Virtual clinics for follow-up of pacemakers and implantable cardioverter defibrillators in children

2019 ◽  
Vol 29 (10) ◽  
pp. 1243-1247
Author(s):  
Georgia Spentzou ◽  
Kaitlin Mayne ◽  
Helen Fulton ◽  
Karen McLeod
Keyword(s):  
Parent Satisfaction ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Devices ◽  
Digital Medicine ◽  
Implantable Cardiac Devices ◽  
System Data ◽  
Set Up ◽  
Cardioverter Defibrillators ◽  
Virtual Clinic

AbstractThere is growing interest in the use of digital medicine to reduce the need for traditional outpatient follow-up. Remote interrogation of pacemakers and implantable cardioverter defibrillators is now possible with most devices. The aim of our study was to evaluate the safety and efficacy of virtual pacing clinics in following up children with pacemakers and implantable cardioverter defibrillators, including epicardial systems.Methods:The study was retrospective over 8 years (2010–2017), with review of patient records and analysis of downloads from the implantable cardiac devices to the virtual clinics.Results:A total of 75 patients were set up for virtual clinic follow-up during the study period, 94.5% with a pacemaker and 5.5% an implantable cardioverter defibrillator. The majority (76.8%) had an epicardial system. Data on lead impedance, battery longevity, programmed parameters, detected arrhythmias, percentage pacing and delivered defibrillator therapies were obtainable by download. Lead threshold measurements were obtainable via download in 83.7% of the devices, including epicardial systems. No concerning device issue was missed. In 15% of patients a major issue was detected remotely, including three patients with lead fractures. The virtual clinics resulted in fewer hospital attendances while enhancing monitoring and enabling more frequent device checks. The vast majority (91.4%) of families who responded to a questionnaire were satisfied with the virtual clinic follow-up.Conclusions:Virtual clinics allow safe and effective follow-up of children with pacemakers and implantable cardioverter defibrillators, including those with epicardial systems and are associated with high levels of parent satisfaction.

Economics of new therapies in electrophysiology

ESC CardioMed ◽  
2018 ◽  
pp. 3133-3135
Author(s):  
Giuseppe Boriani ◽  
Lucia D’Angiolella ◽  
Fabiana Madotto
Keyword(s):  
Cost Effective ◽  
Typical Case ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Resynchronization Therapy ◽  
Cardiac Devices ◽  
Implantable Cardiac Devices ◽  
Effective Assessment ◽  
Cardioverter Defibrillators

Diagnostic and prognostic improvements in electrophysiology have been spectacular and mainly been attributable to the development of implantable cardiac devices, such as implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy pacemakers (CRT-Ps), and resynchronization therapy pacemakers with defibrillation therapy (CRT-D). These therapies are expensive because of both up-front initial implant costs and for subsequent check-up, device replacement, and possible complications. As this is a typical case in which a therapy is both costly and effective, assessment of cost-effectiveness of these device therapies becomes of paramount importance. According to recent studies, these treatments are broadly cost-effective when applied adequately and correctly analysed over a long-term period. The up-front initial cost of the devices and their implant are sometimes short-term barriers to the implementation of cost-effective therapeutic strategies.

scholarly journals Evaluation and Monitoring of Patients With Cardiovascular Implantable Electronic Devices Undergoing Noncardiac Surgery

2017 ◽  
Vol 10 ◽  
pp. 117863291668607
Author(s):  
Eduard Sklyar ◽  
Jonathan N Bella
Keyword(s):  
Electronic Devices ◽  
Normal Function ◽  
Noncardiac Surgery ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiovascular Implantable Electronic Devices ◽  
Cardiac Devices ◽  
Implantable Cardiac Devices ◽  
Basic Concepts ◽  
Evaluation And Monitoring ◽  
Cardioverter Defibrillators

In this article, the reader will get some insights into managing patient with implantable cardiac devices while undergoing noncardiac surgery. We will review basic concepts regarding normal function of pacemakers and implantable cardioverter defibrillators, understanding how their function will be influenced during noncardiac surgeries. You will be guided through management steps from preoperative, intraoperative, and postoperative aspects. In an ever-changing world of medicine, it is important to keep up with progress as more and more patients get implantable cardiac devices.

scholarly journals Clinical Medicine: Advances in Implantable Cardiac Devices

1970 ◽  
Vol 9 (3) ◽  
Author(s):  
Jorge Palazollo MD ◽  
Sheldon M. Singh MD
Keyword(s):  
Clinical Medicine ◽  
Cardiac Pacing ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Device ◽  
Cardiac Devices ◽  
Slow Pulse ◽  
Implantable Cardiac Device ◽  
Implantable Cardiac Devices ◽  
Future Technologies ◽  
Cardioverter Defibrillators

The use of implantable cardiac devices has increased and will continue to increase as the population ages. For more than 50 years, patients with a slow pulse have enjoyed the benefits of cardiac pacing to alleviate symptoms and, in some cases, prolong life. Implantable cardiac devices have evolved; in addition to providing pacing support, some devices – namely, implantable cardioverter defibrillators (ICDs) – can also terminate malignant ventricular arrhythmias, facilitate the synchronization of ventricular function, monitor clinical variables, and store a wealth of information to assist clinical management. This review discusses currently available device diagnostics, highlights some advances in implantable cardiac device therapy, and provides a preview of future technologies that may improve the care of patients who have these devices.

