RESUMEN
Background One third of primary prevention implantable cardioverter-defibrillator patients receive appropriate therapy, but all remain at risk of defibrillator complications. Information on these complications in contemporary cohorts is limited. This study assessed complications and their risk factors after defibrillator implantation in a Dutch nationwide prospective registry cohort and forecasts the potential reduction in complications under distinct scenarios of updated indication criteria. Methods and Results Complications in a prospective multicenter registry cohort of 1442 primary implantable cardioverter-defibrillator implant patients were classified as major or minor. The potential for reducing complications was derived from a newly developed prediction model of appropriate therapy to identify patients with a low probability of benefitting from the implantable cardioverter-defibrillator. During a follow-up of 2.2 years (interquartile range, 2.0-2.6 years), 228 complications occurred in 195 patients (13.6%), with 113 patients (7.8%) experiencing at least one major complication. Most common ones were lead related (n=93) and infection (n=18). Minor complications occurred in 6.8% of patients, with lead-related (n=47) and pocket-related (n=40) complications as the most prevailing ones. A surgical reintervention or additional hospitalization was required in 53% or 61% of complications, respectively. Complications were strongly associated with device type. Application of stricter implant indication results in a comparable proportional reduction of (major) complications. Conclusions One in 13 patients experiences at least one major implantable cardioverter-defibrillator-related complication, and many patients undergo a surgical reintervention. Complications are related to defibrillator implantations, and these should be discussed with the patient. Stricter implant indication criteria and careful selection of device type implanted may have significant clinical and financial benefits.
Asunto(s)
Muerte Súbita Cardíaca , Desfibriladores Implantables , Cardioversión Eléctrica , Complicaciones Posoperatorias , Implantación de Prótesis/efectos adversos , Anciano , Muerte Súbita Cardíaca/epidemiología , Muerte Súbita Cardíaca/prevención & control , Desfibriladores Implantables/efectos adversos , Desfibriladores Implantables/clasificación , Desfibriladores Implantables/estadística & datos numéricos , Cardioversión Eléctrica/efectos adversos , Cardioversión Eléctrica/instrumentación , Cardioversión Eléctrica/métodos , Análisis de Falla de Equipo/métodos , Análisis de Falla de Equipo/estadística & datos numéricos , Femenino , Humanos , Masculino , Evaluación de Necesidades , Países Bajos/epidemiología , Selección de Paciente , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Sistema de Registros/estadística & datos numéricos , Reoperación/estadística & datos numéricos , Medición de Riesgo , Factores de RiesgoRESUMEN
Background Large-scale studies describing modern populations using an implantable cardioverter-defibrillator (ICD) are lacking. We aimed to analyze the incidence of arrhythmia, device interventions, and mortality in a broad spectrum of real-world ICD patients with different heart disorders. Methods and Results The UMBRELLA study is a prospective, multicenter, nationwide study of contemporary patients using an ICD followed up by remote monitoring, with a blinded review of arrhythmic episodes. From November 2005 to November 2017, 4296 patients were followed up. After 46.6±27.3 months, 16 067 episodes of sustained ventricular arrhythmia occurred in 1344 patients (31.3%). Appropriate ICD therapy occurred in 27.3% of study population. Patients with ischemic cardiomyopathy (hazard ratio [HR], 1.51; 95% CI, 1.29-1.78), dilated cardiomyopathy (HR, 1.28; 95% CI, 1.07-1.53), and valvular heart disease (HR, 1.94; 95% CI, 1.43-2.62) exhibited a higher risk of appropriate ICD therapies, whereas patients with hypertrophic cardiomyopathy (HR, 0.72; 95% CI, 0.54-0.96) and Brugada syndrome (HR, 0.25; 95% CI, 0.14-0.45) showed a lower risk. All-cause death was 13.4% at follow-up. Ischemic cardiomyopathy (HR, 3.09; 95% CI, 2.58-5.90), dilated cardiomyopathy (HR, 3.33; 95% CI, 2.18-5.10), and valvular heart disease (HR, 3.97; 95% CI, 2.25-6.99) had the worst prognoses. Delayed high-rate detection was enabled in 39.7% of patients, and single-zone programming occurred in 52.6% of primary prevention patients. Both parameters correlated with lower risk of first appropriate ICD therapy, with no excess risk of mortality. The rate of inappropriate shocks at follow-up was low (6%) and did not differ among type of ICD but was lower in SmartShock-capable devices. Conclusions Irrespective of the cause, contemporary ICD patients with heart failure-related disorders had a similar risk of ICD life-saving interventions and death. Current ICD programming recommendations still need to be implemented. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NTC01561144.
