Abstract 13327: Prediction of Upcoming Therapeutic Episodes of ICD Through Routine Data in Routine Device Clinic of ICD Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Tamami Fujiishi ◽  
Shinichi Niwano ◽  
Masami Murakami ◽  
Hironori Nakamura ◽  
Tazuru Igarashi ◽  
...  
Keyword(s):  
Routine Data ◽  
Shock Therapy ◽  
Device Management ◽  
Icd Therapy ◽  
Electrical Instability ◽  
Significant Difference ◽  
Life Threatening ◽  
Near Future ◽  
Spontaneous Rhythm

Background: Although implantable cardioverter-defibrillator (ICD) prevents sudden death of patients with life-threatening arrhythmia, prediction of upcoming ICD therapy, if possible, would be an important issue in device management. In the present study, the relationship between ICD therapeutic episodes and preceding routine device data was evaluated to clarify the predictors for ICD actuation in near future. Methods: The study population consisted of 100 consecutive ICD patients. All patients were followed up in the device clinic in every 4-month period, and their total follow-up periods of 22.8±4.1 months were divided into 734 4-month observation windows. The common data in device clinic including 12-lead ECG, chest X-ray, and interrogated device data were compared between patients with and without ICD therapeutic episodes during upcoming 4-month windows. To avoid inappropriate weighting on data of specific cases, such as unusual data in cases with frequent shock therapy, sampling number was limited 4-8 times in one case, and all data were evaluated as change during preceding 4 months, e.g., QTc calculated by subtracting 4 month preceding QTc from the recent QTc. Results: During 3.2±1.3 month follow-up, among 734 observation windows, appropriate and inappropriate ICD therapies appeared in 54 (ATP: 29, shock: 25) and 20 (ATP: 11, shock: 9) windows. When the patients were divided into spontaneous rhythm and paced-rhythm groups (n=558 and 170), spontaneous rhythm group did not show any significant difference in parameters between the windows with and without therapeutic episodes. In contrast in paced-rhythm group, RV lead impedance was significantly lower in the windows with therapeutic episodes in comparison with those without (-19.8±43.5Ω vs. 7.4±44.7Ω, p=0.047). Conclusions: Upcoming ICD therapy in near future might be able to be predicted by change in RV lead impedance at least in cases with paced-rhythm in ICD patients. It might reflect the electrical instability in cases with ICD therapeutic episodes.

Abstract 12976: Malignant Type of Electrical Storm in Patients With an Implantable Cardiac Shock Device: Results From the Nippon Storm Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Takashi Noda ◽  
Takashi Kurita ◽  
Takashi Nitta ◽  
Hiroshi Frushima ◽  
Naoki Matsumoto ◽  
...  
Keyword(s):  
Shock Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Electrical Storm ◽  
Clinical Aspects ◽  
Ventricular Ejection Fraction ◽  
Significant Difference ◽  
Cardiac Shock ◽  
Multiple Episodes

Introduction: Electrical storm (ES) referred to as multiple device therapies is an important clinical problem in patients (pts) with an implantable cardiac shock device (ICSD), such as implantable cardioverter-defibrillator or cardiac resynchronization therapy device with defibrillator. Detailed clinical aspects of ES, however, remain unclear in the Asian large population. Methods: We analyzed the data of the Nippon Storm Study which was a prospective observational study and consisted of 1570 pts enrolled from 48 Japanese ICSD centers designed to clarify the clinical aspects of ES. The study population included 493 (31%) pts with ischemic heart disease (IHD) and 357 (23%) pts with dilated cardiomyopathy (DCM). They had a mean LVEF of 43±19 %. Results: ES occurred in 96 (6.4%) pts during a median follow-up of 28 (23-33) months. Compared to pts without ES, pts with ES showed a significantly lower left ventricular ejection fraction (43% vs 38 %, respectively, p=0.005). No significant difference regarding ES incidence was observed between pts with IHD and pts with DCM (log-rank p=0.77). A sub-analysis of the ES characteristics revealed that the mortality in patients with shock therapy during the first ES episode and those with the incidence of multiple episodes of ES during the follow-up was significantly higher than those without (12/18 vs 30/78; p=0.03, 12/18 vs 26/78, p<0.01, respectively, Table). Conclusions: Shock therapy during the first ES episode and multiple episodes of ES were related to significantly higher mortality in pts with ICSD. There can be a malignant entity of ES.

