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المؤلفون: Hirad Yarmohammadi, David Martin, Peter Hoffmeister, Sebhat A. Erqou, Adelqui Peralta, Matthew F Yuyun, Justin B. Echouffo-Tcheugui, Jagmeet P. Singh, Jacob Joseph
المصدر: Circulation: Arrhythmia and Electrophysiology. 14
مصطلحات موضوعية: Male, medicine.medical_specialty, medicine.medical_treatment, Electric Countershock, Action Potentials, 030204 cardiovascular system & hematology, Risk Assessment, Ventricular Function, Left, 03 medical and health sciences, 0302 clinical medicine, Heart Rate, Risk Factors, Physiology (medical), Internal medicine, medicine, Humans, 030212 general & internal medicine, Device Removal, Aged, Generator (computer programming), business.industry, Incidence, Arrhythmias, Cardiac, Stroke Volume, Middle Aged, Implantable cardioverter-defibrillator, Defibrillators, Implantable, Death, Sudden, Cardiac, Treatment Outcome, Meta-analysis, Relative risk, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, All cause mortality
الوصف: Background: Uncertainty still surrounds implantable cardioverter defibrillator (ICD) generator change at time of elective replacement indicator, in primary prevention patients with improved left ventricular ejection fraction (LVEF) beyond guideline recommendations or without prior appropriate ICD therapies. Methods: We conducted a meta-analysis of studies assessing the risk of appropriate ICD therapies and all-cause mortality after generator change in patients with improved LVEF>35% versus unimproved LVEF≤35% or patients without versus with prior appropriate ICD therapies during the life of their first ICD generator. A systematic electronic search of PubMed, EMBASE, and Cochrane Library databases until December 31, 2019 was performed. Estimates were combined using random-effects model meta-analyses. Results: In 15 studies that included 29 730 patients, 25.3% had LVEF improvement >35% at time of generator change. The pooled annual incidence of appropriate ICD therapies was significantly lower in those with improved LVEF, compared with patients with unimproved LVEF: 4.6% versus 10.7%; risk ratio, 0.50 (95% CI, 0.36–0.68), P P P =0.750). In 8 studies (N=27 209), the pooled incidence of ventricular arrhythmia was significantly lower in patients without prior ICD therapies (3.9% per annum), compared with those with prior ICD therapies (12.5 % per annum), risk ratio of 0.37 (95% CI, 0.33–0.41), P Conclusions: There was significant reduction in risk of ventricular arrhythmias and mortality in patients with improved versus unimproved LVEF or those who received versus those who did not receive appropriate ICD therapies during the life of their first ICD generator. However, we found a substantial residual outcome risk in these groups of patients.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::46f05197e3e72f2011c4c07f65b8793a
https://doi.org/10.1161/circep.120.009139 -
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المؤلفون: Albert L. Waldo, Impact Study Investigators, John Ip, David Martin, Mark S. Wathen, Malcolm M. Bersohn, Wassim K Choucair, Joseph G. Akar, Jonathan L. Halperin, Gregory Y.H. Lip
المصدر: The American journal of cardiology. 118(11)
مصطلحات موضوعية: Male, medicine.medical_specialty, medicine.drug_class, Population, Administration, Oral, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Atrial Fibrillation, Medicine, Humans, 030212 general & internal medicine, education, Stroke, Blood Coagulation, New York Heart Association Class I, Aged, education.field_of_study, Univariate analysis, biology, Dose-Response Relationship, Drug, business.industry, Warfarin, Anticoagulants, Atrial fibrillation, Vitamin K antagonist, Middle Aged, medicine.disease, Defibrillators, Implantable, Transthyretin, Treatment Outcome, Cardiology, biology.protein, Female, Cardiology and Cardiovascular Medicine, business, medicine.drug