Asunto(s)
Desfibriladores Implantables , Cardioversión Eléctrica , Taquicardia Ventricular , Estudios de Cohortes , Desfibriladores Implantables/efectos adversos , Desfibriladores Implantables/clasificación , Desfibriladores Implantables/estadística & datos numéricos , Cardioversión Eléctrica/efectos adversos , Cardioversión Eléctrica/instrumentación , Cardioversión Eléctrica/métodos , Cardioversión Eléctrica/estadística & datos numéricos , Análisis de Falla de Equipo , Femenino , Cardiopatías/clasificación , Cardiopatías/complicaciones , Cardiopatías/mortalidad , Cardiopatías/terapia , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Evaluación de Necesidades , Servicios Preventivos de Salud/métodos , Servicios Preventivos de Salud/estadística & datos numéricos , Medición de Riesgo , España/epidemiología , Análisis de Supervivencia , Taquicardia Ventricular/epidemiología , Taquicardia Ventricular/terapiaRESUMEN
The purpose of this European Heart Rhythm Association (EHRA) prospective snapshot survey is to provide an overview of the factors influencing patient selection for the implantation of a particular type of device: subcutaneous implantable cardioverter-defibrillator (S-ICD) or transvenous implantable cardioverter-defibrillator (TV-ICD), across a broad range of tertiary European centres. A specially designed electronic questionnaire was sent via the internet to tertiary reference centres routinely implanting both TV-ICDs and S-ICDs. These centres were asked to prospectively include and fill-in this questionnaire for all consecutive patients implanted with an implantable cardioverter-defibrillator (ICD) (both TV-ICD and S-ICD) during an 8-week period of time. Questions concerned standards of care and policies used for patient management, focusing particularly on the reasons for choosing one or the other type of ICD for each patient. In total 20 centres participated at the survey and entered individual data from a total of 429 consecutive patients (men 76.3%). Indication of implantation was primary prevention for 73% of the patients. Implanted devices were distributed between cardiac resynchronisation therapy (CRT) ones with back-up defibrillators (31.6%), single-chamber TV-ICD (29.5%), S-ICD (19.8%), and dual-chamber TV-ICD (19.1%).The rate of S-ICD shows the current penetration of this treatment in everyday practice. Main reasons favouring the use of an S-ICD were young age (66.7%), anticipated (38.9%) or previous (9.3%) lead-related complications, and elevated risk (18.5%) or previous device infection (7.4%). Importantly, the choice for this device was also based on patient preference (16.7%) or active lifestyle (13%). The three most frequent reasons for the use of a transvenous device were the option of antitachycardia pacing (43.2%), and logically, the current or expected need for CRT (40%) or for permanent pacing (39.6%). This snapshot survey with individual patient data provides a contemporary insight into ICD implantation and management in the European electrophysiology tertiary centres. It also helps to better understand the reasons which condition the choice between a S-ICD and a traditional TV-ICD. Finally, it gives a picture of the distribution of various types of ICD, few years after the introduction of the S-ICD in the Europe.