Relation between resting heart rate and the risk of ventricular tachyarrhythmias in MADIT-RIT

EP Europace ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. 281-287
Author(s):  
Roy Beinart ◽  
Valentina Kutyifa ◽  
Scott McNitt ◽  
David Huang ◽  
Mehmet Aktas ◽  
...  
Keyword(s):  
Heart Rate ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Continuous Measure ◽  
Ventricular Tachyarrhythmias ◽  
Resting Heart Rate ◽  
Icd Therapy ◽  
Kaplan Meier ◽  
Life Threatening

Abstract Aims To explore the association between resting heart rate (RHR) and ventricular tachyarrhythmias (VTA) events among patients who were enrolled in MADIT-RIT. Methods and results Multivariate Cox proportional hazards regression modelling was employed to evaluate the association between baseline RHR [dichotomized at the lower quartile (≤63 b.p.m.) and further assessed as a continuous measure] and the risk for any VTA, fast VTA (&gt;200 b.p.m.), and appropriate implantable cardioverter-defibrillator (ICD) therapy, among 1500 patients who were enrolled in MADIT-RIT. Kaplan–Meier survival analysis showed that at 2 years of follow-up the rate of any VTA was significantly lower among patients with low baseline RHR (≤63 b.p.m.) as compared with faster RHR (11% vs. 19%, respectively; P = 0.001 for the overall difference during follow-up). Similar results were shown for the association with the rate of fast VTA (8% vs. 14%, respectively; P = 0.016), and appropriate ICD therapy (10% vs. 18%, respectively; P = 0.004). Multivariate analysis, after adjustment for medical therapy, showed that low baseline RHR was associated with a significant 45% (P = 0.002) reduction in the VTA risk as compared with faster baseline RHRs. When assessed as a continuous measure, each 10 b.p.m. decrement in RHR was associated with a corresponding 13% (P = 0.014) reduction in the VTA risk. Conclusion In MADIT-RIT, low RHR was independently associated with a lower risk for life-threatening arrhythmic events. These findings suggest a possible role for RHR for improved selection of candidates for ICD therapy.

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.

scholarly journals Impact of COVID-19 Pandemic on Severe Ventricular Arrhythmia and Icd Therapy

2021 ◽  
Author(s):  
Abdulcebbar SİPAL ◽  
Mujdat AKTAS ◽  
Tayyar AKBULUT ◽  
Faysal SAYLIK
Keyword(s):  
Ventricular Fibrillation ◽  
Ventricular Arrhythmia ◽  
Ventricular Arrhythmias ◽  
Shock Therapy ◽  
Antitachycardia Pacing ◽  
Before And After ◽  
Life Threatening ◽  
Recorded Data ◽  
Ventricular Tachycardias

Abstract BACKGROUND AND OBJECTIVES: The regular clinical follow-up of the patient with the implantable cardioverter-defibrillator (ICD) device was seriously affected by the COVID-19 outbreak. Due to the high risk of contamination, patients didn’t admit to the clinics for the ICD device control. It has been observed that arrhythmic events increased during the COVID-19 outbreak. In this study, we aimed to investigate the frequency of severe ventricular arrhythmias and ICD device therapy in COVID-19 patients with ICD.METHODS: In this single center-observational study, we assessed severe ventricular arrhytmias and ICD therapies by analyzing recorded data of 33 patients (24 males, 72.7%) 3 months before and after getting COVID-19 during the COVID-19 pandemic in Van, Turkey, between 15 August 2020 and 15 January 2021. RESULTS: Before the diagnosis of COVID-19, 6 ventricular tachycardias and 1 ventricular fibrillation were observed. When we analyzed the records after the diagnosis COVID-19, 17 ventricular tachycardia and 3 ventricular fibrillation episodes were observed. Considering the the ICD device therapies, 5 of these severe tachyarrhythmias were terminated by antitachycardia pacing (ATP) and 2 with shock therapy before the diagnosis of COVID-19. After the COVID-19, 14 of them were terminated by ATP and 6 of them ere terminated by shock therapy.CONCLUSION: The effects of the COVID-19 pandemic, especially on ventricular arrhythmia, have not been reported sufficiently. In our study, it was observed that life-threatening ventricular arrhythmias and the ICD therapies were increased in patients with COVID-19, especially in the first month after the diagnosis COVID-19.

scholarly journals The Joint Vasculitis Registry in German-speaking countries (GeVas) – a prospective, multicenter registry for the follow-up of long-term outcomes in vasculitis

