Current Clinical Practice in Patients With Cardiac Implantable Electronic Devices (CIED) Undergoing Radiotherapy (RT)

Abstract Patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy (RT) are more common due to the ageing of the population. With newer CIEDs’ implementing the complementary metal-oxide semiconductor (CMOS) technology which allows the miniaturization of CIED, it is also more susceptible to RT. Effects of RT on CIED ranges from device interference, device operational/memory errors of permanent damage. These malfunctions can cause life-threatening clinical effects. Cumulative dose is not the only component of RT that causes CIED malfunction, as neutron use and dose rate effect also affects CIEDs. The management of this patient cohort in clinical practice is inconsistent due to the lack of a consistent guideline from manufacturers and physician specialty societies. Our review will focus on the current clinical practice and the recently updated guidelines of managing patients with CIED undergoing RT. We aim to simplify the evidence and provide a simple and easy to use guide based on the recent guidelines.

Download Full-text

Subclinical Atrial Fibrillation and Risk of Stroke: Past, Present and Future

Medicina ◽

10.3390/medicina55100611 ◽

2019 ◽

Vol 55 (10) ◽

pp. 611 ◽

Cited By ~ 3

Author(s):

AlTurki ◽

Marafi ◽

Russo ◽

Proietti ◽

Essebag

Keyword(s):

Atrial Fibrillation ◽

Clinical Practice ◽

Electronic Devices ◽

High Rate ◽

Cardiac Monitoring ◽

Stroke Event ◽

Cardiac Implantable Electronic Devices ◽

Increased Risk ◽

History Of ◽

New Evidence

Subclinical atrial fibrillation (SCAF) describes asymptomatic episodes of atrial fibrillation (AF) that are detected by cardiac implantable electronic devices (CIED). The increased utilization of CIEDs renders our understanding of SCAF important to clinical practice. Furthermore, 20% of AF present initially as a stroke event and prolonged cardiac monitoring of stroke patients is likely to uncover a significant prevalence of SCAF. New evidence has shown that implanting cardiac monitors into patients with no history of atrial fibrillation but with risk factors for stroke will yield an incidence of SCAF approaching 30–40% at around three years. Atrial high rate episodes lasting longer than five minutes are likely to represent SCAF. SCAF has been associated with an increased risk of stroke that is particularly significant when episodes of SCAF are greater than 23 hours in duration. Longer episodes of SCAF are incrementally more likely to progress to episodes of SCAF >23 hours as time progresses. While only around 30–40% of SCAF events are temporally related to stroke events, the presence of SCAF likely represents an important risk marker for stroke. Ongoing trials of anticoagulation in patients with SCAF durations less than 24 hours will inform clinical practice and are highly anticipated. Further studies are needed to clarify the association between SCAF and clinical outcomes as well as the factors that modify this association.

Download Full-text

Implementation of remote follow-up of cardiac implantable electronic devices in clinical practice: organizational implications and resource consumption

Journal of Cardiovascular Medicine ◽

10.2459/jcm.0000000000001011 ◽

2020 ◽

Vol 21 (9) ◽

pp. 648-653

Author(s):

Massimiliano Maines ◽

Giancarlo Tomasi ◽

Paolo Moggio ◽

Francesco Peruzza ◽

Domenico Catanzariti ◽

...

Keyword(s):

Clinical Practice ◽

Electronic Devices ◽

Resource Consumption ◽

Cardiac Implantable Electronic Devices

Download Full-text

Change in the use of remote monitoring of cardiac implantable electronic devices in Italian clinical practice over a 5-year period

Journal of Cardiovascular Medicine ◽

10.2459/jcm.0000000000000950 ◽

2020 ◽

Vol 21 (4) ◽

pp. 305-314 ◽

Cited By ~ 3

Author(s):

Pietro Palmisano ◽

Donato Melissano ◽

Gabriele Zanotto ◽

Giovanni Battista Perego ◽

Tiziano Toselli ◽

...