Asunto(s)
Toma de Decisiones Clínicas/métodos , Desfibriladores Implantables , Cardioversión Eléctrica/instrumentación , Taquicardia Ventricular/prevención & control , Anciano , Actitud del Personal de Salud , Desfibriladores Implantables/clasificación , Desfibriladores Implantables/estadística & datos numéricos , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prioridad del Paciente/estadística & datos numéricos , Selección de Paciente , Nivel de Atención/estadística & datos numéricos , Encuestas y Cuestionarios , Taquicardia Ventricular/epidemiología , Centros de Atención Terciaria/estadística & datos numéricosRESUMEN
Aims: Dual coil (DC) electrodes are preferred to single coil (SC) electrodes because of an assumed higher shock efficacy. However, DC-electrodes may be associated with an increased difficulty and risk of lead extraction. We aimed to compare SC- and DC-electrodes with respect to the first shock efficacy (FSE) after implantable cardioverter defibrillator (ICD) implantation. Methods and results: One thousand and seventy-seven patients of the NORDIC ICD trial were randomly assigned to first time ICD implantation with or without defibrillation (DF) testing. The electrode configuration was determined before randomization. One thousand and sixty-seven patients eventually received an ICD, 516 (48.4%) with a SC- and 551 (51.6%) with a DC-electrode. DC-electrodes were preferentially selected in older patients, renal failure, atrial fibrillation, dual chamber, Cardiac Resynchronization Therapy (CRT) devices, angiotensin-converting-enzyme (ACE) inhibitors/angiotensin (AT) receptor blockers and without Sotalol. However, the preference of the investigational site was dominant over clinical parameters. The DF energy at the final electrode position was higher in SC-electrodes (adjusted difference +1.15 J; P = 0.005; only patients tested). Less patients with DC-electrodes required intra-operative system reconfiguration (adjusted difference -3.9; P = 0.046; only patients tested). Using mixed logistic regression, the FSE was 92.6% in SC- and 97.8% in DC-electrodes (adjusted odds ratio 4.3 (95% confidence interval [1.9, 9.8]; P < 0.001)). Conclusion: Dual coil-electrode selection mainly depends on the preference of the investigational site and seems to be preferred in older patients, renal failure, atrial fibrillation, dual chamber, and CRT devices. Patients with DC-electrodes required less intraoperative system reconfigurations. Dual coil-electrodes provided a substantially higher FSE during follow-up. Mortality rates were not significantly different in patients with DC- and SC-electrodes.
Asunto(s)
Arritmias Cardíacas/terapia , Desfibriladores Implantables , Cardioversión Eléctrica/instrumentación , Anciano , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatología , Desfibriladores Implantables/efectos adversos , Desfibriladores Implantables/clasificación , Cardioversión Eléctrica/métodos , Diseño de Equipo/métodos , Femenino , Humanos , Cuidados Intraoperatorios/métodos , Masculino , Persona de Mediana Edad , Selección de Paciente , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
Inappropriate implantable cardioverter-defibrillator (ICD) shock therapy is painful, stressful, and typically occurs unexpected in conscious patients and may be related to a less favourable prognosis. In our institution, we have observed four cases of multiple inappropriate ICD shocks during reset to VVI backup mode. All four patients were implanted with a St Jude Medical ICD since 2010. The reset to VVI backup mode happens as a 'safety' response when the ICD encounters errors in the software or hardware often due to electromagnetic interference. The ICD then operates in a simple mode, with only a ventricular fibrillation (VF) zone starting at 146 b.p.m., with shock therapy only and changes in sensitivity settings making the ICD more sensitive. In all cases, the reason for the multiple inappropriate shocks was that the VF zone was reached due to exercise-induced sinus tachycardia or due to oversensing during sinus rhythm. The VVI backup mode has to balance between protection from failure of ICD therapy during life-threatening ventricular arrhythmias and from inappropriate shocks. It seems the non-programmable parameters in VVI backup mode of St Jude Medical ICDs carry an unacceptable high risk of inappropriate shocks during normal rhythm as illustrated by our four cases. A higher VF zone comparable with the zones chosen by the other manufacturer would give a better balance, since it is very unlikely that a patient will need shock therapy urgently for slow ventricular tachycardia.
