			Home About us Contact

ICD Patients (icd + patient)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Severe Atrioventricular Decoupling, Uncoupling, and Ventriculoatrial Coupling During Enhanced Atrial Pacing: Incidence, Mechanisms, and Implications for Minimizing Right Ventricular Pacing in ICD Patients

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2008
MICHAEL O. SWEENEY M.D.
Background: Enhanced AAI/R pacing minimizes right ventricular pacing but may permit or induce AV decoupling (AV-DC) due to unrestricted AV intervals (AVIs). The purpose of this study was to characterize and quantify AVI behavior in a randomized trial of enhanced AAI/R pacing in ICD patients. Methods: One hundred twenty-one patients in the Marquis ICD MVPÔ Study, a randomized 1-month crossover comparison of cumulative% ventricular pacing (Cum%VP) in enhanced AAIR (MVP) vs DDD/R, were analyzed. AV-DC was defined as ,40% AVIs >300 ms; VA coupling (VA-C) was defined as%V-atrial pace (AP) intervals <300 ms. Dynamic AVI behavior and increases in Cum%VP due to AV block (AV uncoupling, AV-UC) were characterized using Holters with real-time ICD telemetry. Results: AV-DC occurred in 17 (14%) of patients. Baseline PR, amiodarone, nighttime, lower rate >60 beats/min, rate response, and Cum%AP were associated with longer AVIs. Logistic regression identified baseline PR (odds ratio [OR]= 1.024, 95% confidence interval [CI] 1.007,1.042; P = 0.005), and Cum%AP (OR = 1.089, 95% CI 1.027,1.154; P = 0.004) as predictors of AV-DC. AV-DC was associated with ,10-fold increases in both Cum%VP (13.6 ± 28.3% vs 1.2 ± 3.9%; P = 0.023) due to transient AV-UC) and VA-C (6.0 ± 17.5% vs 0.5 ± 1.2%, P = 0.028). AV coupling (<40% AVIs >300 ms) was preserved in 104 (86%) patients. Conclusions: AV-DC, VA-C, and AV-UC may be worsened or induced by enhanced AAI/R pacing. Conservative programming of lower rate and rate response should reduce the risk of AV-DC by reducing Cum%AP. [source]

Rationale and Design of the OPTION Study: Optimal Antitachycardia Therapy in ICD Patients without Pacing Indications

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2010
CHRISTOF KOLB M.D.
Background:,Implantable cardioverter-defibrillators (ICDs) represent the treatment of choice for primary and secondary prevention of sudden cardiac death but ICD therapy is also plagued by inappropriate shocks due to supraventricular tachyarrhythmias. Dual-chamber (DC) ICDs are considered to exhibit an enhanced discrimination performance in comparison to single-chamber (SC) ICDs, which results in reduction of inappropriate detections in a short- to mid-term follow-up. Comparative data on long-term follow-up and especially on inappropriate shocks are limited. Methods:,The aim of the OPTION study is to assess whether an optimized treatment with DC ICDs improves patient outcome and decreases the rate of inappropriate shocks in comparison to SC ICDs. DC ICD therapy optimization is achieved by optimal customizing of antitachycardia therapy parameters, activation of discrimination algorithms, antitachycardia pacing in the slow ventricular tachycardia zone, and avoidance of right ventricular pacing with the SafeR algorithm mode. The OPTION study, a prospective, multicenter, randomized, single-blinded, parallel study, will randomize 450 patients on a 1:1 allocation to either an SC arm with backup pacing at VVI 40 beats per minute (bpm) or to the DC arm with SafeR pacing at 60 bpm. Patients will be followed for 27 months. Primary outcome measure is the time to first occurrence of inappropriate shock and a combined endpoint of cardiovascular morbidity and all-cause mortality. Conclusion:,The study will evaluate the relative performance of DC in comparison to SC ICDs in terms of inappropriate shock reduction and patient outcome. (PACE 2010; 33:1141,1148) [source]

Relationship between the Duration of the Basal QRS Complex and Electrical Therapies for Ventricular Tachycardias among ICD Patients

