implantable cardiac defibrillators
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Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S209-S210
Author(s):  
Sisir Siddamsetti ◽  
Arshad Muhammad Iqbal ◽  
Sandeep Gautam

Author(s):  
Geoffrey R. Wong ◽  
Megan Ang ◽  
Jasveer Jayarajan ◽  
Fiona Walker ◽  
Pier D. Lambiase

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
G Cinier ◽  
MI Hayiroglu ◽  
AC Yumurtas ◽  
Z Kolak ◽  
T Cetin ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Background Implantable cardiac defibrillators (ICD’s) are recommended in patients with heart failure with reduced ejection fraction (HFrEF) of nonischemic etiology. Determining patients who are at high risk despite ICD implantation is of clinical value. Methods Between 2009-2019 patients who were implanted ICD due to nonischemic HFrEF were included to the present analysis. Baseline characteristics, laboratory parameters and echocardiographic findings were obtained from the electronic database. The primary outcome was all-cause mortality. Appropriate and inappropriate device therapies were also extracted from the database and was confirmed with patients’ reports. Predictors for long term all-cause mortality was determined by using Cox regression analysis. Results Overall, 1199 patients were screened and 238 were eligible for the analysis. ICD’s were implanted for primary and secondary prevention in 68 (28.6%) and 170 (71.4%) of patients respectively. Multivariate analysis revealed that increased pro-BNP [Hazard ratio (HR): 1.001, 95% Confidence interval (CI): 1.000 – 1.001, p = 0.024] and reduced left ventricle ejection fraction (HR: 0.950, 95% CI: 0.907 – 0.994, p: 0.026) predicted all-cause mortality during long term follow up. Pro-BNP > 425 pg/ml has sensitivity and specificity of 74% for each in predicting all-cause mortality. Conclusion Among patients who were implanted ICD for HFrEF of nonischemic etiology, higher pro-BNP prior to the implantation and lower LVEF predicted all-cause mortality during long term follow up. Table 1Univariate analysisP valueHR (95% CI)Multivariate analysisP valueHR (95% CI)Diabetes mellitus0.0062.587 (1.315 - 5.090)Diabetes mellitus0.1441.837 (0.812 - 4.153)Atrial fibrillation0.0023.080 (1.531 - 6.195)Atrial fibrillation0.1811.738 (0.774 - 3.903)NYHA > 20.0172.394 (1.168 - 4.908)NYHA > 20.2531.642 (0.701 - 3.847)RDW0.0441.191 (1.005 - 1.412)RDW0.6461.046 (0.862 - 1.270)Lymphocytes0.0220.616 (0.408- 0.932)Lymphocytes0.1650.683 (0.399 - 1.170)Blood urea nitrogen0.0381.015 (1.001- 1.030)Blood urea nitrogen0.1521.015 (0.995 - 1.036)Pro-BNP<0.0011.001 (1.000 - 1.001)Pro-BNP0.0241.001 (1.000 - 1.001)Albumin<0.0010.252 (0.143 - 0.444)Albumin0.0790.525 (0.256 - 1.079)Ejection fraction<0.0010.921 (0.885 - 0.959)Ejection fraction0.0260.950 (0.907 - 0.994)LVEDD0.0011.408 (1.017 - 1.079)LVEDD0.1521.078 (0.973 - 1.194)LVESD0.0041.038 (1.012 - 1.065)LVESD0.2890.957 (0.883 - 1.038)Appropriate shock in follow-up0.0102.407 (1.237 - 4.684)Appropriate shock in follow-up0.1561.768 (0.805 - 3.883)Univariate and multivariate Cox regression analyses for long-term mortality after ICD implantation Abstract Figure 1


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Fredrick M Ogugua ◽  
Abdulrahman Gamam ◽  
Basilio Addo ◽  
Kofi Osei

Introduction: Remote monitoring (RM) using implantable cardiac defibrillators (ICD) is a rapidly emerging alternative modality in heart failure management. Studies involving US cohorts have shown promising results with RM. We aim to perform a meta-analysis assessing the clinical outcomes of RM versus conventional follow-up among heart failure (HF) patients with an ICD in a European cohort. Methods: Electronic database and reference list searches were conducted to identify European studies assessing patient outcomes when managed with RM using ICD versus conventional follow up. After a review of abstracts and selected full-text articles, we identified four randomized trials (RCT) for inclusion. Quality was assessed using the Cochrane Risk of Bias Tool. The primary outcome was the incidence of HF hospitalization and the secondary outcome was all-cause mortality during the follow-up period. A random-effects model was used. All analysis was performed using Cochrane Revman version 5.3. Results: Four RCT’s were included, with a total of 4504 participants. Mean follow-up time was 22 months. Rate of HF hospitalization with RM was 678 versus 680 with conventional management (RR: 0.98, 95% CI: 0.88 to 1.10, p = 0.75). All-cause mortality with RM was 252 versus 284 with conventional management (RR: 0.88, 95% CI: 0.75 to 1.03, p =0.11). Conclusions: Our study found that in a European cohort, there was no difference in the incidence of HF hospitalization or all-cause mortality among patients managed with RM using ICD and those managed with conventional care. Further research is required to assess the feasibility and generalizability of HF management using ICD’s in different patient populations.


2020 ◽  
Vol 7 ◽  
Author(s):  
Nathan Engstrom ◽  
Geoffrey P. Dobson ◽  
Kevin Ng ◽  
Hayley L. Letson

2020 ◽  
Vol 81 (8) ◽  
pp. 1-10
Author(s):  
Daniel Garner ◽  
Matthew Blackburn ◽  
David J Wright ◽  
Archana Rao

Background/Aims Implantable cardiac defibrillators reduce the risk of sudden cardiac death in selected patients. The value of an implantable cardiac defibrillator declines as the patient's disease progresses. Guidelines suggest that the appropriateness of maintaining implantable cardiac defibrillator therapy be regularly reviewed as part of monitoring of the patient's disease trajectory. It is recommended that implantable cardiac defibrillators are deactivated as patients approach the end of life. Patients with a better understanding of their current state of health and the role that the implantable cardiac defibrillator plays within it are more likely to make informed decisions about the timing of deactivation. Methods: A quality improvement project was undertaken on appropriate deactivation of implantable cardiac defibrillators within a large tertiary cardiac centre. This was driven by audit data showing inadequate patient communication and documentation around deactivation. Drivers for change included the introduction of electronic data records, clinical review of comorbid patients approaching elective battery change and an ongoing forum for patient and carer education. Measured outcomes included the number of deactivations performed, evidence of patient discussion and consent, and timing of deactivation of the implantable cardiac defibrillator. Results There were increased numbers of timely device deactivations undertaken following the interventions with improved documented evidence of patient discussion and consent. The educational forum was received favourably. Conclusions Focused multidisciplinary interventions can impact favourably on appropriate implantable cardiac defibrillator deactivation and improve patient engagement.


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