scholarly journals Identifying At‐Risk Patients for Sustained Atrial High‐Rate Episodes Using the C 2 HEST Score: The West Birmingham Atrial Fibrillation Project

2021 ◽  
Vol 10 (6) ◽  
Author(s):  
Yan‐Guang Li ◽  
Daniele Pastori ◽  
Kazuo Miyazawa ◽  
Farhan Shahid ◽  
Gregory Y. H. Lip
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Electronic Device ◽  
Electronic Devices ◽  
Systolic Heart Failure ◽  
High Rate ◽  
Cardiac Implantable Electronic Device ◽  
The West ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk

Background Sustained atrial high‐rate episodes (SAHREs) among individuals with a cardiac implantable electronic device are associated with an increased risk of adverse outcomes. Risk stratification for the development of SAHREs has never been investigated. We aimed to assess the performance of the C 2 HEST (coronary artery disease or chronic obstructive pulmonary disease [1 point each], hypertension [1 point], elderly [age ≥75 years, 2 points], systolic heart failure [2 points], thyroid disease [1 point]) score in predicting SAHREs in patients with cardiac implantable electronic devices without atrial fibrillation. Methods and Results Five Hundred consecutive patients with cardiac implantable electronic devices in the West Birmingham Atrial Fibrillation Project in the United Kingdom were followed since the procedure to observe the development of SAHREs, defined by atrial high‐rate episodes lasting >24 hours. Risk factors and incidence of SAHREs were analyzed. The predictive value of the C 2 HEST score for SAHRE prediction was evaluated. Over a mean follow‐up of 53.1 months, 44 (8.8%) patients developed SAHREs. SAHREs were associated with higher all‐cause mortality ( P <0.001) and ischemic stroke ( P =0.001). Age and heart failure were associated with SAHRE occurrence. The incidence of SAHREs increased by the C 2 HEST score (39% higher risk per point increase). Among patients with a C 2 HEST score ≥4, the incidence of SAHREs was 3.62% per year (95% CI, 2.14–5.16). The C 2 HEST score had moderate predictive capability (area under the curve, 0.73; 95% CI, 0.64–0.81) and discriminative ability (log‐rank P =0.003), which was better than other clinical scores (CHA 2 DS 2 ‐VASc, CHADS 2 , HATCH). Conclusions The C 2 HEST score predicted SAHRE incidence in patients without atrial fibrillation who had an cardiac implantable electronic device, with the highest risk seen in patients with a C 2 HEST score ≥4 The benefit of using the C 2 HEST score in clinical practice in this patient population needs further investigation.

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

Medicina ◽  
2019 ◽  
Vol 55 (10) ◽  
pp. 611 ◽  
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.

Cardiac implantable electronic device remote monitoring in a large cohort of patients and the need for planning

2020 ◽  
Vol 16 (5) ◽  
pp. 447-456
Author(s):  
Franco Zoppo ◽  
Antonio Lupo ◽  
Giacomo Mugnai ◽  
Francesca Zerbo
Keyword(s):  
Atrial Fibrillation ◽  
Remote Monitoring ◽  
Electronic Device ◽  
Descriptive Analysis ◽  
Electronic Devices ◽  
Standard Of Care ◽  
Large Cohort ◽  
Cardiac Implantable Electronic Device ◽  
Cardiac Implantable Electronic Devices

Aim: The remote monitoring (RM) of cardiac implantable electronic devices (CIED) is standard of care. We describe an organizational and projection RM workload model. Methods: At the time of the analysis (2015), 3995 CIED patients were followed-up; 1582 (40.5%) with RM. All RM transmissions (Tx) have been gathered in five event types. Results: We received 10,406 Tx, classified as: 128 (1.2%) red alerts, 141 (1.3%) atrial fibrillation episodes, 1944 (18.6%) yellow alerts, 403 (3.9%) lost Tx (disconnected/noncompliant patients) and 7790 (75.0%) Tx ‘OK' (un-eventful Tx). At the time of 100% of remote CIED managed, we can expect a total of 25,990 Tx/year. Conclusion: We provide a descriptive analysis of remote monitoring management and workload estimation in a large cohort of CIED patients.

Cryoballoon ablation of atrial fibrillation in patients with advanced systolic heart failure and cardiac implantable electronic devices

2018 ◽  
pp. 1081-1088 ◽  
Author(s):  
Patrycja Pruszkowska ◽  
Radosław Lenarczyk ◽  
Jakub Gumprecht ◽  
Ewa Jedrzejczyk-Patej ◽  
Michał Mazurek ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Electronic Devices ◽  
Systolic Heart Failure ◽  
Cryoballoon Ablation ◽  
Cardiac Implantable Electronic Devices

Performance of the C2HEST score to predict sustained atrial high-rate episodes in patients implanted with cardiac implantable electronic device

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D Pastori ◽  
YG Li ◽  
K Miyazawa ◽  
F Shahid ◽  
GYH Lip
Keyword(s):  
Heart Failure ◽  
Electronic Device ◽  
Systolic Heart Failure ◽  
Area Under The Curve ◽  
Adverse Outcomes ◽  
High Rate ◽  
Chronic Obstructive ◽  
Cardiac Implantable Electronic Device ◽  
Elderly Age ◽  
Discriminative Ability

