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1.
J Rehabil Med ; 52(10): jrm00111, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-32830281

RESUMO

OBJECTIVE: This study elucidated the effects of exercise training on physical activity, 6-min walk distance, and all-cause hospitalization rates in patients with chronic heart failure, and evaluated factors contributing to changes in physical activity. DESIGN: Prospective cohort observational study. PATIENTS AND METHODS: Patients (n =62) who completed an exercise training programme after implantable cardioverter-defibrillator or cardiac resynchronization therapy treatment between May 2017 and May 2018 were included. Patients exercised for 20-50 min 3-5 times weekly for 3 months and were assigned to the active (≥ 10 min/day) or non-active (< 10 min/day) group based on changes in walking times between baseline and 3 months, as assessed by the International Physical Activity Questionnaire. RESULTS: The 6-min walk distance improved in both groups with exercise training. Physical activity level did not increase in some patients, despite improvements in exercise tolerance. Depression improved significantly in the active group, but no correlation was found with physical activity. Factors contributing to physical activity changes were not identified. The all-cause hospitalization rate was lower in the active group during follow-up (mean 10.5 months). CONCLUSION: Exercise training effectively increased 6-min walk distance regardless of physical activity. Non-active patients experienced increased all-cause hospitalizations. Increasing physical activity improves patient outcomes.


Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca/normas , Terapia de Ressincronização Cardíaca/métodos , Desfibriladores Implantáveis/normas , Exercício Físico/fisiologia , Insuficiência Cardíaca/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
2.
Pain Physician ; 23(4): E335-E342, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709179

RESUMO

BACKGROUND: More patients with cardiac implantable electrical devices (CIEDs) are presenting to spine and pain practices for radiofrequency ablation (RFA) procedures for chronic pain. Although the potential for electromagnetic interference (EMI) affecting CIED function is known with RFA procedures, available guidelines do not specifically address CIED management for percutaneous RFA for zygapophyseal (z-joint) joint pain, and thus physician practice may vary. OBJECTIVES: To better understand current practices of physicians who perform RFA for chronic z-joint pain with respect to management of CIEDs. Perioperative CIED management guidelines are also reviewed to specifically address risk mitigation strategies for potential EMI created by ambulatory percutaneous spine RFA procedures. STUDY DESIGN: Web-based provider survey and narrative review. SETTING: Multispecialty pain clinic, academic medical center. METHODS: A web-based survey was created using Research Electronic Data Capture (REDCap). A survey link was provided via e-mail to active members of the Spine Intervention Society (SIS), American Society of Regional Anesthesia and Pain Medicine, as well as distributed freely to community Pain Physicians and any receptive academic departments of PM&R or Anesthesiology. The narrative review summarizes pertinent case series, review articles, a SIS recommendation statement, and multi-specialty peri-operative guidelines as they relate specifically to spine RFA procedures. RESULTS: A total of 197 clinicians participated in the survey from diverse clinical backgrounds, including anesthesiology, physical medicine and rehabilitation, radiology, neurosurgery, and neurology, with 81% reporting fellowship training. Survey responses indicate wide variability in provider management of CIEDs before, during, and after RFA for z-joint pain. Respondents indicated they would like more specific guidelines to aid in management and decision-making around CIEDs and spine RFA procedures. Literature review yielded several practice guidelines related to perioperative management of CIEDs, but no specific guideline for percutaneous spine RFA procedures. However, combining the risk mitigation strategies provided in these guidelines, with interventional pain physician clinical experience allows for reasonable management recommendations to aid in decision-making. LIMITATIONS: Although this manuscript can serve as a review of CIEDs and aid in management decisions in patients with CIEDs, it is not a clinical practice guideline. CONCLUSIONS: Practice patterns vary regarding CIED management in ambulatory spine RFA procedures. CIED presence is not a contraindication for spine RFA but does increase the complexity of a spine RFA procedure and necessitates some added precautions. KEY WORDS: Radiofrequency ablation, neurotomy, cardiac implantable electrical device, zygapophyseal joint, spondylosis, neck pain, low back pain, chronic pain.


