WorldWideScience

Sample records for cardioverter defibrillator icd

  1. Implantable Cardioverter Defibrillator

    Science.gov (United States)

    ... NHLBI on Twitter. What Is an Implantable Cardioverter Defibrillator? An implantable cardioverter defibrillator (ICD) is a small ... pacemakers and defibrillators. Comparison of an Implantable Cardioverter Defibrillator and a Pacemaker The image compares an ICD ...

  2. Implantable cardioverter defibrillator - discharge

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000108.htm Implantable cardioverter defibrillator - discharge To use the sharing features on this ... chest wall. A device called an implantable cardioverter-defibrillator (ICD) was inserted under your skin and muscle. ...

  3. Implantable cardioverter-defibrillator

    Science.gov (United States)

    ... medlineplus.gov/ency/article/007370.htm Implantable cardioverter-defibrillator To use the sharing features on this page, please enable JavaScript. An implantable cardioverter-defibrillator (ICD) is a device that detects any life- ...

  4. Psychosocial impact of implantable cardioverter defibrillators (ICD) in young adults with Tetralogy of Fallot.

    NARCIS (Netherlands)

    Opic, P.; Utens, E.M.; Moons, P.; Theuns, D.A.; Dijk, A.P.J. van; Hoendermis, E.S.; Vliegen, H.W.; Groot, N.M. de; Witsenburg, M.; Schalij, M.; Roos-Hesselink, J.W.

    2012-01-01

    OBJECTIVE: To investigate the psychosocial impact of having an implantable cardioverter defibrillator (ICD) in adults with Tetralogy of Fallot (ToF). METHODS: Included were 26 ToF-patients with an ICD (age 44 +/- 12 years), and two control groups consisting of 28 ToF-patients without an ICD (age 40

  5. Psychosocial impact of implantable cardioverter defibrillators (ICD) in young adults with Tetralogy of Fallot

    NARCIS (Netherlands)

    Opic, Petra; Utens, Elisabeth M. W. J.; Moons, Philip; Theuns, Dominic A. M. J.; van Dijk, Arie P. J.; Hoendermis, Elke S.; Vliegen, Hubert W.; de Groot, Natasja M. S.; Witsenburg, Maarten; Schalij, Martin; Roos-Hesselink, Jolien W.

    2012-01-01

    To investigate the psychosocial impact of having an implantable cardioverter defibrillator (ICD) in adults with Tetralogy of Fallot (ToF). Included were 26 ToF-patients with an ICD (age 44 +/- A 12 years), and two control groups consisting of 28 ToF-patients without an ICD (age 40 +/- A 10 years) an

  6. Psychosocial impact of implantable cardioverter defibrillators (ICD) in young adults with Tetralogy of Fallot

    NARCIS (Netherlands)

    P. Opic (Petra); E.M.W.J. Utens (Elisabeth); P. Moons (Philip); D.A.M.J. Theuns (Dominic); A.P.J. van Dijk (Arie); E.S. Hoendermis (Elke); H.W. Vliegen (Hubert); N. de Groot (Natasja); M. Witsenburg (Maarten); M.J. Schalij (Martin Jan); J.W. Roos-Hesselink (Jolien)

    2012-01-01

    textabstractObjective To investigate the psychosocial impact of having an implantable cardioverter defibrillator (ICD) in adults with Tetralogy of Fallot (ToF). Methods Included were 26 ToF-patients with an ICD (age 44 ± 12 years), and two control groups consisting of 28 ToF-patients without an ICD

  7. Non-pharmacological treatment of heart failure: Implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy

    NARCIS (Netherlands)

    Van Gelder, I.C.; Smit, M.D.; Nieuwland, W; Van Veldhuisen, D.J.

    2006-01-01

    The non-pharmacological therapy of heart failure, in particular an implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy or biventricular stimulation, improves symptoms and survival in patients with heart failure. - An ICD is indicated in many patients with heart failure

  8. Cardioverter-Defibrillator: A Treatment for Arrhythmia

    Science.gov (United States)

    MENU Return to Web version Arrhythmia | Cardioverter-Defibrillator: A Treatment for Arrhythmia What is an implantable cardioverter-defibrillator? An implantable cardioverter-defibrillator (often called an ICD) is a device that keeps ...

  9. Spiritual well-being may buffer psychological distress in patients with implantable cardioverter defibrillators (ICD)

    OpenAIRE

    Salmoirago-Blotcher, Elena; Crawford, Sybil; Tran, Chau; Goldberg, Robert; Rosenthal, Lawrence; Ockene, Ira

    2012-01-01

    Psychological distress is common in patients with implantable cardioverter defibrillators (ICDs) and has been associated with a worse prognosis. The authors examined whether spiritual wellbeing is associated with reduced psychological distress in patients with ICDs. The Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing (FACIT-SWB) questionnare and the Hospital Anxiety and Depression Scale (HADS) were used to measure spiritual wellbeing and overall psychological distress. Mu...

  10. Cognitive behavioral therapy (CBT in a Patient with Implantable Cardioverter Defibrillator (ICD and Posttraumatic stress disorder(PTSD.

    Directory of Open Access Journals (Sweden)

    Sahar Ansari

    2014-09-01

    Full Text Available The implantable cardioverter defibrillator (ICD has currently become the standard treatment for preventing sudden cardiac death. There are some psychological consequences in patients with ICD such as posttraumatic stress disorder (PTSD after the shocks induced by ICD. This report aimed to present the case of a 54-year-old man with ICD who had developed PTSD; his PTSD was treated, using cognitive-behavioral psychotherapy consisting of relaxation, mindfulness and problem solving techniques. In patients with ICD who are experiencing PTSD using cognitive behavioral interventions may be helpful to reduce their psychological sufferings.

  11. Cognitive behavioral therapy (CBT) in a Patient with Implantable Cardioverter Defibrillator (ICD) and Posttraumatic stress disorder(PTSD).

    Science.gov (United States)

    Ansari, Sahar; Arbabi, Mohammad

    2014-07-01

    The implantable cardioverter defibrillator (ICD) has currently become the standard treatment for preventing sudden cardiac death. There are some psychological consequences in patients with ICD such as posttraumatic stress disorder (PTSD) after the shocks induced by ICD. This report aimed to present the case of a 54-year-old man with ICD who had developed PTSD; his PTSD was treated, using cognitive-behavioral psychotherapy consisting of relaxation, mindfulness and problem solving techniques. In patients with ICD who are experiencing PTSD using cognitive behavioral interventions may be helpful to reduce their psychological sufferings.

  12. Monitoring treatment expectations in patients with an implantable cardioverter-defibrillator using the EXPECT-ICD scale

    DEFF Research Database (Denmark)

    Habibovic, Mirela; Pedersen, Susanne S.; van den Broek, Krista C;

    2014-01-01

    AIMS: Patient treatment expectations may affect cardiac outcomes; however, till date, no validated instruments have been developed to monitor treatment expectations in patients with an implantable cardioverter-defibrillator (ICD). This study evaluates the predictive value of the newly developed 10...

  13. Sleep, Psychosocial Functioning, and Device-Specific Adjustment in Patients with Implantable Cardioverter Defibrillators (ICDs).

    Science.gov (United States)

    McCrae, Christina S; Roth, Alicia J; Ford, Jessica; Crew, Earl C; Conti, Jamie B; Berry, Richard B; Sears, Samuel F

    2016-01-01

    Rates of sleep disorders and associated adjustment were examined in patients with implantable cardioverter defibrillators (ICDs; n = 42; Mage = 61.57, SD = 12.60). One night of ambulatory polysomnography, 14 days of sleep diaries, and questionnaires (mood, sleepiness, fatigue, device acceptance) were administered. Controlling for ischemia, MANCOVA examined adjustment by sleep diagnosis. Apnea was most common (28.6%), followed by Insomnia (16.7%) and Comorbid Insomnia/Apnea (11.9%). Patients with insomnia reported poorer mood, greater sleepiness, and lower device acceptance than good sleepers; they also demonstrated poorer mood and less ICD device acceptance than patients with sleep apnea. Patients with comorbid insomnia/apnea also exhibited poorer mood and less ICD device acceptance than good sleepers; however, comorbid patients did not significantly differ from insomnia or apnea patients on any measure. Those with disordered sleep (regardless of type) reported greater fatigue than good sleepers. Assessment (and treatment) of difficulties with sleep, mood, fatigue, and device acceptance may be important for the comprehensive clinical management of ICD patients. Further research appears warranted. PMID:25174823

  14. Implantable Cardioverter-Defibrillators at End of Battery Life: Opportunities for Risk (Re)-Stratification in ICD Recipients.

    Science.gov (United States)

    Merchant, Faisal M; Quest, Tammie; Leon, Angel R; El-Chami, Mikhael F

    2016-02-01

    Although implantable cardioverter-defibrillators (ICDs) are frequently viewed as a lifelong commitment in that patients are routinely scheduled for generator exchange (GE) at end of battery life, several considerations should prompt a reevaluation of risks and benefits before GE. Compared with initial ICD implant, patients receiving replacement devices are older, and have more comorbidities and shorter life expectancy, all of which may limit the benefit of ICD therapy following GE. Additionally, GE is associated with significant complications, including infection, which may increase the risk of mortality. In this paper, we review recent data regarding opportunities for risk stratification before GE, with a particular focus on those with improved left ventricular function and those who have not experienced ICD therapies during the first battery life. We also provide a broader perspective on ICD therapy, focusing on how decisions regarding GE may affect goals of care at the end of life. PMID:26821633

  15. How Will Having an Implantable Cardioverter Defibrillator Affect My Lifestyle?

    Science.gov (United States)

    ... NHLBI on Twitter. How Will an Implantable Cardioverter Defibrillator Affect My Lifestyle? The low-energy electrical pulses ... short time. Devices That Can Disrupt Implantable Cardioverter Defibrillator Functions Once you have an ICD, you have ...

  16. Gender differences in anxiety and concerns about the cardioverter defibrillator

    DEFF Research Database (Denmark)

    Spindler, Helle; Johansen, Jens B; Andersen, Kirsten Krogh;

    2009-01-01

    Little is known about gender differences in the response to implantable cardioverter defibrillator (ICD) therapy. We compared female and male ICD patients on anxiety, depression, health-related quality of life (HRQL), ICD concerns, and ICD acceptance.......Little is known about gender differences in the response to implantable cardioverter defibrillator (ICD) therapy. We compared female and male ICD patients on anxiety, depression, health-related quality of life (HRQL), ICD concerns, and ICD acceptance....

  17. Results of ENHANCED Implantable Cardioverter Defibrillator Programming to Reduce Therapies and Improve Quality of Life (from the ENHANCED-ICD Study)

    DEFF Research Database (Denmark)

    Mastenbroek, Mirjam H.; Pedersen, Susanne S.; van der Tweel, Ingeborg;

    2016-01-01

    -reported outcomes. The "ENHANCED Implantable Cardioverter Defibrillator programming to reduce therapies and improve quality of life" study (ENHANCED-ICD study) was a prospective, safety-monitoring study enrolling 60 primary and secondary prevention patients at the University Medical Center Utrecht. Patients...... during follow-up. In conclusion, the ENHANCED-ICD study demonstrates that programming a NID 60/80 for VT/VF detection is safe for ICD patients and does not negatively impact their quality of life....

  18. A meta-analysis of mortality in end-stage renal disease patients receiving implantable cardioverter defibrillators (ICDs.

    Directory of Open Access Journals (Sweden)

    Tien-Hsing Chen

    Full Text Available Data on the effectiveness of implantable implantable cardioverter defibrillators (ICDs with respect to reducing mortality in patients with chronic kidney disease (CKD and end-stage renal disease (ESRD are lacking. The purpose of this meta-analysis was to compare the mortality of patients with ESRD who have received and not received an ICD. A search was conducted on January 31, 2013 of Medline, Cochrane, EMBASE, and Google Scholar. Studies were selected for inclusion based on the following criteria. 1 Randomized controlled trial. 2 ESRD patients with heart failure. 3 Device therapy (ICD, CRT-defibrillator [CRT-D] used to treat heart failure. 4 Primary outcome is survival analysis. 5 Retrospective study if survival analysis was performed. The primary outcome was overall survival (OS, and the secondary outcome was 2-year survival. Odds ratios (ORs with 95% confidence intervals (CI were calculated, and a χ2-based test of homogeneity was performed. Three studies were included in the analysis. The combined OR for OS was 2.245 (95% CI 1.871 to 2.685, P<0.001, indicating that patients with an ICD had a significantly higher OS than those without an ICD. The combined OR for 2-year survival was 2.312 (95% CI 1.921 to 2.784, P<0.001, indicating that patients with an ICD had a significantly higher 2-year survival rate than those without an ICD. The use of ICD in patients with ESRD is associated with an increase in the OS and the 2-year survival rate.

  19. Concerns about the implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; van Domburg, Ron T; Theuns, Dominic A M J;

    2005-01-01

    Patients with an implantable cardioverter defibrillator (ICD) are at increased risk of anxiety disorders. In turn, anxiety has been identified as a precipitant of ventricular arrhythmias. Anxiety may in part be attributed to concerns about the ICD firing, but the relationship between ICD concerns...

  20. [The implantable cardioverter-defibrillator: sometimes necessary

    NARCIS (Netherlands)

    Smeets, J.L.R.M.

    2004-01-01

    The implantable cardioverter-defibrillator (ICD) is used in patients who are at risk for ventricular fibrillation after having suffered from a myocardial infarction. Initially, patient selection was limited to survivors of impending sudden death with coronary artery disease. Later, ICD implantation

  1. An entirely subcutaneous implantable cardioverter-defibrillator

    NARCIS (Netherlands)

    G.H. Bardy (Gust); W.M. Smith (Warren); A.M. Hood (Margaret); I.G. Crozier (Ian); I.C. Melton (Iain Craig); L.J.L.M. Jordaens (Luc); D.A.M.J. Theuns (Dominic); E. Park (Robert); D.J. Wright (David Justin); D.T. Connelly (Derek); S.P. Fynn (Simon Patrick); F.D. Murgatroyd (Francis); J. Sperzel (Johannes); J. Neuzner (Jörg); S.G. Spitzer (Stefan); A.V. Ardashev (Andrey); A. Oduro (Amo); L. Boersma (Lucas); A.H. Maass (Alexander); I.C. van Gelder (Isabelle); A.A.M. Wilde (Arthur); P.F.H.M. van Pascal; R.E. Knops (Reinoud); C.S. Barr (Craig); P. Lupo (Pierpaolo); R. Cappato (Riccardo); A.A. Grace (Andrew)

    2010-01-01

    textabstractBACKGROUND: Implantable cardioverter-defibrillators (ICDs) prevent sudden death from cardiac causes in selected patients but require the use of transvenous lead systems. To eliminate the need for venous access, we designed and tested an entirely subcutaneous ICD system. METHODS: First, w

  2. Methodological limitations of psychosocial interventions in patients with an implantable cardioverter-defibrillator (ICD A systematic review

    Directory of Open Access Journals (Sweden)

    Ockene Ira S

    2009-12-01

    Full Text Available Abstract Background Despite the potentially life-saving benefits of the implantable cardioverter-defibrillator (ICD, a significant group of patients experiences emotional distress after ICD implantation. Different psychosocial interventions have been employed to improve this condition, but previous reviews have suggested that methodological issues may limit the validity of such interventions. Aim: To review the methodology of previously published studies of psychosocial interventions in ICD patients, according to CONSORT statement guidelines for non-pharmacological interventions, and provide recommendations for future research. Methods We electronically searched the PubMed, PsycInfo and Cochrane databases. To be included, studies needed to be published in a peer-reviewed journal between 1980 and 2008, to involve a human population aged 18+ years and to have an experimental design. Results Twelve studies met the eligibility criteria. Samples were generally small. Interventions were very heterogeneous; most studies used cognitive behavioural therapy (CBT and exercise programs either as unique interventions or as part of a multi-component program. Overall, studies showed a favourable effect on anxiety (6/9 and depression (4/8. CBT appeared to be the most effective intervention. There was no effect on the number of shocks and arrhythmic events, probably because studies were not powered to detect such an effect. Physical functioning improved in the three studies evaluating this outcome. Lack of information about the indication for ICD implantation (primary vs. secondary prevention, limited or no information regarding use of anti-arrhythmic (9/12 and psychotropic (10/12 treatment, lack of assessments of providers' treatment fidelity (12/12 and patients' adherence to the intervention (11/12 were the most common methodological limitations. Conclusions Overall, this review supports preliminary evidence of a positive effect of psychosocial interventions

  3. Results of ENHANCED Implantable Cardioverter Defibrillator Programming to Reduce Therapies and Improve Quality of Life (from the ENHANCED-ICD Study).

    Science.gov (United States)

    Mastenbroek, Mirjam H; Pedersen, Susanne S; van der Tweel, Ingeborg; Doevendans, Pieter A; Meine, Mathias

    2016-02-15

    Novel implantable cardioverter defibrillator (ICD) discrimination algorithms and programming strategies have significantly reduced the incidence of inappropriate shocks, but there are still gains to be made with respect to reducing appropriate but unnecessary antitachycardia pacing (ATP) and shocks. We examined whether programming a number of intervals to detect (NID) of 60/80 for ventricular tachyarrhythmia (VT)/ventricular fibrillation (VF) detection was safe and the impact of this strategy on (1) adverse events related to ICD shocks and syncopal events; (2) ATPs/shocks; and (3) patient-reported outcomes. The "ENHANCED Implantable Cardioverter Defibrillator programming to reduce therapies and improve quality of life" study (ENHANCED-ICD study) was a prospective, safety-monitoring study enrolling 60 primary and secondary prevention patients at the University Medical Center Utrecht. Patients implanted with any type of ICD with SmartShock technology and aged 18 to 80 years were eligible to participate. In all patients, a prolonged NID 60/80 was programmed. The cycle length for VT/fast VT/VF was 360/330/240 ms, respectively. Programming a NID 60/80 proved safe for ICD patients. Because of the new programming strategy, unnecessary ICD therapy was prevented in 10% of ENHANCED-ICD patients during a median follow-up period of 1.3 years. With respect to patient-reported outcomes, levels of distress were highest and perceived health status lowest at the time of implantation, which both gradually improved during follow-up. In conclusion, the ENHANCED-ICD study demonstrates that programming a NID 60/80 for VT/VF detection is safe for ICD patients and does not negatively impact their quality of life.

  4. Living with an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Pedersen, Susanne S; Knudsen, Charlotte; Dilling, Karen;

    2016-01-01

    AIMS: The clinical management and care of patients with an implantable cardioverter defibrillator (ICD) has shifted from face-to-face in-clinic visits to remote monitoring. Reduced interactions between patients and healthcare professionals may impede patients' transition to adapting post......-implant. We examined patients' needs and preferences for information provision and care options and overall satisfaction with treatment. METHODS AND RESULTS: Patients implanted with a first-time ICD or defibrillator with cardiac resynchronization therapy (n = 389) within the last 2 years at Odense University...

  5. Pre-implantation implantable cardioverter defibrillator concerns and Type D personality increase the risk of mortality in patients with an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; van den Broek, Krista C; Erdman, Ruud A M;

    2010-01-01

    Little is known about the influence of psychological factors on prognosis in implantable cardioverter defibrillator (ICD) patients. We examined the influence of the distressed personality (Type D) and pre-implantation device concerns on short-term mortality in ICD patients.......Little is known about the influence of psychological factors on prognosis in implantable cardioverter defibrillator (ICD) patients. We examined the influence of the distressed personality (Type D) and pre-implantation device concerns on short-term mortality in ICD patients....

  6. Cost effectiveness of the implantable cardioverter defibrillator: a preliminary analysis

    OpenAIRE

    O'Brien, Bernie J; Buxton, Martin J; Rushby, Julia A

    1992-01-01

    Background—An implantable cardioverter defibrillator (ICD) may be effective in reducing the risk of sudden cardiac death. The high cost of ICD treatment, however, compared with alternatives raises the question of whether this new technology is an efficient use of scarce health care resources.

