			Home About us Contact

ICD Shocks (icd + shock)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Fatal Inappropriate ICD Shock

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2007
CHRISTIAN VELTMANN M.D.
Introduction: Inappropriate implantable cardioverter defibrillator (ICD) therapy carries a low but relevant risk of ventricular proarrhythmia. In the present case, the extremely rare event of a fatal arrhythmia caused by inappropriate therapy is reported. Dislodgement of the ventricular lead to the level of the tricuspid annulus led to additional sensing of the atrial signal during sinus tachycardia. Spuriously, ventricular fibrillation was sensed and induced inappropriate ICD shocks. The fourth inappropriate shock caused ventricular fibrillation, which was subsequently undersensed by the dislodged lead due to low ventricular amplitudes. The ICD started antibradycardic pacing during ventricular fibrillation. After initial successful resuscitation, the patient died 1 week later due to severe hypoxic brain damage. Although not preventable in the present case, it underlines the necessity of immediate interrogation of the ICD after ICD therapy and deactivation of the ICD in the setting of a dislodged endocardial lead and intensive care monitoring of the patient until revision. [source]

Depression and Anxiety Status of Patients with Implantable Cardioverter Defibrillator and Precipitating Factors

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2006
AHMET KAYA BILGE
Background: Implantable cardioverter defibrillators (ICDs) are life-saving devices in treatment of life-threatening arrhythmia. We evaluate the emotional status of Turkish patients with ICD and try to explain factors that affect emotional status of the patients. Methods: Ninety-one patients with previously implanted ICD were included in the study. Follow-up periods, presence of ICD shock, shock frequency, time of the recent shock, age, and gender were noted. Depression and anxiety scores were evaluated according to Hospital Anxiety and Depression (HAD) chart. Results: Mean anxiety and depression scores were found as 9.1 ± 5.3 and 7.2 ± 5.1, respectively. According to HAD charts, 42 patients (46%) had anxiety and 37 patients (41%) had depression. Depression scores indicated significant difference between subgroups divided on the basis of follow-up periods (P = 0.026) and on the basis of time of recent shock (P = 0.028). There was significant difference in anxiety scores (P = 0.016) between patients with ICD shocks and patients with no shocks. When the patients were divided into subgroups according to shock frequency, both depression (P = 0.024) and anxiety (P = 0.016) scores presented significant difference. In female patients, depression and anxiety scores were found significantly higher compared to male patients (P = 0.046 and P = 0.016, respectively). In multivariate analysis, gender and shock frequency were found as predictors for anxiety scores (P = 0.019 and P = 0.044, respectively). However same analysis revealed no predictive factor for depression score. Conclusion: Our study indicates presence of depression and anxiety in nearly half of the patients with ICD. Consultation with psychiatry should be a part of the treatment for patients with ICD, especially for those who constitute high-risk groups. [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]

Implantable Cardioverter Defibrillators: Do Women Fare Worse Than Men?

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2009
Gender 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]

Fatal Inappropriate ICD Shock

Obesity As a Risk Factor for Sustained Ventricular Tachyarrhythmias in MADIT II Patients

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2007
GRZEGORZ PIETRASIK M.D.
Background: Obesity, as defined by body mass index ,30 kg/m2, has been shown to be a risk factor for cardiovascular disease. However, data on the relationship between body mass index (BMI) and the risk of ventricular arrhythmias and sudden cardiac death are limited. The aim of this study was to evaluate the risk of ventricular tachyarrhythmias and sudden death by BMI in patients after myocardial infarction with severe left ventricular dysfunction. Methods: The risk of appropriate defibrillator therapy for ventricular tachycardia or ventricular fibrillation (VT/VF) by BMI status was analyzed in 476 nondiabetic patients with left ventricular dysfunction who received an implantable cardioverter defibrillator (ICD) in the Multicenter Automatic Defibrillator Implantation Trial-II (MADIT II). Results: Mean BMI was 27 ± 5 kg/m2. Obese patients comprised 25% of the study population. After 2 years of follow-up, the cumulative rates of appropriate ICD therapy for VT/VF were 39% in obese and 24% in nonobese patients, respectively (P = 0.014). In multivariate analysis, there was a significant 64% increase in the risk for appropriate ICD therapy among obese patients as compared with nonobese patients, which was attributed mainly to an 86% increase in the risk of appropriate ICD shocks (P = 0.006). Consistent with these results, the risk of the combined endpoint of appropriate VT/VF therapy or sudden cardiac death (SCD) was also significantly increased among obese patients (Hazard Ratio 1.59; P = 0.01). Conclusions: Our findings suggest that in nondiabetic patients with ischemic left ventricular dysfunction, a BMI ,30 kg/m2 is an independent risk factor for ventricular tachyarrhythmias. [source]