Assuntos
Dor nas Costas/cirurgia , Ablação por Cateter/normas , Desfibriladores Implantáveis/normas , Médicos/normas , Guias de Prática Clínica como Assunto/normas , Inquéritos e Questionários , Anestesia por Condução/métodos , Anestesia por Condução/normas , Anestesiologia/métodos , Anestesiologia/normas , Ablação por Cateter/métodos , Dor Crônica/cirurgia , Humanos , Articulação Zigapofisária/cirurgia
3.
Int J Med Inform ; 138: 104138, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32298971

RESUMO

BACKGROUND: Implantable cardioverter-defibrillators (ICDs) have been shown to reduce sudden cardiac death in appropriately selected patients, but they remain underutilized among indicated patients. OBJECTIVE: To develop a new approach to identifying guideline indications among patients implanted with ICDs by creating algorithms that extract data from electronic health records (EHR). METHODS: Published guidelines providing recommendations for ICD use were distilled into categories of diagnoses, measures, procedures, and terminologies. Criteria for each indication category were translated into clinical algorithms using administrative codes, search terms, and other required data. Cardiologists with guideline-development expertise reviewed these algorithms. After developing applications using a subset of data, phenotypes were evaluated against a curated Optum® de-identified EHR dataset, including 94,441 patients with ≥1 procedure codes for ICD implantation or follow-ups from 47 US provider networks. RESULTS: Guideline-concordant indications were identified in 83.7 % of 49,560 patients with new ICD implants. The percentage of ICD patients with guideline-concordant indications ranged from 69.4%-88.1% for patients whose initial EHR records were 0-6 days to >365 days prior to implant, respectively. Many guideline criteria used data which could only be derived from unstructured provider notes and required significant algorithm development. CONCLUSIONS: Defibrillator implant indications were detected in >80 % of patients receiving ICDs using rule-based algorithms in a curated EHR dataset. Computable phenotypes may enable researchers to analyze EHRs in more reproducible ways, by identifying guideline indications in patients with specific therapies such as ICDs, and, by extension, identifying patients who meet indications yet do not yet have indicated therapies.


Assuntos
Desfibriladores Implantáveis/normas , Registros Eletrônicos de Saúde , Fenótipo , Morte Súbita Cardíaca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes
4.
Intern Med ; 59(11): 1351-1359, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32132336

RESUMO

Objective The decision to perform medical or mechanical therapy in patients with aborted sudden cardiac death (ASCD) due to coronary spasm is controversial. The Japanese Circulation Society guidelines for the diagnosis and treatment of patients with coronary spastic angina mentioned that implantable cardioverter-defibrillator (ICD) is one option in patients with ASCD due to coronary spasm. We investigated the usefulness of spasm provocation tests under medications in five patients with ASCD due to coronary spasm. Methods We performed the spasm provocation tests under medications in five ASCD patients due to coronary spasm. Pharmacological spasm provocation tests, including five acetylcholine (ACh) tests, two ergonovine (ER) tests, and two ACh added after ER tests, were performed to estimate the effect of medications to suppressing the next fatal spasms. Results ACh tests under medications did not provoke spasm in one patient but did provoke in two patients. In the remaining two patients, neither the ACh test nor the ER test provoked spasm, but the ACh added after ER test induced a focal spasm in one coronary artery. We increased the medication dosage in four patients. An ICD was implanted in two patients, including one with refractory spasm and one with left main trunk spasm. One patient died due to pulseless electrical activity without ventricular fibrillation, while the remaining four patients survived. Conclusion Spasm provocation tests under medication in patients with ASCD due to coronary spasm may be an option when deciding on medical or mechanical therapy.


Assuntos
Vasoespasmo Coronário/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/normas , Eletrocardiografia/normas , Ergonovina/normas , Ergonovina/uso terapêutico , Injeções Intra-Arteriais/normas , Idoso , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Ocitócicos/normas , Ocitócicos/uso terapêutico , Guias de Prática Clínica como Assunto , Estudos Retrospectivos
8.
Circulation ; 140(25): e944-e963, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31694402

RESUMO

The widespread use of cardiac implantable electronic devices and wearable monitors has led to the detection of subclinical atrial fibrillation in a substantial proportion of patients. There is evidence that these asymptomatic arrhythmias are associated with increased risk of stroke. Thus, detection of subclinical atrial fibrillation may offer an opportunity to reduce stroke risk by initiating anticoagulation. However, it is unknown whether long-term anticoagulation is warranted and in what populations. This scientific statement explores the existing data on the prevalence, clinical significance, and management of subclinical atrial fibrillation and identifies current gaps in knowledge and areas of controversy and consensus.