Keyword(s):

Clinical Practice ◽

Remote Monitoring ◽

Electronic Devices ◽

Cardiac Implantable Electronic Devices

Download Full-text

Immunotherapy for high grade glioma: current clinical practice for patients with (relapsed) GBM

Klinische Pädiatrie ◽

10.1055/s-0032-1320184 ◽

2012 ◽

Vol 224 (06) ◽

Author(s):

S Van Gool ◽

F Pauwels ◽

S De Vleeschouwer

Keyword(s):

Clinical Practice ◽

High Grade Glioma ◽

High Grade ◽

Current Clinical Practice

Download Full-text

Ankle Brachial Pressure Index and compression application: Review summary

Wound Practice and Research ◽

10.33235/wpr.27.2.74-77 ◽

2019 ◽

Vol 27 (2) ◽

pp. 74-77

Author(s):

Victoria Team ◽

Georgina Gethin ◽

John D Ivory ◽

Kimberley Crawford ◽

Ayoub Bouguettaya ◽

...

Keyword(s):

Content Analysis ◽

Clinical Practice ◽

Venous Insufficiency ◽

Arterial Disease ◽

Leg Ulcers ◽

Current Clinical Practice ◽

Ankle Brachial Pressure Index ◽

Arterial Circulation ◽

Pressure Index ◽

Peripheral Arterial

Venous leg ulcers (VLUs) are a significant complication amongst persons with chronic venous insufficiency (CVI) that frequently follow a cycle of healing and recurrence. Current clinical practice guidelines (CPGs) recommend applying below knee compression to improve VLU healing. Compression could be applied if the Ankle Brachial Pressure Index (ABPI) rules out significant arterial disease, as sufficient peripheral arterial circulation is necessary to ensure safe compression use. We conducted a content analysis of 13 global CPGs on the accuracy of recommendations related to ABPI and compression application. Eight CPGs indicated that compression is recommended when the ABPI is between 0.8 and 1.2 mmHg. However, this review found there is disagreement between 13 global VLU CPGs, with a lack of clarity on whether or not compression is indicated for patients with ABPIs between 0.6 and 0.8 mmHg. Some CPGs recommend reduced compression for treatment of VLUs, while others do not recommend any type of compression at all. This has implications for when it is safe to apply compression, and the inconsistency in evidence indicates that specialist advice may be required at levels beyond the ABPI “safe” range listed above.

Download Full-text

Recent Advances in Pacing and Defibrillation

Asia Pacific Cardiology ◽

10.15420/apc.2011:3:1:74 ◽

2011 ◽

Vol 3 (1) ◽

pp. 74

Author(s):

Kathy L Lee ◽

Keyword(s):

Cardiac Death ◽

Electronic Devices ◽

Implantable Defibrillators ◽

Cardiac Pacemakers ◽

Cardiac Implantable Electronic Devices ◽

Treatment And Prevention ◽

Recent Advances ◽

Pacing Lead ◽

Leadless Pacing ◽

Device Complications

Cardiac pacemakers have been the standard therapy for patients with bradyarrhythmias for several decades. The pacing lead is an integral part of the system, serving as a conduit for the delivery of energy pulses to stimulate the myocardium. However, it is also the Achilles’ heel of pacemakers, being the direct cause of most device complications both acutely during implant and chronically years afterwards. Leadless pacing with ultrasound-mediated energy has been demonstrated in animals and humans to be safe and feasible in acute studies. Implantable defibrillators revolutionised the treatment and prevention of sudden cardiac death. Subcutaneous implantable defibrillators have been under development for more than 10 years. A permanent implantable system has been shown to be feasible in treating induced and spontaneous ventricular tachyarrhythmias. These developments and recent advances in pacing and defibrillation will arouse further interest in the research and development of leadless cardiac implantable electronic devices.

Download Full-text