Implantable Cardiac Devices in the Treatment of Arrhythmias and Congestive Heart Failure

2012 ◽  
Vol 9 (2) ◽  
pp. 99-104
Author(s):  
Soraya M Samii ◽  
Javier E Banchs
Keyword(s):  
Heart Failure ◽  
New Technology ◽  
Standard Of Care ◽  
Cardiac Resynchronization ◽  
Careful Examination ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Devices ◽  
Implantable Cardiac Devices ◽  
Cardioverter Defibrillators ◽  
Improve Patient

The concept of using an implantable device to manage arrhythmias and heart failure started over 50 years ago. Since then, we have seen these devices improve patient outcomes from bradyarrhythmias, atrial fibrillation, ventricular arrhythmias, and heart failure. These devices are now standard of care in the management of patients and include pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) or combination devices. The future may hold expansion of the indications for these devices, with careful examination of the outcomes of today's patients. In addition, there is very exciting new technology that may further advance the management of arrhythmias and heart failure.

Implantable Cardiac Devices in the Treatment of Arrhythmias and Congestive Heart Failure

2012 ◽  
Vol 9 (1) ◽  
pp. 47-52
Author(s):  
Soraya M Samii ◽  
Javier E Banchs
Keyword(s):  
Heart Failure ◽  
New Technology ◽  
Standard Of Care ◽  
Cardiac Resynchronization ◽  
Careful Examination ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Devices ◽  
Implantable Cardiac Devices ◽  
Cardioverter Defibrillators ◽  
Improve Patient

The concept of using an implantable device to manage arrhythmias and heart failure started over 50 years ago. Since then, we have seen these devices improve patient outcomes from bradyarrhythmias, atrial fibrillation, ventricular arrhythmias, and heart failure. These devices are now standard of care in the management of patients and include pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) or combination devices. The future may hold expansion of the indications for these devices, with careful examination of the outcomes of today's patients. In addition, there is very exciting new technology that may further advance the management of arrhythmias and heart failure.

Automatic Remote Monitoring of Implantable Cardiac Devices in Clinical Practice – The Lumos-T Safely Reduces Routine Office Device Follow-up (TRUST) Trial

2010 ◽  
Vol 6 (3) ◽  
pp. 87
Author(s):  
Niraj Varma ◽  
Keyword(s):  
Clinical Practice ◽  
Remote Monitoring ◽  
Home Monitoring ◽  
Implantable Devices ◽  
Cardiac Device ◽  
Cardiac Devices ◽  
Enhance Patient Safety ◽  
Implantable Cardiac Devices ◽  
Post Implantation

The use of implantable electronic cardiac devices is increasing. Post-implantation follow-up is important for monitoring both device function and patient condition; however, clinical practice is inconsistent. For example, implantable cardioverter–defibrillator follow-up schedules vary from every three months to yearly according to facility and physician preference and the availability of resources. Importantly, no surveillance occurs between follow-up visits. By contrast, implantable devices with automatic remote monitoring capability provide a means for performing constant surveillance, with the ability to identify salient problems rapidly. The Lumos-T Reduces Routine Office Device Follow-up Study (TRUST) demonstrated that remote home monitoring reduced clinic burden and allowed early detection of patient and/or system problems, enabling efficient monitoring and an opportunity to enhance patient safety. The results of the trial have significant implications for the management of patients receiving all forms of implantable electronic cardiac device.

scholarly journals Impact of Moderate to Severe Renal Impairment on Mortality and Appropriate Shocks in Patients with Implantable Cardioverter Defibrillators

2010 ◽  
Vol 2010 ◽  
pp. 1-6 ◽  
Author(s):  
Venkata M. Alla ◽  
Kishlay Anand ◽  
Mandeep Hundal ◽  
Aimin Chen ◽  
Showri Karnam ◽  
...  
Keyword(s):  
Linear Models ◽  
Severe Renal Impairment ◽  
Medical Center ◽  
Implantable Cardioverter Defibrillators ◽  
Free Survival ◽  
Kaplan Meier ◽  
Appropriate Shocks ◽  
The Impact ◽  
Cardioverter Defibrillators