Asunto(s)
Arritmias Cardíacas/etiología , Arritmias Cardíacas/prevención & control , Desfibriladores Implantables/efectos adversos , Traumatismos por Electricidad/etiología , Traumatismos por Electricidad/prevención & control , Errores Médicos/prevención & control , Adulto , Anciano , Desfibriladores Implantables/clasificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia del TratamientoRESUMEN
OBJECTIVES: The purpose of this study was to determine if implantation of multiple recalled defibrillator leads is associated with an increased risk of lead failure. BACKGROUND: The authors of the Pacemaker and Implantable Defibrillator Leads Survival Study ("PAIDLESS") have previously reported a relationship between recalled lead status, lead failure, and patient mortality. This substudy analyzes the relationship in a smaller subset of patients who received more than one recalled lead. The specific effects of having one or more recalled leads have not been previously examined. METHODS: This study analyzed lead failure and mortality of 3802 patients in PAIDLESS and compared outcomes with respect to the number of recalled leads received. PAIDLESS includes all patients at Winthrop University Hospital who underwent defibrillator lead implantation between February 1, 1996 and December 31, 2011. Patients with no recalled ICD leads, one recalled ICD lead, and two recalled ICD leads were compared using the Kaplan-Meier method and log-rank test. Sidak adjustment method was used to correct for multiple comparisons. All calculations were performed using SAS 9.4. P-values <.05 were considered statistically significant. RESULTS: This study included 4078 total ICD leads implanted during the trial period. There were 2400 leads (59%) in the no recalled leads category, 1620 leads (40%) in the one recalled lead category, and 58 leads (1%) in the two recalled leads category. No patient received more than two recalled leads. Of the leads categorized in the two recalled leads group, 12 experienced lead failures (21%), which was significantly higher (P<.001) than in the no recalled leads group (60 failures, 2.5%) and one recalled lead group (81 failures; 5%). Multivariable Cox's regression analysis found a total of six significant predictive variables for lead failure including the number of recalled leads (P<.001 for one and two recalled leads group). CONCLUSIONS: The number of recalled leads is highly predictive of lead failure. Lead-based multivariable Cox's regression analysis produced a total of six predictive variable categories for lead failure, one of which was the number of recalled leads. Kaplan-Meier analysis showed that the leads in the two recalled leads category failed faster than both the no recalled lead and one recalled lead groups. The greater the number of recalled leads to which patients are exposed, the greater the risk of lead failure.
Asunto(s)
Desfibriladores Implantables , Cardioversión Eléctrica , Falla de Equipo/estadística & datos numéricos , Recall de Suministro Médico , Marcapaso Artificial , Anciano , Desfibriladores Implantables/efectos adversos , Desfibriladores Implantables/clasificación , Desfibriladores Implantables/estadística & datos numéricos , Cardioversión Eléctrica/efectos adversos , Cardioversión Eléctrica/instrumentación , Cardioversión Eléctrica/métodos , Diseño de Equipo , Análisis de Falla de Equipo/métodos , Análisis de Falla de Equipo/estadística & datos numéricos , Femenino , Cardiopatías/terapia , Humanos , Masculino , Persona de Mediana Edad , Marcapaso Artificial/efectos adversos , Marcapaso Artificial/clasificación , Marcapaso Artificial/estadística & datos numéricos , Estados UnidosRESUMEN
BACKGROUND: After the introduction of the Biotronik Linox S/SD high-voltage lead, several cases of early failure have been observed. OBJECTIVE: The purpose of this article was to assess the performance of the Linox S/SD lead in comparison to 2 other contemporary leads. METHODS: We used the prospective Erasmus MC ICD registry to identify all implanted Linox S/SD (n = 408), Durata (St. Jude Medical, model 7122) (n = 340), and Endotak Reliance (Boston Scientific, models 0155, 0138, and 0158) (n = 343) leads. Lead failure was defined by low- or high-voltage impedance, failure to capture, sense or defibrillate, or the presence of nonphysiological signals not due to external interference. RESULTS: During a median follow-up of 5.1 years, 24 Linox (5.9%), 5 Endotak (1.5%), and 5 Durata (1.5%) leads failed. At 5-year follow-up, the cumulative failure rate of Linox leads (6.4%) was higher than that of Endotak (0.4%; P < .0001) and Durata (2.0%; P = .003) leads. The incidence rate was higher in Linox leads (1.3 per 100 patient-years) than in Endotak and Durata leads (0.2 and 0.3 per 100 patient-years, respectively; P < .001). A log-log analysis of the cumulative hazard for Linox leads functioning at 3-year follow-up revealed a stable failure rate of 3% per year. The majority of failures consisted of noise (62.5%) and abnormal impedance (33.3%). CONCLUSION: This study demonstrates a higher failure rate of Linox S/SD high-voltage leads compared to contemporary leads. Although the mechanism of lead failure is unclear, the majority presents with abnormal electrical parameters. Comprehensive monitoring of Linox S/SD high-voltage leads includes remote monitoring to facilitate early detection of lead failure.