الوصف: Implanted cardiac arrhythmia devices can detect atrial tachyarrhythmias (atrial high-rate episodes [AHREs]) that are considered to correlate with atrial fibrillation and risk of stroke. In the IMPACT trial, oral anticoagulation was initiated when AHREs were detected by implanted cardioverter-defibrillators and withdrawn when they abated, according to a protocol accounting both for AHRE duration as detected by remote device monitoring and stroke risk assessment. In this analysis, we ascertained determinants of time in therapeutic range (TTR) among protocol-determined vitamin K antagonist–treated patients during the trial. We enrolled 2,718 patients with at least 1 additional stroke risk factor (CHADS 2 score ≥1) at 104 arrhythmia centers. The sex, age 2 R 2 ) score is a simple clinical-derived score designed to aid decision-making on whether a patient is likely to achieve good anticoagulation control on vitamin K antagonist (e.g., warfarin), which was calculated and related to TTR achieved using the Rosendaal method. We analyzed 229 patients (mean age 66.7 years; mean CHADS 2 score 2.85 [SD 1.1]) with mean TTR of 0.536 (SD 0.23) overall. Univariate analysis identified 5 variables associated with differences in mean TTR. Mean TTR was lower in those who were women (p = 0.031), of black race (p = 0.005) and in New York Heart Association class IV (p = 0.014), whereas hemoglobin >13.5 g/dl (p = 0.010) and New York Heart Association class I (p = 0.037) were associated with higher mean TTR. There was a significant difference in mean TTR value between US and non-US sites (Canada and Germany) (mean TTR for US: 0.513 vs non-US: 0.686; p 2 R 2 scores of 4 (p = 0.007) and higher (Δ = 0.0612, 95% CI 0.0005 to 0.1219) for patients with SAMe-TT 2 R 2 scores of 1 (p = 0.048). Linear regression confirmed a significant association between lower SAMe-TT 2 R 2 score and improved anticoagulation control (p = 0.0021) with a 1-unit decrease in SAMe-TT 2 R 2 score associated with an increase in TTR of 0.0404 (95% CI 0.0149 to 0.0659). In conclusion, clinical, geographical, and demographic factors were associated with the quality of anticoagulation control as reflected by TTR. Although overall TTR in this population was poor, lower SAMe-TT 2 R 2 scores were associated with better TTR.
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المؤلفون: Richard S. D’Agostino, David Martin, Gregory F. Michaud, Sree Karanam, Islam Bolad, David M. Shahian, Roy M. John, Carolyne MacLellan, Florence Parrella
المصدر: The American Journal of Cardiology. 94:376-378
مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, Ventricular Tachyarrhythmias, Early Recurrence, Defibrillation, medicine.medical_treatment, Risk Assessment, Severity of Illness Index, Cardioverter-Defibrillator, Electrocardiography, Postoperative Complications, Internal medicine, medicine, Humans, Cardiac Surgical Procedures, Aged, Probability, Retrospective Studies, business.industry, Retrospective cohort study, Middle Aged, Survival Analysis, Defibrillators, Implantable, Surgery, Cardiac surgery, Patient population, Treatment Outcome, Tachycardia, Ventricular, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
الوصف: The effectiveness of implantable cardioverter defibrillators (ICDs) implanted in the early postoperative period after cardiac surgery for ventricular tachyarrhythmias is unknown, because all of the major trials excluded this patient population. Thus, a 10-year retrospective study was conducted of patients who had ICDs implanted for de novo postoperative ventricular tachyarrhythmias during the index admission for cardiac surgery. There was a high rate of early recurrence of ventricular tachyarrhythmia treated by defibrillators, and this finding questions the exclusion of this important patient population from large trials.