Cigarette Smoking and the Risk of Supraventricular and Ventricular Tachyarrhythmias in High-Risk Cardiac Patients with Implantable Cardioverter Defibrillators

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2006
ILAN GOLDENBERG M.D.
Introduction: Nicotine elevates serum catecholamine concentration and is therefore potentially arrhythmogenic. However, the effect of cigarette smoking on arrhythmic risk in coronary heart disease patients is not well established. Methods and Results: The risk of appropriate and inappropriate defibrillator therapy by smoking status was analyzed in 717 patients who received an implantable cardioverter defibrillator (ICD) in the Multicenter Automatic Defibrillator Implantation Trial-II. Compared with patients who had quit smoking before study entry (past smokers) and patients who had never smoked (never smokers), patients who continued smoking (current smokers) were significantly younger and generally had more favorable baseline clinical characteristics. Despite this, the adjusted hazard ratio (HR) for appropriate ICD therapy for fast ventricular tachycardia (at heart rates ,180 b.p.m) or ventricular fibrillation was highest among current smokers (HR = 2.11 [95% CI 1.11,3.99]) and intermediate among past smokers (HR = 1.57 [95% CI 0.95,2.58]), as compared with never smokers (P for trend = 0.02). Current smokers also exhibited a higher risk of inappropriate ICD shocks (HR = 2.93 [95% CI 1.30,6.63]) than past (HR = 1.91 [95% CI 0.97,3.77]) and never smokers (P for trend = 0.008). Conclusions: In patients with ischemic left ventricular dysfunction, continued cigarette smoking is associated with a significant increase in the risk of life-threatening ventricular tachyarrhythmias and inappropriate ICD shocks induced by rapid supraventricular arrhythmias. Our findings stress the importance of complete smoking cessation in this high-risk population. [source]

Analysis of Implantable Cardioverter Defibrillator Therapy in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2003
RICHARD C. KLEIN M.D.
Introduction: The implantable cardioverter defibrillator (ICD) is commonly used to treat patients with documented sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Arrhythmia recurrence rates in these patients are high, but which patients will receive a therapy and the forms of arrhythmia recurrence (VT or VF) are poorly understood. Methods and Results: The therapy delivered by the ICD was examined in 449 patients randomized to ICD therapy in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial. Events triggering ICD shocks or antitachycardia pacing (ATP) were reviewed for arrhythmia diagnosis, clinical symptoms, activity at the onset of the arrhythmia, and appropriateness and results of therapy. Both shock and ATP therapies were frequent by 2 years, with 68% of patients receiving some therapy or having an arrhythmic death. An appropriate shock was delivered in 53% of patients, and ATP was delivered in 68% of patients who had ATP activated. The first arrhythmia treated in follow-up was diagnosed as VT (63%), VF (13%), supraventricular tachycardia (18%), unknown arrhythmia (3%), or due to ICD malfunction or inappropriate sensing (3%). Acceleration of an arrhythmia by the ICD occurred in 8% of patients who received any therapy. No physical activity consistently preceded arrhythmias, nor did any single clinical factor predict the symptoms of the arrhythmia. Conclusion: Delivery of ICD therapy in AVID patients was common, primarily due to VT. Inappropriate ICD therapy occurred frequently. Use of ICD therapy as a surrogate endpoint for death in clinical trials should be avoided. (J Cardiovasc Electrophysiol, Vol. 14, pp. 940-948, September 2003) [source]