Assuntos
American Heart Association , Fibrilação Atrial/diagnóstico , Desfibriladores Implantáveis/normas , Conhecimentos, Atitudes e Prática em Saúde , Marca-Passo Artificial/normas , Dispositivos Eletrônicos Vestíveis/normas , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Desfibriladores Implantáveis/tendências , Humanos , Marca-Passo Artificial/tendências , Fatores de Risco , Estados Unidos/epidemiologia , Dispositivos Eletrônicos Vestíveis/tendências
9.
J Am Coll Cardiol ; 74(13): 1682-1692, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31558252

RESUMO

BACKGROUND: Although implantable cardioverter-defibrillators (ICDs) reduce sudden death, these patients die of heart failure (HF) or other diseases. To prevent shocks at the end of life, clinicians should discuss deactivating the defibrillation function. OBJECTIVES: The purpose of this study was to determine if a clinician-centered teaching intervention and automatic reminders increased ICD deactivation discussions and increased device deactivation. METHODS: In this 6-center, single-blinded, cluster-randomized, controlled trial, primary outcomes were proportion of patients: 1) having ICD deactivation discussions; and 2) having the shocking function deactivated. Secondary outcomes included goals of care conversations and advance directive completion. RESULTS: A total of 525 subjects were included with advanced HF who had an ICD: 301 intervention and 224 control. At baseline, 52% (n = 272) were not candidates for advanced therapies (i.e., cardiac transplant or mechanical circulatory support). There were no differences in discussions (41 [14%] vs. 26 [12%]) or deactivation (33 [11%] vs. 26 [12%]). In pre-specified subgroup analyses of patients who were not candidates for advanced therapies, the intervention increased deactivation discussions (32 [25%] vs. 16 [11%]; odds ratio: 2.90; p = 0.003). Overall, 99 patients died; there were no differences in conversations or deactivations among decedents. SECONDARY OUTCOMES: Among all participants, there was an increase in goals of care conversations (47% intervention vs. 38% control; odds ratio: 1.53; p = 0.04). There were no differences in completion of advance directives. CONCLUSIONS: The intervention increased conversations about ICD deactivation and goals of care. HF clinicians were able to apply new communication techniques based on patients' severity of illness. (An Intervention to Improve Implantable Cardioverter-Defibrillator Deactivation Conversations [WISDOM]; NCT01459744).


Assuntos
Desfibriladores Implantáveis/psicologia , Cardioversão Elétrica/psicologia , Insuficiência Cardíaca/psicologia , Assistência ao Paciente/psicologia , Papel do Médico/psicologia , Relações Médico-Paciente , Planejamento Antecipado de Cuidados/normas , Idoso , Comunicação , Desfibriladores Implantáveis/efeitos adversos , Desfibriladores Implantáveis/normas , Cardioversão Elétrica/normas , Feminino , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/normas , Método Simples-Cego
10.
JACC Clin Electrophysiol ; 5(9): 1059-1067, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31537335

RESUMO

OBJECTIVES: This study sought to examine outcomes of our approach to managing a large cohort of patients with Sprint Fidelis (Medtronic, Minneapolis, Minnesota) leads. BACKGROUND: The optimal management approach for patients with leads under advisory is unknown. Concerns regarding the risk of device infection and complications associated with delaying lead extraction have recently been suggested to argue against abandoning leads under advisory. METHODS: All patients with a Sprint Fidelis lead implanted at our institute were included. Lead management options were discussed with patients who presented for device surgery at the time of device upgrade, lead fracture, or elective replacement indicator. Implantation of a new lead with abandonment of the Sprint Fidelis lead was the recommended strategy. Patients were subsequently followed at the device clinic at 6-month intervals and were enrolled prospectively in a longitudinal registry. RESULTS: A total of 520 patients had Sprint Fidelis leads implanted between December 2003 and October 2007 at the study center; 217 patients underwent lead replacement (213 underwent a lead abandonment strategy and 4 underwent a lead extraction strategy). Mean follow-up after lead replacement was 55 ± 33 months. In patients undergoing lead abandonment, 10 of 213 (4.7%) had a procedural complication and 3 of 213 (1.4%) developed subsequent device infection requiring system extraction. CONCLUSIONS: In patients with a Sprint Fidelis lead, implanting a new lead without prophylactic extraction may be a feasible and safe strategy but requires longer follow-up.


