scholarly journals Termination of arrhythmias by anti-tachycardia pacing is associated with very low healthcare utilization compared to shock therapy in patients with an implantable cardioverter defibrillator

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. 992-992
Author(s):  
A. Proclemer ◽  
M. Gasparini ◽  
A. Arenal ◽  
M. Lunati ◽  
J. Martinez Ferrer ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Healthcare Utilization ◽  
Shock Therapy ◽  
Cardioverter Defibrillator

Abstract 5700: Worsening Renal Function and Arrhythmic Event in Implantable Cardioverter Defibrillator Patients with Nonischemic Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Atsushi Takahashi ◽  
Tsuyoshi Shiga ◽  
Daigo Yagishita ◽  
Keisuke Futagawa ◽  
Naoki Serizawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Implantable Cardioverter Defibrillator ◽  
Shock Therapy ◽  
Electrical Storm ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Arrhythmic Event ◽  
Icd Shock

Purpose: Implantable Cardioverter Defibrillator (ICD) prevents sudden cardiac death in high risk patients with heart failure (HF). Worsening renal function (WRF) is associated with mortality in patients with myocardial infarction or HF, but its effect on lethal arrhythmia is unknown. We evaluated the influence of WRF on the occurrence of arrhythmic events in patients with nonischemic HF and ICD. Methods: A total of 286 nonischemic HF patients who underwent ICD implantation between 1990 and 2007 were studied. Estimated Glomerular Filtration Rate (eGFR) was calculated using the Modification of Diet in Renal Disease. Renal dysfunction was defined as eGFR <60mL/min/1.73m 2 and WRF was defined as 15mL/min/1.73m 2 per year. Differences in arrhythmia recurrences according to the eGFR and WRF were compared by Kaplan-Meier survival curves. Results: During a mean follow-up time of 2.2+/−1.0 years, 94 (33%) of 286 patients (mean age; 57+/−15 years, 72% male) experienced appropriate ICD shock therapy. There was a significantly higher cumulative rate of appropriate ICD shock therapy (p<0.05) and electrical storm (p<0.05) in patients with renal dysfunction than others. The patients with renal dysfunction at baseline experience WRF more frequently than other patients (53% vs. 23%, respectively, p<0.01). After correcting for age, sex, left ventricular ejection fraction (LVEF), indication for ICD implantation, and use of beta-blockers in a Cox regression model, WRF was still an independent predictor of the time to first appropriate shock (HR 2.21, 95% CI 1.32–3.69, p<0.05) and electrical storm (HR 2.22, 95% CI 1.19 – 4.13, p<0.05). The result of subgroup analysis of 147 patients with low LVEF (LVEF<35%) indicated that the patients with WRF experienced electrical storms more frequently (p<0.05). Conclusion: WRF is associated with increased rate of arrhythmic event in nonischemic HF patients. Especially, those patients with low LVEF and WRF experience more frequent ICD shocks.

Trigger factors and consequence factors of shock therapy in Japanese patients with implantable cardioverter defibrillator

2017 ◽  
Vol 40 (6) ◽  
pp. 748-748 ◽  
Author(s):  
Yusuke Kondo ◽  
Marehiko Ueda ◽  
Kazuo Miyazawa ◽  
Masahiro Nakano ◽  
Miyo Nakano ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Japanese Patients ◽  
Shock Therapy ◽  
Trigger Factors ◽  
Cardioverter Defibrillator

Effects of implantable cardioverter defibrillator implantation and shock application on serum endothelin-1 and big-endothelin levels

2002 ◽  
Vol 103 (s2002) ◽  
pp. 233S-236S ◽  
Author(s):  
Andrea SZÜCS ◽  
Katalin KELTAI ◽  
Endre ZIMA ◽  
Hajnalka VÁGÓ ◽  
Pál SOÓS ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Heart Diseases ◽  
Shock Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Icd Implantation ◽  
Shock Delivery ◽  
Ventricular Ejection Fraction ◽  
Cardioverter Defibrillator ◽  
Endothelin 1

The incidence of ventricular tachyarrhythmias in the early post-operative period following implantable cardioverter-defibrillator (ICD) implantation is relatively high compared with that in control periods. Since endothelin-1 (ET-1) has been proven to be an endogenous arrhythmogenic substance, we investigated the changes in serum ET-1 and big-ET levels in patients undergoing ICD implantation. Serum concentrations of ET-1 and big-ET were measured in 14 patients with various heart diseases before the operation, as well as 1min and 1h after the last shock therapy. Big-ET levels and the sum of ET-1 and big-ET levels were unchanged immediately after the operation, but had increased significantly by 1h after implantation (before, 1.57±0.61pmol/l; 1min, 1.86±0.87pmol/l; 1h, 4.29±1.65pmol/l for big-ET; before, 3.44±1.07pmol/l; 1min, 3.79±1.29pmol/l; 1h, 6.36±2.03pmol/l for big-ET+ET-1). There was a significant correlation between left ventricular ejection fraction and big-ET level measured 1h after the last shock delivery (r =-0.542, P<0.05). We conclude that the increased big-ET level observed 1h after the last induction and shock therapy of ventricular fibrillation might have a pathophysiological role in the increased incidence of post-operative spontaneous ventricular arrhythmias.

