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

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.

Home Monitoring for Cardiovascular Implantable Electronic Devices

2015 ◽  
Vol 26 (4) ◽  
pp. 343-355 ◽  
Author(s):  
Robin A. Leahy ◽  
Elizabeth E. Davenport
Keyword(s):  
Electronic Devices ◽  
Home Monitoring ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Resynchronization Therapy ◽  
Cardiovascular Implantable Electronic Devices ◽  
Technological Advances ◽  
Cardiac Resynchronization Therapy Devices ◽  
Cardioverter Defibrillators

Recent technological advances in the management of patients with cardiovascular implantable electronic devices (CIEDs) have expanded clinicians’ ability to remotely monitor patients with CIEDs. Remote monitoring, in addition to periodic in-person device evaluation, provides many advantages to patients and clinicians. Aside from the therapeutic and diagnostic benefits of pacemakers, implantable cardioverter-defibrillators, cardiac resynchronization therapy devices, and implantable loop recorders, improvement in clinical outcomes, clinical efficiencies, and patient experience can be realized with the adoption of remote CIED monitoring. These advantages create significant value to both patients and CIED follow-up centers.

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

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.

Local complications in patients with cardiac implantable devices

2019 ◽  
Vol 1 (50) ◽  
pp. 14-18
Author(s):  
Karolina Adamczyk ◽  
Ewa Jędrzejczyk-Patej
Keyword(s):  
Electronic Devices ◽  
Implantable Devices ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Systemic Complications ◽  
Local Complications ◽  
Cardiac Implantable Electronic Devices ◽  
Cardioverter Defibrillators ◽  
Life Prolongation ◽  
Pocket Hematoma

Cardiac implantable electronic devices (CIEDs) such as pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), both with or without cardiac resynchronization therapy (CRT), became one of the fundamental therapies in present-day electrocardiology. The CIED patients population is increasing year by year due to a growing number of CIED implantations annually and a life prolongation among patients with CIEDs through better pharmacology combined with the proper electrotherapy and patient care. Invasive procedures related to CIED such as an implantation, a replacement or an up-grade of any kind electrotherapy device involves the risk of complications. Pocket hematoma or infection, which are local complications, should be recognized rapidly and treat properly in order to avoid more threatening systemic complications.

Economics of new therapies in electrophysiology

ESC CardioMed ◽  
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.

scholarly journals Tatalaksana Perioperatif pada Pasien dengan Cardiac Implantable Electronic Devices (Cieds) atau Alat Elektronik Kardiovaskular Implan (Aleka)

2019 ◽  
Vol 11 (2) ◽  
pp. 81
Author(s):  
Cindy Elfira Boom ◽  
Ornella Widyapuspita
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Electronic Devices ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardiac Implantable Electronic Devices

Jumlah pasien pengguna cardiac implantable electronic devices (CIEDs) atau alat elektronik kardiovaskular implan (ALEKA) hingga saat ini makin bertambah setiap tahunnya di penjuru dunia, namun masih banyak ahli anestesi yang belum nyaman dalam mengelola pelayanan perioperatif pada pasien-pasien tersebut dikarenakan kurangnya pengetahuan dan pengalaman pemrograman alat untuk menatalaksana pasien. Alat elektronik kardiovaskular implan merupakan sebuah istilah yang mencakup penggunaan alat pacu jantung untuk bradiaritmia dan implantable cardioverter defibrilator (ICD)/defibrilator kadioverter implan (DKI) untuk takiaritmia, serta cardiac resynchronization therapy (CRT)/ terapi resinkronisasi jantung (TRJ) untuk disfungsi diastolik dengan hambatan konduksi. Hingga saat ini, tercatat setidaknya lebih dari 250.000 pasien dewasa maupun anak menjalani pemasangan alat pacu jantung tiap tahunnya, oleh karena itu, penting bagi seorang dokter anestesi untuk memahami dan mampu membuat perencanaan perioperatif dengan tim multidisiplin agar dapat menurunkan morbiditas dan mortalitas pasien. Tinjauan pustaka ini dibuat untuk memberikan info seputar ALEKA dengan berfokus pada manajemen perioperatif pasien dengan ALEKA, serta algoritma tatalaksana yang dapat diimplementasikan dalam praktik sehari-hari.

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