Asunto(s)
Arritmias Cardíacas/terapia , Desfibriladores Implantables , Cardioversión Eléctrica , Falla de Equipo/estadística & datos numéricos , Anciano , Desfibriladores Implantables/efectos adversos , Desfibriladores Implantables/clasificación , Diagnóstico Precoz , Cardioversión Eléctrica/efectos adversos , Cardioversión Eléctrica/instrumentación , Cardioversión Eléctrica/métodos , Impedancia Eléctrica , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Países Bajos , Sistema de Registros/estadística & datos numéricos , Tecnología de Sensores Remotos/métodosRESUMEN
BACKGROUND: Arrhythmias are frequent in Takotsubo cardiomyopathy (TTC) and a major determinant of outcome. OBJECTIVE: The purpose of this study was to provide a rationale for management strategies, particularly for permanent device implantation given the reversible nature of TTC. METHODS: Treatment strategies of arrhythmias including ventricular fibrillation (VF), ventricular tachycardia (VT), asystole, pulseless electrical activity, and complete atrioventricular (AV) or sinoatrial block were assessed in a bicentric cohort of consecutive patients with TTC (n = 286) with a mean follow-up period of 3.3 ± 2.4 years. RESULTS: The prevalence of arrhythmias during the acute phase of TTC was 12.2% (n = 35), consisting predominantly of VT (n = 16 [5.6%]), VF (n = 7 [2.4%]), and complete AV block (n = 8 [2.8%]). Seven patients received a permanent pacemaker because of complete AV (n = 6) or sinoatrial (n = 1) block. Regular device checkups were available in 2 patients and demonstrated ongoing high-degree AV block despite recovery of left ventricular function. Three patients with transient bradyarrhythmias who did not receive devices died shortly after hospital discharge from unknown causes. One patient received an implantable cardioverter-defibrillator after resuscitation for VF and did not require device interventions during 2-year follow-up. Patients with polymorphic VT (n = 7), monomorphic VT (n = 6), or VF (n = 2) who were discharged from hospital survived or died of noncardiac reasons, with the cause of death remaining unclear in 1 patient with monomorphic sustained VT. CONCLUSION: Our data suggest that bradyarrhythmias in the acute setting of TTC may require permanent pacemaker implantation. In contrast, polymorphic ventricular arrhythmias might be managed with a temporary approach (eg, wearable cardioverter-defibrillators) until recovery of repolarization time and left ventricular function.
Asunto(s)
Arritmias Cardíacas , Bradicardia/terapia , Muerte Súbita Cardíaca/prevención & control , Desfibriladores Implantables , Marcapaso Artificial/estadística & datos numéricos , Cardiomiopatía de Takotsubo , Anciano , Arritmias Cardíacas/etiología , Arritmias Cardíacas/mortalidad , Arritmias Cardíacas/fisiopatología , Arritmias Cardíacas/terapia , Bradicardia/etiología , Bradicardia/fisiopatología , Muerte Súbita Cardíaca/etiología , Desfibriladores Implantables/clasificación , Desfibriladores Implantables/estadística & datos numéricos , Electrocardiografía/métodos , Femenino , Finlandia/epidemiología , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Análisis de Supervivencia , Cardiomiopatía de Takotsubo/complicaciones , Cardiomiopatía de Takotsubo/epidemiología , Cardiomiopatía de Takotsubo/fisiopatologíaRESUMEN
BACKGROUND: We observed a case of conductor externalization in a Biotronik Linox lead. OBJECTIVE: The purpose of this study was to investigate lead performance of the Linox lead and the identical Sorin Vigila lead and prevalence of conductor externalization. METHODS: We compared lead performance of all Linox and Vigila leads implanted at our center (BL group; n = 93) with that of all Boston Scientific Endotak Reliance leads (ER group; n = 190) and Medtronic Sprint Quattro leads (SQ group; n = 202) implanted during the same period. We screened all patients in the BL group for conductor externalization. RESULTS: We identified 8 cases of lead failures in the BL group (index case of conductor externalization, 6 cases of nonphysiological high-rate sensing, and 1 case of high-voltage conductor fracture). Prospective fluoroscopic screening of 98% of all active BL group cases revealed 1 additional case of conductor externalization. The median follow-up was 41, 27, and 29 months for the BL group, ER group, and SQ group, respectively; lead survival was 94.9%, 99.2%, and 100% at 3 years and 88%, 97.5%, and 100% at 5 years (P = .038 for BL group vs ER group and P = .007 for BL group vs SQ group using the log-rank test). Younger age at implant was an independent predictor of lead failure in the BL group (adjusted hazard ratio 0.85; 95% confidence interval 0.77-0.94; P = .001). CONCLUSION: At our center, survival of the Linox lead is 88% at 5 years and significantly worse than that of other leads. Conductor externalization is present in a minority of failed Linox leads. Younger age at implant is an independent predictor of Linox lead failure.