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2010
JAVIER JIMÉNEZ-CANDIL M.D., Ph.D.
Background:,In implantable cardioverter-defibrillators (ICD) patients, the duration of the basal QRS complex (QRSd) is not associated with a greater risk of developing ventricular tachyarrhythmias. QRSd could be inversely related to the effectiveness of antitachycardia pacing (ATP) because it may be associated with longer conduction times of the paced-impulses and hence, with a greater propensity to require shocks to terminate ventricular tachycardias (VTs). Methods:,We followed 216 ICD patients (pacing site: right ventricular apex; QRSd , 100: 34%) for 21 ± 12 months. ICD programming was standardized. QRSd was determined on the electrocardiogram (50 mm/s) at device implantation. Results:,Five hundred and fifty-one VTs (cycle length: 329 ± 35 ms) occurred in 67 patients (36% had a QRSd , 100 ms). ATP terminated 86% of VTs and 11% needed shocks. Mean ATP efficiency per patient was 83%. QRSd was significantly correlated with the probability of successful ATP (C-coefficient: 0.66), the best cut-off point being 100 (sensitivity and specificity of 91% and 49%). Patients with QRSd , 100 had a higher ATP effectiveness (98% vs 75%; P = 0.003) and fewer VTs terminated by shocks (1% vs 23%; P = 0.003). By logistic regression, QRSd > 100 remained as an independent predictor of receiving shocks to terminate VTs (P = 0.01). According to Kaplan-Meier analysis, the occurrence of VTs was similar regardless of the QRSd (30% vs 38%; P = 0.2), but the incidence of shock due to VTs was higher in patients with a QRSd > 100 (19% vs 7%; P = 0.01). Conclusion:,Since QRSd is a negative and independent predictor of effective ATP, ICD patients with QRSd > 100 ms require shocks more frequently to terminate VTs. (PACE 2010; 596,604) [source]

Underutilization of the DDIR Mode in ICD Patients

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4p1 2003
S. SERGE BAROLD
No abstract is available for this article. [source]

Comparison of Quantitative T-Wave Alternans Profiles of Healthy Subjects and ICD Patients

ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2009
B.Eng., Euler De Vilhena Garcia Ph.D., M.Sc.
Background: Current relevance of T-wave alternans is based on its association with electrical disorder and elevated cardiac risk. Quantitative reports would improve understanding on TWA augmentation mechanisms during mental stress or prior to tachyarrhythmias. However, little information is available about quantitative TWA values in clinical populations. This study aims to create and compare TWA profiles of healthy subjects and ICD patients, evaluated on treadmill stress protocols. Methods: Apparently healthy subjects, not in use of any medication were recruited. All eligible ICD patients were capable of performing an attenuated stress test. TWA analysis was performed during a 15-lead treadmill test. The derived comparative profile consisted of TWA amplitude and its associated heart rate, at rest (baseline) and at peak TWA value. Chi-square or Mann-Whitney tests were used with p values , 0.05. Discriminatory performance was evaluated by a binary logistic regression model. Results: 31 healthy subjects (8F, 23M) and 32 ICD patients (10F, 22M) were different on baseline TWA (1 ± 2 ,V; 8 ± 9 ,V; p < 0.001) and peak TWA values (26 ± 13 ,V; 37 ± 20 ,V; p = 0,009) as well as on baseline TWA heart rate (79 ± 10 bpm; 67 ± 15 bpm; p < 0.001) and peak TWA heart rate (118 ± 8 bpm; 90 ± 17 bpm; p < 0.001). The logistic model yielded sensitivity and specificity values of 88.9% and 92.9%, respectively. Conclusions: Healthy subjects and ICD patients have distinct TWA profiles. The new TWA profile representation (in amplitude-heart rate pairs) may help comparison among different research protocols. [source]

Diagnosis and Management of Inadvertently Placed Pacing and ICD Leads in the Left Ventricle: A Multicenter Experience and Review of the Literature

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2000
BERRY M. VAN GELDER
Three patients from different centers with pacemaker or ICD leads endocardially implanted in the left ventricle are described. All leads, two ventricular pacing leads and one ICD lead, were inserted through a patent foramen ovale or an atrial septum defect. The diagnosis was made 9 months. 14 months, and 16 years, respectively, after implantation. All patients had right bundle branch block configuration during ventricular pacing. Chest X ray was suggestive of a left-sided positioned lead except in the ICD patient. Diagnosis was confirmed with echocardiography in all patients. One patient with a ventricular pacing lead presented with a transient ischcmic attack at 1-month postimplantation. During surgical repair of the atrial septum defect 14 months later, the lead was extracted and thrombus was attached to the lead despite therapy with aspirin. The other patients were asymptomatic without anticoagulation (9 months and 16 years after implant). No thrombus was present on the ICD lead at the time of the cardiac transplantation in one patient. We reviewed 27 patients with permanent leads described in the literature. Ten patients experienced thromboembolic complications, including three of ten patients on antiplatelet therapy. The lead was removed in six patients, anticoagulation with warfarin was effective for secondary prevention in the four remaining patients. In the asymptomatic patients, the lead was removed in five patients. In the remaining patients, 1 patient was on warfarin, 2 were on antiplatelet therapy, and in 3 patients the medication was unknown. After malposition was diagnosed, three additional patients were treated with warfarin. In conclusion, if timely removal of a malpositioned lead in the left ventricle is not preformed, lifelong anticoagulation with warfarin can be recommended as the first choice therapy and lead extraction reserved in case of failure or during concomitant surgery. [source]