Abstract Funding Acknowledgements Type of funding sources: None. Background Sustained atrial high-rate episodes (SAHRE), which are considered ‘subclinical atrial fibrillation’ (AF), increase the risk of adverse outcomes in patients with a cardiac implantable electronic device (CIED). Risk stratification for the development of SAHREs has never been investigated. Purpose To assess test the performance of the C2HEST score (coronary artery disease or chronic obstructive pulmonary disease [1 point each]; hypertension [1 point]; elderly [age ≥75 years, 2 points]; systolic heart failure [2 points]; thyroid disease [1 point]) in predicting SAHRE in patients implanted with CIED without AF. Methods Retrospective study including 500 consecutive patients implanted with CIEDs in the West Birmingham in the UK. Patients were followed after implantation to record the development of SAHRE lasting &gt;24h. Risk factors and incidence of SAHRE were analyzed. The predictive value of the C2HEST score for SAHRE prediction was evaluated. Results During 53.1 months of follow-up, 44 (8.8%) patients developed SAHRE. SAHRE was associated with higher all-cause mortality (P &lt; 0.001) and ischemic stroke (P = 0.001). Age and heart failure were associated with SAHRE occurrence. The incidence of SAHRE increased by the C2HEST score (39% higher risk per point increase)(table). Among those with C2HEST score ≥4, the incidence of SAHRE was 3.62%/year (95%CI 2.14-5.16). The C2HEST score had a moderate predictive capability (area under the curve 0.73 [95%CI 0.64-0.81]) and discriminative ability (log-rank P = 0.003), which was better than other clinical scores (CHA2DS2-VASc, CHADS2, HATCH). Conclusions The C2HEST score predicted SAHRE incidence in non-AF subjects with CIED, with the highest risk seen in patients with C2HEST score ≥4 The benefit of using the C2HEST score in clinical practice in this patient population needs further investigation. C2HEST score Subjects n (%) SAHRE (n) Incident rate (95%CI) Hazard Ratio (95% CI) P 0-1 144 (28.5%) 5 0.85 (0.27-1.94) Reference Reference 2-3 211 (42.2%) 17 1.87 (1.06-2.91) 2.06 (0.76-5.59) 0.159 ≥4 145 (29.0%) 22 3.62 (2.14-5.16) 4.25 (1.61-11.22) 0.004

scholarly journals Protecting the most vulnerable during COVID-19 and beyond: a case report on the remote management of heart failure patients with cardiac implantable electronic devices

2020 ◽  
Vol 4 (FI1) ◽  
pp. 1-6
Author(s):  
Fozia Zahir Ahmed ◽  
Carol Crosbie ◽  
Matthew Kahn ◽  
Manish Motwani
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Electronic Devices ◽  
Management Strategies ◽  
Phone Call ◽  
Cardiac Resynchronization ◽  
Physiological Data ◽  
Related Data ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk

Abstract Background Heart failure (HF) patients with cardiac implantable electronic devices (CIEDs) represent an important cohort. They are at increased risk of hospitalization and mortality. We outline how remote-only management strategies, which leverage transmitted health-related data, can be used to optimize care for HF patients with a CIED during the COVID-19 pandemic. Case summary An 82-year-old man with HF, stable on medical therapy, underwent cardiac resynchronization therapy implantation in 2016. Modern CIEDs facilitate remote monitoring by providing real-time physiological data (thoracic impedance, heart rate and rhythm, etc.). The ‘Triage Heart Failure Risk Score’ (Triage-HFRS), available on Medtronic CIEDs, integrates several monitored physiological parameters into a risk prediction model classifying patients as low, medium, or high risk of HF events within 30 days. In November 2019, the patient was enrolled in an innovative clinical pathway (Triage-HF Plus) whereby any ‘high’ Triage-HF risk status transmission prompts a phone call-based virtual consultation. A high-risk alert was received via remote transmission on 11 March, triggering a phone call assessment. Upon reporting increasing breathlessness, diuretics were initiated. The prescription was remotely issued and delivered to the patient’s home. This approach circumvented the need for all face-to-face reviews, delivering care in an entirely remote manner. Discussion The challenges posed by COVID-19 have prompted us to think differently about how we deliver care for patients, both now and following the pandemic. Contemporary CIEDs facilitate the ability to remotely monitor HF patients by providing rich physiological data that can help identify individuals at elevated risk of decompensation using automated device-generated alerts.

Avoiding implant complications in cardiac implantable electronic devices: what works?