Asunto(s)
Muerte Súbita Cardíaca/prevención & control , Desfibriladores Implantables/efectos adversos , Electrodos Implantados/efectos adversos , Falla de Prótesis , Taquicardia Ventricular/terapia , Adulto , Factores de Edad , Anciano , Muerte Súbita Cardíaca/etiología , Desfibriladores Implantables/clasificación , Diseño de Equipo , Análisis de Falla de Equipo/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , SuizaRESUMEN
BACKGROUND: Implantable cardioverter-defibrillators (ICD) provide treatment for life-threatening ventricular tachyarrhythmias. Failure of the pace/sense conductor of an ICD lead can cause noise on the sensing electrogram (EGM) that may be misinterpreted as ventricular activity, triggering inappropriate therapy. An algorithm based upon the confirmation of ventricular activity from a far-field EGM has been developed to reduce inappropriate therapies resulting from this type of lead failure, while ensuring that appropriate therapy is delivered. The objectives of this study were to evaluate the algorithm's ability to discriminate lead noise from ventricular tachycardia/ventricular fibrillation (VT/VF) and to determine whether it inhibits inappropriate shocks without delaying appropriate shocks. METHODS: The algorithm was prospectively tested using near- and far-field EGM recordings from patients in three conditions: normal sinus rhythm with sustained and non-sustained lead noise via manipulation of the ICD pocket or lead system, and VT/VF induced during defibrillation threshold testing. The recordings were played through a bench-top device running the algorithm with the diagnosis, time to diagnosis, and inhibition of therapy documented. RESULTS: The algorithm detected noise and withheld inappropriate therapy in 231 of 238 recordings of sustained lead noise that would otherwise have been diagnosed as VT/VF (97.1%). Non-sustained lead noise was correctly diagnosed in 47 of the 52 recordings (90.4%). The device appropriately identified all 853 recordings of VT/VF (100%), without an increase in the time to detection (0.01 ± 0.14 s). CONCLUSIONS: The SecureSense(TM) algorithm correctly diagnosed sustained and non-sustained lead noise recordings without compromising detection of VT/VF. Use of the algorithm may reduce inappropriate shocks and alert clinicians to lead noise indicative of lead failure.
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Algoritmos , Desfibriladores Implantables/efectos adversos , Traumatismos por Electricidad/prevención & control , Electrocardiografía/métodos , Electrodos Implantados , Análisis de Falla de Equipo/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Desfibriladores Implantables/clasificación , Traumatismos por Electricidad/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Relación Señal-Ruido , Adulto JovenRESUMEN
AIMS: Longevity of implantable cardioverter defibrillators (ICDs) is crucial for patients and healthcare systems as replacements impact on infection rates and cost-effectiveness. Aim was to determine longevity using very large databases of two teaching hospitals with a high number of replacements and a rather homogeneous distribution among manufacturers. METHODS AND RESULTS: The study population consists of all patients in whom an ICD was inserted in. All ICD manufacturers operating in Switzerland and the Netherlands and all implanted ICDs were included. Implantable cardioverter defibrillator replacements due to normal battery depletion were considered events, and other replacements were censored. Longevity was assessed depending on manufacturers, pacing mode, implant before/after 2006, and all parameters combined. We analysed data from 3436 patients in whom 4881 ICDs [44.2% VVI-ICDs, 27.4% DDD-ICDs, 26.3% cardiac resynchronization therapy (CRT)-ICDs, 2.0% subcutaneous ICDs] were implanted. The four major manufacturers had implant shares between 18.4 and 31.5%. Replacement due to battery depletion (27.4%) was performed for 1339 ICDs. Patient survival at 5 years was 80.1%. Longevity at 5 years improved in contemporary compared with elderly ICDs [63.9-80.6% across all ICDs, of 73.7-92.1% in VVIs, 58.2-76.1% in DDDs, and of 47.1-66.3% in CRT defibrillators, all P value < 0.05]. Remarkable differences were seen among manufacturers, and those with better performance in elderly ICDs were not those with better performance in contemporary ones. CONCLUSION: Implantable cardioverter defibrillator longevity increased in contemporary models independent of manufacturer and pacing mode. Still, significant differences exist among manufacturers. These results might impact on device selection.