Effective Management of ICD Patient Psychosocial Issues and Patient Critical Events

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2009
SAMUEL F. SEARS Ph.D.
The clinical management of implantable cardioverter-defibrillator (ICD) patients involves successful medical and psychosocial care to reduce mortality and morbidity. Desirable quality of life (QoL) and psychosocial outcomes for ICD patients are achievable for a majority of ICD patients. Patient critical events, such as ICD shocks or ICD recalls, may occur that can dramatically alter the course of patient adjustment if not properly managed. Continuing care strategies that attend to patient critical events as they emerge may improve the psychosocial adjustment and improve the return to optimal daily functioning for ICD patients. This paper reviews QoL and psychosocial outcomes for ICD patients, patient critical events, and clinical implications for patient care. Patient critical events discussed in this paper include perioperative education, ICD shock events, device recalls, and end of life. The clinical management strategies for each of these patient critical events are suggested including patient education, psychosocial information provision, activity prescriptions, recall planning, and shock planning. [source]

Severe Atrioventricular Decoupling, Uncoupling, and Ventriculoatrial Coupling During Enhanced Atrial Pacing: Incidence, Mechanisms, and Implications for Minimizing Right Ventricular Pacing in ICD Patients

Is Defibrillation Testing Still Necessary?

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2008
A Decision Analysis, Markov Model
Objective: To assess the impact of defibrillation threshold (DFT) testing of implanted cardioverter-defibrillators (ICDs) on survival. Background: DFT testing is generally performed during implantation of ICDs to assess sensing and termination of ventricular fibrillation. It is common clinical practice to defibrillate ventricular fibrillation twice at an output at least 10 J below the maximum output of the device, providing a 10 J safety margin. However, there are few data regarding impact of DFT testing on outcomes. Methods: Decision analysis and Monte Carlo simulation were used to assess expected outcomes of DFT testing. Survival of a hypothetical cohort of patients was assessed according to two strategies,routine DFT testing at time of ICD implant versus no DFT testing. Assumptions in the model were varied over a range of reasonable values to assess outcomes under a variety of scenarios. Results: Five-year survival with DFT and no-DFT strategies were similar at 59.72% and 59.36%, respectively. The results were not sensitive to changing risk estimates for arrhythmia incidence and safety margin. Results of the Monte Carlo simulation were qualitatively similar to the base case scenario and consistent with a small and nonsignificant survival advantage with routine DFT testing. Conclusions: The impact of DFT testing on 5-year survival in ICD patients, if it exists, is small. Survival appears higher with DFT testing as long as annual risk of lethal arrhythmia or the risk of a narrow safety margin is at least 5%, although the incremental benefit is marginal and 95% confidence intervals cross zero. A prospective randomized study of DFT testing in modern devices is warranted. [source]

Simultaneous Atrial and Ventricular Anti-Tachycardia Pacing as a Novel Method of Rhythm Discrimination

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2006
SAMIR SABA M.D.
Background: Inappropriate shocks remain a problem in patients with defibrillators (ICD). Objective: To evaluate a new discrimination algorithm for supraventricular (SVT) and ventricular (VT) tachycardias, based on the response to simultaneous (A+V) atrial (A) and ventricular (V) anti-tachycardia pacing (ATP). Methods: Patients undergoing electrophysiological testing or dual-chamber implantable cardioverter-defibrillator (ICD) implantation were enrolled (N = 32) and underwent A+V ATP through a Marquis ICD with investigational software. If persisting after ATP, the rhythm was classified as VT if the first electrical event was sensed on the V channel and as an SVT otherwise. Results: Arrhythmia sequences (N = 275; 53 VT; 222 SVT) were analyzed in 26 patients (age = 51 ± 17 years, 13 men, LVEF = 0.49 ± 0.14). In response to A+V ATP, 55% of SVT versus 41% of VT episodes were terminated (P = NS). Termination of VT but not of SVT was more likely with faster (50% at ATP/arrhythmia cycle length (CL) = 0.81 vs 8% at ATP/arrhythmia CL = 0.88, P = 0.02) but not with longer ATP bursts (P = NS). Of the 115 arrhythmias that persisted after A+V ATP, the algorithm correctly classified 24 of 24 VT (GEE-adjusted sensitivity = 100%) and 85 of 91 SVT (GEE-adjusted specificity = 93%). Proarrhythmia was noted after two A+V ATP, in the form of atrial fibrillation induction and VT acceleration. Conclusions: We describe a new algorithm that can discriminate between SVT and VT with a high sensitivity and specificity. This form of ATP can terminate 55% of SVT sequences. The performance of this new algorithm merits further testing in a large population of dual-chamber ICD patients. [source]