  7. Somatosensory amplification mediates sex differences in psychological distress among cardioverter-defibrillator patients

    DEFF Research Database (Denmark)

    Versteeg, Henneke; Baumert, Jens; Kolb, Christof;

    2010-01-01

    The present study examined whether female patients with an implantable cardioverter defibrillator (ICD) report more psychological distress than male patients, and whether somatosensory amplification mediates this relationship. Design: Consecutive ICD patients (N = 241; 33% women) participating in...

  8. Prognostic importance of distressed (Type D) personality and shocks in patients with an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Denollet, Johan; Tekle, Fetene B; Pedersen, Susanne S.;

    2013-01-01

    Clinical trials have shown the benefit of implantable cardioverter defibrillator (ICD) treatment. In this study, we examined the importance of chronic psychological distress and device shocks among ICD patients seen in clinical practice....

  9. Anxiety and risk of ventricular arrhythmias or mortality in patients with an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Habibović, Mirela; Pedersen, Susanne S.; van den Broek, Krista C;

    2013-01-01

    A subgroup of patients with an implantable cardioverter defibrillator (ICD) experiences anxiety after device implantation. The purpose of the present study was to evaluate whether anxiety is predictive of ventricular arrhythmias and all-cause mortality 1 year post ICD implantation.......A subgroup of patients with an implantable cardioverter defibrillator (ICD) experiences anxiety after device implantation. The purpose of the present study was to evaluate whether anxiety is predictive of ventricular arrhythmias and all-cause mortality 1 year post ICD implantation....

  10. Intra-operative defibrillation testing and clinical shock efficacy in patients with implantable cardioverter-defibrillators

    DEFF Research Database (Denmark)

    Bänsch, Dietmar; Bonnemeier, Hendrik; Brandt, Johan;

    2015-01-01

    AIMS: This trial was designed to test the hypothesis that shock efficacy during follow-up is not impaired in patients implanted without defibrillation (DF) testing during first implantable cardioverter-defibrillator (ICD) implantation. METHODS AND RESULTS: Between February 2011 and July 2013, 1077...... within 30 days in 94 patients (17.6%) tested compared with 89 events in 74 patients (13.9%) not tested (P = 0.095). CONCLUSION: Defibrillation efficacy during follow-up is not inferior in patients with a 40 J ICD implanted without DF testing. Defibrillation testing during first time ICD implantation...

  11. Phantom shocks in patients with implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Moons, Philip; Zwisler, Ann-Dorthe;

    2013-01-01

    The aim of this trial was to assess a combined rehabilitation intervention including an exercise training component and a psycho-educational component in patients treated with implantable cardioverter defibrillator (ICD). The hypothesis was that the intervention would reduce the occurrence of...

  12. Behavioral interventions in patients with an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Habibović, Mirela; Burg, Matthew M; Pedersen, Susanne S.

    2013-01-01

    The implantable cardioverter defibrillator (ICD) is the first-line treatment for primary and secondary prevention of sudden cardiac death. A subgroup of patients experience psychological distress postimplant, and no clear evidence base exists regarding how best to address patients' needs. The aim...... of this critical review is to provide an overview of behavioral interventions in ICD patients to date, and to delineate directions for future research using lessons learned from the ongoing RISTA and WEBCARE trials....

  13. Implantable cardioverter-defibrillators in congenital heart disease

    OpenAIRE

    Chubb, H; Rosenthal, E

    2016-01-01

    Implantable cardioverter-defibrillators (ICD) have an important role in reducing sudden cardiac death in patients with congenital heart disease (CHD); however, the benefit of ICDs needs to be weighed up against both short-term and long-term adverse effects, which are difficult to evaluate in the heterogeneous CHD population. A tailored approach, taking into account risk stratification and patient-specific factors, is needed to select the most appropriate strategy. This review discusses primar...

  14. Monitoring device acceptance in implantable cardioverter defibrillator patients using the Florida Patient Acceptance Survey

    DEFF Research Database (Denmark)

    Versteeg, Henneke; Starrenburg, Annemieke; Denollet, Johan;

    2012-01-01

    Patient device acceptance might be essential in identifying patients at risk for adverse patient-reported outcomes following implantation of an implantable cardioverter defibrillator (ICD). We examined the validity and reliability of the Florida Patient Acceptance Scale (FPAS) and identified...

  15. Implantable cardioverter defibrillator specific rehabilitation improves health cost outcomes

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Zwisler, Ann-Dorthe; Koch, Mette Bjerrum;

    2015-01-01

    ) were randomized (1:1) to comprehensive cardiac rehabilitation or usual care. Outcomes were measured by implantable cardioverter defibrillator therapy history from patient records and national register follow-up on mortality, hospital admissions and costs. RESULTS: No significant differences were found...... was -6,789 USD/-5,593 Euro in favour of rehabilitation. CONCLUSION: No long-term health outcome benefits were found for the rehabilitation programme. However, the rehabilitation programme resulted in a reduction in total attributable direct costs.......OBJECTIVE: The Copenhagen Outpatient ProgrammE - implantable cardioverter defibrillator (COPE-ICD) trial included patients with implantable cardioverter defibrillators in a randomized controlled trial of rehabilitation. After 6-12 months significant differences were found in favour...

  16. Optimizing defibrillation waveforms for ICDs.

    Science.gov (United States)

    Kroll, Mark W; Swerdlow, Charles D

    2007-04-01

    While no simple electrical descriptor provides a good measure of defibrillation efficacy, the waveform parameters that most directly influence defibrillation are voltage and duration. Voltage is a critical parameter for defibrillation because its spatial derivative defines the electrical field that interacts with the heart. Similarly, waveform duration is a critical parameter because the shock interacts with the heart for the duration of the waveform. Shock energy is the most often cited metric of shock strength and an ICD's capacity to defibrillate, but it is not a direct measure of shock effectiveness. Despite the physiological complexities of defibrillation, a simple approach in which the heart is modeled as passive resistor-capacitor (RC) network has proved useful for predicting efficient defibrillation waveforms. The model makes two assumptions: (1) The goal of both a monophasic shock and the first phase of a biphasic shock is to maximize the voltage change in the membrane at the end of the shock for a given stored energy. (2) The goal of the second phase of a biphasic shock is to discharge the membrane back to the zero potential, removing the charge deposited by the first phase. This model predicts that the optimal waveform rises in an exponential upward curve, but such an ascending waveform is difficult to generate efficiently. ICDs use electronically efficient capacitive-discharge waveforms, which require truncation for effective defibrillation. Even with optimal truncation, capacitive-discharge waveforms require more voltage and energy to achieve the same membrane voltage than do square waves and ascending waveforms. In ICDs, the value of the shock output capacitance is a key intermediary in establishing the relationship between stored energy-the key determinant of ICD size-and waveform voltage as a function of time, the key determinant of defibrillation efficacy. The RC model predicts that, for capacitive-discharge waveforms, stored energy is minimized

  17. Development of a hybrid battery system for an implantable biomedical device, especially a defibrillator/cardioverter (ICD)

    Science.gov (United States)

    Drews, Jürgen; Wolf, R.; Fehrmann, G.; Staub, R.

    An implantable defibrillator battery has to provide pulse power capabilities as well as high energy density. Low self-discharge rates are mandatory and a way to check the remaining available capacity is necessary. These requirements are accomplished by a system consisting of a lithium/manganese dioxide 6 V battery, plus a lithium/iodine-cell. The use of a high rate 6 V double-cell design in combination with a high energy density cell reduces the total volume required by the power source within an implantable defibrillator. The design features and performance data of the hybrid system are described.

  18. Development of a hybrid battery system for an implantable biomedical device, especially a defibrillator/cardioverter (ICD)

    Energy Technology Data Exchange (ETDEWEB)

    Drews, J.; Wolf, R.; Fehrmann, G.; Staub, R. [Litronik GmbH und Co., Pirna (Germany)

    1999-07-01

    An implantable defibrillator battery has to provide pulse power capabilities as well as high energy density. Low self-discharge rates are mandatory and a way to check the remaining available capacity is necessary. These requirements are accomplished by a system consisting of a lithium/manganese dioxide 6 V battery, plus a lithium/iodine-cell. The use of a high rate 6 V double-cell design in combination with a high energy density cell reduces the total volume required by the power source within an implantable defibrillator. The design features and performance data of the hybrid system are described. (orig.)

  19. Implantable cardioverter-defibrillator oversensing due to electric shock

    Directory of Open Access Journals (Sweden)

    Jurčević Ružica

    2010-01-01

    Full Text Available Introduction. We described the first case of oversensing due to electric shock in Serbia, in a 54-year-old man who had implantable cardioverter-defibrillator (ICD. Case Outline. In July 2002, the patient had acute anteroseptal myocardial infarction and ventricular fibrillation (VF which was terminated with six defibrillation shocks of 360 J. Coronary angiography revealed 30% stenosis of circumflex artery, the left anterior descending coronary artery was recanalized and the right coronary artery was without stenosis. Left ventricular ejection fraction was 20%. In December 2003, an electrophysiology study was performed and ventricular tachycardia (VT was induced and terminated with 200 J defibrillation shock. Single chamber ICD Medtronic Gem III VR was implanted in January 2004 and defibrillation threshold was 12 J. The patient was followed up during three years every three months and there were no VT/VF episodes and VT/VF therapies. In December 2007, the patient experienced electric shock through the fork while he was making barbecue on the electric grill. ICD recognized this event in VF zone (oversensing and delivered defibrillation shock of 18 J. The electrogram of the episode showed ventricular sensing - intrinsic sinus rhythm with electric shock potentials which were misidentified as VF. After charge time of 3.16 seconds, ICD delivered defibrillation shock and sinus rhythm was still present. Conclusion. Oversensing of ICD has different aetiology and the most common cause is supraventricular tachyarrhythmia.

  20. The occupational routine of patients implanted with cardioverter-defibrillator

    Directory of Open Access Journals (Sweden)

    Juliana Mannini

    2015-03-01

    Full Text Available Implantable cardioverter-defibrillators (ICD have become a reference as to the standard of care for patients with potentially lethal ventricular arrhythmias. The ICD treats the symptoms of the disease with no impact on its cause; however, the electrical discharge originating from the operating mechanism of this device has been the source of many studies addressing the quality of life of this population. The specific literature points to limitations of patients implanted with cardioverter-defibrillators regarding activities such as working and driving, but little has been discussed whether other areas of occupational performance are also limited. The purpose of this prospective exploratory research, which uses a case study design of quantitative nature, is to know the routine of patients implanted with cardioverter-defibrillator. Fifteen subjects with ICD participated in the study; they were outpatients in the arrhythmia sector of the ‘Clementino Fraga Filho’ University Hospital - HUCFF. The instruments for data collection included an initial interview, SF36 inventory, Role Checklist, and an open question. The results showed interference in the routine occupational performance and occupational roles evaluated, as well as in the fields of mental health and vitality, with greater focus on influences arising from the pathology than the mechanism of the device.

  1. The dilemma of implantable cardioverter-defibrillator therapy in the geriatric population

    Institute of Scientific and Technical Information of China (English)

    Diana Revenco; James P Morgan; Lana Tsao

    2011-01-01

    Current guidelines for implantable cardioverter-defibrillator(ICD)therapy in heart failure patients were established by multiple device trials;however,very few geriatric patients(patients≥65 years old)were included in these studies.This article explores the controversies of ICD implantation in the geriatric population,management of delivered ICD therapy in this age group,and the end of life care in patients with ICD.

  2. E-Health to Manage Distress in Patients With an Implantable Cardioverter-Defibrillator

    DEFF Research Database (Denmark)

    Habibović, Mirela; Denollet, Johan; Cuijpers, Pim;

    2014-01-01

    UNLABELLED: The Web-based distress management program for patients with an implantable cardioverter-defibrillator (ICD; WEBCARE) was developed to mitigate distress and enhance health-related quality of life in ICD patients. This study investigated the treatment effectiveness at 3-month follow-up ...

  3. Emotional distress in partners of patients with an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Van Den Broek, Krista C; Habibović, Mirela; Pedersen, Susanne S.

    2010-01-01

    Both patients with an implantable cardioverter defibrillator (ICD) and their partners face challenges when adapting to the ICD. Distress is a burden on its own for partners but may also affect well being and health of patients. This review provides a systematic overview of the literature on psych...

  4. Shock as a determinant of poor patient-centered outcomes in implantable cardioverter defibrillator patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Van Den Broek, Krista C; Van Den Berg, Martha;

    2010-01-01

    The medical benefits of the implantable cardioverter defibrillator (ICD) are well established, but ICD shocks are known to influence patient-centered outcomes. In this viewpoint, we examine the strength of the evidence as found in primary and secondary prevention trials that used quality of life ...

  5. Psychological vulnerability, ventricular tachyarrhythmias and mortality in implantable cardioverter defibrillator patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Brouwers, Corline; Versteeg, Henneke

    2012-01-01

    Implantable cardioverter defibrillator (ICD) therapy is the first-line treatment for the prevention of sudden cardiac death. Despite the demonstrated survival benefits of the ICD, predicting which patients will die from a ventricular tachyarrhythmia remains a major challenge. So far, psychological...

  6. Increased anxiety in partners of patients with a cardioverter-defibrillator

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; VAN DEN Berg, Martha; Erdman, Ruud A M;

    2009-01-01

    The partner of the implantable cardioverter-defibrillator (ICD) patient serves as an important source of support for the patient, which may be hampered if the partner experiences increased distress. We examined (1) potential differences in anxiety and depressive symptoms in ICD patients compared...

  7. Ventricular Tachyarrhythmias and Mortality in Patients With an Implantable Cardioverter Defibrillator

    DEFF Research Database (Denmark)

    Mastenbroek, Mirjam H; Versteeg, Henneke; Jordaens, Luc;

    2014-01-01

    Objective We examined whether depression is independently associated with implantable cardioverter defibrillator (ICD) therapy for ventricular tachyarrhythmias and mortality. Methods A cohort of 430 consecutive patients with a first-time ICD (79% men; mean [standard deviation] age = 57.8 [12...

  8. Influence of diabetes mellitus on inappropriate and appropriate implantable cardioverter-defibrillator therapy and mortality in the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) Trial

    DEFF Research Database (Denmark)

    Ruwald, Martin H.; Zareba, Wojciech; Jons, Christian;

    2013-01-01

    The relationship between diabetes mellitus and risk of inappropriate or appropriate therapy in patients receiving an implantable cardioverter-defibrillator (ICD) and resynchronization therapy has not been investigated thoroughly. The effect of innovative ICD programming on therapy delivery in the...

  9. Making post-mortem implantable cardioverter defibrillator explantation safe

    DEFF Research Database (Denmark)

    Räder, Sune B E W; Zeijlemaker, Volkert; Pehrson, Steen;

    2009-01-01

    that the resting voltage over the operating person would not exceed 50 V. CONCLUSION: The use of intact medical gloves made of latex, neoprene, or plastic eliminates the potential electrical risk during explantation of an ICD. Two gloves on each hand offer sufficient protection. We will recommend the use......AIMS: The aim of this study is to investigate whether protection with rubber or plastic gloves during post-mortem explantation of an implantable cardioverter defibrillator (ICD) offers enough protection for the explanting operator during a worst-case scenario (i.e. ICD shock). METHODS AND RESULTS......: We investigated the insulating properties of rubber and plastic gloves (double layer) within the first 60 min exposure (mimicking the maximum time of an explantation procedure) to saline (simulating the effects of body fluids on the gloves). For latex gloves, we measured an increase in voltage up...

  10. The effect of intermittent atrial tachyarrhythmia on heart failure or death in cardiac resynchronization therapy with defibrillator versus implantable cardioverter-defibrillator patients

    DEFF Research Database (Denmark)

    Ruwald, Anne-Christine; Pietrasik, Grzegorz; Goldenberg, Ilan;

    2014-01-01

    OBJECTIVES: This study aimed to investigate the effect of both history of intermittent atrial tachyarrhythmias (IAT) and in-trial IAT on the risk of heart failure (HF) or death comparing cardiac resynchronization therapy with defibrillator (CRT-D) to implantable cardioverter-defibrillator (ICD) t...

  11. Economic evaluations of implantable cardioverter defibrillators: a systematic review.

    Science.gov (United States)

    García-Pérez, Lidia; Pinilla-Domínguez, Pilar; García-Quintana, Antonio; Caballero-Dorta, Eduardo; García-García, F Javier; Linertová, Renata; Imaz-Iglesia, Iñaki

    2015-11-01

    The aim of this paper was to review the cost-effectiveness studies of implantable cardioverter defibrillators (ICD) for primary or secondary prevention of sudden cardiac death (SCD). A systematic review of the literature published in English or Spanish was performed by electronically searching MEDLINE and MEDLINE in process, EMBASE, NHS-EED, and EconLit. Some keywords were implantable cardioverter defibrillator, heart failure, heart arrest, myocardial infarction, arrhythmias, syncope, sudden death. Selection criteria were the following: (1) full economic evaluations published after 1995, model-based studies or alongside clinical trials (2) that explored the cost-effectiveness of ICD with or without associated treatment compared with placebo or best medical treatment, (3) in adult patients for primary or secondary prevention of SCD because of ventricular arrhythmias. Studies that fulfilled these criteria were reviewed and data were extracted by two reviewers. The methodological quality of the studies was assessed and a narrative synthesis was prepared. In total, 24 studies were included: seven studies on secondary prevention and 18 studies on primary prevention. Seven studies were performed in Europe. For secondary prevention, the results showed that the ICD is considered cost-effective in patients with more risk. For primary prevention, the cost-effectiveness of ICD has been widely studied, but uncertainty about its cost-effectiveness remains. The cost-effectiveness ratios vary between studies depending on the patient characteristics, methodology, perspective, and national settings. Among the European studies, the conclusions are varied, where the ICD is considered cost-effective or not dependent on the study. PMID:25323413

  12. Spinal cord stimulation for refractory angina in patients implanted with cardioverter defibrillators: five case reports

    DEFF Research Database (Denmark)

    Enggaard, Thomas P; Andersen, Claus; Scherer, Christian

    2010-01-01

    Patients implanted with a cardioverter defibrillator (ICD) who are suffering from refractory angina pectoris could benefit from spinal cord stimulation (SCS) due to the well-documented pain relieving effect. However, the combined treatment remains controversial. The aim of the study is to report...... tolerable level of stimulation was carried out to exclude inference with the ICD. The following treatment with SCS has in all cases been successful, with significant pain relief and improved quality of life. There were no incidences of inappropriate defibrillator shocks. Spinal cord stimulation...... successful long-term treatment with SCS in five patients implanted with cardioverter defibrillators. The combined treatments with ICD and thoracic epidural electrical stimulation were used in five patients with refractory angina pectoris. During the procedure of the implantation, testing with the maximal...

  13. Gender disparities in anxiety and quality of life in patients with an implantable cardioverter-defibrillator

    DEFF Research Database (Denmark)

    Habibović, Mirela; van den Broek, Krista C; Theuns, Dominic A M J;

    2011-01-01

    A paucity of studies in implantable cardioverter-defibrillator (ICD) patients has examined gender disparities in patient-reported outcomes, such as anxiety and quality of life (QoL). We investigated (i) gender disparities in anxiety and QoL and (ii) the magnitude of the effect of gender vs. New...

  14. Undertreatment of anxiety and depression in patients with an implantable cardioverter-defibrillator

    DEFF Research Database (Denmark)

    Hoogwegt, Madelein T; Kupper, Nina; Theuns, Dominic A M J;

    2012-01-01

    Twenty-five to 33% of patients with an implantable cardioverter-defibrillator (ICD) experience anxiety and depression, but it is not known whether their symptoms are adequately treated. We investigated (a) whether patients with clinically relevant symptoms of distress received appropriate treatment...

