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Ventricular Arrhythmias in Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Antonis S. Manolis, Antonis A. Manolis, Theodora A. Manolis
The overall prevalence of reentrant monomorphic VT is not known, because VT can precede SCD and therefore cannot be ascertained. It is more prevalent in diseases more likely to have scar, including prior MI, NICM, infiltrative diseases, and myocarditis. In an ICD cohort with underlying structural heart disease, including both primary and secondary prevention patients, over a mean of 11±3 months, 81% of occurring ventricular tachyarrhythmias were attributable to VT amenable to antitachycardia pacing, implying reentrant monomorphic VT.18
Implantation of Pacemakers and ICDs
Published in Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski, Handbook of Cardiac Electrophysiology, 2020
Kushwin Rajamani, Michael P. Brunner, Oussama M. Wazni, Bruce L. Wilkoff
The subcutaneous ICD (Figure 13.5) was introduced in 2009 and avoids the vascular space completely.9 It is ideal for patients with challenging vascular access, prior infections, and younger patients. The sensing/defibrillation coil lead is tunneled subcutaneously along the left sternal edge and connected to a pulse generator located in the left mid-axillary line for rhythm identification and defibrillation. The device provides limited post-defibrillation pacing and is therefore contraindicated among patients with a pacing indication or need for antitachycardia pacing.
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
Early pacemakers helped people with complete heart block continue living and with symptomatic bradyarrhythmias increase function. Today, patients in these groups are considered pacemaker dependent if they have an absolute need for a pacemaker generated heartbeat (atrial or ventricular) to prevent symptoms or prolong life. Although the majority of pacemakers are still placed for bradyarrhythmias, pacemakers can also be used to address tachyarrhythmias with antitachycardia pacing and advanced HF with resynchronization therapy. Over time, pacemakers have progressed from fixed rate, single-chamber devices to dual chamber and now biventricular devices.
Mexiletine for ventricular arrhythmias in patients with chronic coronary syndrome: a cohort study
Published in Acta Cardiologica, 2022
Giacomo Mugnai, Carla Paolini, Stefano Cavedon, Alessandro Mecenero, Cosimo Perrone, Claudio Bilato
The efficacy of mexiletine was evaluated by comparing the incidence of VT/VF and the number of ICD interventions during mexiletine treatment with an equal time interval before the initiation of the drug (Table 3). The VT/VF episodes before the beginning of mexiletine therapy were 74: 62 VTs and 12 VF. As showed in Table 3 and Figure 1, both the incidence of VT/VF episodes and the number of ICD interventions significantly decreased after the mexiletine treatment: the number of VT/VF episodes significantly decreased to 33 (p = 0.002). Likewise, the number of affected patients was significantly reduced from 34 to 14. Similarly, ICD interventions occurred in 24 patients before mexiletine treatment and only in 13 patients after mexiletine, with an overall reduction of ICD from 116 to 52 (p = 0.02). In details, antitachycardia pacing (ATP) and shocks were appropriately released 80 and 36 times, respectively, before mexiletine treatment and 40 and 12 times, thereafter. Patients treated by shock delivery decreased from 19 (55.9%) before mexiletine to 9 (26.5%) after mexiletine. Among these 9 patients, 4 (44.4%) experienced at least a 50% reduction of the number of shocks after mexiletine treatment. Of note, all the 7 patients with history of only VF (i.e. excluding those having VT degeneration into VF) did not experience any arrhythmic events after the initiation of mexiletine. Among the 4 patients receiving mexiletine in combination with amiodarone, 2 still suffered ventricular arrhythmias although with a partial reduction of the total events and ICD therapies.
CPR Induced Inappropriate Shocks from a Subcutaneous Implantable Cardioverter Defibrillator during Out-of-Hospital Cardiac Arrest
Published in Prehospital Emergency Care, 2020
Patrik Cmorej, Eva Smrzova, David Peran, Tana Bulikova
A subcutaneous implantable cardioverter defibrillator (S-ICD) is a device designed for the treatment of ventricular tachycardia or ventricular fibrillation. It represents an alternative to the transvenous implantable cardioverter defibrillator (TV-ICD) (1). A major advantage of S-ICD is the subcutaneous positioning of the electrodes (Figure 1), which eliminates complications associated with the intravenous implantation of electrodes. In general, there is a lower risk of infectious complications and bleeding (2, 3). Implantation of the S-ICD does not require fluoroscopy to check the position of the electrode. Compared to TV-ICD, the S-ICD is unable to ensure permanent pacing in bradycardia or antitachycardia pacing. The device provides optional programable post-shock, on-demand bradycardia pacing therapy. When enabled via the programmer, bradycardia pacing occurs at a non-programable rate of 50 bpm for up to 30 sec. The pacing output is fixed at 200 mA and uses a 15 ms biphasic waveform (4). The S-ICD is as effective in terminating induced ventricular fibrillation as TV-ICD, although it requires higher energy levels (36.6 ± 19.8 J vs. 11.1 ± 8.5 J, p < 0.001) (5). The aim of this article is to draw attention to a case of inappropriate S-ICD shocks in a patient with out-of-hospital sudden cardiac arrest, in whom defibrillation shocks were induced in verified asystole by chest compressions during cardiopulmonary resuscitation (CPR).
Driving restriction in patients with cardiac implantable electronic devices: an overview of worldwide regulations
Published in Expert Review of Medical Devices, 2020
Jacopo F. Imberti, Marco Vitolo, Marco Proietti, Igor Diemberger, Matteo Ziacchi, Mauro Biffi, Giuseppe Boriani
Modern ICDs are programmed to deliver bursts of antitachycardia pacing (ATP), which are effective in terminating fast VT and are associated with a low risk of syncope [58,59]. Kim et al. [60]reported that in a predominantly primary prevention population, the likelihood of receiving a shock at 6 months when the first ventricular arrhythmia was terminated by a shock was 30%. By contrast, when the first ventricular arrhythmia was terminated by ATP the risk of shock was 9.9%, 3 times lower. Consequently, ATP can further reduce the number of SCI and accidents during driving and, therefore, the duration of the driving restrictions might be less restrictive when applied to drivers receiving ATP [60].