Abstract 2037: Renal Dysfunction and Appropriate Shock Therapy in Implantable Cardioverter Defibrillator Patients with Nonischemic Heart Failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Atsushi Takahashi ◽  
Tsuyoshi Shiga ◽  
Keisuke Futagawa ◽  
Ryusuke Kimura ◽  
Koichiro Ejima ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Insufficiency ◽  
Renal Dysfunction ◽  
Implantable Cardioverter Defibrillator ◽  
Shock Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Icd Shock

Background: Implantable Cardioverter Defibrillator (ICD) prevent sudden cardiac death in high risk patients with heart failure. The presence of coexisting conditions has a substantial effect on the rate of arrhythmic events in heart failure patients. Renal dysfunction is associated with mortality in patients with myocardial infarction or heart failure, but the influence of degrees of renal impairment is less well defined. Methods: A total of 221 patients who underwent ICD implantation were included between 1990 and 2006. Gromerular Filteration Rate (GFR) was estimated using the Modification of Diet in Renal Disease (MDRD) and renal insufficiency was defined as MDRD GFR<60mL/min/1.73m 2 . Differences in arrhythmia recurrences according to the MDRD GFR were compared by Kaplan-Meier survival curves. Results: During a mean follow-up time of 3.7±2.8 years, 82 (37%) of 221 patients (mean age; 4.7±1.3 years, 71% male) experienced appropriate ICD shock therapy. There was a trend of higher cumulative rate of appropriate ICD shock therapies in patients with renal insufficiency than other patients (p<0.10). The result of subgroup analysis of 94 patients with low LVEF (LVEF<35%) indicated that the patients with renal insufficiency experienced electrical storms more frequently (p<0.05). After correcting for age, sex, left ventricular ejection fraction (LVEF), indication for ICD implantation, and use of beta-blockers in a Cox regression model, low MDRD GFR was still an independent predictor of the time to first appropriate ICD shock (hazard ratio [HR] 2.30, 95% confidence interval [CI] 1.13–4.69, p<0.05). Below 60mL/min/1.73m 2 , each reduction of the MDRD GFR by 10 units was associated with a HR for appropriate shock of 1.40 (95% CI, 1.00 to 1.95). Conclusion: Renal insufficiency is associated with increased rate of arrhythmic event in nonischemic HF patients. Especially, those patients with low LVEF and renal dysfunction experience more frequent ICD shocks.

scholarly journals The Significance of Shocks in Implantable Cardioverter Defibrillator Recipients

2016 ◽  
Vol 5 (2) ◽  
pp. 110 ◽  
Author(s):  
Anthony Li ◽  
Amit Kaura ◽  
Nicholas Sunderland ◽  
Paramdeep S Dhillon ◽  
Paul A Scott ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Implantable Cardioverter Defibrillator ◽  
Large Scale ◽  
Strong Association ◽  
Shock Therapy ◽  
Left Ventricular ◽  
Cardioverter Defibrillator ◽  
Patients With Heart Failure ◽  
The Relationship

Large-scale implantable cardioverter defibrillator (ICD) trials have unequivocally shown a reduction in mortality in appropriately selected patients with heart failure and depressed left ventricular function. However, there is a strong association between shocks and increased mortality in ICD recipients. It is unclear if shocks are merely a marker of a more severe cardiovascular disease or directly contribute to the increase in mortality. The aim of this review is to examine the relationship between ICD shocks and mortality, and explore possible mechanisms. Data examining the effect of shocks in the absence of spontaneous arrhythmias as well as studies of non-shock therapy and strategies to reduce shocks are analysed to try and disentangle the shocks versus substrate debate.

scholarly journals RR interval variability in the evaluation of ventricular tachycardia and effects of implantable cardioverter defibrillator therapy

2020 ◽  
Author(s):  
Keita Tsukahara ◽  
Yasushi Oginosawa ◽  
Yoshihisa Fujino ◽  
Toshinobu Honda ◽  
Kan Kikuchi ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Implantable Cardioverter Defibrillator ◽  
Cycle Length ◽  
Shock Therapy ◽  
Cardiac Resynchronization ◽  
Icd Therapy ◽  
Cardioverter Defibrillator ◽  
Rr Interval ◽  
Successful Termination ◽  
Significant Difference

Introduction: An implantable cardioverter defibrillator (ICD) is the most reliable therapeutic device for preventing sudden cardiac death in patients with sustained ventricular tachycardia (VT). Regarding the effectiveness of the ICD, targeted VT is defined based on the tachyarrhythmia cycle length. However, variation of the RR interval variability of VTs does occur. A few studies reported on VT characteristics and effects of ICD therapy according to RR interval variability. This study aimed to identify the clinical characteristics of VTs and effects of ICD therapy according to RR interval variability. Methods: We analyzed 821 VT episodes in 69 of 185 patients treated with ICDs or cardiac resynchronization therapy defibrillators. VTs were classified as regular or irregular based on RR interval variability. We evaluated successful termination using anti-tachycardia pacing (ATP)/shock therapy, spontaneous termination, and acceleration between regular and irregular VTs. Reproducibility of the RR interval variability in one VT episode and within an individual with recurrent VT episodes was evaluated. Results: Regular VT was significantly more successfully terminated than irregular VT by ATP therapy. There was no significant difference in shock therapy or VT acceleration, irrespective of the variability of the VT cycle length. Spontaneous termination of VT occurred significantly more often in irregular than in regular VT. Reproducibility of RR interval variability in an episode and individual was 89% and 73%, respectively. Conclusion: ATP therapy showed greater effectiveness for regular than for irregular VT. Spontaneous termination was more common in irregular than in regular VT. RR interval variability of VTs is reproducible.

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