Multicenter, Prospective, Randomized Safety and Efficacy Study of a New Atrial-Based Managed Ventricular Pacing Mode (MVP) in Dual Chamber ICDs

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2005
MICHAEL O. SWEENEY M.D.
Background: Ventricular desynchronization caused by right ventricular pacing may impair ventricular function and increase risk of heart failure (CHF), atrial fibrillation (AF), and death. Conventional DDD/R mode often results in high cumulative percentage ventricular pacing (Cum%VP). We hypothesized that a new managed ventricular pacing mode (MVP) would safely provide AAI/R pacing with ventricular monitoring and DDD/R during AV block (AVB) and reduce Cum%VP compared to DDD/R. Methods: MVP RAMware was downloaded in 181 patients with Marquis DR ICDs. Patients were initially randomized to either MVP or DDD/R for 1 month, then crossed over to the opposite mode for 1 month. ICD diagnostics were analyzed for cumulative percentage atrial pacing (Cum%AP), Cum%VP, and duration of DDD/R pacing for spontaneous AVB. Results: Baseline characteristics included age 66 ± 12 years, EF 36 ± 14%, and NYHA Class II,III 36%. Baseline PR interval was 190 ± 53 msec and programmed AV intervals (DDD/R) were 216 ± 50 (paced)/189 ± 53 (sensed) msec. Mean Cum%VP was significantly lower in MVP versus DDD/R (4.1 ± 16.3 vs 73.8 ± 32.5, P < 0.0001). The median absolute and relative reductions in Cum%VP during MVP were 85.0 and 99.9, respectively. Mean Cum%AP was not different between MVP versus DDD/R (48.7 ± 38.5 vs 47.3 ± 38.4, P = 0.83). During MVP overall time spent in AAI/R was 89.6% (intrinsic conduction), DDD/R 6.7% (intermittent AVB), and DDI/R 3.7% (AF). No adverse events were attributed to MVP. Conclusions: MVP safely achieves functional atrial pacing by limiting ventricular pacing to periods of intermittent AVB and AF in ICD patients, significantly reducing Cum%VP compared to DDD/R. MVP is a universal pacing mode that adapts to AVB and AF, providing both atrial pacing and ventricular pacing support when needed. [source]

Improved Survival of Cardiac Transplantation Candidates with Implantable Cardioverter Defibrillator Therapy:

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2003
Role of Beta-Blocker or Amiodarone Treatment
Introduction: Survival in patients awaiting cardiac transplantation is poor due to the severity of left ventricular dysfunction and the susceptibility to ventricular arrhythmia. The potential role of implantable cardioverter defibrillators (ICDs) in this group of patients has been the subject of increasing interest. The aims of this study were to ascertain whether ICDs improve the survival rate of patients on the waiting list for cardiac transplantation and whether any improvement is independent of concomitant beta-blocker or amiodarone therapy. Methods and Results: Data comprised findings from 310 consecutive patients at a single center who were evaluated and deemed suitable for cardiac transplantation and placed on the waiting list. Kaplan-Meier actuarial approach was used for survival analysis. Survival analysis censored patients at time of transplantation or death. Of the 310 patients, 111 (35.8%) underwent successful cardiac transplantation and 164 (52.9%) died while waiting; 35 patients remain on the waiting list. Fifty-nine (19%) patients had ICD placement for ventricular arrhythmias prior to or after being listed. Twenty-nine (49.1%) ICD patients survived until cardiac transplantation, 13 (22%) patients died, and 17 (28.8%) remain on the waiting list. Among non-ICD patients, 82 (32.7%) received transplants, 151 (60.2%) died, and 18 (7.2%) remain on the waiting list. Survival rates at 6 months and 1, 2, 3, and 4 years were better for all ICD patients compared to non-ICD patients (log-rankx2, P = 0.0001). By multivariate analysis, ICD therapy and beta-blocker treatment were the strongest predictors of survival. Further, ICD treatment was associated with improved survival independent of concomitant treatment with beta-blocker or amiodarone. Among ICD and non-ICD patients treated with a beta-blocker or amiodarone, survivals at the 1 and 4 years were 93% vs 69% and 57% vs 32%, respectively (log-rankx2, P = 0.003). Conclusion: ICD therapy is associated with improved survival in high-risk cardiac transplant candidates, and ICD benefit appears to be independent of concomitant treatment. (J Cardiovasc Electrophysiol, Vol. 14, pp. 578-583, June 2003) [source]