Assuntos
Desfibriladores Implantáveis , Remoção de Dispositivo , Idoso , Desfibriladores Implantáveis/efeitos adversos , Desfibriladores Implantáveis/normas , Desfibriladores Implantáveis/estatística & dados numéricos , Remoção de Dispositivo/instrumentação , Remoção de Dispositivo/métodos , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Humanos , Masculino , Recall de Dispositivo Médico , Pessoa de Meia-Idade , Estudos Prospectivos , Reoperação/estatística & dados numéricos
11.
Circ Arrhythm Electrophysiol ; 12(9): e007488, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431050

RESUMO

BACKGROUND: Implantable cardioverter-defibrillators are used to prevent sudden cardiac death in patients with cardiac sarcoidosis. The most recent recommendations for implantable cardioverter-defibrillator implantation in these patients are in the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. These recommendations, based on observational studies or expert opinion, have not been assessed. We aimed to assess them. METHODS: We performed a large retrospective cohort study of patients with biopsy-proven sarcoidosis and known or suspected cardiac sarcoidosis that underwent cardiovascular magnetic resonance imaging. Patients were followed for a composite end point of significant ventricular arrhythmia or sudden cardiac death. The discriminatory performance of the Guideline recommendations was tested using time-dependent receiver operating characteristic analyses. The optimal cutoff for the extent of late gadolinium enhancement predictive of the composite end point was determined using the Youden index. RESULTS: In 290 patients, the class I and IIa recommendations identified all patients who experienced the composite end point during a median follow-up of 3.0 years. Patients meeting class I recommendations had a significantly higher incidence of the composite end point than those meeting class IIa recommendations. Left ventricular ejection fraction (LVEF) >35% with >5.7% late gadolinium enhancement on cardiovascular magnetic resonance imaging was as sensitive as and significantly more specific than LVEF >35% with any late gadolinium enhancement. Patients meeting 2 class IIa recommendations, LVEF >35% with the need for a permanent pacemaker and LVEF >35% with late gadolinium enhancement >5.7%, had high annualized event rates. Excluding 2 class IIa recommendations, LVEF >35% with syncope and LVEF >35% with inducible ventricular arrhythmia, resulted in improved discrimination for the composite end point. CONCLUSIONS: We assessed the Guideline recommendations for implantable cardioverter-defibrillator implantation in patients with known or suspected cardiac sarcoidosis and identified topics for future research.


Assuntos
American Heart Association , Cardiomiopatias/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/normas , Guias de Prática Clínica como Assunto , Sarcoidose/terapia , Sociedades Médicas , Biópsia , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico , Morte Súbita Cardíaca/etiologia , Feminino , Seguimentos , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sarcoidose/complicações , Sarcoidose/diagnóstico , Estados Unidos
12.
JACC Clin Electrophysiol ; 5(8): 935-943, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31439295

RESUMO

OBJECTIVES: A prospective, multicenter study was performed to assess the safety and efficacy of the Durata and Optisure HV leads and the Ellipse VR implantable cardioverter-defibrillator (ICD) (St. Jude Medical, Sylmar, California) in a 1.5-T magnetic resonance imaging (MRI) environment. The primary safety objective was >90% freedom from MRI scan-related complications. The primary efficacy objectives were absence of change in capture threshold and absence of decrease of sensing amplitude from pre-MRI examination to 1 month after MRI. BACKGROUND: MRI scanning of patients has been shown to be safe in patients with magnetic resonance-conditional implantable cardioverter-defibrillators (ICD) systems. METHODS: Patients with a previously implanted magnetic resonance-conditional system underwent a nondiagnostic MRI scan. After the scan, a questionnaire was given to investigators and patients who returned for 1-month follow-up examination. A subset of patients underwent ventricular tachyarrhythmia or ventricular fibrillation (VT/VF) induction testing after the MRI to evaluate defibrillation function. RESULTS: There were 220 patients (81% male; 62.1 ± 11.2 years of age) enrolled who received an MRI scans from 29 centers. All primary safety and efficacy endpoints were met (p < 0.0001). No significant detection delays were found in 34 patients who had VT/VF episodes after the MRI scan was performed. Most physicians reported easy and acceptable programming and ease of MRI scheduling. CONCLUSIONS: The MRI Ready MRI-conditional ICD system is safe, and electrical performance was not affected in patients receiving a 1.5-T whole-body MRI scan. Investigators reported favorable collaboration between cardiologists and radiologists in the MRI Ready IDE clinical trial. (A Clinical Evaluation of the Durata or Optisure High Voltage Leads and Ellipse VR ICD Undergoing MRI, an IDE Study [MRI Ready IDE]; NCT02787291).


