Temporary device malfunction of an MR conditional cardiac resynchronization defibrillator when undergoing MRI without appropriate re-programming: a case report

Abstract Background Magnetic resonance (MR) imaging (MRI) for patients with implantable cardiac devices is becoming more routine, with the development of MR conditional devices allowing more patients access to the imaging they need. However, for this to be performed safely, strict protocols must be followed necessitating close collaboration between cardiology and radiology departments. We present a case where mandatory device re-programming of a cardiac resynchronization therapy defibrillator device into MRI mode was not performed pre-scan leading to temporary device dysfunction with no clinical consequences. Case summary A 72-year-old man presented to a device clinic for a routine device interrogation. An atrial tachycardia response episode was recorded at the same time as the patient reported having undergone an MRI scan at a local centre. The electrogram demonstrated temporary right ventricular loss of capture with standard output programming, and a short episode of oversensing on the atrial and ventricular channel which was not sustained for long enough to meet tachycardia detection. Discussion We demonstrate two potential electrophysiological effects of MRI on pacemakers, where the device had not been appropriately re-programmed pre-procedure. This illustrates that whilst MRI in patients with implantable cardiac devices is safe, strict protocols must be followed requiring robust multidisciplinary communication.

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Economics of new therapies in electrophysiology

ESC CardioMed ◽

10.1093/med/9780198784906.003.0761 ◽

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.

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Imaging for electrophysiological procedures

The ESC Textbook of Cardiovascular Imaging ◽

10.1093/med/9780198849353.003.0022 ◽

2021 ◽

pp. 303-314

Author(s):

Louisa O’Neill ◽

Iain Sim ◽

John Whitaker ◽

Steven Williams ◽

Henry Chubb ◽

...

Keyword(s):

Sudden Death ◽

Rapid Development ◽

Imaging Modalities ◽

Cardiac Resynchronization ◽

Cardiac Devices ◽

Electrophysiological Procedures ◽

Implantable Cardiac Devices ◽

Sudden Death Prevention

Electrophysiology is one of the most rapidly growing area of cardiology. Currently >50,000 catheter ablations are performed in Europe every year and >200,000 patients receive a device for arrhythmia treatment, sudden death prevention, or cardiac resynchronization. The advantages and limitations of fluoroscopy are well known. The rapid development of implantable cardiac devices therapies and ablation procedures all depend on accurate and reliable imaging modalities for preprocedural assessments, intraprocedural guidance, detection of complications, and post-procedural assessment for the longitudinal follow-up of patients. Therefore, over the last decades, imaging become an integral part of electrophysiological procedures.

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Abstract 15038: Gender Differences Amongst Caucasians and African Americans in Rates of Arrhythmias, Implantable Cardiac Devices, and In-hospital Mortality in Sarcoidosis Patients With Cardiomyopathy

Circulation ◽

10.1161/circ.142.suppl_3.15038 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Chaitanya Rojulpote ◽

Karthik Gonuguntla ◽

Shivaraj Patil ◽

Pranav Karambelkar ◽

Tapan Buch ◽

...

Keyword(s):

Gender Differences ◽

Coronary Artery ◽

Catheter Ablation ◽

Hospital Mortality ◽

Bypass Graft ◽

Muscle Disease ◽

Cardiac Resynchronization ◽

Cardiac Devices ◽

History Of ◽

Implantable Cardiac Devices

Introduction: The prevalence of sarcoid cardiomyopathy (SCM) with female predominance is well known. However, gender differences amongst individual races remains poorly studied. Hypothesis: We sought to determine and compare within each gender and race, the rates of arrhythmias, implantable cardiac devices, and in-hospital mortality in patients with SCM after excluding those with a history of coronary artery disease. Methods: The Nationwide Inpatient Sample was queried from 2010 to 2014 using ICD-9 diagnosis code (135) for sarcoidosis among patients >18 years old. We combined it with code (425.8) for cardiomyopathy in other diseases including sarcoid and sarcoid heart muscle disease. We excluded patients with a history of prior myocardial infarction, percutaneous coronary intervention and coronary artery bypass graft. Results: From 2010 to 2014, we identified 9,063 patients with SCM (mean age = 53.11 ± 11.28 years; men 51.8% and black 52.5%). Upon comparison of gender within races, event rates per 100 patients were (white male, white female, black male, black female; p-value): atrial fibrillation (20.7, 18.8, 18, 16.1; p=0.172), ventricular fibrillation (VF) (4.1, 1.7, 2.3, 2.1; p<0.001), ventricular tachycardia (VT) (33.1, 19.3, 25.1, 21; p<0.001), complete heart block (CHB) (9.1, 8.6, 3.4, 3.6; p=0.58), second degree Mobitz type II (0.3, 0.35, 0.8, 0.4; p=0.717), implantable cardioverter-defibrillator (ICD) (13.3, 9.3, 8.4, 9.2; p<0.001), cardiac resynchronization therapy defibrillator (CRT-D) (5.5, 1.4, 3.4, 2.5; p<0.001), permanent pacemaker (PPM) (2.2, 4.1, 1.1, 1.6; p<0.001), sudden cardiac arrest (SCA) (1.3, 1.7, 1.3, 2.4; p=0.34), endomyocardial biopsy (EMB) (3.6, 2.1, 1.9, 2.3; p=0.011), cardiac MRI (CMR) (1.4, 0.3, 0.7, 1.3; p=0.002), cardiogenic shock (2.5, 1.4, 3, 3; p=0.027), orthotopic heart transplantation (OHT) (2.3, 1.4, 1.1, 0.2; p=0.05), catheter ablation (8.3, 4.5, 3.8, 1.9; p<0.001), and in-hospital mortality (1.7, 3, 2.9, 2.6; p=0.008). Conclusion: White males had higher rates of VF, VT, CHB, but they also had a lower in-hospital mortality and SCA rates likely due to higher procedural rates such as EMB, ICD, CRT-D, catheter ablation and OHT as compared to others.