  15. SUDDEN CARDIAC DEATH AND THE USE OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS IN PEDIATRIC-PATIENTS

    NARCIS (Netherlands)

    SILKA, MJ; KRON, J; DUNNIGAN, A; DICK, M; BINKBOELKENS, M; ERICKSON, CC; JEDEIKIN, R; WETZEL, GT; VANHARE, GF; CAMPBELL, R; WALSH, E; SAUL, JP; SCHAFFER, MS; KARPAWICH, P; VOGEL, RL; BENSON, DW; DEAL, B; SCAGLIOTTI, D; STERBA, R; HORDOF, AJ; KRONGRAD, E; KANTER, RJ; EPSTEIN, M; COHEN, M; BEDER, S; HAMILTON, R; FOURNIER, A; HUBBARD, J; CHRISTIANSEN, JL; JENNINGS, J; VILLAFANE, J; PORTER, CBJ; CASE, C; GILLETTE, PC; BELAND, M; KUGLER, JD; OCONNOR, BK; ALLENDER, H; HERNDON, SP; SMITH, RT; BURTON, D; KURER, CC; BYRUM, C; GUAM, WE; FRIEDMAN, R; PERRY, JC; SCOTT, W; MEHTA, AV; PICKHOFF, AS; FISH, F; YEAGER, S; KAWABORI, [No Value; TRIPPLE, M; ROSENFELD, LE

    1993-01-01

    Background. During the past decade. the implantable cardioverter-defibrillator (ICD) has emerged as the primary therapeutic option for survivors of sudden cardiac death (SCD). Investigation of the clinical efficacy of these devices has primarily assessed outcome in adults with coronary artery diseas

  16. Experiences of patients with implantable cardioverter defibrillator in Turkey: A qualitative study

    Directory of Open Access Journals (Sweden)

    Özgür Aslan

    2012-01-01

    Full Text Available Background. There has been an increase in the number of patients with implantable cardioverter defibrillator (ICD. It isimportant to understand ICD patients’ experiences with it.Aim. The aim of this study was to describe experiences of patients with implantable cardioverter defibrillator (ICD.Methodology. A qualitative approach was used. Focus group interviews were used to obtain data from 19 patients whowere implanted cardioverter defibrillator at two centers in Izmir, Turkey. The patients were assigned into four groups. Thedata was analyzed using qualitative content analysis.Results. The analysis revealed six main themes: activities of daily living, social life, familial relationships, emotionalchanges, implantable cardioverter defibrillator shocks and experiences with receiving information and counselling fromhealth care providers.Conclusions. It can be concluded that patients with ICD experience physical and psychological problems and are not offeredthe education they need. To reduce the fears of the patients and their families and to prepare them for possible life stylechanges, comprehensive training programs that start in the pre-implantation period and continue into the post-implantationperiod should be organized.

  17. Relation of statin therapy to psychological functioning in patients with an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Hoogwegt, Madelein T; Theuns, Dominic A M J; Kupper, Nina;

    2013-01-01

    patients, in general, and patients with an implantable cardioverter defibrillator (ICD), in particular. We investigated the association between statin therapy and symptoms of anxiety and depression and patients' health status during the 12 months after implantation, reckoning with statin type and dosage...

  18. Dual-chamber implantable cardioverter-defibrillator. Is it useful in patient with permanent atrial fibrillation?

    Science.gov (United States)

    Porres-Aracama, José M; Cerezuela, José Luis; García-Urra, Francisco; Luque-Lezcano, Oscar; Herrero, Vicente

    2016-08-01

    In patients with permanent atrial fibrillation (AF) and implantable cardioverter-defibrillator (ICD) implant indication, a single-chamber device is the choice because AF does not provide interesting information for the treatment. It is very unusual to find patients with permanent AF that coexist with atrial tachycardia with various degree of Atrioventricular block. PMID:27525075

  19. Driving restrictions after implantable cardioverter defibrillator implantation: an evidence-based approach

    OpenAIRE

    Thijssen, Joep; Borleffs, C. Jan Willem; van Rees, Johannes B.; de Bie, Mihály K; van der Velde, Enno T.; Van Erven, Lieselot; Bax, Jeroen J; Cannegieter, Suzanne C.; Schalij, Martin J

    2011-01-01

    Aims Little evidence is available regarding restrictions from driving following implantable cardioverter defibrillator (ICD) implantation or following first appropriate or inappropriate shock. The purpose of the current analysis was to provide evidence for driving restrictions based on real-world incidences of shocks (appropriate and inappropriate). Methods and results A total of 2786 primary and secondary prevention ICD patients were included. The occurrence of shocks was noted during a medi...

  20. Cost Effectiveness of Implantable Cardioverter Defibrillator Therapy versus Drug Therapy for Patients at High Risk of Sudden Cardiac Death

    OpenAIRE

    Spath, Marian A.; Bernie J. O'Brien

    2002-01-01

    The implantable cardioverter defibrillator (ICD) is a therapy for patients at risk of sudden cardiac death due to ventricular tachycardia (VT) or ventricular fibrillation (VF). But the apparent high cost of ICD therapy relative to antiarrhythmic drugs such as amiodarone has raised questions about the cost effectiveness of ICD therapy versus drug therapy. To inform this debate we reviewed the literature on ICD cost effectiveness. An electronic and manual search was conducted for articles publi...

  1. Pacemakers and Implantable Defibrillators

    Science.gov (United States)

    ... need a cardiac pacemaker or an implantable cardioverter defibrillator (ICD). They are devices that are implanted in ... can act as both a pacemaker and a defibrillator. Many ICDs also record the heart's electrical patterns ...

  2. Type D personality is associated with increased anxiety and depressive symptoms in patients with an implantable cardioverter defibrillator and their partners

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; van Domburg, Ron T; Theuns, Dominic A M J;

    2014-01-01

    We investigated the prevalence of anxiety and depressive symptoms in patients with an implantable cardioverter defibrillator (ICD) and their partners, and the role of personality factors and social support as determinants of distress.......We investigated the prevalence of anxiety and depressive symptoms in patients with an implantable cardioverter defibrillator (ICD) and their partners, and the role of personality factors and social support as determinants of distress....

  3. The automatic implantable cardioverter-defibrillator.

    Science.gov (United States)

    Mirowski, M; Reid, P R; Mower, M M; Watkins, L; Platia, E V; Griffith, L S; Juanteguy, J M

    1984-05-01

    The automatic implantable cardioverter-defibrillator is an electronic device designed to monitor the heart continuously, to identify malignant ventricular tachyarrhythmias, and then to deliver effective countershock to restore normal rhythm. There are two defibrillating electrodes which are also used for waveform analysis; one is located in the superior vena cava, the other is placed over the cardiac apex. A third bipolar right ventricular electrode serves for rate counting and R-wave synchronization. When ventricular fibrillation occurs, a 25 joule pulse is delivered; when ventricular tachycardia faster than a preset rate is detected, the discharge is R-wave synchronized. The device can recycle three times if required. Special batteries can deliver over 100 shocks or provide a 3-year monitoring life. Implantation of the device is made either through a thoracotomy or by a subxiphoid approach. Thus far, the device has been implanted in 160 patients with a follow-up of 42 months. Acceleration of ventricular tachycardia to a faster rhythm or to ventricular fibrillation occurred only rarely and is dealt with most successfully through recycling. Actuarial analysis of the initial 52 patients has indicated 22.9% one-year total mortality, a 52% decrease from the 48% mortality that would be expected in the same group of patients without the device; the mortality attributed to arrhythmias was only 8.5%. In conclusion, the automatic cardioverter-defibrillator can reliably identify and correct potentially lethal ventricular tachyarrhythmias, leading to a substantial increase in survival in properly selected high-risk patients. PMID:6204311

  4. Initial Experiences of Implantable Cardioverter-Defibrillator Treatment in Patients with Ventricular Tachyarrhythmias

    OpenAIRE

    CHINUSHI, Masaomi; Aizawa, Yoshifusa; Abe, Akira; Shiba, Masami; Washizuka, Takashi; Tamura, Makoto; Igarashi, Yutaka; Kusano, Yoriko; Niwano, Shinichi; Shibata, Akira; Watanabe, Hiroshi; Eguchi, Shoji

    1996-01-01

    Implantable cardioverter-defibrillators (ICD) were implanted in 11 patients with drug refractory ventricular tachyarrhythmias. Both ventricular fibrillation (VF) and sustained ventricular tachycardia (VT) were documented in 4 of the 11 patients, and VF or VT was observed in the other 4 and 3 patients, respectively. The mean left ventricular ejection fraction of the 11 patients was 40±22%; underlying heart diseases were observed in 9 patients, old myocardial infarction in 4 patients, and dilat...

  5. Attitudes towards implantable cardioverter-defibrillator therapy: a national survey in Danish health-care professionals

    DEFF Research Database (Denmark)

    Johansen, Jens B; Mortensen, Peter T; Videbæk, Regitze;

    2011-01-01

    Aims The aim of this study was to examine health-care professionals attitudes towards implantable cardioverter-defibrillator (ICD) therapy and issues discussed with patients. Methods and results Survey of 209 health-care professionals providing specialized treatment and care of ICD patients at the......-physicians. Physicians were less likely to believe that their personal attitude towards ICD treatment has no influence on how they deal professionally with patients (27.8 vs. 43.6%; P = 0.04). Physicians and non-physicians were equally positive towards ICD therapy as primary prophylaxis in ischaemic cardiomyopathy (87...... discussing ICD treatment with candidate patients. At the same time, physicians are more aware that their attitude towards ICD treatment may influence how they deal professionally with patients compared with non-physicians....

  6. Shock and patient preimplantation type D personality are associated with poor health status in patients with implantable cardioverter-defibrillator

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Tekle, Fetene B; Hoogwegt, Madelein T;

    2012-01-01

    Implantable cardioverter-defibrillator (ICD) shock is a critical event to patients associated with well-being after implantation, although other factors may play an equally important role. We compared the association of shock and the patient's preimplantation personality with health status, using...

  7. Patient-reported outcomes in Danish implantable cardioverter defibrillator patients with a Sprint Fidelis lead advisory notification

    DEFF Research Database (Denmark)

    Pedersen, Susanne S; Versteeg, Henneke; Nielsen, Jens Cosedis;

    2011-01-01

    Few studies have investigated the association between implantable cardioverter defibrillators (ICDs) and lead advisory notifications and patient-reported outcomes (PROs). We examined (i) whether the mode used to inform patients about a device advisory is associated with PROs, and (ii) whether pat...

  8. Arrhythmia detection in single- and dual-chamber implantable cardioverter defibrillators: the more leads, the better?

    Science.gov (United States)

    Francia, Pietro; Balla, Cristina; Uccellini, Arianna; Cappato, Riccardo

    2009-09-01

    The implantable cardioverter defibrillator (ICD) offers life-saving therapies for primary and secondary prevention of sudden cardiac death in high-risk patients. However, ICD detection algorithms consistently misclassify a substantial proportion of supraventricular rhythms, thus carrying the risk for inappropriate therapies. Although single-chamber ICD (Sc-ICD) discrimination tools have been reported to provide high specificity in rejecting sinus tachycardia and atrial fibrillation with a relatively low ventricular rate, accurate recognition of atrial fibrillation with faster ventricular rates, atrial tachycardias, atrial flutter, and some reentrant tachycardias is still an issue. Dual-chamber ICDs (Dc-ICDs) are supposed to overcome specificity issues by enhancing detection algorithms with information derived from the atrial and ventricular timing relationship. The initial promise of Dc-ICDs was to improve detection specificity without compromising sensitivity, and to translate this advantage over Sc-ICDs in a more selective use of aggressive therapies. Despite this solid background, superiority of Dc- over Sc-ICDs has never been convincingly demonstrated. The present review focuses on the efficacy of contemporary ICD arrhythmia discrimination tools and appraises the so far reported evidence supporting the superiority of Dc-ICDs in preventing inappropriate therapies.

  9. Use of the Wearable Cardioverter Defibrillator in High-Risk Populations.

    Science.gov (United States)

    Lamichhane, Madhab; Safadi, Abdul; Surapaneni, Phani; Salehi, Negar; Thakur, Ranjan K

    2016-08-01

    The United States Food and Drug Administration has approved the wearable cardioverter defibrillator (WCD) for use in patients who are at high risk for sudden cardiac arrest (SCA) and who do not yet have an established indication for an implantation cardioverter defibrillator (ICD) or have contraindications for device implantation for various reasons. The WCD is typically used for primary prevention in (1) high-risk patients with reduced left ventricular ejection fraction (LVEF) ≤35 % after recent acute myocardial infarction (MI) during the 40-day ICD waiting period, (2) before and after coronary artery bypass graft or percutaneous coronary intervention during the 90-day ICD waiting period, (3) after recently diagnosed nonischemic dilated cardiomyopathy (NICM) during the 3- to 9-month medical therapy optimization period, or (4) for those with inherited proarrhythmic conditions such as long QT syndrome or hypertrophic cardiomyopathy. Unlike the automatic external defibrillator, the WCD does not require assistance from bystanders for therapy and conscious patients can delay or avert therapy with the use of response buttons. The WCD exhibits a small risk of inappropriate shock, mostly due to supraventricular tachycardia and/or electrical noise. Multiple non-randomized observational studies have shown high efficacy in detection and appropriate shock therapy for sustained ventricular tachyarrhythmias. This paper discusses the use of the WCD for prevention of SCA in patients with various cardiac substrates. PMID:27319008

  10. Pacemakers and implantable cardioverter defibrillators - general and anesthetic considerations

    Directory of Open Access Journals (Sweden)

    Amy G. Rapsang

    2014-06-01

    Full Text Available A pacemaking system consists of an impulse generator and lead or leads to carry the electrical impulse to the patient's heart. Pacemaker and implantable cardioverter defibrillator codes were made to describe the type of pacemaker or implantable cardioverter defibrillator implanted. Indications for pacing and implantable cardioverter defibrillator implantation were given by the American College of Cardiologists. Certain pacemakers have magnet-operated reed switches incorporated; however, magnet application can have serious adverse effects; hence, devices should be considered programmable unless known otherwise. When a device patient undergoes any procedure (with or without anesthesia, special precautions have to be observed including a focused history/physical examination, interrogation of pacemaker before and after the procedure, emergency drugs/temporary pacing and defibrillation, reprogramming of pacemaker and disabling certain pacemaker functions if required, monitoring of electrolyte and metabolic disturbance and avoiding certain drugs and equipments that can interfere with pacemaker function. If unanticipated device interactions are found, consider discontinuation of the procedure until the source of interference can be eliminated or managed and all corrective measures should be taken to ensure proper pacemaker function should be done. Post procedure, the cardiac rate and rhythm should be monitored continuously and emergency drugs and equipments should be kept ready and consultation with a cardiologist or a pacemaker-implantable cardioverter defibrillator service may be necessary.

  11. Gender disparities in psychological distress and quality of life among patients with an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Brouwers, Corline; van den Broek, Krista C; Denollet, Johan;

    2011-01-01

    A subset of patients with an implantable cardioverter defibrillator (ICD) reports psychological distress and poor quality of life (QoL). Gender is one of the factors that has been proposed to explain individual differences in these outcomes. In this viewpoint, we (1) review the evidence for gender...... disparities in psychological distress and QoL in ICD patients by means of a systematic review, and (2) provide recommendations for future research and clinical implications. A systematic search of the literature identified 18 studies with a sample size ≥ 100 that examined gender disparities in anxiety....../depression and QoL in ICD patients (mean prevalence of women = 21%; mean age = 62 years). Our review shows that there is insufficient evidence to conclude that gender per se is a major autonomous predictor for disparities in psychological distress and QoL in ICD patients. Women had a higher prevalence of anxiety...

  12. Patients' perspective on deactivation of the implantable cardioverter-defibrillator near the end of life

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Chaitsing, Rismy; Szili-Torok, Tamas;

    2013-01-01

    for information; and the prevalence and correlates of a favorable attitude toward deactivation. Three cohorts of ICD patients (n = 440) extracted from our institutional database were asked to complete a survey that included a vignette about deactivation near the end of life. Of the 440 patients approached, 294......Recent guidelines have emphasized the importance of discussing the issue of deactivation near the end of life with patients with an implantable cardioverter-defibrillator (ICD). Few studies have examined the patient perspective and patients' wishes. We examined patients' knowledge and wishes...... (67%) completed the survey. Most patients (68%) were aware that it is possible to turn the ICD off, and 95% believed it is important to inform patients about the possibility. Of the patients completing the survey, 84% indicated a choice for or against deactivation. Psychological morbidity...

  13. Surgical techniques for implanting implantable cardioverter defibrillators in children and infants.

    Science.gov (United States)

    Suzuki, Shoji; Motohashi, Shinya; Matsumoto, Masahiko

    2014-10-01

    Implantable cardioverter defibrillators (ICDs) are now being used in children. ICDs can be used to prevent sudden cardiac death caused by not only congenital heart defects, but also various non-structural diseases, such as long QT syndrome. However, a standard implantation technique for children, especially infants, has not yet been established. As the surgical implantation in infants is not amenable to transvenous lead placement, it was necessary to choose from epicardial, subcutaneous and pericardial ICD systems. However, many of these systems are associated with high rates of late complications. Lead fracture, insulation breakage, migration, buckling or crinkling of the patch lead and constrictive pericarditis have been reported as the most common lead-related complications. An increase in the defibrillation threshold is another issue that must be considered when using an ICD in a child or infant. Further studies on the outcomes, psychosomatic impact and other specific complications in the pediatric population need to be considered. The clinical use of ICDs in infants is still limited. Therefore, it is important to have many surgical options available so that the treatment can be custom-tailored to suit individual patients. PMID:24154922

  14. Temporal Influence of Heart Failure Hospitalizations Prior to Implantable Cardioverter Defibrillator or Cardiac Resynchronization Therapy With Defibrillator on Subsequent Outcome in Mild Heart Failure Patients (from MADIT-CRT)

    DEFF Research Database (Denmark)

    Lee, Andy Y; Moss, Arthur J; Ruwald, Martin H;

    2015-01-01

    effects on subsequent outcomes and benefit from cardiac resynchronization therapy with a defibrillator (CRT-D). Multivariate Cox models were used to determine the temporal influence of previous HF hospitalization on the end point of HF or death within all left bundle branch block implantable cardioverter-defibrillator...... (ICD) and CRT-D patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT) trial (n = 1,250) and to evaluate the clinical benefit of CRT-D implantation, comparing CRT-D patients with ICD patients within each previous HF hospitalization...

  15. Frequent Home Monitoring of ICD Is Effective to Prevent Inappropriate Defibrillator Shock Delivery

    Directory of Open Access Journals (Sweden)

    Paolo Bifulco

    2014-01-01

    Full Text Available Recently, in the context of telemedicine, telemonitoring services are gaining attention. They are offered, for example, to patients with implantable cardioverter defibrillators (ICDs. A major problem associated with ICD therapy is the occurrence of inappropriate shocks which impair patients’ quality of life and may also be arrhythmogenic. The telemonitoring can provide a valid support to intensify followup visits, in order to improve the prevention of inappropriate defibrillator shock, thus enhancing patient safety. Inappropriate shock generally depends on atrial fibrillation, supraventricular tachycardia, and abnormal sensing (such as those caused by electromagnetic interferences. As a practical example, an unusual case of an ICD patient who risked an inappropriate shock while taking a shower is reported. Continuous remote telemonitoring was able to timely warn cardiologist via GSM-SMS, who were able to detect improper sensing examining the intracardiac electrogram via Web. Patient was promptly contacted and warned to not further come in contact with the hydraulic system and any electrical appliance to prevent an inappropriate defibrillator shock. This demonstrates the effectiveness and usefulness of continuous remote telemonitoring in supporting ICD patients.