Assuntos
Desfibriladores Implantáveis , Imagem por Ressonância Magnética , Segurança do Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Desfibriladores Implantáveis/efeitos adversos , Desfibriladores Implantáveis/normas , Desfibriladores Implantáveis/estatística & dados numéricos , Feminino , Humanos , Imagem por Ressonância Magnética/efeitos adversos , Imagem por Ressonância Magnética/normas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
13.
Qual Life Res ; 28(11): 2901-2908, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31292822

RESUMO

PURPOSE: The "distressed" (Type D) personality trait has been reported to be over-represented in patients with heart failure (HF) compared to the background population and may provide prognostic information for mortality. We examined the association between Type D personality and outcomes in the DANISH trial (The Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators in Patients with Non-ischemic Systolic Heart Failure on Mortality). METHODS: The DANISH trial included a total of 1116 patients with non-ischemic HF on guideline-recommended therapy. Type D personality was assessed with the Type D Scale (DS14) at baseline and investigated through follow-up accordingly. Multivariable Cox proportional hazard models were used to compare hazard ratios (HR) of cardiovascular and all-cause mortality. RESULTS: Type D personality assessment was completed by 873 (78%) patients at baseline and Type D personality was found in 120 (14%) patients. The median follow-up was 67 months (interquartile range [IQR] 48-83). Among patients with versus without Type D personality, 22% versus 19% died from all-cause yielding similar incidence rates of 4.62 (95% CI 3.14-6.87) versus 3.95 (95% CI 3.37-4.66) per 100 person-years. The adjusted risk of all-cause mortality was not significantly different in patients with versus without Type D personality with an adjusted HR of 1.31 (95% CI 0.84-2.03, p = 0.23) with similar results for cardiovascular death (HR 1.46 (95% CI 0.88-2.44, p = 0.15). CONCLUSION: Type D personality was not significantly associated with increased risk of all-cause mortality or cardiovascular death in patients with non-ischemic HF.


Assuntos
Desfibriladores Implantáveis/normas , Insuficiência Cardíaca/psicologia , Qualidade de Vida/psicologia , Personalidade Tipo D , Idoso , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
16.
J Cardiothorac Vasc Anesth ; 33(12): 3427-3436, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30928289

RESUMO

Biotronik cardiovascular implantable electronic devices, specifically Biotronik pacemakers, contain unique features that are relevant to perioperative management. For example, Biotronik pacemakers have a programmable response to magnet application, a default magnet response that does not result in sustained asynchronous pacing, and a unique method of rate adaptation (eg, closed loop stimulation). This review article focuses on these unique features; the interpretation of Biotronik interrogation reports; and the basic programming (eg, mode, rate, rate adaptation, tachyarrhythmia therapies) relevant to the perioperative management of Biotronik cardiovascular implantable electronic devices.


Assuntos
Anestesiologistas/normas , Estenose das Carótidas/cirurgia , Desfibriladores Implantáveis/normas , Assistência Perioperatória/normas , Guias de Prática Clínica como Assunto/normas , Idoso de 80 Anos ou mais , Estenose das Carótidas/fisiopatologia , Eletrocardiografia/métodos , Eletrocardiografia/normas , Humanos , Masculino , Assistência Perioperatória/métodos
17.
J Am Heart Assoc ; 8(6): e010346, 2019 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-30857452

