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Receiving ICDs (receiving + icd)
Selected AbstractsThe Defibrillation Safety Margin of Patients Receiving ICDs: A Matter of DefinitionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2005S. SERGE BAROLD No abstract is available for this article. [source] Implantable Cardioverter Defibrillators: Do Women Fare Worse Than Men?JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2009Gender Comparison in the INTRINSIC RV Trial Introduction: Due to limited enrollment of women in previous trials, there is a paucity of data comparing outcome and arrhythmic events in men versus women with implantable cardioverter defibrillators (ICDs). Methods and Results: We analyzed outcome of patients in the INTRINSIC RV (Inhibition of Unnecessary RV Pacing with AV Search Hysteresis in ICDs) trial based on gender. Women comprised 19% (293/1530) of the INTRINSIC RV population. Compared with men, women were less likely to have coronary disease, ischemic cardiomyopathy, and hyperlipidemia, and were more likely to have congestive heart failure and diabetes. Women were less likely to receive beta blockers and ACE inhibitors, and more likely to receive diuretics. Over 10.8 ± 3.5 months of follow-up, unadjusted mortality was higher in women than men (6.8% vs 4.1%, P = 0.04). Heart failure hospitalizations occurred in 7.9% of women versus 5.7% of men (P = 0.13). After adjustment for baseline differences and drug therapy, there was no significant difference in mortality between men and women. Adverse events were observed more often in women. There were no gender differences in the percentage of patients receiving appropriate or inappropriate ICD shocks. Conclusions: In INTRINSIC RV, women receiving ICDs differed from men regarding baseline characteristics and drug therapy. After adjusting for baseline differences and medical therapy, there were no differences in heart failure hospitalization, survival, or ICD shock therapy during follow-up. Apparent undertreatment of heart failure and greater frequency of adverse advents in women receiving ICDs warrant further investigation. [source] Psychopathology in Patients with ICDs over Time: Results of a Prospective StudyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2010SURAJ KAPA M.D. Introduction:The effects of implantable cardioverter defibrillators (ICDs) and ICD shocks on psychological state have previously been studied. However, it is still unclear how health-related quality-of-life changes over time using standardized assessments. We sought to characterize the effects of ICDs and ICD shocks on psychological outcomes. Methods:Three hundred-eight patients receiving ICDs were prospectively identified. Baseline QOL assessments including standardized psychological surveys [Hospital Anxiety and Depression Scale (HADS), Impact of Events Scale-Revised (IES-R), and Short Form 36 Health Survey (SF-36)] were obtained within 2 months of device implantation and at 6 and 12 months, respectively. Outcomes including ICD shocks were followed over the 12-month study period. Results:The number of patients meeting criteria for anxiety or posttraumatic stress disorder (PTSD) at baseline (78/223, 35%) was higher than at 6 (34/223, 15%) or 12 (34/223, 15%) months (P < 0.01). There was a significant improvement over time in HADS (P < 0.001) and IES-R (PTSD) scores (P < 0.001). Amongst the 20 patients who received ICD shocks, no significant differences were observed in IES-R, SF-36, or HADS scores when compared with those who did not receive shocks at any time point. Patients who experienced electrical storms (N = 5) had significantly higher baseline PTSD scores (29.6 ± 11.4 vs 14.6 ± 11.6, P < 0.01). Conclusions:Patients receiving ICDs have significant rates of baseline psychopathology after implantation. However, psychological assessment scores tend to improve with time. ICD shocks do not appear to significantly impact psychological state. These results suggest the importance of close screening and referral for possible psychopathology in patients receiving ICDs, especially in the peri-implant period. (PACE 2010; 33:198,208) [source] Impact of Renal Function on Survival in Patients with Implantable Cardioverter-DefibrillatorsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2007MINTU P. TURAKHIA M.D. Background:Although chronic renal insufficiency (CRI) is associated with increased cardiac and noncardiac mortality, there is limited data on the relationship between CRI and survival in patients with implantable cardioverter-defibrillators (ICDs), particularly across a wide range of renal function. Methods:We studied 507 consecutive patients receiving first-time ICDs from 1993,2003 at a single center. Preimplant serum creatinine measurements were used to determine glomerular filtration rate (GFR) and stage of chronic kidney disease (CKD). The primary outcome was time to death. Results:During a mean follow-up of 4 years, all-cause mortality through completion of follow-up increased stepwise by GFR stage (I: 16%, II: 20%, III: 35%; IV: 40%; V: 50%; P < 0.001 for trend). After multivariate adjustment, CRI was independently associated with death (HR = 1.7, P = 0.02), as were a serum creatinine ,2.0 mg/dL (HR 2.5, P = 0.003) and the presence of end-stage renal disease (HR 6.8; P < 0.001). For every 10-unit decrease in GFR, the adjusted hazard of death increased 12% (P = 0.04). Conclusion:The presence of CRI prior to implant is independently associated with increased mortality in patients receiving ICDs. The risk is proportional to the degree of renal dysfunction and is apparent even when GFR is only mildly reduced. Differences in mortality are observed within the first year of implant, and patients on dialysis are at highest risk. Because randomized trials of ICDs have not included large numbers of patients with moderate or severe renal disease, our findings may have important implications in prognosis and case selection of patients who otherwise meet current indications for ICD implantation. [source] | ||||||||||