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Christof Iking-Konert ◽  
Pia Wallmeier ◽  
Sabrina Arnold ◽  
Sabine Adler ◽  
Kirsten de Groot ◽  
...  
Keyword(s):  
Extended Period ◽  
High Morbidity ◽  
Systematic Analysis ◽  
Web Based ◽  
German Speaking ◽  
Organ Manifestations ◽  
Life Threatening ◽  
Near Future

Abstract Background Vasculitides comprise a group of rare diseases which affect less than 5 in 10.000 individuals. Most types of vasculitis can become organ- and life-threatening and are characterized by chronicity, high morbidity and relapses, altogether resulting in significant morbidity and mortality. Previous studies have been either monocentric or mainly retrospective – studies with a prospective design mostly consisted of rather small cohorts of 100 to 200 patients. The aim of the Joint Vasculitis Registry in German-speaking countries (GeVas) is to record all patients who have been recently diagnosed with vasculitis or who have changed their treatment due to a relapse (inception cohort). In GeVas, data are collected prospectively in a multicenter design in Germany, Austria and Switzerland. By this approach, courses of vasculitis and their outcomes can be monitored over an extended period. Methods GeVas is a prospective, web-based, multicenter, clinician-driven registry for the documentation of organ manifestations, damage, long-term progress and other outcomes of various types of vasculitis. The registry started recruiting in June 2019. As of October 2020, 14 centers have been initiated and started recruiting patients in Germany. Involvement of sites in Austria and the German-speaking counties of Switzerland is scheduled in the near future. Discussion In June 2019, we successfully established a prospective multicenter vasculitis registry being the first of its kind in German-speaking countries. The participating centers are currently recruiting, and systematic analysis of long-term vasculitis outcomes is expected in the ensuing period. Trial registration German Clinical Trials Register (Deutsches Register Klinischer Studien): DRKS00011866. Registered 10 May 2019.

Abstract 2256: Predictors of “Life-Threatening” Fast VT or VF in Arrhythmogenic Right Ventricular Dysplasia

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Douglas W Laidlaw ◽  
David Lucier ◽  
James P Daubert ◽  
Frank I Marcus ◽  
Melvin M Scheinman ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Secondary Prevention ◽  
Right Ventricular ◽  
Task Force ◽  
Cumulative Risk ◽  
Arrhythmogenic Right Ventricular Dysplasia ◽  
Icd Therapy ◽  
Right Ventricular Dysplasia ◽  
Life Threatening

Introduction: The Multidisciplinary Study of Right Ventricular Dysplasia is an NIH-funded, multicenter, prospective registry of patients meeting Task-Force criteria for arrhythmogenic right ventricular dysplasia (ARVD). Previous studies have used the occurrence of “life-threatening” fast VT or VF as a surrogate for sudden cardiac death in patients with an ICD, however the patient characteristics associated with sudden cardiac death in ARVD remain poorly defined. Methods: All patients in the ARVD registry that underwent implantation of an ICD were studied. Baseline characteristics of patients who received ICD therapy for fast VT/VF (with a cycle length of <250msec) were compared to those patients who did not receive ICD therapy. The cumulative risk of appropriate ICD therapy for fast VT/VF was determined by the Kaplan-Meier method for patients receiving an ICD for primary or secondary prevention. Results: 80 patients in the ARVD registry underwent implantation of an ICD. Of those, 61 patients (76%) had an ICD implanted for secondary prevention and 19 patients (24%) for primary prevention. Over a mean follow-up of 1.7 years, 17.5% of patients experienced appropriate ICD therapy for fast VT/VF, including 18% of patients with an ICD implanted for secondary prevention and 15.8% of patients with and ICD implanted for primary prevention. Among all baseline imaging, echocardiographic, and electrcardiographic characteristics, none were significantly associated with the occurance of fast VT/VF during follow-up. In a Kaplan-Meier analysis, there was no significant diffference in the cumulative risk of ICD therapy for fast VT/VF between primary or secondary prevention cohorts (log rank p-value = 0.69). Conclusions: In this registry of patients meeting the current Task Force criteria for ARVD, there is a high incidence of “life-threatening” fast VT/VF during follow-up, and the probability of fast VT/VF is similar in patients with an ICD for secondary prevention compared to those with an ICD for primary prevention. Furthermore, baseline characteristics do not reliably predict a future risk of life threatening arrhythmias in this cohort.