Psychopathology in Patients with ICDs over Time: Results of a Prospective Study

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2010
SURAJ 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]

A Rare type of Ventricular Oversensing in ICD Therapy,Inappropriate ICD Shock Delivery Due to Triple Counting

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2010
MICHAEL GUENTHER M.D.
Irregular sensing by triple counting of wide QRS complexes resulted in inappropriate shocks in a patient with a biventricular implantable cardioverter defibrillator (ICD): A 66-year-old male patient with ischemic cardiomyopathy, left bundle branch block, and impaired left ventricular function received a biventricular ICD for optimal therapy of heart failure (CHF). Two years after implantation, the patient experienced recurrent unexpected ICD shocks without clinical symptoms of malignant tachyarrhythmia, or worsened CHF. The patient's condition rapidly worsened, with progressive cardiogenic shock and electrical,mechanical dissociation. After unsuccessful resuscitation of the patient the interrogation of the ICD showed an initial triple counting of extremely wide and fragmented QRS complexes with inappropriate shocks. (PACE 2010; 33:e17,e19) [source]

Antitachycardia Pacing for Spontaneous Rapid Ventricular Tachycardia in Patients with Prophylactic Cardioverter-Defibrillator Therapy

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2006
WOLFRAM GRIMM
Aims: Antitachycardia pacing (ATP) has not routinely been used in patients who received implantable cardioverter defibrillators (ICDs) for primary prevention of sudden death. This study investigated the efficacy of empirical ATP to terminate rapid ventricular tachycardia (VT) in heart failure patients with prophylactic ICD therapy. Methods and Results: Ninety-three patients with a mean left ventricular ejection fraction of 22 ± 7% (range: 9,35%) due to nonischemic or ischemic cardiomyopathy received prophylactic ICDs with empiric ATP. At least 2 ATP sequences with 6-pulse burst pacing trains at 81% of VT cycle length (CL) were programmed in one or two VT zones for CL below 335 ± 23 ms and above 253 ± 18 ms. Ventricular flutter and fibrillation (VF) with CL below 253 ± 18 ms were treated in a separate VF zone with ICD shocks without preceding ATP attempts. During 38 ± 27 months follow-up, 339 spontaneous ventricular tachyarrhythmias occurred in 36 of 93 study patients (39%). A total of 232 VT episodes, mean CL 293 ± 22 ms, triggered ATP in 25 of 36 patients with ICD interventions (69%). ATP terminated 199 of 232 VT episodes (86%) with a mean CL of 294 ± 23 ms in 23 of 25 patients (88%) who received ATP therapy. ATP failed to terminate or accelerated 33 of 232 VT episodes (14%) with a mean CL of 287 ± 19 ms in 12 of 25 patients (48%) who received ATP therapy. Conclusions: Painfree termination of rapid VT with empirical ATP is common in heart failure patients with prophylactic ICD therapy. The occasional inability of empiric ATP to terminate rapid VT in almost 50% of patients who receive ATP for rapid VT warrants restrictive ICD programming with regard to the number of ATP attempts in order to avoid syncope before VT termination occurs. [source]

Depression and Anxiety Status of Patients with Implantable Cardioverter Defibrillator and Precipitating Factors