  16. Impact of carvedilol and metoprolol on inappropriate implantable cardioverter-defibrillator therapy

    DEFF Research Database (Denmark)

    Ruwald, Martin H; Abu-Zeitone, Abeer; Jons, Christian;

    2013-01-01

    The goal of this study was to evaluate the effects of carvedilol and metoprolol on the endpoint of inappropriate implantable cardioverter-defibrillator therapy in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy) study.......The goal of this study was to evaluate the effects of carvedilol and metoprolol on the endpoint of inappropriate implantable cardioverter-defibrillator therapy in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy) study....

  17. Comorbidity burden is associated with poor psychological well-being and physical health status in patients with an implantable cardioverter-defibrillator

    DEFF Research Database (Denmark)

    Hoogwegt, Madelein T; Kupper, Nina; Jordaens, Luc;

    2013-01-01

    Comorbidity burden has been linked to survival in patients with an implantable cardioverter-defibrillator (ICD), but no study has examined the influence on psychological well-being and health status. We examined the relationship between comorbidity burden and anxiety, depression, and health status...

  18. Long-term follow-up of prophylactic implantable cardioverter-defibrillator- only therapy: Comparison of ischemic and nonischemic heart disease

    NARCIS (Netherlands)

    T. Smith (Tim); D.A.M.J. Theuns (Dominic); K. Caliskan (Kadir); L.J.L.M. Jordaens (Luc)

    2011-01-01

    textabstractBackground: The benefits of primary prophylactic implantable cardioverter-defibrillators (ICDs) are actually debated, as some drawbacks become more apparent and as the natural history of cardiac disease seems to improve. Therefore, contemporary follow-up data of non-trial populations tre

  19. The distressed (Type D) personality in both patients and partners enhances the risk of emotional distress in patients with an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    van den Broek, Krista C; Versteeg, Henneke; Erdman, Ruud A M;

    2011-01-01

    A subgroup of patients with an implantable cardioverter defibrillator (ICD) experiences emotional distress. This may be related to partner factors. We examined the impact of the personality of the partner (i.e., the distressed (Type D) personality) in combination with that of the patient on anxiety...

  20. Comprehensive cardiac rehabilitation improves outcome for patients with implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Pedersen, Preben Ulrich; Zwisler, Ann-Dorthe;

    2015-01-01

    Aims:The aim of this randomised clinical trial was to assess a comprehensive cardiac rehabilitation intervention including exercise training and psycho-education vs 'treatment as usual' in patients treated with an implantable cardioverter defibrillator (ICD).Methods:In this study 196 patients...... with first time ICD implantation (mean age 57.2 (standard deviation (SD)=13.2); 79% men) were randomised (1:1) to comprehensive cardiac rehabilitation vs 'treatment as usual'. Altogether 144 participants completed the 12 month follow-up. The intervention consisted of twelve weeks of exercise training and one...... rehabilitation significantly increased VO2 uptake after exercise training to 23.0 (95% confidence interval (CI) 20.9-22.7) vs 20.8 (95% CI 18.9-22.7) ml/min/kg in the control group (p=0.004 (multiplicity p=0.015)). Comprehensive cardiac rehabilitation significantly increased general health; at three months (mean...

  1. Genome-wide association of implantable cardioverter-defibrillator activation with life-threatening arrhythmias.

    Directory of Open Access Journals (Sweden)

    Sarah S Murray

    Full Text Available OBJECTIVES: To identify genetic factors that would be predictive of individuals who require an implantable cardioverter-defibrillator (ICD, we conducted a genome-wide association study among individuals with an ICD who experienced a life-threatening arrhythmia (LTA; cases vs. those who did not over at least a 3-year period (controls. BACKGROUND: Most individuals that receive implantable cardioverter-defibrillators never experience a life-threatening arrhythmia. Genetic factors may help identify who is most at risk. METHODS: Patients with an ICD and extended follow-up were recruited from 34 clinical sites with the goal of oversampling those who had experienced LTA, with a cumulative 607 cases and 297 controls included in the analysis. A total of 1,006 Caucasian patients were enrolled during a time period of 13 months. Arrhythmia status of 904 patients could be confirmed and their genomic data were included in the analysis. In this cohort, there were 704 males, 200 females, and the average age was 73.3 years. We genotyped DNA samples using the Illumina Human660 W Genotyping BeadChip and tested for association between genotype at common variants and the phenotype of having an LTA. RESULTS AND CONCLUSIONS: We did not find any associations reaching genome-wide significance, with the strongest association at chromosome 13, rs11856574 at P = 5×10⁻⁶. Loci previously implicated in phenotypes such as QT interval (measure of the time between the start of the Q wave and the end of the T wave as measured by electrocardiogram were not found to be significantly associated with having an LTA. Although powered to detect such associations, we did not find common genetic variants of large effect associated with having a LTA in those of European descent. This indicates that common gene variants cannot be used at this time to guide ICD risk-stratification. TRIAL REGISTRATION: ClinicalTrials.gov NCT00664807.

  2. Beta-blocker therapy is not associated with symptoms of depression and anxiety in patients receiving an implantable cardioverter-defibrillator

    DEFF Research Database (Denmark)

    Hoogwegt, Madelein T; Kupper, Nina; Theuns, Dominic A M J;

    2012-01-01

    Beta-blockers are frequently prescribed to implantable cardioverter-defibrillator (ICD) patients. Beta-blocker therapy has been proposed to induce emotional distress such as depression and anxiety, but a paucity of studies has examined the relationship between beta-blockers and distress. We...... investigated the association between beta-blocker therapy, including type and dosage, and symptoms of anxiety and depression in a consecutive cohort of patients receiving an ICD....

  3. Elderly Benefit from Using Implantable Defibrillators

    Science.gov (United States)

    ... org Learn More Elderly benefit from using implantable defibrillators June 17, 2013 Categories: Heart News Study Highlights: Older people may benefit from implantable cardioverter defibrillators (ICDs) as much as younger people. Overall health, ...

  4. Arrhythmia Management in the Elderly-Implanted Cardioverter Defibrillators and Prevention of Sudden Death.

    Science.gov (United States)

    Manian, Usha; Gula, Lorne J

    2016-09-01

    We present an overview of arrhythmia management in elderly patients as it pertains to implantable cardioverter defibrillator (ICD) therapy and prevention of sudden death. Treatment of arrhythmia in elderly patients is fraught with challenges pertaining to goals of care and patient frailty. With an ever increasing amount of technology available, realistic expectations of therapy need to balance quality and quantity of life. The ICD is an important treatment option for selected patients at risk of ventricular arrhythmia and sudden cardiac death. However, the incidence of sudden death as a percentage of all-cause mortality decreases with age. Studies have reported that 20% of elderly patients might die within 1 year of an episode of life-threatening ventricular arrhythmia, but most because of nonarrhythmic causes. This illustrates the 'sudden cardiac death paradox,' with a great proportion of death in elderly patients, even those at risk for ventricular arrhythmias, attributable to medical conditions that cannot be addressed by an ICD. We discuss current practices in ICD therapy in elderly patients, existing evidence from registries and clinical trials, approaches to risk stratification, and important ethical considerations. Although the decision on whether ICD insertion is appropriate in the elderly population remains an area of uncertainty from an evidence-based and ethical perspective, we offer insight on potential clinical and research strategies for this growing population. PMID:27568872

  5. Patient perceptions of implantable cardioverter-defibrillator deactivation discussions: A qualitative study

    Directory of Open Access Journals (Sweden)

    Jane MacIver

    2016-04-01

    Full Text Available Background: There is a class I recommendation for implantable cardioverter-defibrillator deactivation discussions to occur between physicians and heart failure patients. Few studies have reported the patient’s perspective on the timing of implantable cardioverter-defibrillator deactivation discussions. Aim: To determine patient awareness, preferences and timing of implantable cardioverter-defibrillator deactivation discussions. Design: Grounded theory was used to collect and analyze interview data from 25 heart failure patients with an implantable cardioverter-defibrillator. Setting and participants: Patients with an implantable cardioverter-defibrillator, from the Heart Function Clinic at University Health Network (Toronto, Canada. Results: The sample (n = 25 was predominately male (76% with an average age of 62 years. Patients identified three stages where they felt implantable cardioverter-defibrillator deactivation should be discussed: (1 prior to implantation, (2 with any significant deterioration but while they were of sound mind to engage in and communicate their preferences and (3 at end of life, where patients wished further review of their previously established preferences and decisions about implantable cardioverter-defibrillator deactivation. Most patients (n = 17, 68% said they would consider deactivation, six (24% were undecided and two (8% were adamant they would never turn it off. Conclusion: The patient preferences identified in this study support the need to include information on implantable cardioverter-defibrillator deactivation at implant, with change in clinical status and within broader discussions about end-of-life treatment preferences. Using this process to help patients determine and communicate their implantable cardioverter-defibrillator deactivation preferences may reduce the number of patients experiencing distressing implantable cardioverter-defibrillator shocks at end of life.

  6. Prevention of sudden cardiac death by the implantable cardioverter defibrilator

    Directory of Open Access Journals (Sweden)

    Kovačević Dragan V.

    2011-01-01

    Full Text Available Introduction. Sudden cardiac death or, as it is also called, a modern man’s killer occurs a few hours after the beginning of the disease. Sudden death is the one that happens within an hour from the onset of the subjective discomforts regardless of the existence of any previous disease. According to modern statistics, 450.000 people die suddenly in the USA and 150,000 in Germany. Causes of sudden death. The most frequent causes of sudden death are cardiologic or, in other words, a heart rhythm disorder such as ventricular tachycardia, ventricular fibrillation and bradycardiac rhythm disorder. All these reasons can be efficiently prevented by the implantation of the cardioverter defibrillators. Implantable cardioverter defibrillator. In comparison with the already known medications, the defibrillator seems to be the most efficient in prevention of sudden cardiac death. This fact has been confirmed by large multicentre studies. The implantation itself is a routine procedure. It lasts about an hour and it often passes without any complications. The patient leaves the hospital a few days after the procedure. About 150 of these procedures are performed per year at the Institute of Cardiovascular Diseases Vojvodina. The Social Insurance Fund bears medical costs and the patient only pays the participation fee, which is symbolical if compared to the value and use of the device. Owing to this fact, this device is available to every patient thus making the efficient sudden cardiac death prevention possible.

  7. Embodied Revelation: A Classic Grounded Theory of Heart Failure Patient Decision Making Surrounding Primary Prevention Implantable Cardioverter Defibrillator Therapy

    Directory of Open Access Journals (Sweden)

    Vera Barton-Caro Ph.D.,

    2015-12-01

    Full Text Available The purpose of this classic grounded theory study was to explain the complex decision making process of heart failure (HF patients considering primary prevention implantable cardioverter defibrillator (ICD therapy. Sudden cardiac death (SCD is the leading cause of death for people with HF as well as the primary cause of death in the United States (US. ICDs represent the standard of care as the only effective therapy for primary prevention of SCD. However, a significant proportion of qualifying HF patients declines this invasive, yet life-saving device. The grounded theory is of Embodied revelation. The threat of SCD for ICD candidates consists of four stages: living in conscious denial, heightening of awareness, sanctioning ICD therapy, and living in new assurance. The first stage ends abruptly with the critical juncture of grasping the threat of SCD. This grounded theory has implications for research, nursing and medical practice, as well as bioethical considerations.

  8. 12. Physicians’ knowledge and attitudes in Saudi Arabia regarding implantable cardioverter-defibrillators and cardiac resynchronization therapy

    Directory of Open Access Journals (Sweden)

    A. Aljasser

    2016-07-01

    Full Text Available Information is limited regarding the knowledge and attitudes of physicians in Saudi Arabia involved in the referral of patients for implantable cardioverter-defibrillator (ICD and cardiac resynchronization and defibrillation therapy (CRT-D devices implantation. As such knowledge is the key to provide the patient with an important treatment, we aimed for its assessment. We conducted personal interviews with physicians involved in treating patients with heart failure. We included all hospitals in Riyadh region that has no cardiac electrophysiology service. Every participant was met in person and received an oral questionnaire that aims to assess basic knowledge about ICD and CRT.63 physicians were met from 13 hospitals (14 consultants and 49 specialist. 41% of participants use ⩽35% as the LVEF criterion for ICD referral in patients with cardiomyopathy. 30% of participants use ⩽35% as the LVEF criterion for CRT referral. 24% of participants were not aware about CRT as a therapy for patients with heart failure. 50% of the consultants use ⩽35% for ICD and CRT referral. 70% of the participants think that ICD may improve heart failure symptoms. 45% of participants who were about CRT do not think that CRT-D may prevent sudden death due to arrhythmia.There is a lack of knowledge with current clinical guidelines regarding ICD and CRT implantation. This finding highlights the need to improve the dissemination of guidelines to practitioners involved in managing patients with heart failure in an effort to improve ICD and CRT utilization.

  9. Automatic implantable cardioverter/defibrillator discharges and acute myocardial injury

    Energy Technology Data Exchange (ETDEWEB)

    Avitall, B.; Port, S.; Gal, R.; McKinnie, J.; Tchou, P.; Jazayeri, M.; Troup, P.; Akhtar, M. (Univ. of Wisconsin-Milwaukee Clinical Campus (USA))

    1990-05-01

    Multiple defibrillations by the automatic implantable cardioverter/defibrillator (AICD) have been reported to result in localized epicardial damage. No data exist, however, regarding whether this damage can be detected in the clinical setting or whether it interferes with the detection of true myocardial infarction. Forty-nine patients who received defibrillations by patch electrodes were studied prospectively. We attempted to document the presence of myocardial injury with the following three commonly used modalities for the detection of myocardial infarction: serial electrocardiographic changes, serial creatine phosphokinase (CPK) and CPK-MB release, and technetium 99m pyrophosphate scanning. Fifteen patients received defibrillations by AICD patches at the time of AICD generator replacement. Nine patients received defibrillations at the time of new AICD lead placement. The average total energy delivered was 85 +/- 29 J. None of these patients had detectable myocardial injury. Ten patients had defibrillations by the AICD patches at the time of bypass operation. One patient in this group developed acute myocardial infarction in the inferior wall after posterior descending coronary bypass operation, as detected by electrocardiogram, 99mTc pyrophosphate scanning, and CPK-MB analysis. Fifteen patients were evaluated for spontaneous AICD discharges. Thirteen had a maximum of five consecutive shocks, and cumulative energy delivered was not greater than 330 J. None of these patients had detectable injury. Two patients had CPK-MB release of 15.3% and 7.5%, respectively. One of these patients had a positive 99mTc pyrophosphate scan. These two patients received 12 and 17 rapid and consecutive AICD discharges, respectively, with cumulative delivered energy of 360 and 510 J, respectively.

  10. Single-coil and dual-coil defibrillator leads and association with clinical outcomes in a complete Danish nationwide ICD cohort

    DEFF Research Database (Denmark)

    Larsen, Jacob M; Hjortshøj, Søren P; Nielsen, Jens C;

    2016-01-01

    BACKGROUND: The best choice of defibrillator lead in patients with routine implantable cardioverter-defibrillator (ICD) is not settled. Traditionally, most physicians prefer dual-coil leads but the use of single-coil leads is increasing. OBJECTIVE: The purpose of this study was to compare clinical...... outcomes in patients with single- and dual-coil leads. METHODS: All 4769 Danish patients 18 years or older with first-time ICD implants from 2007 to 2011 were included from the Danish Pacemaker and ICD Register. Defibrillator leads were 38.9% single-coil leads and 61.1% dual-coil leads. The primary end...... point was all-cause mortality. Secondary end points were lowest successful energy at implant defibrillation testing, first shock failure in spontaneous arrhythmias, structural lead failure, and lead extraction outcomes. RESULTS: Single-coil leads were associated with lower all-cause mortality...

  11. A trial design for evaluation of empiric programming of implantable cardioverter defibrillators to improve patient management

    Directory of Open Access Journals (Sweden)

    Morgan John M

    2004-11-01

    Full Text Available Abstract The delivery of implantable cardioverter defibrillator (ICD therapy is sophisticated and requires the programming of over 100 settings. Physicians tailor these settings with the intention of optimizing ICD therapeutic efficacy, but the usefulness of this approach has not been studied and is unknown. Empiric programming of settings such as anti-tachycardia pacing (ATP has been demonstrated to be effective, but an empiric approach to programming all VT/VF detection and therapy settings has not been studied. A single standardized empiric programming regimen was developed based on key strategies with the intention of restricting shock delivery to circumstances when it is the only effective and appropriate therapy. The EMPIRIC trial is a worldwide, multi-center, prospective, one-to-one randomized comparison of empiric to physician tailored programming for VT/VF detection and therapy in a broad group of about 900 dual chamber ICD patients. The trial will provide a better understanding of how particular programming strategies impact the quantity of shocks delivered and facilitate optimization of complex ICD programming.

  12. Relation between emotional distress and heart rate variability in patients with an implantable cardioverter-defibrillator

    DEFF Research Database (Denmark)

    Hoogwegt, Madelein T; Pedersen, Susanne S.; Theuns, Dominic A M J;

    2014-01-01

    We investigated the relationship between Type D personality, depression, and anxiety, and heart rate variability (HRV) in 64 patients with an implantable cardioverter-defibrillator (ICD). HRV was obtained via 24-h Holter monitoring, and 24-h, 30-min daytime rest and 30-min nighttime sleep HRV were...... for depression (lower RMSSD: p = .10; lower pNN50: p = .09). During daytime rest, similar results were found for anxiety and depression. During sleep, only noteworthy adjusted associations were found for depression (lower root mean square of successive differences in NN intervals [RMSSD]: p = .06; lower pNN50: p...... = .043). A Benjamini-Hochberg correction for multiple testing led to reduction of the number of significant relationships, but there was still support for lower autonomic control patients with Type D personality and depression. Future research with larger sample sizes is warranted....

  13. [Implantable cardioverter-defibrillator at the end of life].

    Science.gov (United States)

    Pfeiffer, D; Hagendorff, A; Kühne, C; Reinhardt, S; Klein, N

    2015-06-01

    Brady- and tachyarrhythmias at the end of life are common observations. Implantable cardioverter-defibrillators answer with antibrady and antitachycardia pacing, which will not be associated with any complaints of the dying patient. In contrast, defibrillation and cardioversion shocks are extremely painful. Therefore shocks should be inactivated at the end of life. Family doctors, internists, emergency physicians and paramedics are unable to inactivate shocks. Deactivation of shocks at the end of life is not comparable to euthanasia or assisted suicide, but allow the patient to die at the end of an uncurable endstage disease. Deactivation of shocks should be discussed with the patient before initial implantation of the devices. The precise moment of the inactivation at the end of life should be discussed with patients and relatives. There is no common recommendation for the time schedule of this decision; therefore it should be based on the individual situation of the patient. Emergency health care physicians need magnets and sufficient information to inactivate defibrillators. The wishes of the patient have priority in the decision process and should be written in the patient's advance directive, which must be available in the final situation. However the physician must not necessarily follow every wish of the patient. As long as the laws in the European Union are not uniform, German recommendations are needed. PMID:26001358

  14. Predictors of appropriate therapy in patients with implantable cardioverter-defibrillator for primary prevention of sudden cardiac death

    Directory of Open Access Journals (Sweden)

    Dennis W. Zhu

    2010-02-01

    Full Text Available The purpose of this study was to evaluate predictors of appropriate therapy in patients with implantable cardioverter-defibrillators (ICD for primary prevention of sudden cardiac death. A retrospective cohort of 321 patients with systolic heart failure undergoing ICD placement for primary prevention of sudden cardiac death was queried with a mean follow-up period of 2.6 years. Appropriate ICD therapy was defined as therapy delivered for termination of a ventricular tachyarrhythmia. Appropriate ICD therapy was delivered in 142 (44% of the patients. In a multivariate model, body mass index ≥28.8 kg/m2 , chronic kidney disease, left ventricular ejection fraction ≤20% and metabolic syndrome were found to be independent predictors of appropriate ICD therapy. Appropriate ICD therapy was associated with higher cardiovascular mortality. These findings show the importance of identification of risk factors, especially metabolic syndrome, in patients following ICD implantation as aggressive treatment of these co-morbidities may decrease appropriate ICD therapy and cardiovascular mortality.