Relationship between Thyroglobulin and Tumor Detectabilily with Thallium-201 in Differentiated Thyroid Cancer

2000 ◽  
Vol 39 (01) ◽  
pp. 10-15 ◽  
Author(s):  
S. P. Müller ◽  
Ch. Reiners ◽  
A. Bockisch ◽  
Katja Brandt-Mainz
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Roc Analysis ◽  
Tsh Suppression ◽  
Significant Difference ◽  
Test Specificity ◽  
The Relationship ◽  
Tumor Scintigraphy ◽  
Tsh Stimulation

Summary Aim: Tumor scintigraphy with 201-TICI is an established diagnostic method in the follow-up of differentiated thyroid cancer. We investigated the relationship between thyroglobulin (Tg) level and tumor detectability. Subject and methods: We analyzed the scans of 122 patients (66 patients with proven tumor). The patient population was divided into groups with Tg above (N = 33) and below (N = 33) 5 ng/ml under TSH suppression or above (N = 33) and below (N = 33) 50 ng/ml under TSH stimulation. Tumor detectability was compared by ROC-analysis (True-Positive-Fraction test, specificity 90%). Results: There was no significant difference (sensitivity 75% versus 64%; p = 0.55) for patients above and below 5 ng/ml under TSH suppression and a just significant difference (sensitivity 80% versus 58%; p = 0.04) for patients above and below 50 ng/ml under TSH stimulation. In 18 patients from our sample with tumor, Tg under TSH suppression was negative, but 201-TICI-scan was able to detect tumor in 12 patients. Conclusion: Our results demonstrate only a moderate dependence of tumor detectability on Tg level, probably without significant clinical relevance. Even in patients with slight Tg elevation 201-TICI scintigraphy is justified.

The Evolution of Lead Extraction

2009 ◽  
Vol 5 (1) ◽  
pp. 32
Author(s):  
Melanie Maytin ◽  
Laurence M Epstein ◽  
◽  
Keyword(s):  
Natural Selection ◽  
Lead Extraction ◽  
Significant Morbidity ◽  
Extraction Techniques ◽  
Extraction Technology ◽  
Device Management ◽  
Future Developments ◽  
The Past ◽  
New Methods ◽  
Life Threatening

Prior to the introduction of successful intravascular countertraction techniques, options for lead extraction were limited and dedicated tools were non-existent. The significant morbidity and mortality associated with these early extraction techniques limited their application to life-threatening situations such as infection and sepsis. The past 30 years have witnessed significant advances in lead extraction technology, resulting in safer and more efficacious techniques and tools. This evolution occurred out of necessity, similar to the pressure of natural selection weeding out the ineffective and highly morbid techniques while fostering the development of safe, successful and more simple methods. Future developments in lead extraction are likely to focus on new tools that will allow us to provide comprehensive device management and the design of new leads conceived to facilitate future extraction. With the development of these new methods and novel tools, the technique of lead extraction will continue to require operators that are well versed in several methods of extraction. Garnering new skills while remembering the lessons of the past will enable extraction technologies to advance without repeating previous mistakes.

Melatih Kepemimpinan Perangkat Desa Kebonharjo Kulonprogo: Membangun Sikap Anti Korupsi

2018 ◽  
Vol 1 ◽  
pp. 107
Author(s):  
Adi Heryadi ◽  
Evianawati Evianawati
Keyword(s):  
Transformational Leadership ◽  
Data Collection ◽  
Paired Samples ◽  
Significant Difference ◽  
Before And After ◽  
Post Test ◽  
Sample Test ◽  
Corruption Perception ◽  
Measuring Tool

This study aims to prove whether transformational leadership training is effective for building anti-corruption attitudes of villages in Kebonharjo village, subdistrict Samigaluh Kulonprogo. This research is an experimental research with one group pre and posttest design.Subject design is 17 people from village of 21 candidates registered. Measuring tool used in this research is the scale of anti-corruption perception made by the researcher referring to the 9 anti-corruption values with the value of reliability coefficient of 0.871. The module used as an intervention made by the researcher refers to the transformational leadership dimension (Bass, 1990). The data collected is analyzed by statistical analysis of different test Paired Sample Test. Initial data collection results obtained sign value of 0.770 which means> 0.05 or no significant difference between anti-corruption perception score between before and after training. After a period of less than 1 (one) month then conducted again the measurement of follow-up of the study subjects in the measurement again using the scale of anti-corruption perception. The results of the second data collection were analysed with Paired Samples Test and obtained the value of 0.623 sign meaning p> 0.05 or no significant difference between post test data with follow-up data so that the hypothesis of this study was rejected.

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