Asunto(s)
Desfibriladores Implantables/estadística & datos numéricos , Remoción de Dispositivos/estadística & datos numéricos , Falla de Equipo/estadística & datos numéricos , Anciano , Análisis Costo-Beneficio , Desfibriladores Implantables/clasificación , Desfibriladores Implantables/normas , Suministros de Energía Eléctrica , Diseño de Equipo , Análisis de Falla de Equipo , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Países Bajos , Suiza , Factores de TiempoAsunto(s)
Desfibriladores Implantables/clasificación , Desfibriladores Implantables/estadística & datos numéricos , Remoción de Dispositivos/estadística & datos numéricos , Suministros de Energía Eléctrica/estadística & datos numéricos , Insuficiencia Cardíaca/prevención & control , Industrias/estadística & datos numéricos , HumanosRESUMEN
AIMS: Device replacement at the time of battery depletion of implantable cardioverter-defibrillators (ICDs) may carry a considerable risk of complications and engenders costs for healthcare systems. Therefore, ICD device longevity is extremely important both from a clinical and economic standpoint. Cardiac resynchronization therapy defibrillators (CRT-D) battery longevity is shorter than ICDs. We determined the rate of replacements for battery depletion and we identified possible determinants of early depletion in a series of patients who had undergone implantation of CRT-D devices. METHODS AND RESULTS: We retrieved data on 1726 consecutive CRT-D systems implanted from January 2008 to March 2010 in nine centres. Five years after a successful CRT-D implantation procedure, 46% of devices were replaced due to battery depletion. The time to device replacement for battery depletion differed considerably among currently available CRT-D systems from different manufacturers, with rates of batteries still in service at 5 years ranging from 52 to 88% (log-rank test, P < 0.001). Left ventricular lead output and unipolar pacing configuration were independent determinants of early depletion [hazard ratio (HR): 1.96; 95% 95% confidence interval (CI): 1.57-2.46; P < 0.001 and HR: 1.58, 95% CI: 1.25-2.01; P < 0.001, respectively]. The implantation of a recent-generation device (HR: 0.57; 95% CI: 0.45-0.72; P < 0.001), the battery chemistry and the CRT-D manufacturer (HR: 0.64; 95% CI: 0.47-0.89; P = 0.008) were additional factors associated with replacement for battery depletion. CONCLUSION: The device longevity at 5 years was 54%. High left ventricular lead output and unipolar pacing configuration were associated with early battery depletion, while recent-generation CRT-Ds displayed better longevity. Significant differences emerged among currently available CRT-D systems from different manufacturers.