A literature review comparing the experiences and emergent needs of adult patients with permanent pacemakers (PPMs) and implantable cardioverter defibrillators (ICDs)

JOURNAL OF CLINICAL NURSING, Issue 15-16 2010
Jenny Tagney
Aims and objectives., This literature review aims to critically appraise any published studies that compare the experiences of patients with permanent pacemakers and those with implantable cardioverter defibrillators. It seeks to identify issues that are similar or unique to one or other group; whether identified needs are being met by current nursing practice and considers how any gaps might be addressed. Background., Increasing numbers of patients are receiving pacemakers and implantable cardioverter defibrillators (ICDs) as indications for devices continue to expand worldwide. Technical follow-up of such patients is well structured. There is an increasing body of knowledge regarding ICD patients' experiences with promising work testing recovery interventions but less seems to be known about pacemaker patients. Design., Systematic review. Methods., Using an integrative approach, electronic searches using comprehensive search terms were supplemented by following reference lists and key journals from 1975,2008. Conclusion., From the direct comparison studies identified, ICD patients who experience shocks are more likely to report lifestyle limitations than pacemaker patients. However, ICD and pacemaker patients share similar outcomes, with both groups reporting increased anxiety and depression. Whilst experiences of ICD patients have been well reported, experiences of patients receiving pacemakers for any reason and pacemakers or ICDs for heart failure (bi-ventricular devices or cardiac resynchronisation therapy , CRT) remain largely unknown. Although psychosocial interventions are suggested for both groups, these have apparently only been tested and reported for ICD patients. Relevance to clinical practice., Nurses internationally encounter increasing numbers of patients with pacemakers and ICDs from primary to tertiary clinical care settings, therefore knowledge of patient experiences relating to such devices and their impact is important to inform care planning. Whilst interventions to assist ICD patients are being tested, further research is required regarding the experiences of patients with contemporary pacemakers to inform care planning and potential nursing support interventions. [source]

Relationship between the Duration of the Basal QRS Complex and Electrical Therapies for Ventricular Tachycardias among ICD Patients

Pre-ICD Illness Beliefs Affect Postimplant Perceptions of Control and Patient Quality of Life

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2010
CLAIRE N. HALLAS Ph.D.
Background: The implantable cardioverter defibrillator (ICD) is a device used in the treatment of ventricular arrhythmias and the prevention of sudden cardiac death. However, the ICD has been associated with negative psychological outcomes such as anxiety, depression, panic, and poor quality of life (QoL). Recent studies suggest that the preimplantation psychology of patients, combined with their postimplantation perceptions about their cardiac condition, are greater contributory factors than their medical status to a poor outcome. Method: Our study employed an interview-based qualitative grounded theory methodology to explore whether medical history hetereogeneity and illness beliefs impact on the QoL of 13 ICD patients. Results: Perceived control emerged as the core category related to QoL with three subsystem themes related to control: (1) illness beliefs, attributions, and appraisals; (2) coping resources and strategies; and (3) the social world. Patients at risk for the poorest adaptation were younger (<45), unemployed, and with an acute onset cardiac history. These patients interpreted their illness as severe, utilized emotion-focused coping (e.g., avoidance of situations), and believed themselves to be socially excluded. Adjusted patients used proactive problem-focused coping (e.g., normalizing) and minimized consequences of the device. Conclusions: The data developed a theoretical model of QoL, which identified perceived control, illness beliefs, and coping impacting on adjustment. From our study, we have a wider understanding of the combination psychological issues relevant to ICD patients and are able to treat those at risk with interventions to promote adjustment in the context of a society that values health and well-being. (PACE 2010; 33:256,265) [source]

Age-Specific Differences in Women with Implantable Cardioverter Defibrillators: An International Multi Center Study

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2008
LAUREN D. VAZQUEZ M.S.
Background: Common psychological adjustment difficulties have been identified for groups of implantable cardioverter defibrillator patients, such as those who are young (<50 years old), have been shocked, and are female. Specific aspects and concerns, such as fears of death or shock and body image concerns, that increase the chance of distress, have not been examined in different aged female implantable cardioverter defibrillator (ICD) recipients. The aim of the study was to investigate these areas of adjustment across three age groups of women from multiple centers. Methods: Eighty-eight female ICD patients were recruited at three medical centers: Shands Hospital at the University of Florida, Brigham and Women's Hospital in Boston, and Royal North Shore Hospital in Sydney, Australia. Women completed individual psychological assessment batteries, measuring the constructs of shock anxiety, death anxiety, and body image concerns. Medical record review was conducted for all patients regarding cardiac illnesses and ICD-specific data. Results: Multivariate and univariate analyses of variance revealed that younger women reported significantly higher rates of shock and death anxiety (Pillai's F = 3.053, P = 0.018, ,2p= 0.067) and significantly greater body image concerns (Pillai's F = 4.198, P = 0.018, ,2p= 0.090) than middle- and older-aged women. Conclusions: Women under the age of 50 appear to be at greater risk for the development of psychosocial distress associated with shock anxiety, death anxiety, and body image. Clinical-based strategies and interventions targeting these types of adjustment difficulties in younger women may allow for improved psychosocial and quality of life outcomes. [source]

