Paul J Veugelers
BMC Medical Research Methodology , 2011, DOI: 10.1186/1471-2288-11-173
Abstract: Linkage of a population-based survey with anthropometric measures in elementary school children in 2003 with longitudinal administrative health data (physician visits and hospital discharges 1992-2006) from the Canadian province of Nova Scotia. Measured obesity was defined based on the CDC cut-offs applied to the measured BMI. An ICD code-based diagnosis obesity was defined as one or more ICD-9 (278) or ICD-10 code (E66-E68) of obesity from a physician visit or a hospital stay. Sensitivity and specificity were calculated and health care cost estimates based on measured obesity and ICD-based obesity were compared.The sensitivity of an ICD code-based obesity diagnosis was 7.4% using ICD codes between 2002 and 2004. Those correctly identified had a higher BMI and had higher health care utilization and costs.An ICD diagnosis of obesity in Canadian administrative health data grossly underestimates the true prevalence of childhood obesity and overestimates the health care cost differential between obese and non-obese children.The prevalence of childhood overweight and obesity has reached epidemic proportions in Western countries [1]. One of the emerging and costly consequences of this epidemic is the increase in health care utilization by obese children for a number of conditions [2-4]. Documenting these disparities in health care use can help to better target prevention efforts and resource allocation. Administrative databases provide an invaluable tool in this respect as they capture information on physician-diagnosed conditions for a large sample of the population. However, a significant shortcoming of these databases for their use in obesity research is the lack of data on body weight. Previous studies have often linked utilization data with anthropometric data from surveillance systems, hospital charts, or surveys to identify overweight and obese children [2-5]. Such linkage may not always be feasible and other investigators have used an ICD-9/10 diagnosis of obesity
The Effect of Opium Addiction on Arrhythmia Following Acute Myocardial Infarction
Fatemeh Mirzaiepour,Morvarid Dadras,Afsaneh Forood,Hamid Najafipour
Acta Medica Iranica , 2012,
Abstract: The effect of opium addiction on the appearance of different types of arrhythmias after acute myocardial infarction (AMI) has been assessed in few studies. This study is aimed to determine the effect of opium on post-MI arrhythmia and also to address the differences in the appearance of different types of arrhythmias after AMI between opium addicted and non-addicted patients. In this comparative study, participants were classified into two groups with opium addiction (n=94) and without opium addiction (n=106). Post-MI arrhythmias were determined among each group. Study populations were included all patients with first AMI admitted within 6 hours of the onset of chest pain to coronary care units (CCU) of two teaching hospitals affiliated to Kerman University of Medical Sciences (KUMS) in the city of Kerman, Iran. Opium addicted subjects had significantly more frequency of arrhythmia than non-opium addicted subjects (80.9% vs. 22.6%, respectively; P<0.001). Opium addiction was a strong predictor for the occurrence of post-MI arrhythmias in two models of crude analysis (crude OR=14.4, P<0.001) and after adjusting for potential confounder factors (adjusted OR = 21.9, P<0.001). The prevalence of sinus tachycardia, sinus bradycardia and atrial fibrillation in opium addicts were significantly higher than non opium addicts (P<0.05). The results of our study showed that opium addiction is a potential and strong risk for occurring post-MI arrhythmias.
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