Asunto(s)
Desfibriladores Implantables/clasificación , Desfibriladores Implantables/estadística & datos numéricos , Remoción de Dispositivos/estadística & datos numéricos , Suministros de Energía Eléctrica/estadística & datos numéricos , Insuficiencia Cardíaca/prevención & control , Industrias/estadística & datos numéricos , Dispositivos de Terapia de Resincronización Cardíaca/clasificación , Dispositivos de Terapia de Resincronización Cardíaca/estadística & datos numéricos , Suministros de Energía Eléctrica/clasificación , Diseño de Equipo , Falla de Equipo , Análisis de Falla de Equipo/métodos , Análisis de Falla de Equipo/estadística & datos numéricos , Insuficiencia Cardíaca/epidemiología , Humanos , Italia/epidemiología , Evaluación de la Tecnología Biomédica/métodos , Evaluación de la Tecnología Biomédica/estadística & datos numéricosRESUMEN
Patients with cardiac implantable electrical devices should take precautions when exposed to electromagnetic fields. Possible interference as a result of proximity to electromagnets or electricity flow from electronic tools employed in clinical odontology remains controversial. The objective of this study was to examine in vitro the capacity of dental equipment to provoke electromagnetic interference in pacemakers and implantable cardioverter defibrillators. Six electronic dental instruments were tested on three implantable cardioverter defibrillators and three pacemakers from different manufacturers. A simulator model, submerged in physiological saline, with elements that reproduced life-size anatomic structures was used. The instruments were analyzed at differing distances and for different time periods of application. The dental instruments studied displayed significant differences in their capacity to trigger electromagnetic interference. Significant differences in the quantity of registered interference were observed with respect to the variables manufacturer, type of cardiac implant, and application distance but not with the variable time of application. The electronic dental equipment tested at a clinical application distance (20 cm) provoked only slight interference in the pacemakers and implantable cardioverter defibrillators employed, irrespective of manufacturer.
Asunto(s)
Desfibriladores Implantables , Equipo Dental , Equipos y Suministros Eléctricos , Seguridad de Equipos , Marcapaso Artificial , Interfase Hueso-Implante/anatomía & histología , Desfibriladores Implantables/clasificación , Implantación Dental Endoósea/instrumentación , Cavidad Pulpar/anatomía & histología , Prueba de la Pulpa Dental/instrumentación , Raspado Dental/instrumentación , Campos Electromagnéticos , Electrocirugia/instrumentación , Falla de Equipo , Humanos , Ensayo de Materiales , Modelos Anatómicos , Odontometría/instrumentación , Marcapaso Artificial/clasificación , Preparación del Conducto Radicular/instrumentación , Factores de Tiempo , Ápice del Diente/anatomía & histología , Terapia por Ultrasonido/instrumentaciónAsunto(s)
Desfibriladores Implantables/efectos adversos , Electrodos Implantados/efectos adversos , Marcapaso Artificial/efectos adversos , Neumotórax/diagnóstico por imagen , Neumotórax/etiología , Radiografía Torácica/métodos , Desfibriladores Implantables/clasificación , Electrodos Implantados/clasificación , Diseño de Equipo , Falla de Equipo , Análisis de Falla de Equipo/métodos , Humanos , Marcapaso Artificial/clasificación , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/métodosRESUMEN
BACKGROUND: Subcutaneous implantable cardioverter defibrillator (S-ICD) systems have no components in contact with the heart and may avoid complications such as lead fracture, venous obstruction, or endocarditis that occur with transvenous leads. Concerns have been raised regarding inappropriate shocks and pocket erosion with S-ICD systems. We have compared the performance of S-ICD and transvenous ICD systems in children and teenagers. METHODS: We studied consecutive patients <20 years of age who received an ICD over a 4-year period in two Scottish centers. Baseline characteristics, complications, and ICD therapy were recorded. The primary outcome measure was survival. The secondary outcome measure was survival-free from inappropriate ICD therapy or system revision. RESULTS: Nine S-ICD were implanted in nine patients. Eight transvenous ICD were implanted in six patients; two were redo procedures. Baseline characteristics were well matched. Median duration of follow-up was lower for S-ICD (20 months) than for transvenous ICD (36 months, P = 0.0262). Survival was 100% in both groups. Survival free of inappropriate therapy or system revision was 89% for S-ICD and 25% for transvenous ICD systems (log-rank test, P = 0.0237). No S-ICD were extracted, but three transvenous ICD were extracted due to infection (n = 1) and lead failure (n = 2). CONCLUSIONS: In real-world use in children and teenagers, S-ICD may offer similar survival benefit to transvenous ICD, with a lower incidence of complications requiring reoperation. In the absence of randomized trials, S-ICD should be compared prospectively with transvenous ICD in large multicenter registries with comparable periods of follow-up.