Experience with Implantable Cardioverter-Defibrillator Therapy in Grown-Ups with Congenital Heart Disease

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2008
MAREN TOMASKE M.D.
Implantable cardioverter-defibrillators (ICD) are increasingly implanted for primary or secondary prevention of sudden death in young patients with congenital heart disease, cardiomyopathies, or channelopathies. Although major advances in ICD technology and implant techniques have facilitated ICD therapy in young patients, complications such as lead failures, inappropriate shocks, system infections, and negative psychosocial impacts are of concern. The various underlying cardiovascular disease states and a lack of standardized ICD protocols for young patients often necessitate individualized implant techniques, ICD programming, and follow-up. Young ICD patients need a thorough follow-up to ensure adequate therapy, and psychosocial problems have to be addressed. [source]

Clustering of Device-Related Concerns and Type D Personality Predicts Increased Distress in ICD Patients Independent of Shocks,

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2008
SUSANNE S PEDERSEN Ph.D.
Background: This study examined the impact of clustering of device-related concerns and Type D personality on anxiety and depressive symptoms during a six-month period and the clinical relevance of shocks, implantable cardioverter defibrillator (ICD) concerns, and Type D. Methods: Consecutively implanted ICD patients (n = 176) completed questionnaires at baseline and six months and were divided into four risk groups: (1) No risk factors (neither ICD concerns nor Type D); (2) ICD concerns only; (3) Type D only; (4) Clustering (both ICD concerns and Type D). Results: The prevalence of Type D and concerns were 21.6% and 34.7%. Analysis of variance for repeated measures showed a reduction in anxiety over time (P < 0.001), with the risk groups exerting a stable (P = 0.14) but differential effect (P < 0.001); the highest level was seen in the clustering group. Similar results were found for depression, although depressive symptoms did not decrease (P = 0.08) and the impact of clustering was less clear. These results were confirmed in adjusted analysis, with shocks (P = 0.024) also being associated with anxiety but not depression. The impact of ICD concerns and Type D personality on anxiety and depression at baseline and six months was large (,0.8) compared to negligible to moderate for shocks (0.0,0.6). Conclusions: ICD patients with psychosocial risk factor clustering had the highest level of anxiety, whereas the pattern for depression was less consistent. Shocks influenced outcomes, but the impact was smaller compared to ICD concerns and Type D personality. It may be timely to expand the focus beyond shocks when seeking to identify ICD patients at risk for adverse clinical outcome due to their psychological profile. [source]

Psychological Intervention Following Implantation of an Implantable Defibrillator: A Review and Future Recommendations

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2007
SUSANNE S. PEDERSEN Ph.D.
Background:The medical benefits of the implantable cardioverter defibrillator (ICD) are unequivocal, but a subgroup of patients experiences emotional difficulties following implantation. For this subgroup, some form of psychological intervention may be warranted. This review provides an overview of current evidence on the efficacy of psychological intervention in ICD patients and recommendations for future research. Methods:We searched the PubMed and PsycInfo databases in the period between January 1980 and April 2007, using a set of a priori determined keywords. Based on the search and a hand search of the reference lists of the included articles, we identified nine studies that fulfilled the inclusion criteria. Results:The majority of studies used a randomized controlled trial design, but studies varied considerably in sample size, response, attrition rate, and type of intervention. However, most interventions were multifactorial, using cognitive behavioral therapy as one of the mainstays of treatment. Overall, psychological interventions seem to have little impact on shocks and heart rate variability. Some studies found a decrease in depressive symptoms and gains in quality of life, but the most notable effects are seen in improved exercise capacity and reductions in anxiety. Effect sizes for changes in anxiety in the intervention group ranged from small to large compared to small in the usual care group, using Cohen's effect size index. Conclusions:Preliminary evidence from small-scale intervention trials suggests that psychological intervention is worthwhile in ICD patients. Nevertheless, large-scale, well-designed trials are warranted to substantiate these findings. A multifactorial approach using a cognitive behavioral component paired with exercise training is likely to be the most successful. [source]

A Clinical Risk Score to Predict the Time to First Appropriate Device Therapy in Recipients of Implantable Cardioverter Defibrillators