  15. Clinical Course After Cardioverter-Defibrillator Implantation: Chagasic Versus Ischemic Patients

    Science.gov (United States)

    Pereira, Francisca Tatiana Moreira; Rocha, Eduardo Arrais; Monteiro, Marcelo de Paula Martins; Lima, Neiberg de Alcantara; Rodrigues Sobrinho, Carlos Roberto Martins; Pires Neto, Roberto da Justa

    2016-01-01

    Background: The outcome of Chagas disease patients after receiving implantable cardioverter defibrillator (ICD) is still controversial. Objective: To compare clinical outcomes after ICD implantation in patients with chronic Chagas cardiomyopathy (CCC) and ischemic heart disease (IHD). Methods: Prospective study of a population of 153 patients receiving ICD (65 with CCC and 88 with IHD). The devices were implanted between 2003 and 2011. Survival rates and event-free survival were compared. Results: The groups were similar regarding sex, functional class and ejection fraction. Ischemic patients were, on average, 10 years older than CCC patients (p < 0.05). Patients with CCC had lower schooling and monthly income than IHD patients (p < 0.05). The number of appropriate therapies was 2.07 higher in CCC patients, who had a greater incidence of appropriate shock (p < 0.05). Annual mortality rate and electrical storm incidence were similar in both groups. There was no sudden death in CCC patients, and only one in IHD patients. Neither survival time (p = 0.720) nor event-free survival (p = 0.143) significantly differed between the groups. Conclusion: CCC doubles the risk of receiving appropriate therapies as compared to IHD, showing the greater complexity of arrhythmias in Chagas patients. PMID:27411097

  16. Remote monitoring of implantable cardioverter-defibrillators. Problems and implications using a telemonitoring system.

    Science.gov (United States)

    Siebermair, J; Clauss, S; Martens, E; Schuessler, F; Oversohl, N; Haserueck, N; Estner, H L; Kääb, S; Wakili, R

    2015-04-01

    The rising number of implantable devices has led to an increase in device-related workload, e.g., regular interrogation follow-up visits. Telemonitoring systems for implantable cardioverter-defibrillators (ICDs) seem to be a promising tool for reducing workload and costs, and they have the potential of optimizing patient care. However, issues such as practical functionality of ICD telemonitoring in daily routine may affect its broad implementation. The objective of this study was to evaluate potential problems during the implementation of a telemonitoring system, Medtronic CareLink™ (CL™) with respect to the installation and data transmission process. A total of 159 patients with ICDs who were equipped with the CL™ system were evaluated and followed up for 16 months regarding the success rate of the first data transmission via the telemonitoring system. In this cohort, a high rate of nontransmission of 23.9 % was observed after the 16-month follow-up. A detailed interview of these patients (no transmission) revealed that the main reasons for failed transmissions were due to the patients' loss of interest in the concept (approximately 50 %) as well as technical problems (approximately 25 %) with setting up the system. These results indicate that telemonitoring systems bear potential problems and that the evaluation of patient motivation and technical support options seems to play an important role in establishing the functionality of these systems. PMID:24848864

  17. Association of psychiatric history and type D personality with symptoms of anxiety, depression, and health status prior to ICD implantation

    DEFF Research Database (Denmark)

    Starrenburg, Annemieke H; Kraaier, Karin; Pedersen, Susanne S.;

    2013-01-01

    Personality factors and psychiatric history may help explain individual differences in risk of psychological morbidity and poor health outcomes in patients with an implantable cardioverter defibrillator (ICD)....

  18. 可嵌入心电震发生器的电击系统方案%A Shocking System Solution for Implantable Cardioverter Defibrillators

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@ 可嵌入心电震发生器(Implantable Cardioverter Defibrillators-ICD)已通用几年了.ICD在连接到心脏的两个电极之间施加高压脉冲,它随时检测心脏纤维性颤动.此脉冲可高达800V,在几毫秒期间电流达几十安培.

  19. Behandling med implanterbar defibrillator

    DEFF Research Database (Denmark)

    Roseva-Nielsen, Natasha G; Svendsen, Jesper Hastrup

    2003-01-01

    About 20 years ago the first patient received an implantable cardioverter defibrillator (ICD), and since then the number of implants have increased dramatically. The ICD can terminate ventricular fibrillation and ventricular tachycardia. Studies of secondary prophylaxis show that ICD treatment can...

  20. Cost-Effectiveness of Adding Cardiac Resynchronization Therapy to an Implantable Cardioverter-Defibrillator Among Patients With Mild Heart Failure

    DEFF Research Database (Denmark)

    Woo, Christopher Y; Strandberg, Erika J; Schmiegelow, Michelle D;

    2015-01-01

    . INTERVENTION: CRT-D or ICD alone. OUTCOME MEASURES: Life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). RESULTS OF BASE-CASE ANALYSIS: Use of CRT-D increased life expectancy (9.8 years versus 8.8 years), QALYs (8.6 years versus 7.6 years), and costs ($286......, shorter CRT-D battery life, and older age also made the cost-effectiveness of CRT-D less favorable. LIMITATIONS: The estimated mortality reduction for CRT-D was largely based on a single trial. Data on patients with NYHA class I symptoms were limited. The cost-effectiveness of CRT-D in patients with NYHA......BACKGROUND: Cardiac resynchronization therapy (CRT) reduces mortality and heart failure hospitalizations in patients with mild heart failure. OBJECTIVE: To estimate the cost-effectiveness of adding CRT to an implantable cardioverter-defibrillator (CRT-D) compared with implantable cardioverter...

  1. Implantable cardioverter defibrillator therapy in pediatric and congenital heart disease patients: a single tertiary center experience in Korea

    Directory of Open Access Journals (Sweden)

    Bo Kyung Jin

    2013-03-01

    Full Text Available Purpose: The use of implantable cardioverter defibrillators (ICDs to prevent sudden cardiac death is increasing in children and adolescents. This study investigated the use of ICDs in children with congenital heart disease. Methods: This retrospective study was conducted on the clinical characteristics and effectiveness of ICD implantation at the department of pediatrics of a single tertiary center between 2007 and 2011. Results: Fifteen patients underwent ICD implantation. Their mean age at the time of implantation was 14.5±5.4 years (range, 2 to 22 years. The follow-up duration was 28.9±20.4 months. The cause of ICD implantation was cardiac arrest in 7, sustained ventricular tachycardia in 6, and syncope in 2 patients. The underlying disorders were as follows: ionic channelopathy in 6 patients (long QT type 3 in 4, catecholaminergic polymorphic ventricular tachycardia [CPVT] in 1, and J wave syndrome in 1, cardiomyopathy in 5 patients, and postoperative congenital heart disease in 4 patients. ICD coils were implanted in the pericardial space in 2 children (ages 2 and 6 years. Five patients received appropriate ICD shock therapy, and 2 patients received inappropriate shocks due to supraventricular tachycardia.During follow-up, 2 patients required lead dysfunction-related revision. One patient with CPVT suffered from an ICD storm that was resolved using sympathetic denervation surgery. Conclusion: The overall ICD outcome was acceptable in most pediatric patients. Early diagnosis and timely ICD implantation are recommended for preventing sudden death in high-risk children and patients with congenital heart disease.

  2. T-wave oversensing and inappropriate shocks in implantable cardioverter def ibrillators

    Institute of Scientific and Technical Information of China (English)

    GAO Lei; LU Cai-yi; WANG Shi-wen; XUE Qiao; YAN Wei; ZHOU Sheng-hua; CHEN Rui; LIU Peng; ZHAI Jin-yue

    2010-01-01

    @@ The implantable cardioverter defibrillator (ICD) represents today the treatment and prophylaxis of choice for patients at risk for sustained ventricular tachyarrhythmias.1"6 Accurate sensing of ventricular tachyarrhythmias is a critical aspect of the function of ICD.

  3. Assessment of a remote monitoring system for implantable cardioverter defibrillators.

    Science.gov (United States)

    Masella, Cristina; Zanaboni, Paolo; Di Stasi, Francesca; Gilardi, Serena; Ponzi, Patrizia; Valsecchi, Sergio

    2008-01-01

    We conducted a multicentre study in five Italian hospitals to assess the feasibility of a remote monitoring service for the follow-up of implanted cardiac devices. The system was designed to monitor device performance as well as physiological aspects of the patient's condition. Sixty-seven patients (mean age 64 years) affected by chronic heart failure and with a biventricular implantable cardioverter defibrillator for cardiac re-synchronization therapy (CRT-D) were enrolled for a three-month observation period. A total of 267 device recordings were transmitted through the ordinary telephone network, with a success rate of 99%. The telemonitoring service was more efficient than conventional face-to-face follow-up in terms of the time savings: both for physicians (4.7 minutes versus 15 minutes for remote and conventional monitoring) and for patients (6.6 minutes versus 116.3 minutes). In addition, a total of 23 clinical events occurred during the study, but only two cases required a clinic visit, thus reducing inappropriate hospital admissions. Finally, the service was well accepted by all the users. PMID:18776073

  4. Characteristics associated with low treatment satisfaction in patients with implanted cardioverter defibrillators: results from the LICAD study.

    Science.gov (United States)

    Ladwig, Karl-Heinz; Deisenhofer, Isabelle; Simon, Heidi; Schmitt, Claus; Baumert, Jens J

    2005-06-01

    The evaluation of low treatment satisfaction (LTS) with an implanted cardioverter defibrillator (ICD) remains a neglected area of clinical research. However, a trustful attitude toward an ICD is crucial. Within the scope of ICD health technology assessment, we searched for predictors of LTS. Of 195 ICD patients enrolled (mean 59.8 years, standard deviation 12.6), 163 (83.6%) were men and 26 (16.4%) were women. We measured anxiety, helplessness, and depression with standardized instruments and LTS with 11 dichotomous items concerning a mistrustful attitude, a negative body image, and low appraisal. A total of 47 (24.1%) patients were considered as LTS patients. Multivariate logistic regression was used for assessment of LTS. Adjusted for age and survey, LTS was significantly more prevalent in depressed, anxious, and phobic patients. Multivariate logistic regression including medical and psychological covariates revealed the experience of > or =5 shocks with an odds ratio (OR) of 10.17 (95% CI 3.57-29.00, P effect on LTS. Age, educational status, and depression were not significant. LTS patients required more support for living with the ICD (P < or = 0.001). Thus, LTS serves as surrogate measure for deteriorated psychic health. Clinicians should be advised to identify LTS patients and to consider psychotherapeutic counseling for them. PMID:15955182

  5. Physical Activity in Primary Versus Secondary Prevention Indication Implantable Cardioverter Defibrillator Recipients 6–12 Months After Implantation – A Cross-Sectional Study With Register Follow Up

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Thygesen, Lau Caspar; Svendsen, Jesper Hastrup;

    2015-01-01

    OBJECTIVES: To describe physical activity status among patients with implantable cardioverter defibrillators (ICDs) according to the indication for ICD implant compared with international guidelines and compared with a matched healthy reference population to detect potential for improved physical...... outcomes; to describe patients' beliefs regarding participation in physical exercise by ICD indication; to describe factors predicting low physical activity; and to describe physical activity as a predictor of mortality. DESIGN: National survey with register follow-up. Comparisons were made to a matched...... healthy reference population, and patients were followed in registers for 15 months. SETTING: Patients are identified from national registers and questionnaires are distributed by postal mail. PARTICIPANTS: All diagnostic profiles and indications were included as were both single-chamber ICD...

  6. Cognitive-Behavioral Treatment of Posttraumatic Stress in Patients With Implantable Cardioverter Defibrillators: Results From a Randomized Controlled Trial.

    Science.gov (United States)

    Ford, Jessica; Rosman, Lindsey; Wuensch, Karl; Irvine, Jane; Sears, Samuel F

    2016-08-01

    Approximately 20% of patients with implantable cardioverter defibrillators (ICDs) suffer from posttraumatic stress disorder (PTSD) due to a history of cardiac arrest, device implantation, and ICD shock. There has been very little examination of treatment of PTSD symptoms in these patients. This study evaluated the effect of a specific cognitive-behavioral therapy (CBT) intervention for ICD patients with high levels of PTSD symptoms: a manualized program consisting of 8 telephone sessions with a trained counselor, a patient education book, and a stress management procedure on compact disc. Participants were 193 ICD patients, who were randomized to CBT or usual cardiac care (UCC) who completed self-report surveys at the time of recruitment and 6 and 12 months after initial measurement. Previous publication on the primary research evaluation questions reported that the CBT condition resulted in greater improvement on PTSD and depression symptoms than the UCC for the general population of ICD patients, but did not evaluate the effect on those with elevated symptoms of PTSD. The authors conducted secondary analyses of the effect of treatment on high and low PTSD symptom groups based on a cutoff for the Impact of Event Scale-Revised (Weiss & Marmar, 1997). Participants in the CBT group who had high symptoms experienced significantly greater symptom reduction from baseline to 12 months (d = 2.44, p = .021) than the UCC group (d = 1.12). Participants with low symptoms had small reductions regardless of group assignment (d = 0.16, p = .031). ICD-focused CBT was sufficient to produce a large, statistically significant reduction in PTSD symptoms in ICD patients with indications for treatment.

  7. Cognitive-Behavioral Treatment of Posttraumatic Stress in Patients With Implantable Cardioverter Defibrillators: Results From a Randomized Controlled Trial.

    Science.gov (United States)

    Ford, Jessica; Rosman, Lindsey; Wuensch, Karl; Irvine, Jane; Sears, Samuel F

    2016-08-01

    Approximately 20% of patients with implantable cardioverter defibrillators (ICDs) suffer from posttraumatic stress disorder (PTSD) due to a history of cardiac arrest, device implantation, and ICD shock. There has been very little examination of treatment of PTSD symptoms in these patients. This study evaluated the effect of a specific cognitive-behavioral therapy (CBT) intervention for ICD patients with high levels of PTSD symptoms: a manualized program consisting of 8 telephone sessions with a trained counselor, a patient education book, and a stress management procedure on compact disc. Participants were 193 ICD patients, who were randomized to CBT or usual cardiac care (UCC) who completed self-report surveys at the time of recruitment and 6 and 12 months after initial measurement. Previous publication on the primary research evaluation questions reported that the CBT condition resulted in greater improvement on PTSD and depression symptoms than the UCC for the general population of ICD patients, but did not evaluate the effect on those with elevated symptoms of PTSD. The authors conducted secondary analyses of the effect of treatment on high and low PTSD symptom groups based on a cutoff for the Impact of Event Scale-Revised (Weiss & Marmar, 1997). Participants in the CBT group who had high symptoms experienced significantly greater symptom reduction from baseline to 12 months (d = 2.44, p = .021) than the UCC group (d = 1.12). Participants with low symptoms had small reductions regardless of group assignment (d = 0.16, p = .031). ICD-focused CBT was sufficient to produce a large, statistically significant reduction in PTSD symptoms in ICD patients with indications for treatment. PMID:27415850

  8. Appropriate evaluation and treatment of heart failure patients after implantable cardioverter-defibrillator discharge: time to go beyond the initial shock.

    Science.gov (United States)

    Mishkin, Joseph D; Saxonhouse, Sherry J; Woo, Gregory W; Burkart, Thomas A; Miles, William M; Conti, Jamie B; Schofield, Richard S; Sears, Samuel F; Aranda, Juan M

    2009-11-24

    Multiple clinical trials support the use of implantable cardioverter-defibrillators (ICDs) for prevention of sudden cardiac death in patients with heart failure (HF). Unfortunately, several complicating issues have arisen from the universal use of ICDs in HF patients. An estimated 20% to 35% of HF patients who receive an ICD for primary prevention will experience an appropriate shock within 1 to 3 years of implant, and one-third of patients will experience an inappropriate shock. An ICD shock is associated with a 2- to 5-fold increase in mortality, with the most common cause being progressive HF. The median time from initial ICD shock to death ranges from 168 to 294 days depending on HF etiology and the appropriateness of the ICD therapy. Despite this prognosis, current guidelines do not provide a clear stepwise approach to managing these high-risk patients. An ICD shock increases HF event risk and should trigger a thorough evaluation to determine the etiology of the shock and guide subsequent therapeutic interventions. Several combinations of pharmacologic and device-based interventions such as adding amiodarone to baseline beta-blocker therapy, adjusting ICD sensitivity, and employing antitachycardia pacing may reduce future appropriate and inappropriate shocks. Aggressive HF surveillance and management is required after an ICD shock, as the risk of sudden cardiac death is transformed to an increased HF event risk. PMID:19926003

  9. Longitudinal changes in intracardiac repolarization lability in patients with implantable cardioverter-defibrillator

    Directory of Open Access Journals (Sweden)

    Abhilash eGuduru

    2013-08-01

    Full Text Available Background─While it is known that elevated baseline intracardiac repolarization lability is associated with the risk of fast ventricular tachycardia (FVT /ventricular fibrillation (VF, the effect of its longitudinal changes on the risk of FVT/VF is unknown. Methods and Results─Near-field (NF right ventricular (RV intracardiac electrograms (EGMs were recorded every 3-6 months at rest in 248 patients with structural heart disease (mean age 61.2±13.3; 185[75%] male; 162[65.3%] ischemic cardiomyopathy and implanted cardioverter-defibrillator (ICD or cardiac resynchronization therapy defibrillator (CRT-D [201 (81% primary prevention]. Intracardiac beat-to-beat QT variability index (QTVINF was measured on NF RV EGM. During the first study phase (median 18 months, participants made on average 2.4 visits. Then remote follow-up was continued for an additional median period of 3 years. Average QTVINF did not change during the first year after ICD implantation (-0.342±0.603 at baseline vs. -0.262±0.552 at 6 months vs. -0.334±0.603 at 12 months; however, it decreased thereafter (-0.510±0.603 at 18 months; P=0.042. Adjusted population-averaged GEE model showed that the odds of developing FVT/VF increased by 75% for each 1 unit increase in QTVINF. (OR 1.75 [95%CI 1.05-2.92]; P=0.031. However, individual patient–specific QTVINF trends (increasing, decreasing, flat varied from patient to patient. For a given patient, the odds of developing FVT/VF were not associated with increasing or decreasing QTVINF over time (OR 1.27; [95%CI 0.05–30.10]; P = 0.881.Conclusion─While on average the odds of FVT/VF increased with an increase in QTVINF, patient-specific longitudinal trends in QTVINF did not affect the odds of FVT/VF.

  10. Wrong detection of ventricular fibrillation in an implantable cardioverter defibrillator caused by the movement near the MRI scanner bore.