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المؤلفون: David Martin, Ferdinand J. Venditti, David M. Shahian, Mark O'connell
المصدر: Pacing and Clinical Electrophysiology. 18:711-715
مصطلحات موضوعية: Male, medicine.medical_specialty, Cost effectiveness, Defibrillation, Cost-Benefit Analysis, medicine.medical_treatment, media_common.quotation_subject, Ventricular tachycardia, Veins, Internal medicine, Methods, medicine, Humans, Thoracotomy, Aged, media_common, business.industry, Convalescence, General Medicine, Length of Stay, Middle Aged, Implantable cardioverter-defibrillator, medicine.disease, Hospital Charges, Defibrillators, Implantable, Anesthesia, Ventricular fibrillation, Cardiology, Female, Implant, Cardiology and Cardiovascular Medicine, business
الوصف: To assess the economic impact of a transvenous lead system for an implantable cardioverter defibrillator (ICD), we evaluated the hospital charges for two groups of patients: group I patients (n = 23) underwent implantation of an ICD generator with an epicardial lead system via a thoracotomy and group II patients (n = 25) underwent implantation of the same generator using transvenous leads. There was no difference in demographics between the two groups. There was a 15% decrease in total charges for the transvenous group compared to the thoracotomy group ($54,142 vs $63,359, P < 0.05). Evaluation of the component charges revealed that the decline could be attributed to a reduction in implant ($27,328 vs $29,285, P < 0.02) and convalescent charges ($7,703 vs $15,179, P < 0.01) for the transvenous group. There was a corresponding decrease in length of stay for the transvenous group (22 vs 29 days, P < 0.05) largely secondary to a 38% reduction in convalescent length of stay (8 vs 13 days, P < 0.05). We conclude that the use of transvenous lead systems for the ICD results in a significant reduction in hospital charges as well as hospital length of stay.
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المؤلفون: Ferdinand J. Venditti, David Martin, Jonathan R. Ellis
المصدر: Circulation. 90:1820-1825
مصطلحات موضوعية: Male, medicine.medical_specialty, Defibrillation, medicine.medical_treatment, Veins, Cardioverter-Defibrillator, Recurrence, Physiology (medical), Internal medicine, medicine, Humans, Lead (electronics), Electrodes, Aged, business.industry, Lead system, Follow up studies, Equipment Design, Middle Aged, medicine.disease, Shock delivery, Defibrillators, Implantable, Electrophysiology, Shock (circulatory), Ventricular Fibrillation, Ventricular fibrillation, Cardiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
الوصف: BACKGROUND Reduction in R-wave amplitude immediately after defibrillation shocks in an integrated shock/sense transvenous cardioverter-defibrillator (TCD) lead system has prompted concerns regarding adequate sensing after failed shocks. We therefore studied redetection characteristics for ventricular fibrillation after unsuccessful defibrillation shocks in a TCD system to determine if these observations have clinical relevance. METHODS AND RESULTS Fifty patients with this shock/sense TCD lead system underwent conversion testing of their TCD at several time intervals. There were a total of 142 failed shocks events recorded, including 10, 15, 70, and 47 events at implantation, predischarge, and 2- and 6-month testing, respectively. Initial detection time (IDT) and redetection time (RDT) for ventricular fibrillation were measured from event markers for all unsuccessful defibrillation shocks. To assess the effect of failed shocks on electrogram quality, 54 failed shock episodes were evaluated in 37 of the 50 patients by measuring electrograms during VF before and after shock. Mean RDT for the entire group was 5.3 +/- 3.5 seconds compared with an IDT of 4.5 +/- 3.3 seconds (P = NS). There were no significant differences between IDT and RDT at implantation or any follow-up testing period, despite a significant decline in R-wave amplitude from 8.1 +/- 3.5 to 6.8 +/- 2.8 mV (P < .0001) measured 3 to 6 seconds after shock delivery. Analysis of 8 individuals with any extended RDT (> or = 10 seconds) showed no significant differences in clinical or implantation characteristics when compared with 42 individuals without extended RDT. CONCLUSIONS In this integrated shock/sense TCD lead system, unsuccessful shock delivery has no significant effect on redetection of ventricular fibrillation at device implantation or up to 6 months of follow-up, despite an observed reduction in postshock R-wave amplitude. Therefore, the reported reduction in electrogram quality after a shock is of no practical importance because sensing of ventricular fibrillation does not appear to be compromised in this particular TCD system. Whether this applies to other implantable cardioverter-defibrillator pulse generators and lead systems with different sensing characteristics requires further evaluation.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::aa9f244448e08a12305983aae94d7737