EP Europace ◽  
2020 ◽  
Author(s):  
Maria Hee Jung Park Frausing ◽  
Mads Brix Kronborg ◽  
Jens Brock Johansen ◽  
Jens Cosedis Nielsen
Keyword(s):  
Primary Prevention ◽  
Electronic Device ◽  
Electronic Devices ◽  
Evidence Base ◽  
Cardiac Implantable Electronic Device ◽  
Cardiac Implantable Electronic Devices ◽  
What Works ◽  
Preventive Actions ◽  
Implant Complications ◽  
Patients Experience

Abstract Nearly one in ten patients experience complications in relation to cardiac implantable electronic device (CIED) implantations. CIED complications have serious implications for the patients and for the healthcare system. In light of the rising rates of new implants and consistent rate of complications, primary prevention remains a major concern. To guide future efforts, we sought to review the evidence base underlying common preventive actions made during a primary CIED implantation.

scholarly journals Subclinical and Device-Detected Atrial Fibrillation: Pondering the Knowledge Gap: A Scientific Statement From the American Heart Association

Circulation ◽  
2019 ◽  
Vol 140 (25) ◽  
Author(s):  
Peter A. Noseworthy ◽  
Elizabeth S. Kaufman ◽  
Lin Y. Chen ◽  
Mina K. Chung ◽  
Mitchell S.V. Elkind ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
American Heart ◽  
Electronic Devices ◽  
Heart Association ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk ◽  
Scientific Statement ◽  
Existing Data

The widespread use of cardiac implantable electronic devices and wearable monitors has led to the detection of subclinical atrial fibrillation in a substantial proportion of patients. There is evidence that these asymptomatic arrhythmias are associated with increased risk of stroke. Thus, detection of subclinical atrial fibrillation may offer an opportunity to reduce stroke risk by initiating anticoagulation. However, it is unknown whether long-term anticoagulation is warranted and in what populations. This scientific statement explores the existing data on the prevalence, clinical significance, and management of subclinical atrial fibrillation and identifies current gaps in knowledge and areas of controversy and consensus.

Abstract 103: A Meta Analysis of Antibiotic Envelope Use to Prevent Cardiac Implantable Electronic Device Infections

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Muhammad U Khan ◽  
Ahmad Naeem Lone ◽  
Muhammad Khan ◽  
shahul valavoor ◽  
Muhammad Munir ◽  
...  
Keyword(s):  
Infection Prevention ◽  
Electronic Device ◽  
Meta Analysis ◽  
Electronic Devices ◽  
Control Group ◽  
Preventive Strategy ◽  
Cardiac Implantable Electronic Device ◽  
Cardiac Implantable Electronic Devices ◽  
Device Infection ◽  
Effective Preventive Strategy

Introduction: Cardiac Implantable Electronic Device (CIED) infections are a major source of morbidity, mortality and increased healthcare cost. There are several well established risk factors associated with increased infection. An antibiotic coated envelope has been developed as an infection prevention intervention. Hypothesis: Whether antibiotic coated envelope is an effective preventive strategy against Cardiac Implantable Electronic Device Infections. Methods: 6 trials comparing use of antibiotic envelope to control, including 1 randomized trial and 5 cohort studies were selected using PubMed and Embase data bases through May 2019. The efficacy end point was prevention of CIED Infection. Outcomes were combined using random effects model and estimated by odds ratio with 95% confidence intervals (CI). Results: In our analysis of total 12,024 patients undergoing CIED implantation, 5,844 patients received antibiotic envelope while 6,180 patients were included in the control group. Antibiotic envelope was superior to control in reducing the risk of device infection (OR 0.40 CI [0.17-0.95], p=0.04). Conclusions: The use of antibiotic envelope in Cardiac Implantable Electronic Devices (CIED) is associated with reduced incidence of CIED infection.

scholarly journals Home Management of Heart Failure and Arrhythmias in Patients with Cardiac Devices during Pandemic

2021 ◽  
Vol 10 (8) ◽  
pp. 1618
Author(s):  
Andrea Matteucci ◽  
Michela Bonanni ◽  
Marco Centioni ◽  
Federico Zanin ◽  
Francesco Geuna ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ventricular Tachycardia ◽  
Hospital Admissions ◽  
Electronic Devices ◽  
Home Monitoring ◽  
Home Management ◽  
Cardiac Implantable Electronic Devices ◽  
Cardiac Devices ◽  
The Impact

Background: The in-hospital management of patients with cardiac implantable electronic devices (CIEDs) changed early in the COVID-19 pandemic. Routine in-hospital controls of CIEDs were converted into remote home monitoring (HM). The aim of our study was to investigate the impact of the lockdown period on CIEDs patients and its influence on in-hospital admissions through the analysis of HM data. Methods: We analysed data recorded from 312 patients with HM during the national quarantine related to COVID-19 and then compared data from the same period of 2019. Results: We observed a reduction in the number of HM events in 2020 when compared to 2019. Non-sustained ventricular tachycardia episodes decreased (18.3% vs. 9.9% p = 0.002) as well as atrial fibrillation episodes (29.2% vs. 22.4% p = 0.019). In contrast, heart failure (HF) alarm activation was lower in 2019 than in 2020 (17% vs. 25.3% p = 0.012). Hospital admissions for critical events recorded with CIEDs dropped in 2020, including those for HF. Conclusions: HM, combined with telemedicine use, has ensured the surveillance of CIED patients. In 2020, arrhythmic events and hospital admissions decreased significantly compared to 2019. Moreover, in 2020, patients with HF arrived in hospital in a worse clinical condition compared to previous months.

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