RESUMO

Background Patients with heart failure and an implantable cardioverter-defibrillator ( ICD ) for primary prevention are at increased mortality risk after receiving shock therapy. We sought to determine the prognostic significance of ICD therapies, both shock and antitachycardia pacing, delivered for different ventricular arrhythmia ( VA ) rates. Methods and Results We evaluated mortality risk among 1790 ICD -implanted patients from MADIT -CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). For the first analysis, patients were divided into mutually exclusive groups by the rate of treated VA only: slow VA (<200 beats per minute) and fast VA (≥200 beats per minute or ventricular fibrillation). In a secondary analysis, both the type of ICD therapy and VA rate were used. The reference group was always patients who had no ICD therapy. ICD therapy for fast VA was associated with increased mortality risk (hazard ratio [ HR] , 2.27; 95% CI , 1.48-3.48; P<0.001). However, mortality risk after ICD therapy for slow VA was similar to the risk related to no ICD therapy ( HR , 1.45; 95% CI , 0.86-2.44; P=0.162). Consistently, shocks ( HR , 2.96; 95% CI , 1.91-4.60; P<0.001) and antitachycardia pacing ( HR , 2.22; 95% CI , 0.96-5.14; P=0.063) for fast VA were both associated with increased mortality risk. Shocks and antitachycardia pacing for slow VA were not significantly associated with increased mortality risk ( HR , 1.43 [95% CI , 0.52-3.92; P=0.489]; and HR , 1.43 [95% CI, 0.80-2.56; P=0.232], respectively). Conclusions In patients with mild heart failure receiving ICD for primary prevention, mortality is associated with the rate of underlying VA rather than the type of therapy. These findings suggest that fast VA is a marker for increased mortality rather than shock therapy directly contributing to increased risk. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 00180271.


Assuntos
Desfibriladores Implantáveis/normas , Insuficiência Cardíaca/terapia , Frequência Cardíaca/fisiologia , Taquicardia Ventricular/terapia , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Estados Unidos/epidemiologia
18.
Pract Radiat Oncol ; 9(4): 274-279, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30790716

RESUMO

Magnetic resonance imaging (MRI) guided radiation therapy is reported for the first time in a patient with an implantable cardioverter defibrillator (ICD) and cardiac fibroma in the left ventricle. Stereotactic body radiation therapy was delivered in 5 fractions at a dose of 700 cGy/fraction using a 0.35 T MRI-linear accelerator with real-time tumor tracking and beam gating. The average treatment time per fraction was 12.13 minutes, including gating dead time and gantry rotation, and the average duty cycle was 56.8%. Lessons learned included the need for MRI safety workflows that address the ICD and are tailored to the radiation oncology environment, selection of a suitable tracking target to ensure satisfactory duty cycle, and the presence of null band artifacts within the tracking target caused by ferrous components in the ICD.


Assuntos
Desfibriladores Implantáveis/normas , Coração/efeitos da radiação , Imagem por Ressonância Magnética/métodos , Humanos , Masculino , Pessoa de Meia-Idade
19.
Anesthesiology ; 130(4): 530-540, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30601218

