Recent Advances in Pacing and Defibrillation

Cardiac pacemakers have been the standard therapy for patients with bradyarrhythmias for several decades. The pacing lead is an integral part of the system, serving as a conduit for the delivery of energy pulses to stimulate the myocardium. However, it is also the Achilles’ heel of pacemakers, being the direct cause of most device complications both acutely during implant and chronically years afterwards. Leadless pacing with ultrasound-mediated energy has been demonstrated in animals and humans to be safe and feasible in acute studies. Implantable defibrillators revolutionised the treatment and prevention of sudden cardiac death. Subcutaneous implantable defibrillators have been under development for more than 10 years. A permanent implantable system has been shown to be feasible in treating induced and spontaneous ventricular tachyarrhythmias. These developments and recent advances in pacing and defibrillation will arouse further interest in the research and development of leadless cardiac implantable electronic devices.

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Considerations in Patients With Cardiac Implantable Electronic Devices at End of Life

AACN Advanced Critical Care ◽

10.4037/nci.0000000000000111 ◽

2015 ◽

Vol 26 (4) ◽

pp. 356-363

Author(s):

Melanie T. Gura

Keyword(s):

Terminal Illness ◽

Electronic Devices ◽

Cardiac Resynchronization ◽

Implantable Cardioverter Defibrillators ◽

Resynchronization Therapy ◽

Cardiac Pacemakers ◽

Cardiac Implantable Electronic Devices ◽

Life Saving ◽

Cardioverter Defibrillators ◽

Proactive Communication

Since the introduction of implantable cardiac pacemakers in 1958 and implantable cardioverter-defibrillators in 1980, these devices have been proven to save and prolong lives. Pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy are deemed life-sustaining therapies. Despite these life-saving technologies, all patients ultimately will reach the end of their lives from either their heart disease or development of a terminal illness. Clinicians may be faced with patient and family requests to withdraw these life-sustaining therapies. The purpose of this article is to educate clinicians about the legal and ethical principles that underlie withdrawal of life-sustaining therapies such as device deactivation and to highlight the importance of proactive communication with patients and families in these situations.

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Late Breaking Clinical Trials: what do they change in everyday practice in patients who are or will be implanted with cardiac electrotherapy device?

In a good rythm ◽

10.5604/01.3001.0014.0496 ◽

2020 ◽

Vol 4 (53) ◽

pp. 4-7

Author(s):

Ewa Jędrzejczyk-Patej ◽

Michał Mazurek

Keyword(s):

Clinical Trials ◽

Electronic Devices ◽

Everyday Practice ◽

Cardiac Resynchronization ◽

Cardiac Pacemakers ◽

Cardiac Implantable Electronic Devices ◽

Cardioverter Defibrillators

Patients with cardiac implantable electronic devices (CIEDs) constitute a considerable population. Issues related to CIEDs both in the field of cardiac pacemakers, cardioverter-defibrillators, and cardiac resynchronization are still intensively studied. This article presents the results of selected, relevant studies on CIEDs announced or published in 2019.

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Recommendations on sports cardiology and exercise in patients with cardiac arrhythmias, channelopathies, CARDIOMOPATHIA AND implanted dEVICES ACCORDING TO THE LATEST GUIDELINES OF European Society of Cardiology – part 1

In a good rythm ◽

10.5604/01.3001.0014.7472 ◽

2021 ◽

Vol 4 (57) ◽

pp. 12-17

Author(s):

Magdalena Bajer ◽

Agnieszka Kotalczyk ◽

Michał Mazurek ◽

Ewa Jędrzejczyk-Patej

Keyword(s):

Cardiac Death ◽

Electronic Devices ◽

Shared Decision ◽

Sports Cardiology ◽

Cardiac Implantable Electronic Devices ◽

Increased Risk ◽

Competitive Athletes ◽

Esc Guidelines ◽

European Society Of Cardiology ◽

Implanted Devices

Competitive athletes should be screened for cardiovascular diseases associated with an increased risk of sudden cardiac death. Patients with arrhythmias, channelopathies, cardiomyopathies and cardiac implantable electronic devices should be assessed, and the level of acceptable physical activity should be established. It is crucial to personalize the guidelines and involve the patients in shared decision making. The following article provides an overview of exercise recommendations for patients with arrhythmias and cardiac implantable electronic devices on the basis of the 2020 ESC Guidelines on Sports Cardiology and Exercise. It was divided into two parts.

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JASTRO/JCS Guidelines for radiotherapy in patients with cardiac implantable electronic devices

Journal of Radiation Research ◽

10.1093/jrr/rraa102 ◽

2020 ◽

Vol 62 (1) ◽

pp. 172-184

Author(s):

Toshiki Ohno ◽

Toshinori Soejima ◽

Yukio Sekiguchi ◽

Takayuki Hashimoto ◽

Izumi Koike ◽

...

Keyword(s):

Japanese Society ◽

Electronic Devices ◽

Implantable Cardioverter Defibrillators ◽

Implantable Defibrillators ◽

English Version ◽

Cardiac Implantable Electronic Devices ◽

New Findings ◽

Multidisciplinary Working ◽

Medical Physicists ◽

Cardioverter Defibrillators

ABSTRACT This publication is an English version of the Japanese Society for Radiation Oncology (JASTRO) and The Japanese Circulation Society official guidelines for patients with cardiac implantable electronic devices (CIEDs). Several radiotherapy-associated malfunctions have been reported for CIEDs such as pacemakers and implantable cardioverter-defibrillators. Accordingly, guidelines for radiotherapy in patients with CIEDs have been issued by other countries and societies. In August 2010, JASTRO published the ‘Radiotherapy Guidelines for Patients with Pacemakers and Implantable Defibrillators’ (hereafter referred to as the former guidelines). Given new findings in this decade, a multidisciplinary working group of radiation oncologists, medical physicists, radiation therapists and cardiologists jointly reviewed and revised the former guidelines.