Long-Term Outcomes of a Telephone Intervention After an ICD

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2005
CYNTHIA M. DOUGHERTY
Background: The purpose of this study was to determine the long-term benefits of participating in a structured, 8-week educational telephone intervention delivered by expert cardiovascular nurses post-ICD. The intervention was aimed to (1) increase physical functioning, (2) increase psychological adjustment, (3) improve self-efficacy in managing the challenges of ICD recovery, and (4) lower levels of health care utilization over usual care in the first 12 months post-ICD. This article reports on the 6- and 12-month outcomes of the nursing intervention trial. Methods and Results: A two-group (N = 168) randomized control group design was used to evaluate intervention efficacy with persons receiving an ICD for the secondary prevention of sudden cardiac arrest. Measures were obtained at baseline, 6 and 12 months post hospitalization. Outcomes included (1) physical functioning (Patient Concerns Assessment [PCA], Short Form Health Survey [SF-12], ICD shocks), (2) psychological adjustment (State-Trait Anxiety Inventory [STAI], Centers for Epidemiologic Studies,Depression [CES-D], fear of dying), (3) self-efficacy (Sudden Cardiac Arrest,Self-Efficacy [SCA-SE], Sudden Cardiac Arrest,Behavior [SCA-B], Sudden Cardiac Arrest,Knowledge [SCA-K]), and (4) health care utilization (emergency room [ER] visits, outpatient visits, hospitalizations). Using repeated measures ANOVA, the 6- and 12-month benefits of the intervention over usual care were in reductions in physical concerns (P = 0.006), anxiety (P = 0.04), and fear of dying (P = 0.01), with enhanced self-confidence (P = 0.04) and knowledge (P = 0.001) to manage ICD recovery. There were no statistically significant differences between the groups on total outpatient visits, hospitalizations, or ER visits over 12 months. Conclusion: A structured 8-week post-hospital telephone nursing intervention after an ICD had sustained 12-month improvements on patient concerns, anxiety, fear of dying, self-efficacy, and knowledge. Results may not apply to individuals with congestive heart failure who receive an ICD for primary prevention of sudden cardiac arrest. [source]

Patients' Attitudes Toward Implanted Defibrillator Shocks

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2000
MAHA AHMAD
In addition to its beneficial effect on patient survival, the implanted cardioverter defibriliator (ICD) changes a patient's life physically, socially, and psychologically. For improved patient management, it is important to understand the quality-of-life changes that accompany this mode of treatment. To this end, 119 patients were surveyed retrospectively and interviewed concurrently regarding their emotional, physical, and behavioral responses to ICD shocks and to the device itself. Most (55%) correctly estimated the total number of shocks they had received within a 10% margin. They found the shocks severe, 79% assigning a score between 3 and 5 on a scale of 1,5. Common descriptions of the shock sensation were a blow to the body or a spasm causing the entire body to jump. Most patients tolerated the shocks as life saving, but 23% dreaded shocks and 5% even said they would rather be without the ICD and take their chances. After a shock, 50% of patients called their physician and 42% continued their daily routine. Thirty percent went to a hospital emergency room or called a rescue service. Sixty-five percent had no preshock prodromes. Fifty-four percent were interested in the programmable option of a warning signal prior to a shock, while 31 % preferred no warning. Of the 74% who were advised not to drive after implantation, 29% drove anyway. Five patients were shocked while driving with no resulting accidents. We conclude that most patients find ICD shocks moderately uncomfortable, but they tolerate them because of the lifesaving protection provided by the device. [source]

Prophylactic Implantation of Cardioverter Defibrillators in Idiopathic Nonischemic Cardiomyopathy for the Primary Prevention of Death: A Narrative Review

CLINICAL CARDIOLOGY, Issue 5 2010
Cihan Cevik MD, FESC
Implantable cardioverter defibrillator (ICD) therapy reduces sudden cardiac death rates and reduces mortality in patients with ischemic heart disease and low ejection fractions. One-third of the deaths in patients with nonischemic cardiomyopathy are sudden. However, the efficacy of ICDs in the primary prevention of death in these patients is less clear. The most common cause of mortality in patients treated with ICDs is heart failure progression. ICD shocks can cause direct myocardial injury, fibrosis, inflammation, and adverse psychological outcomes, and these changes may contribute to the ventricular dysfunction in patients who already have a significantly depressed ejection fraction. We have reviewed the published randomized controlled trials and meta-analysis of prophylactic ICD therapy in the primary prevention of death in patients with nonischemic cardiomyopathy. The individual randomized controlled trials do not report a statistically significant reduction of mortality unless the ICD treatment is added to cardiac resynchronization therapy, but the meta-analysis did show a significant mortality reduction and favored ICD therapy in these patients. Medical management of many study participants was suboptimal, at least based on current guidelines. The patients with non-ischemic cardiomyopathy have good outcomes with medical therapy, and ICD therapy in this relatively low-risk population needs better selection criteria. Copyright © 2010 Wiley Periodicals, Inc. [source]