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Cardiac Devices (cardiac + device)
Selected AbstractsHome Monitoring in Patients with Implantable Cardiac Devices: Is There a Potential Reduction of Stroke Risk?JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2009Results from a Computer Model Tested Through Monte Carlo Simulations Introduction: Patients with pacemakers and implantable defibrillators (ICD) may experience asymptomatic atrial fibrillation (AF), detected with a delay depending on the in-person follow-up schedule. Home monitoring (HM) remote control with automatic alerts for AF may drive early anticoagulation, potentially reducing stroke risk. Methods and Results: A sample of 136 pacemaker (103) and ICD (33) patients with or without cardiac resynchronization therapy not taking anticoagulation at implant were monitored remotely with HM. Upon HM alerts for AF, patients were recalled to update therapy. Two-year data were entered in a computer Monte Carlo model, simulating 4,000 virtual subjects with the same AF and CHADS2 stroke risk distribution of our real population. Simulations reproduced a 2-year follow-up. Two thousand subjects were supposed to be followed with HM (HM group) and 2,000 with standard in-person follow-up (SF group) at 3, 6, 9, or 12 months. Two-year Kaplan-Meier cumulative probability of ,24-hour AF was 15.6% (95%CI 8.5,23.3%); the AF-related symptom rate was 27% and the median CHADS2 score was 2. As a result of simulations, stroke incidence in case of AF was 2.3 ± 1.1% in the HM group and 2.4 ± 1.1%, 2.5 ± 1.2%, 2.7 ± 1.2%, and 2.9 ± 1.3% in the SF group with 3-, 6-, 9-, and 12-month follow-up programs, with odds ratios of 0.97 (95%CI 0.93,1.01), 0.91 (0.88,0.95), 0.87 (0.84,0.90), and 0.82 (0.79,0.85) (HM better if odds ratios <1), respectively. Conclusions: Daily HM potentially reduces the stroke risk by 9% to 18% with respect to SF with intervisit intervals of 6 to 12 months. [source] Interference in Implanted Cardiac Devices, Part IPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2002SERGIO L. PINSKI First page of article [source] Iatrogenic complications and risks of nerve conduction studies and needle electromyographyMUSCLE AND NERVE, Issue 5 2003Amer Al-Shekhlee MD Abstract Electrodiagnostic procedures are routinely performed in patients with a variety of neuromuscular disorders. These studies are generally well tolerated and rarely thought to be associated with any significant side effects. However, needle electromyography is an invasive procedure and under certain situations has the potential to be associated with iatrogenic complications, including bleeding, infection, nerve injury, pneumothorax, and other local trauma. Similar complications are possible if needles are used for either stimulating or recording. In addition, like all other electrical devices and monitoring equipment connected to patients, electrodiagnostic testing carries the risk of stray leakage currents that under certain circumstances can result in electrical injury, especially in patients in the intensive care setting. Similarly, certain precautions are required during nerve conduction studies (NCS) in patients with pacemakers and other similar cardiac devices. In this review, we address the known and theoretical complications of NCS and needle electrode examination, and the possible methods to avoid such hazards. Muscle Nerve 27: 517,526, 2003 [source] Effects of Scatter Radiation on ICD and CRT FunctionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2008SURAJ KAPA M.D. Background: Effects of direct radiation on implantable cardiac devices have been well studied. However, the effects of scatter radiation are not as clear. Recommendations on management of patients with implantable cardiac devices undergoing radiotherapy are based on limited studies mostly involving pacemakers. We sought to elucidate the effects of scatter radiation on implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT)-ICDs. Methods: We exposed 12 ICDs and eight CRT-ICDs to 400 cGy of scatter radiation from a 6-MV photon beam. Devices were programmed with nominal parameters and interrogated prior to radiation, after each fraction, upon completion of the radiation course and again 1 week later. A retrospective review of patients undergoing radiotherapy at the Mayo Clinic,Rochester between 2002 and 2007 in whom the device was outside the radiation field was also performed. There were 13 patients with devices undergoing radiotherapy during this time period, 12 of whom were interrogated prior to and after radiation. Results: Interrogation reports were reviewed for device reset or parameter changes. There was no evidence of reset or malfunction during or after radiation. Also, no episodes of device reset, inappropriate sensing or therapy, or changes in programmed parameters were found in our review of patients undergoing radiotherapy. Conclusions: Device reset or malfunction associated with scatter radiation likely represents an unpredictable, rare occurrence. While we see no clear contraindication to radiotherapy in patients with ICDs or CRT-ICDs, precautions should be taken to avoid direct radiation exposure and to closely evaluate patient outcomes before and after the radiation course. [source] R-Wave Detection by Subcutaneous ECG.ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2001Possible Use for Analyzing R-R Variability Background: Atrial arrhythmia (AA) discrimination remains a technological challenge for implanted cardiac devices. We examined the feasibility of R-wave detection by a subcutaneous far field ECG (SFFECG) and analysis of these signals for R to R variability as an indicator of atrial arrhythmia (AA). Methods: Surface ECG and SFFECG (from the pacemaker pocket) were recorded in sixteen patients (61.5 ± 11.4 years) with AA. The SFFECG was recorded with a pacemaker sized four electrode array acutely placed in the pacemaker pocket during implantation. The signals were analyzed to obtain peak-to-peak R wave amplitude and R to R interval variability (indicative of AAs). Results: In sixteen patients R waves were visually discernible in all recordings. The percentage over and under detection for automatic R wave recognition SFFECG was 3 and 9%, respectively. R to R variability analysis using the SFFECG produced results concordant to those using the surface ECG. Conclusion: SFFECG might be a helpful adjunct in implantable device systems for detection of R waves and may be used for measurement of R to R variability. A.N.E. 2001;6(1):18,23 [source] Increased need for combinated nervus vagus-stimulators and electronic cardiac devices: aspects on methods and safetyACTA NEUROLOGICA SCANDINAVICA, Issue 4 2010R. Cáceres No abstract is available for this article. [source] | ||||||||||||||||||||||