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MRI for patients with cardiac implantable electronic devices: simplifying complexity with a ‘one-stop’ service model

BMJ Quality & Safety ◽

10.1136/bmjqs-2018-009079 ◽

2019 ◽

Vol 28 (10) ◽

pp. 853-858 ◽

Cited By ~ 4

Author(s):

Anish N Bhuva ◽

Patricia Feuchter ◽

Angela Hawkins ◽

Lizette Cash ◽

Redha Boubertakh ◽

...

Keyword(s):

Waiting Time ◽

Waiting Times ◽

Electronic Devices ◽

National Standard ◽

Service Model ◽

Cardiac Pacemakers ◽

Cardiac Implantable Electronic Devices ◽

Service Redesign ◽

Mri Scans ◽

One Stop

BackgroundPatients with cardiac pacemakers and defibrillators are disadvantaged because of poor access to MRI scans, leading to late and misdiagnosis particularly for cancer and neurological disease. New technology allied to tested protocols now allows safe MRI scanning of such patients; however, logistical barriers persist.AimTo deliver a streamlined sustainable service that provides timely MRI scans to patients with cardiac implantable electronic devices (CIEDs).MethodsPatients requested a ‘one-stop’ service for MRI, whereby devices could be reprogrammed and scans acquired at a single location and visit. To provide this ‘one-stop’ service, we trained a team including administrators, physicians, cardiac physiologists and radiographers. A standard protocol was used to prevent unnecessary request refusals and delays to scheduling. Service volume, waiting time and safety were analysed 6 months before and 2 years after service redesign. Waiting times for internal and external inpatient referrals plus time to treatment for patients on a cancer pathway were analysed.Results215 MRI scans were performed over 2 years. After service redesign, MRI provision increased six-fold to 20 times the national average with reduced waiting time from 60 to 15 days and no adverse events. Departmental throughput was maintained. 85 (40%) referrals were external. 41 (19%) inpatients were scanned, reducing bed-stay by 3 days for internal referrals. 24 (11%) scans were for suspected cancer, 83% allowed treatment within the national standard of 62 days. There was no preintervention service for either inpatients or suspected cancer investigation.ConclusionImplementation of a ‘one-stop’ service model to provide MRI for patients with CIEDs is safe, streamlined, scalable and has reduced delays making economic and clinical sense. Protocols and checklists are available at mrimypacemaker.com.

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Recent advances in cardiac implantable electronic devices

Recent Advances in Cardiology 16 ◽

10.5005/jp/books/12195_11 ◽

2014 ◽

pp. 155-155

Author(s):

Dennis Chong ◽

Bernard Clarke ◽

Amir Zaidi

Keyword(s):

Electronic Devices ◽

Cardiac Implantable Electronic Devices ◽

Recent Advances

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Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change

European Radiology ◽

10.1007/s00330-019-06449-5 ◽

2019 ◽

Vol 30 (3) ◽

pp. 1378-1384 ◽

Cited By ~ 5

Author(s):

A. N. Bhuva ◽

R. Moralee ◽

J. C. Moon ◽

C. H. Manisty

Keyword(s):

Treatment Planning ◽

Cancer Diagnosis ◽

Financial Incentives ◽

Electronic Devices ◽

Healthcare Providers ◽

Diagnosis And Treatment ◽

Cardiac Device ◽

Cardiac Pacemakers ◽

Cardiac Implantable Electronic Devices ◽

Mri Scans

Abstract More than half of us will need a magnetic resonance imaging (MRI) scan in our lifetimes. MRI is an unmatched diagnostic test for an expanding range of indications including neurological and musculoskeletal disorders, cancer diagnosis, and treatment planning. Unfortunately, patients with cardiac pacemakers or defibrillators have historically been prevented from having MRI because of safety concerns. This results in delayed diagnoses, more invasive investigations, and increased cost. Major developments have addressed this—newer devices are designed to be safe in MRI machines under specific conditions, and older legacy devices can be scanned provided strict protocols are followed. This service however remains difficult to deliver sustainably worldwide: MRI provision remains grossly inadequate because patients are less likely to be referred, and face difficulties accessing services even when referred. Barriers still exist but are no longer technical. These include logistical hurdles (poor cardiology and radiology interaction at physician and technician levels), financial incentives (re-imbursement is either absent or fails to acknowledge the complexity), and education (physicians self-censor MRI requests). This article therefore highlights the recent changes in the clinical, logistical, and regulatory landscape. The aim of the article is to enable and encourage healthcare providers and local champions to build MRI services urgently for cardiac device patients, so that they may benefit from the same access to MRI as everyone else. Key Points • There is now considerable evidence that MRI can be provided safely to patients with cardiac implantable electronic devices (CIEDs). However, the volume of MRI scans delivered to patients with CIEDs is fifty times lower than that of the estimated need, and patients are approximately fifty times less likely to be referred. • Because scans for this patient group are frequently for cancer diagnosis and treatment planning, MRI services need to develop rapidly, but the barriers are no longer technical. • New services face logistical, educational, and financial hurdles which can be addressed effectively to establish a sustainable service at scale.

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