    Science.gov (United States)

    Mattei, Eugenio; Censi, Federica; Triventi, Michele; Mancini, Matteo; Napolitano, Antonio; Genovese, Elisabetta; Cannata, Vittorio; Falsaperla, Rosaria; Calcagnini, Giovanni

    2015-01-01

    The static magnetic field generated by MRI systems is highly non-homogenous and rapidly decreases when moving away from the bore of the scanner. Consequently, the movement around the MRI scanner is equivalent to an exposure to a time-varying magnetic field at very low frequency (few Hz). For patients with an implanted cardiac stimulators, such as an implantable cardioverter/defibrillator (ICD), the movements inside the MRI environment may thus induce voltages on the loop formed by the leads of the device, with the potential to affect the behavior of the stimulator. In particular, the ICD's detection algorithms may be affected by the induced voltage and may cause inappropriate sensing, arrhythmia detections, and eventually inappropriate ICD therapy.We performed in-vitro measurements on a saline-filled humanshaped phantom (male, 170 cm height), equipped with an MRconditional ICD able to transmit in real-time the detected cardiac activity (electrograms). A biventricular implant was reproduced and the ICD was programmed in standard operating conditions, but with the shock delivery disabled. The electrograms recorded in the atrial, left and right ventricle channels were monitored during rotational movements along the vertical axis, in close proximity of the bore. The phantom was also equipped with an accelerometer and a magnetic field probe to measure the angular velocity and the magnetic field variation during the experiment. Pacing inhibition, inappropriate detection of tachyarrhythmias and of ventricular fibrillation were observed. Pacing inhibition began at an angular velocity of about 7 rad/s, (dB/dt of about 2 T/s). Inappropriate detection of ventricular fibrillation occurred at about 8 rad/s (dB/dt of about 3 T/s). These findings highlight the need for a specific risk assessment of workers with MR-conditional ICDs, which takes into account also effects that are generally not considered relevant for patients, such as the movement around the scanner bore. PMID

  11. Implante de cardio-desfibrilador em gestantes com cardiomiopatia hipertrófica Implantable cardioverter-defibrillator in pregnant women with hypertrophic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Leonardo Jorge Cordeiro de Paula

    2010-09-01

    Full Text Available Descrevemos os casos de duas gestantes portadoras de cardiomiopatia hipertrófica com alto risco de morte súbita arrítmica, que foram submetidas a implante de cardioversor-desfibrilador automático (CDI no intercurso da gestação. O momento para a realização do procedimento e os cuidados necessários para o implante do CDI durante a gestação são discutidos e foram os principais objetivos deste relato.We describe the successful implantation of a cardioverter-defibrillator (ICD in two pregnant women with hypertrophic cardiomyopathy at high risk. The indication of ICD and the necessary care for ICD implantation during pregnancy are discussed and were the main objectives of this case report.

  12. A pilot study of a mindfulness based stress reduction program in adolescents with implantable cardioverter defibrillators or pacemakers.

    Science.gov (United States)

    Freedenberg, Vicki A; Thomas, Sue A; Friedmann, Erika

    2015-04-01

    Adolescents with implantable cardioverter defibrillators (ICDs) or pacemakers (PMs) face unique challenges that can cause psychosocial distress. Psychosocial interventions are effective for adults with cardiac devices and could potentially impact adolescents' adjustment to these devices. Mindfulness Based Stress Reduction (MBSR) is a structured psycho-educational program that includes meditation, yoga, and group support and has been studied extensively among adults. This study examined the feasibility of the MBSR program for adolescents with ICDs/PMs, a population previously unexamined in the research literature. The participants completed measures of anxiety and depression (Hospital Anxiety and Depression Scale) and coping (Responses to Stress Questionnaire) at baseline and after the six-session MBSR intervention. Mean age of the cohort (n = 10) was 15 ± 3 years, 6 were male, 6 had a PM, and 4 had an ICD. Feasibility was demonstrated by successful recruitment of 10 participants, 100 % participation and completion. Anxiety decreased significantly following the intervention, with a large effect size, t[9] = 3.67, p MBSR interventions in adolescents with high-risk cardiac diagnoses.

  13. A pilot study of a mindfulness based stress reduction program in adolescents with implantable cardioverter defibrillators or pacemakers.

    Science.gov (United States)

    Freedenberg, Vicki A; Thomas, Sue A; Friedmann, Erika

    2015-04-01

    Adolescents with implantable cardioverter defibrillators (ICDs) or pacemakers (PMs) face unique challenges that can cause psychosocial distress. Psychosocial interventions are effective for adults with cardiac devices and could potentially impact adolescents' adjustment to these devices. Mindfulness Based Stress Reduction (MBSR) is a structured psycho-educational program that includes meditation, yoga, and group support and has been studied extensively among adults. This study examined the feasibility of the MBSR program for adolescents with ICDs/PMs, a population previously unexamined in the research literature. The participants completed measures of anxiety and depression (Hospital Anxiety and Depression Scale) and coping (Responses to Stress Questionnaire) at baseline and after the six-session MBSR intervention. Mean age of the cohort (n = 10) was 15 ± 3 years, 6 were male, 6 had a PM, and 4 had an ICD. Feasibility was demonstrated by successful recruitment of 10 participants, 100 % participation and completion. Anxiety decreased significantly following the intervention, with a large effect size, t[9] = 3.67, p depression (r = -.88, p = .001). Post-intervention, the group independently formed their own Facebook group and requested to continue meeting monthly. Although generalizability is limited due to the small sample size, this successful pilot study paves the way for larger studies to examine the efficacy of MBSR interventions in adolescents with high-risk cardiac diagnoses. PMID:25519914

  14. 起搏器和植入性心律转复除颤器的召回和安全警示%Recalls and Safety Alerts Involving Pacemakers and Implantable Cardioverter-Defibrillator Generators

    Institute of Scientific and Technical Information of China (English)

    William H.Maisel; Maisel O. Sweeney; William G.Stevenson; Kristin E.Ellison; Laurence M. Epstein

    2002-01-01

    @@ 背景:起搏器和植入性心律转复除颤器(implantable cardioverter-defibrillator,ICD)常常发生出乎预料的故障,需由美国食品与药物管理局(FDA)召回(recall).尽管起搏器和ICD植入日益增多,但对它们的召回和安全警示(报告)知之甚少.

  15. Psychological intervention following implantation of an implantable defibrillator

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; van den Broek, Krista C; Sears, Samuel F

    2007-01-01

    The medical benefits of the implantable cardioverter defibrillator (ICD) are unequivocal, but a subgroup of patients experiences emotional difficulties following implantation. For this subgroup, some form of psychological intervention may be warranted. This review provides an overview of current...

  16. Clinical effects and implications of cardiac rehabilitation for implantable cardioverter defibrillator patients

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Moons, Philip; Christensen, Anne Vingaard;

    2015-01-01

    BACKGROUND:: The Copenhagen Outpatient ProgrammE-Implantable Cardioverter Defibrillator trial was a randomized clinical trial that compared a complex rehabilitation intervention including exercise training and psychoeducational interventions with usual care. A significant difference between...... rehabilitation and usual care was found in physical capacity and general and mental health. However, the clinical effect sizes of these findings were not investigated, and the findings from the quantitative and qualitative analyses were not triangulated to address the issue of whether the qualitative results......-time implantable cardioverter defibrillator implantation were randomized (1:1) to comprehensive cardiac rehabilitation (12 weeks of exercise training and 1 year of psychoeducational follow-up) versus treatment as usual. Two primary outcomes, perceived health (Short Form-36) and peak oxygen uptake, were used. Cohen...

  17. Investigation of Pt, Ti, TiN, and nano-porous carbon electrodes for implantable cardioverter-defibrillator applications

    Energy Technology Data Exchange (ETDEWEB)

    Norlin, A.; Pan, J.; Leygraf, C

    2004-09-15

    The electrochemical behavior and stability of Pt, Ti, TiN, and nano-porous carbon for implantable cardioverter-defibrillator (ICD) electrode application were investigated in a phosphate buffered saline solution. The electrochemical interfacial properties were examined by electrochemical impedance spectroscopy, and the potential and current response during ICD shock pulses were recorded by a digital oscilloscope. Changes in surface composition and structure were investigated using X-ray photoelectron spectroscopy and environmental scanning electron microscopy. When exposed to anodic 700 V shock pulses with duration of 10 ms, only Pt was stable, nano-porous carbon electrode was slightly attacked, whereas Ti and TiN electrodes suffered severe degradation. Upon cathodic shock pulsing, all the materials were stable, but Ti and TiN electrodes with a smooth surface showed evidence of hydrogen adsorption. Porous and rough electrodes produced less gas evolution compared to a smooth surfaces, due to a higher amount of charge transferred through non-Faradaic processes. The reason for this could be higher interfacial capacity due to the large surface area.

  18. Gender differences in appropriate shocks and mortality among patients with primary prophylactic implantable cardioverter-defibrillators: Systematic review and meta-analysis

    CERN Document Server

    Conen, David; Röver, Christian; Bergau, Leonard; Muñoz, Pascal; Wijers, Sofieke; Sticherling, Christian; Zabel, Markus; Friede, Tim

    2016-01-01

    BACKGROUND: Some but not all prior studies have shown that women receiving a primary prophylactic implantable cardioverter defibrillator (ICD) have a lower risk of death and appropriate shocks than men. PURPOSE: To evaluate the effect of gender on the risk of appropriate shock, all-cause mortality and inappropriate shock in contemporary studies of patients receiving a primary prophylactic ICD. DATA SOURCE: PubMed, LIVIVO, Cochrane CENTRAL between 2010 and 2016. STUDY SELECTION: Studies providing at least 1 gender-specific risk estimate for the outcomes of interest. DATA EXTRACTION: Abstracts were screened independently for potentially eligible studies for inclusion. Thereby each abstract was reviewed by at least two authors. DATA SYNTHESIS: Out of 680 abstracts retained by our search strategy, 20 studies including 46'657 patients had gender-specific information on at least one of the relevant endpoints. Mean age across the individual studies varied between 58 and 69 years. The proportion of women enrolled ran...

  19. Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators

    DEFF Research Database (Denmark)

    Zaremba, Tomas; Jakobsen, Annette Ross; Søgaard, Mette;

    2016-01-01

    defibrillators malfunctioning at low radiation doses. Besides scant knowledge about optimal safety measures, only little is known about the exact prevalence of patients with devices undergoing RT. In this review, we provide a short overview of the principles of RT and present the current evidence on the...

  20. The Medtronic Sprint Fidelis Lead Advisory Notification has no adverse impact on patient reported outcomes in Danish implantable cardioverter defibrillator patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne Møller; Versteeg, Henneke; Nielsen, Jens C.;

    The Medtronic Sprint Fidelis Lead Advisory Notification has no adverse impact on patient reported outcomes in Danish implantable cardioverter defibrillator patients.......The Medtronic Sprint Fidelis Lead Advisory Notification has no adverse impact on patient reported outcomes in Danish implantable cardioverter defibrillator patients....

  1. The Medtronic Sprint Fidelis Lead Advisory Notification Has No Adverse Impact on Patient Reported Outcomes in Danish Implantable Cardioverter Defibrillator Patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne Møller; Versteeg, Henneke; Nielsen, Jens C.;

    The Medtronic Sprint Fidelis Lead Advisory Notification Has No Adverse Impact on Patient Reported Outcomes in Danish Implantable Cardioverter Defibrillator Patients.......The Medtronic Sprint Fidelis Lead Advisory Notification Has No Adverse Impact on Patient Reported Outcomes in Danish Implantable Cardioverter Defibrillator Patients....

  2. Beam Profile Disturbances from Implantable Pacemakers or Implantable Cardioverter-Defibrillator Interactions

    Energy Technology Data Exchange (ETDEWEB)

    Gossman, Michael S., E-mail: mgossman@tsrcc.com [Tri-State Regional Cancer Center, Medical Physics Section, Ashland, KY (United States); Comprehensive Heart and Vascular Associates, Heart and Vascular Center, Ashland, KY (United States); Medtronic, Inc., External Research Program, Mounds View, MN (United States); Nagra, Bipinpreet; Graves-Calhoun, Alison; Wilkinson, Jeffrey [Tri-State Regional Cancer Center, Medical Physics Section, Ashland, KY (United States); Comprehensive Heart and Vascular Associates, Heart and Vascular Center, Ashland, KY (United States); Medtronic, Inc., External Research Program, Mounds View, MN (United States)

    2011-01-01

    The medical community is advocating for progressive improvement in the design of implantable cardioverter-defibrillators and implantable pacemakers to accommodate elevations in dose limitation criteria. With advancement already made for magnetic resonance imaging compatibility in some, a greater need is present to inform the radiation oncologist and medical physicist regarding treatment planning beam profile changes when such devices are in the field of a therapeutic radiation beam. Treatment plan modeling was conducted to simulate effects induced by Medtronic, Inc.-manufactured devices on therapeutic radiation beams. As a continuation of grant-supported research, we show that radial and transverse open beam profiles of a medical accelerator were altered when compared with profiles resulting when implantable pacemakers and cardioverter-defibrillators are placed directly in the beam. Results are markedly different between the 2 devices in the axial plane and the sagittal planes. Vast differences are also presented for the therapeutic beams at 6-MV and 18-MV x-ray energies. Maximum changes in percentage depth dose are observed for the implantable cardioverter-defibrillator as 9.3% at 6 MV and 10.1% at 18 MV, with worst distance to agreement of isodose lines at 2.3 cm and 1.3 cm, respectively. For the implantable pacemaker, the maximum changes in percentage depth dose were observed as 10.7% at 6 MV and 6.9% at 18 MV, with worst distance to agreement of isodose lines at 2.5 cm and 1.9 cm, respectively. No differences were discernible for the defibrillation leads and the pacing lead.

  3. Inappropriate shocks in the subcutaneous ICD

    DEFF Research Database (Denmark)

    Olde Nordkamp, Louise R A; Brouwer, Tom F; Barr, Craig;

    2015-01-01

    BACKGROUND: The entirely subcutaneous implantable cardioverter-defibrillator (S-ICD) eliminates the need for transvenous leads, and therefore has the potential to improve lead-longevity and reduce lead-related complications. The S-ICD has a morphology-based sensing algorithm of which inappropriat...

  4. Efficacy of cognitive behavioral therapy in reducing psychiatric symptoms in patients with implantable cardioverter defibrillator: an integrative review

    Directory of Open Access Journals (Sweden)

    A.C.C.O. Maia

    2014-04-01

    Full Text Available This article is a systematic review of the available literature on the benefits that cognitive behavioral therapy (CBT offers patients with implanted cardioverter defibrillators (ICDs and confirms its effectiveness. After receiving the device, some patients fear that it will malfunction, or they remain in a constant state of tension due to sudden electrical discharges and develop symptoms of anxiety and depression. A search with the key words “anxiety”, “depression”, “implantable cardioverter”, “cognitive behavioral therapy” and “psychotherapy” was carried out. The search was conducted in early January 2013. Sources for the search were ISI Web of Knowledge, PubMed, and PsycINFO. A total of 224 articles were retrieved: 155 from PubMed, 69 from ISI Web of Knowledge. Of these, 16 were written in a foreign language and 47 were duplicates, leaving 161 references for analysis of the abstracts. A total of 19 articles were eliminated after analysis of the abstracts, 13 were eliminated after full-text reading, and 11 articles were selected for the review. The collection of articles for literature review covered studies conducted over a period of 13 years (1998-2011, and, according to methodological design, there were 1 cross-sectional study, 1 prospective observational study, 2 clinical trials, 4 case-control studies, and 3 case studies. The criterion used for selection of the 11 articles was the effectiveness of the intervention of CBT to decrease anxiety and depression in patients with ICD, expressed as a ratio. The research indicated that CBT has been effective in the treatment of ICD patients with depressive and anxiety symptoms. Research also showed that young women represented a risk group, for which further study is needed. Because the number of references on this theme was small, further studies should be carried out.

  5. Phantom shocks in patients with implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Moons, Philip; Zwisler, Ann-Dorthe;

    2013-01-01

    of phantom shocks.METHODS AND RESULTS: The design was secondary explorative analyses of data from a randomized controlled trial. One hundred and ninety-six patients with first-time ICD implantation (79% male, mean age 58 years) were randomized (1 : 1) to either combined rehabilitation or a control group...

  6. Venous thromboembolism in patients with implantable cardioverter-defibrillators

    DEFF Research Database (Denmark)

    Pedersen, Susanne Bendesgaard; Hjortshøj, Søren Pihlkjær; Bøtker, Hans Erik;

    2016-01-01

    , overall and according to gender, age, Charlson Comorbidity Index score (no, moderate, or severe comorbidity), prior pacemaker or cardiac resynchronization therapy (CRT-D) implantation, and ICD type (single-chamber, dual-chamber, or CRT-D). We computed the risk of VTE within 3 months and 5 years...

  7. Rationale, design, and baseline characteristics of the DANish randomized, controlled, multicenter study to assess the efficacy of Implantable cardioverter defibrillators in patients with non-ischemic Systolic Heart failure on mortality (DANISH)

    DEFF Research Database (Denmark)

    Thune, Jens Jakob; Pehrson, Steen; Nielsen, Jens Cosedis;

    2016-01-01

    BACKGROUND: The effect of an implantable cardioverter defibrillator (ICD) in patients with symptomatic systolic heart failure (HF) caused by coronary artery disease is well documented. However, the effect of primary prophylactic ICDs in patients with systolic HF not due to coronary artery disease...... by coronary artery disease have been randomized to receive an ICD or not, in addition to contemporary standard therapy. The primary outcome of the trial is time to all-cause death. Follow-up will continue until June 2016 with a median follow-up period of 5 years. Baseline characteristics show that enrolled...... (range, 21-84 years) at baseline, and 28% were women. CONCLUSION: DANISH will provide pertinent information about the effect on all-cause mortality of a primary prophylactic ICD in patients with symptomatic systolic HF not caused by coronary artery disease on contemporary standard therapy including CRT....

  8. Intensity of primary emotions in patients after implantation of an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Stoier, Louise; Pedersen, Preben Ulrich; Berg, Selina Kikkenborg

    2013-01-01

    the support needed for coping. Living with an Implantable Cardi- overter Defibrillator can lead to anxiety and depression. Focus on the intensity of the primary emotions might be a potential to prevent development of these psychological states. Objectives: The aim of this paper are 1) to describe......-test. Results: One hundred and ninety-six patients were invited to fill in the questionnaire. It was completed by 182, a response rate of 93 %. Patients with a newly implanted Implantable Cardioverter Defibrillator experienced an increased intensity of joy, sadness, disgust, anticipation, anger, fear...... and surprise. No difference was found regarding the intensity of the primary emotions when the group of patients was divided according to occupation or age. A significant increase in the negative emotions sadness, disgust, anger and surprise was observed in women and in patients who receive the Implantable...

  9. Worldwide experience with a totally subcutaneous implantable defibrillator: Early results from the EFFORTLESS S-ICD registry

    NARCIS (Netherlands)

    P.D. Lambiase (Pier); C.S. Barr (Craig); D.A.M.J. Theuns (Dominic); R.E. Knops (Reinoud); P. Neuzil (Petr); J.B. Johansen (Jens); A.M. Hood (Margaret); S.S. Pedersen (Susanne); S. Kääb (Stefan); F.D. Murgatroyd (Francis); H.L. Reeve (Helen); N. Carter (Nathan); L. Boersma (Lucas)

    2014-01-01

    textabstractAims The totally subcutaneous implantable-defibrillator (S-ICD) is a new alternative to the conventional transvenous ICD system to minimize intravascular lead complications. There are limited data describing the long-term performance of the S-ICD. This paper presents the first large inte

  10. Nurse- and peer-led self-management programme for patients with an implantable cardioverter defibrillator; a feasibility study

    Directory of Open Access Journals (Sweden)

    van Eijk Jacques

    2007-09-01

    Full Text Available Abstract Background The prevalence of cardiovascular disease is increasing. Improved treatment options increase survival after an acute myocardial infarction or sudden cardiac arrest, although patients often have difficulty adjusting and regaining control in daily life. In particular, patients who received an implantable cardioverter defibrillator (ICD experience physical and psychological problems. Interventions to enhance perceived control and acceptance of the device are therefore necessary. This paper describes a small-scale study to explore the feasibility and the possible benefits of a structured nurse- and peer-led self-management programme ('Chronic Disease Self-Management Program' – CDSMP among ICD patients. Methods Ten male ICD patients (mean age = 65.5 years participated in a group programme, consisting of six sessions, led by a team consisting of a nurse specialist and a patient with cardiovascular disease. Programme feasibility was evaluated among patients and leaders by measuring performance of the intervention according to protocol, attendance and adherence of the participating ICD patients, and patients' and leaders' opinions about the programme. In addition, before and directly after attending the intervention, programme benefits (e.g. perceived control, symptoms of anxiety and depression, and quality of life were assessed. Results The programme was conducted largely according to protocol. Eight patients attended at least four sessions, and adherence ranged from good to very good. On average, the patients reported to have benefited very much from the programme, which they gave an overall report mark of 8.4. The leaders considered the programme feasible as well. Furthermore, improvements were identified for general self-efficacy expectancies, symptoms of anxiety, physical functioning, social functioning, role limitations due to physical problems, and pain. Conclusion This study suggests that a self-management programme led by a

  11. Prophylactic use of implantable cardioverter-defibrillators in the elderly population

    Institute of Scientific and Technical Information of China (English)

    Yuchuan LIU; Hue-Teh Shih

    2005-01-01

    @@ Introduction Sudden cardiac death (SCD) accounts for approximately 300,000 deaths each year in the United States. Ventricular fibrillation, as the initial event, had been reported in 65%-85% of these patients.1 An implantable cardioverterdefibrillator (ICD) is the single most effective life saving device to date. The advances in medicine and technology have led to wide spread utilization of defibrillators in developed countries.