https://doi.org/10.1161/01.cir.90.4.1820 -
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المؤلفون: H. H. Noguera, Ferdinand J. Venditti, David Martin, Roy M. John, Adelqui Peralta
المصدر: Heart (British Cardiac Society). 78(1)
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Pacemaker, Artificial, Heart disease, medicine.medical_treatment, Combined use, Amiodarone, Electrocardiography, Internal medicine, medicine, Humans, Thoracotomy, Aged, Aged, 80 and over, medicine.diagnostic_test, Equipment Safety, business.industry, Arrhythmias, Cardiac, Middle Aged, Implantable cardioverter-defibrillator, medicine.disease, Combined Modality Therapy, Defibrillators, Implantable, Ventricular fibrillation, Cardiology, Female, Implant, Cardiology and Cardiovascular Medicine, business, medicine.drug, Follow-Up Studies, Research Article
الوصف: OBJECTIVE: To study the potential interactions in patients with endocardial permanent pacemakers and non-thoracotomy implantable cardioverter defibrillator (ICD) systems. DESIGN: Case series and cohort study. SETTING: Tertiary referral centre. PATIENTS: Fifteen consecutive patients with both endocardial pacemakers (12 dual chamber and three single chamber) and non-thoracotomy ICD systems. MAIN OUTCOME MEASURES: Detection inhibition of induced ventricular fibrillation; double counting; and pacemaker function after shocks. In the evaluation of detection inhibition, 124 VF inductions were analysed for detection duration compared with induced VF episodes in controls with an ICD but without a pacemaker. RESULTS: Two patients (13%) showed detection inhibition of VF and required pacemaker system change at the time of the ICD implant. With the final lead position, despite frequent pacemaker undersensing of VF, ICD detection of VF was not inhibited during any induction, and neither initial detection nor redetection times for VF were different from controls. Double/triple counting of pacemaker artefact and evoked electrogram was noted in three patients (20%). In two, this was remedied during the implantation procedure, and in the other it was abolished when amiodarone treatment was discontinued. Pacemaker function was affected by ICD discharges in two patients, one who showed postshock atrial undersensing and loss of capture, and another whose pacemaker reverted to VVI mode. CONCLUSIONS: When careful testing is performed at implantation to detect and remedy device interactions, non-thoracotomy ICD treatment and endocardial pacemakers can be used safely in combination.
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المؤلفون: Roy M. John, David Martin, Ferdinand J. Venditti, Adelqui Peralta
المصدر: Pacing and clinical electrophysiology : PACE. 20(3 Pt 1)
مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, Cardiac pacing, business.industry, Defibrillation, medicine.medical_treatment, Cardiac Pacing, Artificial, Mean age, General Medicine, Middle Aged, medicine.disease, Defibrillators, Implantable, Cardioverter-Defibrillator, Internal medicine, Shock (circulatory), Ventricular fibrillation, Ventricular Fibrillation, medicine, Cardiology, Humans, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business
الوصف: Objective: Evaluation of the impact of undersensing on VF detection time and the relationship of undersensing to the programmed shock energy. Background: Failure to reconfirm an ongoing arrhythmia due to undersensing by a noncommitted ICD might prolong the time to therapy. Methods: We measured initial detection times and redetection times at predischarge and at 2 and 6 months in 29 patients (22 men, mean age 60 years) with a noncommitted nonthoracotomy ICD. Telemetry data and output markers were used to analyze each induction. Results: Undersensing hading to failure to reconfirm was present in 44 (11.1%) of 398 episodes of sustained VF and prolonged significantly the median initial detection time from 2.3 seconds (25th and 75th percentiles: 2 and 2.6 s, respectively) to 5.45 seconds (4.3 and 7.35 s. P < 0.0001). One episode required external defibrillation after reconfirmation failure occurred during charging; the total detection time prior to shock was 46 seconds. In a subset of 87 episodes with failed first shocks, the initial detection time was 2.3 seconds (2.1 and 2.8 s) and the redetection time 3 seconds (2.5 and 4.77 s. P < 0.0001). The presence of undersensing prolonged the redetection from 2.6 seconds (2.35 and 3.1 s) to 5.4 seconds (4.53 and 7.35 s, P < 0.0001). Undersensing was more prevalent during the redetection period (P = 0.004) and in episodes of sustained VF in which the first shock energy was higher than 15 f (19.7% vs 5.8%, P < 0.0001). Conclusions: In this automatic defibriliator system, undersensing occurs in 11% of the sustained VF inductions and prolongs detection time significantly. Redetection is longer than initial detection mostly due to the presence of undersensing, the frequency of which is proportional to the programmed energy. The clinical significance of this finding is unknown.