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2007
HAITHAM HREYBE M.D.
Background:To develop a risk score to predict the occurrence of appropriate defibrillator [implantable cardioverter-defibrillator (ICD)] therapies. A simple clinical score predicting the risk of appropriate ICD therapy is lacking. Methods:A Cox regression model was developed from a database of ICD patients at a single tertiary center to predict the time to appropriate ICD therapy defined as shock or antitachycardia pacing. A risk score was derived from this model using half of the database and was validated using the other half. Results:A total of 399 patients were entered into the database between July 2001 and February 2004. There were no statistically significant differences between the derivation (n = 200) and validation (n = 199) groups in any of the demographic or clinical variables recorded. The risk score included three independent variables: indication for ICD implantation (P = 0.03), serum creatinine level (P = 0.015), and QRS width (P = 0.028). The observed risk scores were highly predictive of time to ICD therapy in the validation group (P = 0.02). Conclusion:We describe a new clinical risk score that predicts the time to appropriate device therapy in ICD recipients of a single tertiary center hospital. The performance of this risk score needs to be investigated prospectively in a larger patient population. [source]

Venous Occlusion of the Access Vein in Patients Referred for Lead Extraction:

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2003
Influence of Patient, Lead Characteristics
The aim of this study was to determine the effect of patient and lead characteristics on occlusion of the access vein in pacemaker and ICD patients. Contrast venography of the access vein was obtained in 89 patients (17 patients with an ICD) scheduled for lead extraction. The indication for extraction was infection in 57 patients (systemic infection in 9) and lead malfunction in 32 patients. In 6 of the 89 patients, leads were introduced in both the right and left subpectoral area, resulting in a total of 95 venous entry sites. In 22 of these entry sites one lead was present, in 61 two leads, in 11 three, and in 1 four leads. The vessel patency was graded open or occluded. Occlusion of the subclavian vein occurred in four (13%) patients with lead malfunction versus 18 (32%) patients with infection (P = 0.07). In patients with systemic infection, 5 of 9 showed venous occlusion (P = 0.01 when compared to patients with malfunction, odds ratio 8.75, 95% confidence interval 1.21,64.11). Considered per entry site, the incidence of occlusion was 7 of 22 with one lead present, 17 of 61 with two leads, 0 of 11 with three leads, and 0 of 1 with four leads (P = 0.13). No patient had a superior vena caval occlusion. Patients with systemic infection have an increased risk of occlusion of the access vein. On the contrary, the study found no support for the concept that the risk of venous occlusion increases with a higher number of leads present. (PACE 2003; 26:1649,1652) [source]

The Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7p1 2003
Bruce L. Wilkoff
Introduction: The devices used to prove the benefit of ICD therapy had only VVI pacing but most current ICD devices provide dual chamber pacing therapy. The DAVID trial sought to measure the impact of dual chamber pacing at 70 bpm (DDDR-70) vs. ventricular backup pacing at 40 bpm (VVI-40) in patients with standard indications for ICD implantation but without indications for bradycardia pacing. Methods: This single-blind, multicenter, parallel-group, randomized clinical trial enrolled 506 patients with indications for ICD therapy between 10/2000 and 9/2002. All patients had an LVEF ,0.40, no indication for pacemaker therapy and no persistent atrial arrhythmias. ICDs with dual chamber, rate-responsive pacing capability were implanted and programmed to VVI-40 or DDDR-70. Results: The combined endpoint of mortality or hospitalization for congestive heart failure (CHF) at one year was 16.1% (VVI-40) vs. 26.7% (DDDR-70), (p , 0.03), mortality 6.5% vs. 10.1% (p , 0.15) and CHF hospitalization 13.3% vs. 22.5% (p , 0.07). Conclusion: For ICD patients, DDDR-70 pacing exhibits no clinical advantage over VVI-40 pacing and may increase CHF and mortality. [source]

Implantation of a Dual Chamber Pacing and Sensing Single Pass Defibrillation Lead