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Projected longevities of cardiac implantable defibrillators: a retrospective analysis over the period 2007–17 and the impact of technological factors in determining longevity

EP Europace ◽

10.1093/europace/euz222 ◽

2019 ◽

Vol 22 (1) ◽

pp. 149-155

Author(s):

Maria F Paton ◽

Maurizio Landolina ◽

Jean-Renaud Billuart ◽

Duncan Field ◽

Jonathan Sibley ◽

...

Keyword(s):

Biventricular Pacing ◽

Cardiac Resynchronization ◽

Cardiac Implantable Electronic Devices ◽

Cardiac Devices ◽

Core Function ◽

Battery Capacity ◽

Implantable Cardiac Devices ◽

Battery Energy ◽

The Impact ◽

Current Drain

Abstract Aims Implanters of cardiac implantable electronic devices cannot easily choose devices by longevity as usually current models only have projected longevity data since those with known performance are obsolete. This study examines how projected device longevities are derived, the influencing factors, and their roles in guiding model choice. Methods and results Ninety-eight implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) models released in Europe in 2007–17 were analysed for reported battery capacities, projected longevities for standardized settings stipulated by the French Haute Autorité de Santé (HAS) and manufacturer-chosen settings. Battery capacities and HAS projected longevities increased during the study period. Based on current drain estimation, therapy functions consumed only a small portion (2–7%) of the battery energy for single- and dual-chamber ICDs, but up to 50% (from biventricular pacing) for CRT-Ds. Large differences exist between manufacturers and models both in terms of battery capacity and energy consumption. Conclusion Battery capacity is not the sole driver of longevity for electronic implantable cardiac devices and, particularly for ICDs, the core function consume a large part of the battery energy even in the absence of therapy. Providing standardized current drain consumption in addition to battery capacity may provide more meaningful longevity information among implantable electronic cardiac devices.

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

US Cardiology Review ◽

10.15420/usc.2012.9.2.99 ◽

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.

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

US Cardiology Review ◽

10.15420/usc.2012.9.1.47 ◽

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

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

European Cardiology Review ◽

10.15420/ecr.2010.6.3.87 ◽

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.

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SY.3.1 CLINICAL CHARACTERISTICS AND OUTCOME OF INFECTIVE ENDOCARDITIS INVOLVING IMPLANTABLE CARDIAC DEVICES

International Journal of Antimicrobial Agents ◽

10.1016/s0924-8579(13)70010-4 ◽

2013 ◽

Vol 41 ◽

pp. S3 ◽

Cited By ~ 2

Author(s):

E. Athan ◽

V.H. Chu ◽

P. Tattevin ◽

C. Selton-Suty ◽

P. Jones ◽

...

Keyword(s):

Infective Endocarditis ◽

Clinical Characteristics ◽

Cardiac Devices ◽

Implantable Cardiac Devices

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A CASE REPORT ON CUTIBACTERIUM ACNES- FROM COMMENSAL TO PATHOGEN

10.36106/ijsr/8102359 ◽

2021 ◽

pp. 66-67

Author(s):

R. Prabha ◽

S. Pramodhini ◽

Joshy M Esaow

Keyword(s):

Case Report ◽

Blood Culture ◽

Virulence Factors ◽

Propionibacterium Acnes ◽

Gram Positive ◽

Cardiac Devices ◽

Alternate Explanation ◽

Cutibacterium Acnes ◽

Implantable Cardiac Devices ◽

Slow Growing

Propionibacterium acnes (Cutibacterium acnes) is an anaerobic, gram-positive, slow growing bacteria. It can produce various virulence factors like bioactive exocellular products and metabolites. P.acnes blood isolates were considered signicant if two or more separate blood culture sets were positive on the same day and if systemic inammatory response syndrome (SIRS) was present without any alternate explanation. C.acnes if found in the blood of patients with implantable cardiac devices it should be considered as more than just a skin contaminant. These patients should be treated with appropriate therapies to prevent annihilatory consequences.

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