Clinical Medicine: Advances in Implantable Cardiac Devices

The use of implantable cardiac devices has increased and will continue to increase as the population ages. For more than 50 years, patients with a slow pulse have enjoyed the benefits of cardiac pacing to alleviate symptoms and, in some cases, prolong life. Implantable cardiac devices have evolved; in addition to providing pacing support, some devices – namely, implantable cardioverter defibrillators (ICDs) – can also terminate malignant ventricular arrhythmias, facilitate the synchronization of ventricular function, monitor clinical variables, and store a wealth of information to assist clinical management. This review discusses currently available device diagnostics, highlights some advances in implantable cardiac device therapy, and provides a preview of future technologies that may improve the care of patients who have these devices.

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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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Virtual clinics for follow-up of pacemakers and implantable cardioverter defibrillators in children

Cardiology in the Young ◽

10.1017/s1047951119001823 ◽

2019 ◽

Vol 29 (10) ◽

pp. 1243-1247

Author(s):

Georgia Spentzou ◽

Kaitlin Mayne ◽

Helen Fulton ◽

Karen McLeod

Keyword(s):

Parent Satisfaction ◽

Implantable Cardioverter Defibrillators ◽

Cardiac Devices ◽

Digital Medicine ◽

Implantable Cardiac Devices ◽

System Data ◽

Set Up ◽

Cardioverter Defibrillators ◽

Virtual Clinic

AbstractThere is growing interest in the use of digital medicine to reduce the need for traditional outpatient follow-up. Remote interrogation of pacemakers and implantable cardioverter defibrillators is now possible with most devices. The aim of our study was to evaluate the safety and efficacy of virtual pacing clinics in following up children with pacemakers and implantable cardioverter defibrillators, including epicardial systems.Methods:The study was retrospective over 8 years (2010–2017), with review of patient records and analysis of downloads from the implantable cardiac devices to the virtual clinics.Results:A total of 75 patients were set up for virtual clinic follow-up during the study period, 94.5% with a pacemaker and 5.5% an implantable cardioverter defibrillator. The majority (76.8%) had an epicardial system. Data on lead impedance, battery longevity, programmed parameters, detected arrhythmias, percentage pacing and delivered defibrillator therapies were obtainable by download. Lead threshold measurements were obtainable via download in 83.7% of the devices, including epicardial systems. No concerning device issue was missed. In 15% of patients a major issue was detected remotely, including three patients with lead fractures. The virtual clinics resulted in fewer hospital attendances while enhancing monitoring and enabling more frequent device checks. The vast majority (91.4%) of families who responded to a questionnaire were satisfied with the virtual clinic follow-up.Conclusions:Virtual clinics allow safe and effective follow-up of children with pacemakers and implantable cardioverter defibrillators, including those with epicardial systems and are associated with high levels of parent satisfaction.

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Cardiac device therapy

10.1093/med/9780199568741.003.0121 ◽

2018 ◽

Author(s):

Kim Rajappan

Keyword(s):

Cardiac Resynchronization ◽

Steady Increase ◽

Implantable Cardioverter Defibrillators ◽

Device Therapy ◽

Cardiac Device ◽

Cardiac Devices ◽

Cardiac Resynchronization Therapy Devices ◽

Number Of Patients ◽

Different Types ◽

Cardioverter Defibrillators

The term ‘device therapy’ is used in cardiology to refer to three different types of implantable cardiac-rhythm-management devices: pacemakers, implantable cardioverter defibrillators (also known as ICDs), and cardiac resynchronization therapy devices (also known as CRT devices). There has been a steady increase in the number of patients receiving these cardiac devices; in relation to CRT devices, the increase has been almost exponential.

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Evaluation and Monitoring of Patients With Cardiovascular Implantable Electronic Devices Undergoing Noncardiac Surgery

Health Services Insights ◽

10.1177/1178632916686073 ◽

2017 ◽

Vol 10 ◽

pp. 117863291668607

Author(s):

Eduard Sklyar ◽

Jonathan N Bella

Keyword(s):

Electronic Devices ◽

Normal Function ◽

Noncardiac Surgery ◽

Implantable Cardioverter Defibrillators ◽

Cardiovascular Implantable Electronic Devices ◽

Cardiac Devices ◽

Implantable Cardiac Devices ◽

Basic Concepts ◽

Evaluation And Monitoring ◽

Cardioverter Defibrillators

In this article, the reader will get some insights into managing patient with implantable cardiac devices while undergoing noncardiac surgery. We will review basic concepts regarding normal function of pacemakers and implantable cardioverter defibrillators, understanding how their function will be influenced during noncardiac surgeries. You will be guided through management steps from preoperative, intraoperative, and postoperative aspects. In an ever-changing world of medicine, it is important to keep up with progress as more and more patients get implantable cardiac devices.

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Mobile health and implantable cardiac devices: Patients' expectations

European Journal of Preventive Cardiology ◽

10.1177/2047487319830531 ◽

2019 ◽

Vol 26 (9) ◽

pp. 920-927 ◽

Cited By ~ 4

Author(s):

Giovanni Q Villani ◽

Andrea Villani ◽

Alessia Zanni ◽

Concetta Sticozzi ◽

Diego Penela Maceda ◽

...