  12. Experience With the Wearable Cardioverter-Defibrillator in Patients at High Risk for Sudden Cardiac Death

    Science.gov (United States)

    Günther, Michael; Quick, Silvio; Pfluecke, Christian; Rottstädt, Fabian; Szymkiewicz, Steven J.; Ringquist, Steven; Strasser, Ruth H.; Speiser, Uwe

    2016-01-01

    Background: This study evaluated the wearable cardioverter-defibrillator (WCD) for use and effectiveness in preventing sudden death caused by ventricular tachyarrhythmia or fibrillation. Methods: From April 2010 through October 2013, 6043 German WCD patients (median age, 57 years; male, 78.5%) were recruited from 404 German centers. Deidentified German patient data were used for a retrospective, nonrandomized analysis. Results: Ninety-four patients (1.6%) were treated by the WCD in response to ventricular tachyarrhythmia/fibrillation. The incidence rate was 8.4 (95% confidence interval, 6.8–10.2) per 100 patient-years. Patients with implantable cardioverter-defibrillator explantation had an incidence rate of 19.3 (95% confidence interval, 12.2–29.0) per 100 patient-years. In contrast, an incidence rate of 8.2 (95% confidence interval, 6.4–10.3) was observed in the remaining cardiac diagnosis groups, including dilated cardiomyopathy, myocarditis, and ischemic and nonischemic cardiomyopathies. Among 120 shocked patients, 112 (93%) survived 24 hours after treatment, whereas asystole was observed in 2 patients (0.03%) with 1 resulting death. ConclusionS: This large cohort represents the first nationwide evaluation of WCD use in patients outside the US healthcare system and confirms the overall value of the WCD in German treatment pathways. PMID:27458236

  13. Successful use of wearable cardioverter defibrillator in a patient with dextrocardia and persistent left superior vena cava.

    Science.gov (United States)

    Wan, Chingping; Oren, Jess W; Szymkiewicz, Steven J

    2013-09-01

    Congenital disorders, such as dextrocardia and persistent left superior vena cava, are rare. However, their presence is often associated with other cardiac anomalies, and may lead to lethal ventricular tachyarrhythmias, which result in sudden cardiac death. Treating patients with these disorders can present a challenge to clinicians, as it may cause technical difficulties during interventional procedures, and more often, altered defibrillation techniques in a setting of prehospital sudden cardiac arrest. This report describes the first case of successful defibrillation therapy delivered by the wearable cardioverter defibrillator to a patient with dextrocardia and persistent left superior vena cava during a ventricular tachycardia arrest.

  14. Analysis of implantable cardioverter-defibrillator lead failures%植入型心律转复除颤器导线故障分析

    Institute of Scientific and Technical Information of China (English)

    陈太波; 程康安; 程中伟; 范静波; 姜秀春; 方全

    2011-01-01

    目的 总结分析我院植入型心律转复除颤器( ICD)起搏除颤导线故障病例特点。方法 对2005年10月至2009年12月62例在我院新植入ICD导线患者进行随访分析,所有导线植入均以锁骨下静脉作为入路。随访中出现以下1项或多项异常考虑导线故障:(1)起搏阻抗永久性或间歇性>2000 Ω或<250 Ω;(2)除颤高压阻抗>200 Ω;(3)心内电图证实除颤导线感知非生理性高频噪声导致误放电。结果 中位数随访时间28(10 ~46)个月,4例患者(6.5%)诊断ICD导线故障,导线寿命18~38个月;临床均以ICD误放电至医院就诊,同时程控发现ICD导线起搏阻抗异常。其中l例患者放电前闻及ICD导线阻抗报警,4例患者均重新植入新的起搏感知导线。结论 ICD导线故障是一个值得重视的临床问题。ICD导线阻抗报警功能可能有助于早期发现导线故障。如程控发现仅仅除颤导线起搏阻抗异常,植入新的起搏感知导线可以作为首选的故障处理方法。%Objective The aim of the present study was to analyze the characteristics of patients with defibrillation lead failures after implantable cardioverter-defibrillator( ICD)implantation. Methods From Oct. 2005 to Dec 2009 we implanted a new defibrillation lead for 62 consecutive cases, among which all leads were implanted by puncture of the subclavian vein. A lead failure was diagnosed if one or more of the following criteria were met: ( 1 ) permanent or temporary pacing impedance increased to more than 2000 ohms or decreased to less than 200 to 250 ohms; ( 2 ) permanent or temporary high voltage impedance increased to more than 200ohms ; (3) inappropriate shock due to oversensing non-physiologic high frequence noises was documented by intracardiac electrogram. Results During the median follow-up of 28 months ( between 10 and 46 months after implantation) 4 (6. 5% )defibrillation leads failed and the leads survival time ranged

  15. Postoperative infection with the automatic implantable cardioverter defibrillator: clinical presentation and use of the gallium scan in diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, P.A.; Wallace, S.; Tucker, B.; Hurvitz, R.J.; Ilvento, J.; Mirabel, G.S.; Cannom, D.S.

    1988-08-01

    This report describes three patients with infection involving an automatic implantable cardioverter defibrillator. All three patients presented with fever, fluid in the pulse generator pocket, leukocytosis and an elevated erythrocyte sedimentation rate. A gallium scan, together with aspiration and culture of the fluid from the pocket, confirmed the diagnosis in each case.

  16. The mismatch between patient life expectancy and the service life of implantable devices in current cardioverter-defibrillator therapy: a call for larger device batteries.

    Science.gov (United States)

    Neuzner, Jörg

    2015-06-01

    In 2005, Bob Hauser published a paper in the Journal of the American College of Cardiology entitled "The growing mismatch between patient longevity and the service life of Implantable Cardioverter-Defibrillators". Now, nearly a decade later, I would like to perform a second look on the problem of a mismatching between ICD device service life and the survival of ICD recipients. Since 2005, the demographics of the ICD population has changed significantly. Primary prevention has become the dominant indication in defibrillator therapy and device implantation is indicated more and more in earlier stages of cardiac diseases. In former larger scale ICD trials, the patient average 5-year survival probability was in a range of 68-71%; in newer CRT-D trials in a range of 72-88%. Due to a progressively widened ICD indication and implantation preferentially performed in patients with better life expectancy, the problem of inadequate device service life is of growing importance. The early days of defibrillator therapy started with a generator volume of 145 ccm and a device service life service life were similar challenges for the technicians. Today, we have reached a formerly unexpected extent of device miniaturization. However, technologic improvements were often preferentially translated in further device miniaturization and not in prolonging device service life. In his analysis, Bob Hauser reported a prolonged device service life of 2.3 years in ICD models with a larger battery capacity of 0.54 up to 0.69 Ah. Between 2008 and 2014, several studies had been published on the problem of ICD longevity in clinical scenarios. These analyses included "older" and currently used single chamber, dual chamber and CRT devices. The reported average 5-year device service life ranged from 0 to 75%. Assuming today technology, larger battery capacities will only result in minimal increase in device volume. Selected ICD patients may further benefit from device miniaturization-but the vast

  17. Implantable cardioverter-defibrillator therapy in a 34-year-old patient with eating disorders and after the third sudden cardiac arrest.

    Science.gov (United States)

    Piotrowicz, Ewa; Orzechowski, Piotr; Bilinska, Maria; Przybylski, Andrzej; Szumowski, Lukasz; Piotrowicz, Ryszard

    2015-03-01

    Eating disorders (ED) such as anorexia nervosa and bulimia are psychiatric diseases associated with the highest mortality rate of any other psychiatric disorders. More recently, long-term outcome studies with follow-up of over 20 years report a mortality of between 15% and 18% (Casiero and Frishman, Cardiol Rev 14(5), 227, 2006). The sudden death secondary to arrhythmias is often the cause of death in these patients (Casiero and Frishman, Cardiol Rev 14(5), 227, 2006). A case of life-threatening ventricular arrhythmia (VA) in a patient with ED is presented. Clinical records (cardiologic, psychiatric), electrocardiograms, echocardiogram, coronary angiogram, cardiac magnetic resonance, and endocrine diagnostics were performed. Finally a cardioverter-defibrillator (ICD) was implanted in the patient after her third cardiac arrest. An optimal approach to antiarrhythmic therapy in such patients is a real challenge for a cardiologist.

  18. Relevance of guideline-based ICD indications to clinical practice

    OpenAIRE

    Al-Jefairi, Nora; Burri, Haran

    2014-01-01

    The implantable cardioverter-defibrillator (ICD) has established itself as life-saving therapy in patients at risk for sudden cardiac death. Remarkable technological advances have made ICDs easier and safer to implant, with improved therapeutic and diagnostic functions and reduced morbidity.

  19. 埋藏式心脏转复除颤器植入术中除颤阈值测试的管理%Management of defibrillation threshold test in the implantation of implantable cardioverter defibrillator

    Institute of Scientific and Technical Information of China (English)

    周燕; 王玉如; 翟大玲; 徐金凤; 胡玉芳; 陈桂花; 何英; 殷雪梅

    2013-01-01

    目的 探讨埋藏式心脏转复除颤器(ICD)植入术中除颤阈值(DFT)测试过程中的监护与管理要点,降低测试过程中的并发症发生率.方法 回顾性分析50例植入ICD患者术中DFT测试与管理的过程,观察在规范化监护和管理下并发症的发生率.结果 50例患者植入手术过程顺利.1例患者在测试中首次除颤未成功,第2次予最大能量除颤成功;1例在行DFT测试后出现持续低血压和低血氧状态,通过及时应用升压药和增大给氧流量后恢复;1例患者诱发室颤未成功,放弃DFT测试,给予经验性能量设置.术后所有患者生命体征平稳,无手术相关重大并发症发生.结论 ICD除颤阈值测试的过程中,有出现持续低血压、低血氧和除颤阈值偏高等情况的可能,全面、有效的监护管理能显著降低DFT测试中的风险.%Objective To explore the guardianship and management points of defibrillation threshold test(DFT) in the implantation of implantable cardioverter defibrillator (ICD). Methods Test and management procedures of DFT in 50 patients with ICD implantation were analyzed retrospectively. Incidence rate of complications was observed under the standardized guardianship and management. Results All the patients had successful operations. One patient failed in the first defibrillation, and then had successful defibrillation with a maximum energy in second time. One patient had persistent hypotension and hypoxemia after DFT, which were corrected after application of pressor agent and increasing of oxygen flow. One patient received empirical energy setting instead of DFT because of ventricular fibrillation. After the operation, all the patients'vital signs were stable, and no one had severe operation- related complications. Conclusion Persistent hypotension, hypoxemia and high defibrillation threshold may occur in process of DFT, and comprehensive and effective management and guardianship can significantly reduce the

  20. The NO Regular Defibrillation testing In Cardioverter Defibrillator Implantation (NORDIC ICD) trial

    DEFF Research Database (Denmark)

    Bänsch, Dietmar; Bonnemeier, Hendrik; Brandt, Johan;

    2015-01-01

    was standardized across all participating centres. After inducing a fast ventricular tachycardia (VT) with a heart rate ≥240 b.p.m. or ventricular fibrillation (VF) with a low-energy T-wave shock, DF was attempted with an initial 15 J shock. If the shock reversed the VT or VF, DF testing was considered successful...

  1. Quality of Life in Young Adult Patients with a Cardiogenetic Condition Receiving an ICD for Primary Prevention of Sudden Cardiac Death

    NARCIS (Netherlands)

    Verkerk, Agnes J.; Vermeer, Alexa M.; Smets, Ellen M.; Dekker, Lukas R.; Wilde, Arthur A.; Van Langen, Irene M.; Christiaans, Imke; Nieuwkerk, Pythia T.

    2015-01-01

    BackgroundProphylactic implantable cardioverter defibrillator (ICD) therapy prevents sudden cardiac death (SCD) among young adults with cardiogenetic conditions, but might reduce quality of life (QoL) due to potential device complications, ongoing medical appointments, and lifestyle restrictions. We

  2. Desfibrilador cardioversor automático implantável: experiência inicial Implantable cardioverter defibrillator: initial experience

    Directory of Open Access Journals (Sweden)

    Victor BAUER JÚNIOR

    1999-04-01

    Full Text Available Este estudo tem por objetivo demonstrar o protocolo de implante, técnica utilizada, avaliação dos parâmetros iniciais do implante de desfibrilador cardioversor automático implantável (DCAI e seguimento precoce dos 15 pacientes operados em nosso Serviço. O implante transvenoso nessa série de pacientes obteve sucesso em 14 casos. O limiar de desfibrilação teve média de 8,05 ± 4,60 Joules, onda R 16,00 ± 4,32 mV, "slew rate" 1,25 ± 0,29 V/s, limiar de comando de 0,65 ± 0,80 Volts e resistência de 620,00 ± 102,77 Ohms. O tempo médio de implante foi de 164,17 ± 71,15 minutos. Não ocorreu morte operatória, nem episódios de rejeição ou infecção. A média de seguimento foi de 18,79 ± 13,81 meses sendo que 9 pacientes receberam choques apropriados com reversão das arritmias. Choques inapropriados ocorreram em uma paciente devido à perda do limiar de sensibilidade do cardioversor. Observamos a facilidade técnica do implante utilizando o modelo Phylax 06 na região infraclavicular esquerda com eletrodo único, sendo o DCAI capaz de reconhecer e realizar a terapia de cardioversão ou desfibrilação com sucesso, sugerindo ser um método importante e eficaz para o tratamento dos pacientes que desenvolvem arritmias com alto risco de mortalidade em ambulatório.The implantable cardioverter-defibrillator (ICD is gaining increasing significance in therapy of life-threatening ventricular arrhythmias. Mirowski started to develop experimental automatic implantable defibrillators in the seventies. In 1980, the first human implant of an automatic implantable defibrillator was done by the team of Mirowski in Baltimore, USA. The purpose of this report is to examine 15 implantation at our Institution. Adequate defibrillation thresholds with were obrtained mean 8.0 Joules, slew rate 1.25 V/s and impedance of 620 Ohms. All implants were performed with non-thoracotomy lead, two abdominal implantations and three left pectoral implantations

  3. Silicone Breast Implant and Automatic Implantable Cardioverter Defibrillator: Can They Coexist? A Case Report

    Science.gov (United States)

    Arik, Zaretski

    2016-01-01

    Summary: We present a case of a silicone breast implant rupture after insertion of an automatic implantable cardioverter defibrillator (AICD). A 51-year-old woman presented to our plastic surgery clinic to exchange her silicone breast implants. The patient underwent cosmetic mastopexy and breast augmentation in 2008. Because of recurrent myocardial infarctions and chronic heart failure, she underwent an insertion of an AICD in 2014 in which the left breast implant was hit. In this report, we discuss the first case of an AICD insertion, disrupting a breast implant. This case report illustrates the rare but real possibility of breast implant rupture after even minor surgical manipulation of the breast area. PMID:27622117

  4. Pacemakers and implantable cardioverter defibrillators, unknown to chest radiography: Review, complications and systematic reading

    Energy Technology Data Exchange (ETDEWEB)

    Alandete Germán, Salvador Pascual, E-mail: salaiger@gmail.com; Isarria Vidal, Santiago, E-mail: isarria@comv.es; Domingo Montañana, María Luisa, E-mail: domingo.luimon@gmail.com; De la vía Oraá, Esperanza, E-mail: esviao82@gmail.com; Vilar Samper, José, E-mail: vilarsamper@gmail.com

    2015-03-15

    Highlights: •Radiologists have an important function in the evaluation of these devices. •We revise their radiological appearances and possible complications. •The knowledge in normal aspects and complications is important for radiologist. •To ensure an accurate reading of the chest x-ray, we present a systematic approach. -- Abstract: Chest X-ray is the imaging technique of choice for an initial study of pacemakers and implantable cardio-defibrillators (ICD). Radiologists have an important role in the evaluation of its initial placement and in the assessment during its follow-up. For this reason, it is necessary to know not only the different existing devices and its components but also the reasons of malfunction or possible complications. The purpose of this article is to do a systematic review of the different types of pacemakers and ICD. We review their usual radiological appearances, the possible complications which might take place and its causes of malfunctioning.

  5. Pacemakers and implantable cardioverter defibrillators, unknown to chest radiography: Review, complications and systematic reading

    International Nuclear Information System (INIS)

    Highlights: •Radiologists have an important function in the evaluation of these devices. •We revise their radiological appearances and possible complications. •The knowledge in normal aspects and complications is important for radiologist. •To ensure an accurate reading of the chest x-ray, we present a systematic approach. -- Abstract: Chest X-ray is the imaging technique of choice for an initial study of pacemakers and implantable cardio-defibrillators (ICD). Radiologists have an important role in the evaluation of its initial placement and in the assessment during its follow-up. For this reason, it is necessary to know not only the different existing devices and its components but also the reasons of malfunction or possible complications. The purpose of this article is to do a systematic review of the different types of pacemakers and ICD. We review their usual radiological appearances, the possible complications which might take place and its causes of malfunctioning

  6. Prophylactic implantable defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia and no prior ventricular fibrillation or sustained ventricular tachycardia.

    LENUS (Irish Health Repository)

    Corrado, Domenico

    2010-09-21

    The role of implantable cardioverter-defibrillator (ICD) in patients with arrhythmogenic right ventricular cardiomyopathy\\/dysplasia and no prior ventricular fibrillation (VF) or sustained ventricular tachycardia is an unsolved issue.

  7. Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure

    DEFF Research Database (Denmark)

    Køber, Lars; Thune, Jens J; Nielsen, Jens C;

    2016-01-01

    Background The benefit of an implantable cardioverter-defibrillator (ICD) in patients with symptomatic systolic heart failure caused by coronary artery disease has been well documented. However, the evidence for a benefit of prophylactic ICDs in patients with systolic heart failure that is not due...

  8. General anaesthesia for insertion of an automated implantable cardioverter defibrillator in a child with Brugada and autism

    Directory of Open Access Journals (Sweden)

    Shwetal Goraksha

    2010-01-01

    Full Text Available A 14-year-old autistic boy presented with acute gastroenteritis and hypotension. The electrocardiogram showed a ventricular fibrillation rhythm - he went into cardiorespiratory arrest and was immediately resuscitated. On investigation, the electrocardiogram showed a partial right bundle branch block with a "coved" pattern of ST elevation in leads v 1 -v 3 . A provisional diagnosis of Brugada syndrome was made, for which an automated implantable cardioverter defibrillator (AICD implantation was advised. Although the automated implantable cardioverter defibrillator implantation is usually performed under sedation, because this was an autistic child, he needed general anaesthesia. We performed the procedure uneventfully under general anaesthesia and he was discharged after a short hospital stay.