RESUMO

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Electromagnetic interference from monopolar electrosurgery may disrupt implantable cardioverter defibrillators.Current management recommendations by the American Society of Anesthesiologists and Heart Rhythm Society are based on expert clinical opinion since there is a paucity of data regarding the risk of electromagnetic interference to implantable cardioverter defibrillators during surgery. WHAT THIS ARTICLE TELLS US THAT IS NEW: With protocolized electrosurgery dispersive electrode positioning in patients with implantable cardioverter defibrillators, the risk of clinically meaningful electromagnetic interference was 7% in above-the-umbilicus noncardiac surgery and 0% in below-the-umbilicus surgery. In cardiac surgery, clinically meaningful electromagnetic interference with use of an underbody dispersive electrode was 29%.Despite protocolized dispersive electrode positioning, the risk of electromagnetic interference in above-the-umbilicus surgery is high, supporting recommendations to suspend antitachycardia therapy when monopolar electrosurgery is used above the umbilicus.With protocolized dispersive electrode positioning, the risk of electromagnetic interference in below-the-umbilicus surgery is negligible, implying that suspending antitachycardia therapy might be unnecessary in these cases.With an underbody dispersive electrode, the risk of electromagnetic interference in cardiac surgery is high. BACKGROUND: The goal of this study was to determine the occurrence of intraoperative electromagnetic interference from monopolar electrosurgery in patients with an implantable cardioverter defibrillator undergoing surgery. A protocolized approach was used to position the dispersive electrode. METHODS: This was a prospective cohort study including 144 patients with implantable cardioverter defibrillators undergoing surgery between May 2012 and September 2016 at an academic medical center. The primary objectives were to determine the occurrences of electromagnetic interference and clinically meaningful electromagnetic interference (interference that would have resulted in delivery of inappropriate antitachycardia therapy had the antitachycardia therapy not been programmed off) in noncardiac surgeries above the umbilicus, noncardiac surgeries at or below the umbilicus, and cardiac surgeries with the use of an underbody dispersive electrode. RESULTS: The risks of electromagnetic interference and clinically meaningful electromagnetic interference were 14 of 70 (20%) and 5 of 70 (7%) in above-the-umbilicus surgery, 1 of 40 (2.5%) and 0 of 40 (0%) in below-the-umbilicus surgery, and 23 of 34 (68%) and 10 of 34 (29%) in cardiac surgery. Had conservative programming strategies intended to reduce the risk of inappropriate antitachycardia therapy been employed, the occurrence of clinically meaningful electromagnetic interference would have been 2 of 70 (2.9%) in above-the-umbilicus surgery and 3 of 34 (8.8%) in cardiac surgery. CONCLUSIONS: Despite protocolized dispersive electrode positioning, the risks of electromagnetic interference and clinically meaningful electromagnetic interference with surgery above the umbilicus were high, supporting published recommendations to suspend antitachycardia therapy whenever monopolar electrosurgery is used above the umbilicus. For surgery below the umbilicus, these risks were negligible, implying that suspending antitachycardia therapy is likely unnecessary in these patients. For cardiac surgery, the risks of electromagnetic interference and clinically meaningful electromagnetic interference with an underbody dispersive electrode were high. Conservative programming strategies would not have eliminated the risk of clinically meaningful electromagnetic interference in either noncardiac surgery above the umbilicus or cardiac surgery.


Assuntos
Desfibriladores Implantáveis/normas , Eletrodos Implantados/normas , Fenômenos Eletromagnéticos , Eletrocirurgia/normas , Marca-Passo Artificial/normas , Adulto , Idoso , Desfibriladores Implantáveis/efeitos adversos , Eletrodos Implantados/efeitos adversos , Eletrocirurgia/instrumentação , Eletrocirurgia/métodos , Feminino , Cardiopatias/fisiopatologia , Cardiopatias/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos
20.
Hellenic J Cardiol ; 60(5): 276-281, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29292244

RESUMO

BACKGROUND: Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) reduce sudden cardiac death and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). Current guidelines do not suggest any upper age limit for ICD and CRT but recommend avoidance of ICD and CRT in frail patients with a life expectancy of less than 1 year. It remains unclear whether elderly patients undergoing CRT derive the same additional benefit from ICDs as younger patients. We aimed to assess the use of ICDs in elderly compared to younger patients receiving CRT. METHODS: We searched electronic databases, up to April 11, 2016, for all studies reporting on ICD use stratified by age in patients who received CRT. We used random-effects meta-analysis models to calculate the summarized baseline characteristics and rates of implantation of ICD among patients enrolled in the studies. RESULTS: We retained six observational studies enrolling 613 patients ≥75 years old and 2810 patients <75 years old. The aggregate mean age was 82.7 years for the elderly patients compared to 66.3 years in the younger patients. There was a significantly lower use of ICDs in elderly patients compared to that in younger patients (37.9% versus 64.3%) (odds ratio: 0.26; 95% confidence intervals: 0.14-0.46; p < 0.0001). CONCLUSIONS: In conclusion, ICD was less frequently used in patients ≥75 years old receiving CRT compared to younger patients receiving CRT. Future studies that evaluate the efficacy and effectiveness of ICDs in elderly patients with indications for CRT are needed to guide management of this increasing population.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/efeitos adversos , Insuficiência Cardíaca/terapia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Desfibriladores Implantáveis/normas , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Expectativa de Vida , Masculino , Estudos Observacionais como Assunto , Estudos Prospectivos , Estudos Retrospectivos , Volume Sistólico/fisiologia
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