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2001
RAINER GRADAUS
GRADAUS, R., et al.: Implantation of a Dual Chamber Pacing and Sensing Single Pass Defibrillation Lead. Dual-chamber ICDs are increasingly used to avoid inappropriate shocks due to supraventricular tachycardias. Additionally, many ICD patients will probably benefit from dual chamber pacing. The purpose of this pilot study was to evaluate the intraoperative performance and short-term follow-up of an innovative single pass right ventricular defibrillation lead capable of bipolar sensing and pacing in the right atrium and ventricle. Implantation of this single pass right ventricular defibrillation lead was successful in all 13 patients (age 63 ± 8 years; LVEF 0.44 ± 0.16; New York Heart Association [NYHA] 2.4 ± 0.4, previous open heart surgery in all patients). The operation time was 79 ± 29 minutes, the fluoroscopy time 4.7 ± 3.1 minutes. No perioperative complications occurred. The intraoperative atrial sensing was 1.7 ± 0.5 mV, the atrial pacing threshold product was 0.20 ± 0.14 V/ms (range 0.03,0.50 V/ms). The defibrillation threshold was 8.8 ± 2.7 J. At prehospital discharge and at 1-month and 3-month follow-up, atrial sensing was 1.9 ± 0.9, 2.1 ± 0.5, and 2.7 ± 0.6 mV, respectively, (P = NS, P < 0.05, P < 0.05 to implant, respectively), the mean atrial threshold product 0.79, 1.65, and 1.29 V/ms, respectively. In two patients, an intermittent exit block occurred in different body postures. All spontaneous and induced ventricular arrhythmias were detected and terminated appropriately. Thus, in a highly selected patient group, atrial and ventricular sensing and pacing with a single lead is possible under consideration of an atrial pacing dysfunction in 17% of patients. [source]

A Prospective Randomized-Controlled Trial of Ventricular Fibrillation Detection Time in a DDDR Ventricular Defibrillator

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2000
KENNETH A. ELLENBOGEN
Implantable cardioverter defibrillators (ICDs) with dual chamber and dual chamber rate responsive pacing may offer hemodynamic advantages for some ICD patients. Separate ICDs and DDDR pacemakers can result in device to device interactions, inappropriate shocks, and underdetection of ventricular fibrillation (VF). The objectives of this study were to compare the VF detection times between the Ventak AV II DR and the Ventak AV during high rate DDDR and DDD pacing and to test the safety of dynamic ventricular refractory period shortening. Patients receiving an ICD were randomized in a paired comparison to pacing at 150 beats/min (DDD pacing) or 175 beats/min (DDDR pacing) during ICD threshold testing to create a "worst case scenario" for VF detection. The VF detection rate was set to 180 beats/min, and VF was induced during high rate pacing with alternating current. The device was then allowed to detect and treat VF. The induction was repeated for each patient at each programmed setting so that all patients were tested at both programmed settings. Paired analysis was performed. Patient characteristics were a mean age of 69 ± 11 years, 78% were men, coronary artery disease was present in 85%, and a mean left ventricular ejection fraction of 0.34 ± 0.11. Fifty-two episodes of VF were induced in 26 patients. Despite the high pacing rate, all VF episodes were appropriately detected. The mean VF detection time was 2.4 ± 1.0 seconds during DDD pacing and 2.9 ± 1.9 seconds during DDDR pacing (P = NS). DDD and DDDR programming resulted in appropriate detection of all episodes of VF with similar detection times despite the "worst case scenario" tested. Delays in detection may be seen with long programmed ventricular refractory periods which shorten the VF sensing window and may be avoided with dynamic ventricular refractory period shortening. [source]

Comparison of Quantitative T-Wave Alternans Profiles of Healthy Subjects and ICD Patients

QT Variability during Rest and Exercise in Patients with Implantable Cardioverter Defibrillators and Healthy Controls

ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2009
Mark C. Haigney M.D.
Background: Increased QT Variability (QTVI) is predictive of life threatening arrhythmias in vulnerable patients. The predictive value of QTVI is based on resting ECGs, and little is known about the effect of acute exercise on QTVI. The relation between QTVI and arrhythmic vulnerability markers such as T-wave alternans (TWA) has also not been studied. This study examined the effects of exercise on QTVI and TWA in patients with arrhythmic vulnerability. Methods: Digitized ECGs were obtained from 47 ICD patients (43 males; age 60.9 ± 10.1) and 23 healthy controls (18 males; age 59.7 ± 9.5) during rest and bicycle exercise. QTVI was assessed using a previously validated algorithm and TWA was measured as both a continuous and a categorical variable based on a priori diagnostic criteria. Results: QTVI increased with exercise in ICD patients (,0.79 ± 0.11 to 0.36 ± 0.08, P < 0.001) and controls (,1.50 ± 0.07 to ,0.19 ± 0.12, P < 0.001), and QTVI levels were consistently higher in ICD patients than controls during rest and exercise (P < 0.001). The magnitude of QTVI increase from baseline levels was not larger among ICD patients versus controls (P > 0.20). Among ICD patients, elevated exercise QTVI was related to lower LV ejection fraction and inducibility of ischemia (P < 0.05). QTVI at rest correlated with exercise TWA (r = 0.54, P = 0.0004). Conclusions: QT variability increases significantly with exercise, and exercise QTVI is related to other well-documented markers of arrhythmic vulnerability, including low ejection fraction, inducible ischemia, and TWA. Resting QTVI may be useful in the risk stratification of individuals incapable of performing standard exercise protocols. [source]