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المؤلفون: Roy M. John, David Martin, Ferdinand J. Venditti
المصدر: The American journal of cardiology. 76(4)
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Heart Diseases, Ventricular tachycardia, Defibrillation threshold, Coronary artery disease, Internal medicine, Idiopathic dilated cardiomyopathy, medicine, Humans, Prospective Studies, Lead (electronics), Aged, Aged, 80 and over, business.industry, valvular heart disease, Equipment Design, Middle Aged, medicine.disease, Defibrillators, Implantable, Ventricular fibrillation, Ventricular Fibrillation, Cardiology, Tachycardia, Ventricular, Female, Implant, Cardiology and Cardiovascular Medicine, business
الوصف: We have previously reported a chronic increase in defibrillation threshold in a non-thoracotomy implantable cardioverter-defibrillator (ICD) system using monophasic waveforms. To determine if this phenomenon is related to the lead system or the waveform used, we studied the chronic defibrillation threshold in consecutive patients receiving an ICD capable of delivering biphasic waveforms with the same lead system previously evaluated. Twenty-five patients received an ICD with biphasic shock waveform and have been followed for 4 to 15 months. All have undergone defibrillation threshold measurements using the identical testing protocol with biphasic waveforms at implant and at 2 months. Coronary artery disease was present in 15, idiopathic dilated cardiomyopathy in 9, and valvular heart disease in 1. The presenting arrhythmia was ventricular fibrillation in 11, ventricular tachycardia in 10, and syncope with inducible ventricular tachycardia in 4. The configuration of the shocking electrodes was randomized; the lead-only configuration was used in 14 patients (56%), and a subcutaneous patch was used in the remaining patients. Mean defibrillation threshold using a step-down technique was 9.8 ± 1.0 J at implant, 13.2 ± 1.6 J at 2 months, and 12.4 ± 1.5 J at 6 months (p = 0.01 by analysis of variance). There was no change in clinical status, cardiac size, radiographic lead position, or impedance between implant and 2 months. These findings suggest the increase in defibrillation threshold in this ICD system is not related to the type of waveform used, but rather is a feature of non-thoracotomy as opposed to epicardial electrodes.
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المؤلفون: Ferdinand J. Venditti, David Martin, Jonathan R. Ellis, David M. Shahian, Warren A. Williamson
المصدر: The Journal of Thoracic and Cardiovascular Surgery. (4):1013-1022
مصطلحات موضوعية: Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, Ischemia, Coronary Disease, Revascularization, Ventricular tachycardia, Angina, Postoperative Complications, Risk Factors, Internal medicine, medicine, Humans, Derivation, Coronary Artery Bypass, Aged, Aged, 80 and over, Ejection fraction, business.industry, Arrhythmias, Cardiac, Middle Aged, medicine.disease, Implantable cardioverter-defibrillator, Defibrillators, Implantable, Surgery, Survival Rate, medicine.anatomical_structure, Multivariate Analysis, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Artery
الوصف: The impact of adjuvant coronary revascularization was studied in a group of 138 recipients of an implantable cardioverter-defibrillator, all of whom had ischemic heart disease as the cause of their arrhythmias. Patients chosen for revascularization had more severe anatomic, symptomatic, or physiologic evidence of active ischemia. There were no operative deaths among 23 patients who actually underwent coronary artery bypass combined with cardioverter-defibrillator implantation; however, operative mortality by the intention-to-treat principle was 8% (2/25). Total cardiac survival was better for patients who underwent revascularization than for those patients who had "high-risk" characteristics and did not undergo revascularization. Stratified subgroup analysis demonstrated significant survival advantages favoring revascularization in patients with three-vessel or left main coronary artery disease, class III or IV angina, and an ejection fraction greater than 25%. Multivariate analysis revealed that low ejection fraction and left main coronary artery disease were independent predictors of decreased survival.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6e90b29c092fb97da399f9b1737f1986
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