Efficacy and Complications of Subcutaneous versus Conventional Cardioverter Defibrillators: A Systematic Review and Meta-analysis.

BACKGROUND/OBJECTIVES: Implantable cardioverter defibrillators are used to prevent sudden cardiac death. The subcutaneous implantable cardioverter-defibrillator was newly developed to overcome the limitations of the conventional implantable cardioverter defibrillator-transvenous device. The subcutaneous implantable cardioverter defibrillator is indicated for young patients with heart disease, congenital heart defects, and poor venous access, who have an indication for implantable cardioverter defibrillator without the need for anti-bradycardic stimulation. We aimed to compare the efficacy and complications of subcutaneous with transvenous implantable cardioverter- defibrillator devices. METHODOLOGY: A systematic review was conducted using different databases. The inclusion criteria were observational and clinical randomized trials with no language limits and no publication date limit that compared subcutaneous with transvenous implantable cardioverter-defibrillators. The selected patients were aged > 18 years with complex ventricular arrhythmia. RESULTS: Five studies involving 2111 patients who underwent implantable cardioverter defibrillator implantation were included. The most frequent complication in the subcutaneous device group was infection, followed by hematoma formation and electrode migration. For the transvenous device, the most frequent complications were electrode migration and infection. Regarding efficacy, the total rates of appropriate shocks were 9.04% and 20.47% in the subcutaneous and transvenous device groups, respectively, whereas inappropriate shocks to the subcutaneous and transvenous device groups were 11,3% and 10,7%, respectively. CONCLUSION: When compared to the transvenous device, the subcutaneous device had lower complication rates owing to lead migration and less inappropriate shocks due to supraventricular tachycardia; nevertheless, infection rates and improper shocks due to T wave oversensing were comparable for both devices CRD42021251569.

Health-Related Quality of Life in Elderly Patients with Pacemakers.

INTRODUCTION: Cardiac pacemaker (PM) therapy is of paramount importance. PM use increases with age, with an estimated increased use of 70% to 80% in patients over 65 years. This study evaluated the perception of the health-related quality of life (HRQoL) of elderly patients with PM, comparing them with patients without PM, by applying two quality of life questionnaires: EuroQoL 5-dimensions (EQ-5D) and 36-Item Short Form Health Survey (SF-36). METHODS: This study included elderly patients divided into a group with PM and another without PM. Information on HRQoL was obtained using the EQ-5D and SF-36 questionnaires. RESULTS: The study involved 104 elderly patients with PM and 150 without PM. The distribution of responses to the EQ-5D was similar between groups. Statistical differences within the gender variable in the group of elderly people with PM were significant for the mobility, habitual activities, and anxiety/depression domains and for the average EQoL utility score and visual analogue scale (EQ-VAS). Elderly patients with PM presented significant differences between New York Heart Association classes 1 and 2 for the mobility domain and EQ-VAS, while those evaluated through SF-36 presented higher averages in vitality, general health status, and pain. However, a different analysis was observed in the physical aspect domain. CONCLUSION: The SF-36 demonstrated that elderly patients with PM had an HRQoL similar to or greater than those without PM. However, the results of the EQ-5D did not show significant differences regarding the implantation of PM and HRQoL between the two groups of elderly individuals in the study.

Effectiveness of multipoint cardiac resynchronizing therapy in heart failure: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Cardiac resynchronization therapy is an important validated technique for patients with dyssynchrony and heart failure. However, the response rate to conventional resynchronization is approximately 50%; therefore, new techniques and schedules have emerged. This study aimed to evaluate the different clinical and echocardiographic variables of conventional versus multipoint cardiac resynchronization therapy. RESEARCH DESIGN AND METHOD: A systematic review was conducted of randomized clinical trials in the PubMed, Cochrane, and Embase databases on cardiac resynchronization intervention with multipoint stimulation clinical and echocardiographic outcomes evaluated before and 3 months after the intervention. RESULTS: Three studies (N = 139) were ultimately selected, and 100% of patients had a New York Heart Association functional class of II-IV, QRS > 120 ms, and a left ventricular ejection fraction < 35%. Significantly greater improvement was observed in the functional class of patients who underwent multipoint versus conventional therapy. The final systolic volume and ejection fraction improved in the multipoint group, but the difference was not statistically significant. CONCLUSIONS: The literature lacks sufficient randomized controlled studies to enable conclusions regarding cardiac resynchronization therapy responses using different strategies. Moreover, the improvement in functional class in the multipoint pacing group involved few patients and had slight statistical relevance.

Health-Related Quality of Life in Elderly Patients with Pacemakers

Abstract Introduction: Cardiac pacemaker (PM) therapy is of paramount importance. PM use increases with age, with an estimated increased use of 70% to 80% in patients over 65 years. This study evaluated the perception of the health-related quality of life (HRQoL) of elderly patients with PM, comparing them with patients without PM, by applying two quality of life questionnaires: EuroQoL 5-dimensions (EQ-5D) and 36-Item Short Form Health Survey (SF-36). Methods: This study included elderly patients divided into a group with PM and another without PM. Information on HRQoL was obtained using the EQ-5D and SF-36 questionnaires. Results: The study involved 104 elderly patients with PM and 150 without PM. The distribution of responses to the EQ-5D was similar between groups. Statistical differences within the gender variable in the group of elderly people with PM were significant for the mobility, habitual activities, and anxiety/depression domains and for the average EQoL utility score and visual analogue scale (EQ-VAS). Elderly patients with PM presented significant differences between New York Heart Association classes 1 and 2 for the mobility domain and EQ-VAS, while those evaluated through SF-36 presented higher averages in vitality, general health status, and pain. However, a different analysis was observed in the physical aspect domain. Conclusion: The SF-36 demonstrated that elderly patients with PM had an HRQoL similar to or greater than those without PM. However, the results of the EQ-5D did not show significant differences regarding the implantation of PM and HRQoL between the two groups of elderly individuals in the study.