Keyword(s):

Remote Monitoring ◽

Healthy Lifestyle ◽

Traditional Approach ◽

Clinical Status ◽

Cardiac Device ◽

Cardiac Devices ◽

Severe Arrhythmia ◽

Healthy Lifestyle Promotion ◽

Implantable Cardiac Device ◽

Implantable Cardiac Devices

Background Mobile computing and communication technologies in health services and information (so-called mHealth) have modified the traditional approach in the follow-up of patients with implantable cardiac devices, increased patient engagement and empowerment, reduced healthcare costs and improved patients' outcome. Recent developments in mobile technology, with the introduction of smartphone-compatible devices that can measure various health parameters and transfer automatically generated data, have increased the potential application of remote monitoring and the interest towards mHealth. However, little is known about the patients' interest and expectations of this new technology. Objective The patients' interest in the possibility of receiving data from their implantable cardiac device, clinical and health advice via remote monitoring on their smartphones were investigated. Methods A questionnaire entitled ‘Expectations for future possibility of self-management of device data’ (Likert scale scored) was submitted to 300 consecutive implantable cardiac device outpatients. The questionnaire was focused on collecting patients’ expectations in receiving direct information regarding their implantable cardiac device status (item 1, five questions), their own clinical status (item 2, seven questions) and advice on healthy lifestyle promotion (item 3, nine questions). Patient characteristics associated with greater interest towards mHealth were also investigated. Results Questionnaires were completed by 268 patients (221 men, aged 69 ± 14 years). The Cronbach test reported an alpha value of 0.98 for item 1, 0.94 for item 2 and 0.97 for item 3. Patients declared to be mainly interested in the device interventions (62%) and in severe arrhythmia occurrence (61%), followed by data on heart failure severity (54%) and their performed physical activity (48%). Patients showed very little interest in ECG tracing (37%), but the lowest interest was expressed towards healthy lifestyle promotion advice (<40%). A higher education degree and the presence of the caregiver positively affected the interest towards remote monitoring information ( P < 0.001). Conclusions The patients' interests were mainly directed at receiving information related to technical data of the implantable cardiac device and not to the overall management of the disease, underlying the insufficient awareness of patients towards the key role of self-control health status and the promotion of a healthy lifestyle.

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New frontiers in cardiac devices

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0304 ◽

2020 ◽

Vol 81 (10) ◽

pp. 92-103

Author(s):

Adam SC Dennis ◽

Jonathan M Behar

Keyword(s):

Clinical Medicine ◽

Heart Rhythm ◽

Diagnostic Tools ◽

Implantable Cardioverter Defibrillators ◽

General Physician ◽

Cardiac Device ◽

Device Management ◽

Cardiac Devices ◽

Diagnostic Potential ◽

Cardiac Resynchronisation

This article provides an overview of current cardiac device management, complications, and future areas for development. The last 70 years have seen huge advances in the field of implantable cardiac devices, from diagnostic tools to electrical therapies for bradycardia, ventricular arrhythmia and cardiac resynchronisation. While out-of-hours specialist cardiology cover and regional arrhythmia pathways are increasingly established, they are not universal, and the management of arrhythmia remains an important facet of clinical medicine for the general physician. This article discusses core recommendations from international guidelines with respect to heart rhythm diagnostics, pacing for bradycardia, cardiac resynchronisation and implantable cardioverter defibrillators, along with common complications. Finally, future innovations such as the diagnostic potential of portable technologies, antibiotic envelopes for cardiac devices and the increasing use of leadless pacemakers are described.

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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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Forensic Significance of Cardiac Implantable Device (Pacemaker)

International Journal of Scientific Research in Science Engineering and Technology ◽

10.32628/ijsrset196369 ◽

2019 ◽

pp. 340-345

Author(s):

Anju Bhatt ◽

Vaishali Ajugiya ◽

Deepika Bhandari ◽

Neeta Khobragade

Keyword(s):

Electronic Device ◽

Implantable Devices ◽

Digital Data ◽

Implantable Cardioverter Defibrillators ◽

Cardiac Device ◽

Treat Heart Failure ◽

Number Of Patients ◽

Implantable Cardiac Device ◽

Cardioverter Defibrillators ◽

Audit Trails

Pacemakers are automated electric medical devices that are imbibed in the pleural cavity near to heart so as to stimulate the heart with electrical inducement to maintain or restore a normal heartbeat. Pacemakers can be implanted temporarily to treat bradycardia after a heart attack, surgery or overdose of medication. They can also be implanted permanently to correct a slow heartbeat or, in some cases, to help treat heart failure. With increase in pacemaker indications and especially implantable cardioverter-defibrillators, the number of patients with implantable devices has been growing steadily. With the enhancement in the technology the design of pacemakers are being modified till date. Pacemakers being an electronic device also stores data of patient's heartrate, pulse rate and number of time it has paced in a day. Since, technology is killing our opportunity to falsify the information; the data stored in the pacemaker can either support or reject the alibi stated by the victim or assailant. The aim of this research paper is to study the concept and type of digital data stored in implantable cardiac device i.e. pacemaker. This study focuses on awareness about the application of pacemaker in solving forensic cases. Digital data provided by the pacemaker in any ongoing investigation will have a huge evidentiary potential, as it can be made admissible in the court of law under Section 65-B of the Indian Evidence Act, 1872. In this paper, we are recommending that pacemakers can be used as digital evidences since, they track the audit trails of the 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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