Background. Due to underrepresentation of patients with chronic kidney disease (CKD) in large Implantable-Cardioverter Defibrillator (ICD) clinical trials, the impact of ICD remains uncertain in this population.Methods. Consecutive patients who received ICD at Creighton university medical center between years 2000–2004 were included in a retrospective cohort after excluding those on maintenance dialysis. Based on baseline Glomerular filtration rate (GFR), patients were classified as severe CKD: GFR < 30 mL/min; moderate CKD: GFR: 30–59 mL/min; and mild or no CKD: GFR ≥ 60 mL/min. The impact of GFR on appropriate shocks and survival was assessed using Kaplan-Meier method and Generalized Linear Models (GLM) with log-link function.Results. There were 509 patients with a mean follow-up of 3.0 + 1.3 years. Mortality risk was inversely proportional to the estimated GFR: 2 fold higher risk with GFR between 30–59 mL/min and 5 fold higher risk with GFR < 30 mL/min. One hundred and seventy-seven patients received appropriate shock(s); appropriate shock-free survival was lower in patients with severe CKD (GFR < 30) compared to mild or no CKD group (2.8 versus 4.2 yrs).Conclusion. Even moderate renal dysfunction increases all cause mortality in CKD patients with ICD. Severe but not moderate CKD is an independent predictor for time to first appropriate shock.

Subcutaneous and single-chamber transvenous defibrillators: a nationwide matched control study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Bodin ◽  
A Bisson ◽  
B Pierre ◽  
J Herbert ◽  
N Clementy ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Propensity Score ◽  
Cardiovascular Death ◽  
Implantable Cardioverter Defibrillators ◽  
Matched Cohort ◽  
Icd Implantation ◽  
Baseline Characteristics ◽  
Artery Disease ◽  
Cardioverter Defibrillators

Abstract Funding Acknowledgements Type of funding sources: None. Introduction / Background Subcutaneous implantable cardioverter–defibrillators (S-ICD) was designed to avoid complications of single-chamber transvenous implantable cardioverter-defibrillators (VVI ICD) by using an entirely extra-thoracic placement. Purpose Our objective was to compare outcomes following first VVI ICD or S-ICD implantation in an exhaustive nationwide matched cohort. Methods This French longitudinal cohort study was based on the national hospitalization database covering hospital care from for the entire population. All adults (age ≥18 years) hospitalized in French hospitals From January 1, 2010 to September 1, 2020, who underwent a VVI ICD or S-ICD implantation were included. Patients with a previous pacemaker or ICD or with a history of infective endocarditis were excluded. Multivariable analyses for clinical outcomes during the whole follow-up in the groups of interests were performed using a Cox model with all baseline characteristics and reporting hazard ratio. Owing to the non-randomized nature of the study, and considering for significant differences in baseline characteristics, propensity-score matching was also used to control for potential confounders of the treatment outcome relationship. Results 21,667 patients were included in the cohort, 19,493 patients had a transvenous VVI ICD and 2,174 had a subcutaneous ICD. Mean age was 61.2 ± 13.2 years in the VVI ICD group and 52.3 ± 17.5 years in the S-ICD goup. Coronary artery disease was present in 71.6% of patients with a VVI ICD and 48.2% of patients with a S-ICD. Mean follow-up was 28.8 ± 31.8 months. S-ICD patients had a significant higher rate of all-cause death (HR: 1.684, 95%CI: 1.309-2.165, p &lt; 0.001). There were no significant differences in cardiovascular death (HR: 1.092, 95%CI: 0.697-1.711, p = 0.70) and infective endocarditis (HR: 0.354, 95%CI: 0.067-1.433, p = 0.15) between the two groups Using propensity score, 1,582 patients with VVI ICD were matched 1:1 with S-ICD patients. Mean follow-up was 4.5 ± 7.2 months. In the matched analysis, there were no significant differences in all-cause death (HR: 1.090, 95%CI: 0.728-1.633, p = 0.68) and cardiovascular death (HR: 1.167, 95%CI: 0.603-2.260, p = 0.65) between the two groups. A trend toward a lower risk of infective endocarditis in the S-ICD group was also observed without reaching significance (HR : 0.219, 95%CI: 0.047-1.017, p = 0.053). A sensitivity analysis in patients with coronary artery disease in the matched cohort was performed. Same trends were observed without significant differences in all-cause death and cardiovascular death. Conclusion Our nationwide study highlighted a higher risk of all-cause death in patients treated with subcutaneous which however was not statistically significant after propensity score matching. No differences regarding cardiovascular mortality was found. An interesting trend toward diminution of infective endocarditis was also observed without reaching significancy.

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