  9. 置入型心律转复除颤器52例术中除颤阈值的测定及术后随访%Safety and efficacy of intraoperative defibrillation threshold measured by defibrillation safety margin n 52 patients with implantable cardioverter defibrillator

    Institute of Scientific and Technical Information of China (English)

    张宇; 袁宽道; 汤宝鹏; 马依彤; 张燕一; 王疆; 李晋新; 张疆华; 许国军

    2010-01-01

    Objective To observe the safety and efficacy of implantable cardioverter defibrillator (ICD) intraoperative defibrillation threshold (DFT) measured by defibrillation safety margin (DSM).Methods Fifty-two patients underwent ICD implantation were enrolled in this study (25 single chamber ICD, 23 double chamber ICD, 4 three chamber ICD). DFT was measured by DSM method. All patients were followuped regularly. Results DFT was ( 13.27 ± 2. 95 ) J and DSM was ( 17. 40 ± 2. 89 ) J in this patient cohort. There were no serious intraoperative complications. Malignant ventricular arrhythmia occurred in 38 patients post ICD, 469 episodes of nonsustained ventricular tachycardia (VT) were spontaneously terminated, 265 episodes were sustained VT and 245 (92. 5% ) episodes were successfully terminated by 1 antitachycardia pace treatment (ATP), 13(4. 89% ) episodes successfully terminated by 2 ATP, and ATP failed to terminate VT in 7 (2. 64% ) episodes and VTs were terminated by low energy cardioversion. All 141 episodes of ventricular fibrillation (VF) were successfully identified, and 14 episodes spontaneously terminated before discharging, 127 VF episodes (91.34%) were terminated by 1 energy shock,defibrillation energy was ( 12. 84 ±3. 18)J, 11 ( 12.2% ) VF episodes were terminated by 2 energy shocks,defibrillation energy was ( 16. 36 ± 2. 34)J. Conclusion It is safe and feasible to use defibrillation threshold measured by DSM for patients receiving ICD implantation.%目的 探讨置入型心律转复除颤器(ICD)置入术中除颤阈值(DFT)的测定方法并观察术后随访结果.方法 52例置入ICD患者,其中单腔ICD 25例(48.08%),双腔ICD 23例(44.23%),三腔ICD 4例(7.69%).置入术中用测定除颤安全范围(DSM)方法进行DFT测定,并对患者进行定期随访.结果 52例ICD置入术中,测得DFT为(13.27±2.95)J,DSM为(17.40±2.89)J,手术中无严重并发症发生.52例中,38例出现恶性室性心律失常,其中469次为非持续性(可自行终

  10. Frequency of inappropriate therapy in patients implanted with dual- versus single-chamber ICD devices in the ICD arm of MADIT-CRT

    DEFF Research Database (Denmark)

    Ruwald, Anne-Christine H; Sood, Nitesh; Ruwald, Martin H;

    2013-01-01

    The majority of implantable cardioverter defibrillators (ICDs) are dual-chamber devices, but studies on the frequency of inappropriate therapy in dual- versus single-chamber devices have shown conflicting results. The aim of this study is to determine whether implantation of dual-chamber ICD...

  11. Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators: a literature review.

    Science.gov (United States)

    Zaremba, Tomas; Jakobsen, Annette Ross; Søgaard, Mette; Thøgersen, Anna Margrethe; Riahi, Sam

    2016-04-01

    An increasing number of patients with implantable cardiac rhythm devices undergo radiotherapy (RT) for cancer and are thereby exposed to the risk of device failure. Current safety recommendations seem to have limitations by not accounting for the risk of pacemakers and implantable cardioverter defibrillators malfunctioning at low radiation doses. Besides scant knowledge about optimal safety measures, only little is known about the exact prevalence of patients with devices undergoing RT. In this review, we provide a short overview of the principles of RT and present the current evidence on the predictors and mechanisms of device malfunctions during RT. We also summarize practical recommendations from recent publications and from the industry. Strongly associated with beam energy of photon RT, device malfunctions occur at ∼3% of RT courses, posing a substantial issue in clinical practice. Malfunctions described in the literature typically consist of transient software disturbances and only seldom manifest as a permanent damage of the device. Through close cooperation between cardiologists and oncologists, a tailored individualized approach might be necessary in this patient group in waiting time for updated international guidelines in the field. PMID:26041870

  12. Prediction of Appropriate Shocks Using 24-Hour Holter Variables and T-Wave Alternans After First Implantable Cardioverter-Defibrillator Implantation in Patients With Ischemic or Nonischemic Cardiomyopathy.

    Science.gov (United States)

    Seegers, Joachim; Bergau, Leonard; Expósito, Pascal Muñoz; Bauer, Axel; Fischer, Thomas H; Lüthje, Lars; Hasenfuß, Gerd; Friede, Tim; Zabel, Markus

    2016-07-01

    In patients treated with implantable cardioverter defibrillator (ICD), prediction of both overall survival and occurrence of shocks is important if improved patient selection is desired. We prospectively studied the predictive value of biomarkers and indexes of cardiac and renal function and spectral microvolt T-wave alternans testing and 24-hour Holter variables in a population who underwent first ICD implantation. Consecutive patients in sinus rhythm with ischemic or dilated cardiomyopathy scheduled for primary or secondary prophylactic ICD implantation were enrolled. Exercise microvolt T-wave alternans and 24-hour Holter for number of ventricular premature contractions (VPCs), deceleration capacity, heart rate variability, and heart rate turbulence were done. Death of any cause and first appropriate ICD shock were defined as end points. Over 33 ± 15 months of follow-up, 36 of 253 patients (14%) received appropriate shocks and 39 of 253 patients (15%) died. Only 3 of 253 patients (1%) died after receiving at least 1 appropriate shock. In univariate analyses, New York Heart Association class, ejection fraction, N-terminal pro brain-type natriuretic peptide (NT-proBNP), renal function, ICD indication, deceleration capacity, heart rate variability, and heart rate turbulence were predictive of all-cause mortality and VPC number and deceleration capacity predicted first appropriate shock. NT-proBNP (≥1,600 pg/ml) was identified as the only independent predictor of all-cause mortality (hazard ratio 3.0, confidence interval 1.3 to 7.3, p = 0.014). In contrast, VPC number predicted appropriate shocks (hazard ratio 2.3, confidence interval 1.0 to 5.5, p = 0.047) as the only independent risk marker. In conclusion, NT-proBNP is a strong independent predictor of mortality in a typical prospective cohort of newly implanted patients with ICD, among many electrocardiographic and clinical variables studied. Number of VPCs was identified as a predictor of appropriate shocks

  13. No Electromagnetic Interference Occurred in a Patient with a HeartMate II Left Ventricular Assist System and a Subcutaneous Implantable Cardioverter-Defibrillator

    OpenAIRE

    Raman, Ajay Sundara; Shabari, Farshad Raissi; Kar, Biswajit; Loyalka, Pranav; Hariharan, Ramesh

    2016-01-01

    The use of subcutaneous implantable cardioverter-defibrillators is a novel option for preventing arrhythmia-mediated cardiac death in patients who are at risk of endovascular-device infection or in whom venous access is difficult. However, the potential for electromagnetic interference between subcutaneous defibrillators and left ventricular assist devices is largely unknown. We report the case of a 24-year-old man in whom we observed no electromagnetic interference between a subcutaneous imp...

  14. Is metal artefact reduction mandatory in cardiac PET/CT imaging in the presence of pacemaker and implantable cardioverter defibrillator leads?

    Energy Technology Data Exchange (ETDEWEB)

    Ghafarian, Pardis [Shahid Beheshti University, Department of Radiation Medicine, Tehran (Iran, Islamic Republic of); Geneva University Hospital, Division of Nuclear Medicine, Geneva 4 (Switzerland); Tehran University of Medical Sciences, Research Center for Science and Technology in Medicine, Tehran (Iran, Islamic Republic of); Aghamiri, S.M.R. [Shahid Beheshti University, Department of Radiation Medicine, Tehran (Iran, Islamic Republic of); Ay, Mohammad R. [Tehran University of Medical Sciences, Research Center for Science and Technology in Medicine, Tehran (Iran, Islamic Republic of); Tehran University of Medical Sciences, Department of Medical Physics and Biomedical Engineering, Tehran (Iran, Islamic Republic of); Tehran University of Medical Sciences, Research Institute for Nuclear Medicine, Tehran (Iran, Islamic Republic of); Rahmim, Arman [Johns Hopkins University, Department of Radiology, Baltimore, MD (United States); Schindler, Thomas H. [Geneva University, Cardiovascular Center, Nuclear Cardiology, Geneva (Switzerland); Ratib, Osman [Geneva University Hospital, Division of Nuclear Medicine, Geneva 4 (Switzerland); Zaidi, Habib [Geneva University Hospital, Division of Nuclear Medicine, Geneva 4 (Switzerland); Geneva University, Geneva Neuroscience Center, Geneva (Switzerland)

    2011-02-15

    Cardiac PET/CT imaging is often performed in patients with pacemakers and implantable cardioverter defibrillator (ICD) leads. However, metallic implants usually produce artefacts on CT images which might propagate to CT-based attenuation-corrected (CTAC) PET images. The impact of metal artefact reduction (MAR) for CTAC of cardiac PET/CT images in the presence of pacemaker, ICD and ECG leads was investigated using both qualitative and quantitative analysis in phantom and clinical studies. The study included 14 patients with various leads undergoing perfusion and viability examinations using dedicated cardiac PET/CT protocols. The PET data were corrected for attenuation using both artefactual CT images and CT images corrected using the MAR algorithm. The severity and magnitude of metallic artefacts arising from these leads were assessed on both linear attenuation coefficient maps ({mu}-maps) and attenuation-corrected PET images. CT and PET emission data were obtained using an anthropomorphic thorax phantom and a dedicated heart phantom made in-house incorporating pacemaker and ICD leads attached at the right ventricle of the heart. Volume of interest-based analysis and regression plots were performed for regions related to the lead locations. Bull's eye view analysis was also performed on PET images corrected for attenuation with and without the MAR algorithm. In clinical studies, the visual assessment of PET images by experienced physicians and quantitative analysis did not reveal erroneous interpretation of the tracer distribution or significant differences when PET images were corrected for attenuation with and without MAR. In phantom studies, the mean differences between tracer uptake obtained without and with MAR were 10.16{+-}2.1% and 6.86{+-}2.1% in the segments of the heart in the vicinity of metallic ICD or pacemaker leads, and were 4.43{+-}0.5% and 2.98{+-}0.5% in segments far from the leads. Although the MAR algorithm was able to effectively improve

  15. Is metal artefact reduction mandatory in cardiac PET/CT imaging in the presence of pacemaker and implantable cardioverter defibrillator leads?

    International Nuclear Information System (INIS)

    Cardiac PET/CT imaging is often performed in patients with pacemakers and implantable cardioverter defibrillator (ICD) leads. However, metallic implants usually produce artefacts on CT images which might propagate to CT-based attenuation-corrected (CTAC) PET images. The impact of metal artefact reduction (MAR) for CTAC of cardiac PET/CT images in the presence of pacemaker, ICD and ECG leads was investigated using both qualitative and quantitative analysis in phantom and clinical studies. The study included 14 patients with various leads undergoing perfusion and viability examinations using dedicated cardiac PET/CT protocols. The PET data were corrected for attenuation using both artefactual CT images and CT images corrected using the MAR algorithm. The severity and magnitude of metallic artefacts arising from these leads were assessed on both linear attenuation coefficient maps (μ-maps) and attenuation-corrected PET images. CT and PET emission data were obtained using an anthropomorphic thorax phantom and a dedicated heart phantom made in-house incorporating pacemaker and ICD leads attached at the right ventricle of the heart. Volume of interest-based analysis and regression plots were performed for regions related to the lead locations. Bull's eye view analysis was also performed on PET images corrected for attenuation with and without the MAR algorithm. In clinical studies, the visual assessment of PET images by experienced physicians and quantitative analysis did not reveal erroneous interpretation of the tracer distribution or significant differences when PET images were corrected for attenuation with and without MAR. In phantom studies, the mean differences between tracer uptake obtained without and with MAR were 10.16±2.1% and 6.86±2.1% in the segments of the heart in the vicinity of metallic ICD or pacemaker leads, and were 4.43±0.5% and 2.98±0.5% in segments far from the leads. Although the MAR algorithm was able to effectively improve the quality of

  16. Long-Term Performance of the Riata/ST Implantable Cardioverter-Defibrillator Lead.

    Science.gov (United States)

    Ströker, Erwin; de Asmundis, Carlo; Vanduynhoven, Philippe; De Vadder, Katrien; De Vusser, Philip; Mullens, Wilfried; Chierchia, Gian-Battista; Brugada, Pedro; Czapla, Jens; La Meir, Mark; Wellens, Francis; Van Herendael, Hugo; Rivero-Ayerza, Maximo

    2016-03-01

    Riata and Riata ST implantable cardioverter-defibrillator leads are prone to structural and electrical failure (EF). Our objective was to evaluate Riata/ST lead performance over a long-term follow-up. Of 184 patients having undergone Riata/ST and Riata ST Optim lead implantation from September 2003 to June 2008, 154 patients were evaluated for EF and radiographic conductor externalization (CE). Survival analysis for EF was performed for Riata/ST leads, both for failure-free lead survival and cumulative hazard. Subanalysis on 7Fr leads was performed to evaluate EF and CE rates both for different Riata ST lead management (monitoring vs proactive) and between Riata ST and Riata ST Optim leads. During a mean follow-up of 7 years, Riata/ST lead EF rate was 13% overall. Similar failure-free survival rate was noted for 7Fr as for 8Fr leads (log-rank, p = 0.63). Of all failed leads, 64% failed only after 5 years of follow-up. Compared with the absolute failure rate of 1.84% per device year, cumulative hazard analysis for leads surviving past 5 years revealed an estimated failure rate of 7% per year. No clinical or procedural predictors for EF were found. The subanalysis on 7Fr leads showed an excellent outcome both for a proactive lead management approach as for Optim leads. In conclusion, long-term survival of the Riata/ST lead is impaired with an accelerating EF risk over time. An initial exponential trend was followed by a linear lead failure pattern for leads surviving past 5 years, corresponding to an estimated 7% annual EF rate. These findings may have repercussions on the lead management strategy in patients currently surviving with a Riata/ST lead to prevent significant clinical events like inappropriate shocks or failed device interventions. PMID:26762730

  17. Rationale and design of a prospective study of the efficacy of a remote monitoring system used in implantable cardioverter defibrillator follow-up: the Lumos-T Reduces Routine Office Device Follow-Up Study (TRUST) study.

    Science.gov (United States)

    Varma, Niraj

    2007-12-01

    Increased implantable cardioverter defibrillator (ICD) implant volumes (and product advisories/recalls) pose management challenges. Most device interrogations at 3- to 6-month routine follow-up visits are "nonactionable," that is, require no clinically significant reprogramming, lead revision, or initiation or up-titration of antiarrhythmic medications. Conversely, implanted devices collect important diagnostic data (eg, atrial fibrillation onset, system integrity) that remain concealed between device interrogations. Remote monitoring may resolve some of these challenges, but has not been studied in a large-scale clinical trial. Home Monitoring (HM) uses automatic (without patient intervention) data and electrogram transmissions with rapid (automatically occur between periodic checks for compromised system integrity (battery, lead parameters, high-voltage circuitry) or arrhythmia occurrence (eg, atrial fibrillation, ventricular arrhythmia). All study patients will have a final office visit 15 months after implant. The results of TRUST may confirm the role of remote monitoring as an intensive surveillance mechanism for device management. PMID:18035071

  18. Nursing Experience on Electrical Storm of Implantable Cardioverter Defibrillator%植入型心脏转复除颤器患者发生电风暴的护理体会

    Institute of Scientific and Technical Information of China (English)

    丁恒

    2010-01-01

    心脏性猝死(sudden cardiac death,SCD)通常是致命性室性心律失常的最终结局.预防室性心律失常所致心源性猝死惟一有效的方法是植入植入型心脏转复除颤器(implantable cardioverter defibrillator,ICD)以减少心脏性猝死的发生[1].ICD已经从对室性心动过速(简称室速)、心室颤动(简称室颤)进行二级预防,扩展到对低射血分数的一级预防.

  19. Estimating dose to implantable cardioverter-defibrillator outside the treatment fields using a skin QED diode, optically stimulated luminescent dosimeters, and LiF thermoluminescent dosimeters

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Maria F., E-mail: chanm@mskcc.org [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Song, Yulin; Dauer, Lawrence T.; Li Jingdong; Huang, David; Burman, Chandra [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2012-10-01

    The purpose of this work was to determine the relative sensitivity of skin QED diodes, optically stimulated luminescent dosimeters (OSLDs) (microStar Trade-Mark-Sign DOT, Landauer), and LiF thermoluminescent dosimeters (TLDs) as a function of distance from a photon beam field edge when applied to measure dose at out-of-field points. These detectors have been used to estimate radiation dose to patients' implantable cardioverter-defibrillators (ICDs) located outside the treatment field. The ICDs have a thin outer case made of 0.4- to 0.6-mm-thick titanium ({approx}2.4-mm tissue equivalent). A 5-mm bolus, being the equivalent depth of the devices under the patient's skin, was placed over the ICDs. Response per unit absorbed dose-to-water was measured for each of the dosimeters with and without bolus on the beam central axis (CAX) and at a distance up to 20 cm from the CAX. Doses were measured with an ionization chamber at various depths for 6- and 15-MV x-rays on a Varian Clinac-iX linear accelerator. Relative sensitivity of the detectors was determined as the ratio of the sensitivity at each off-axis distance to that at the CAX. The detector sensitivity as a function of the distance from the field edge changed by {+-} 3% (1-11%) for LiF TLD-700, decreased by 10% (5-21%) for OSLD, and increased by 16% (11-19%) for the skin QED diode (Sun Nuclear Corp.) at the equivalent depth of 5 mm for 6- or 15-MV photon energies. Our results showed that the use of bolus with proper thickness (i.e., {approx}d{sub max} of the photon energy) on the top of the ICD would reduce the scattered dose to a lower level. Dosimeters should be calibrated out-of-field and preferably with bolus equal in thickness to the depth of interest. This can be readily performed in clinic.

  20. Risk of chronic anxiety in implantable defibrillator patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; den Broek, Krista C van; Theuns, Dominic A M J;

    2011-01-01

    Little is known about the prevalence of chronic anxiety in patients with an implantable cardioverter defibrillator (ICD). In a multi-center, prospective study, we examined 1) the prevalence of chronic anxiety (i.e., patients anxious at implantation and 12 months), and 2) predictors of chronic...... anxiety....

  1. The gulf implantable cardioverter-defibrillator registry: Rationale, methodology, and implementation

    Directory of Open Access Journals (Sweden)

    Alawi A Alsheikh-Ali

    2015-01-01

    Conclusions: Gulf ICD is the first prospective, observational, multi-center, and multinational study of the characteristics and, the outcomes of patients receiving ICDs in the Arab Gulf region. The study will provide valuable insights into the utilization of and outcomes related to ICD therapy in the Gulf region.

  2. Relevance of guideline-based ICD indications to clinical practice.

    Science.gov (United States)

    Al-Jefairi, Nora; Burri, Haran

    2014-01-01

    The implantable cardioverter-defibrillator (ICD) has established itself as life-saving therapy in patients at risk for sudden cardiac death. Remarkable technological advances have made ICDs easier and safer to implant, with improved therapeutic and diagnostic functions and reduced morbidity. Guidelines on ICD indications have been proposed by American and European scientific societies since a number of years, based upon trials and expert opinion. In the context of variable economic and political constraints, it is questionable whether these guidelines may be applied to all settings. This review discusses the guideline-based indications, critically examines their applicability to clinical practice, and discusses alternatives to ICD therapy.

  3. Programming implantable cardioverter-defibrillators in primary prevention: higher or later.

    Science.gov (United States)

    Clementy, Nicolas; Pierre, Bertrand; Simeon, Edouard; Lallemand, Bénédicte; Fauchier, Laurent; Babuty, Dominique

    2014-05-01

    Defibrillator shocks, appropriate or not, are associated with significant morbidity, as they decrease quality of life, can be involved in depression and anxiety, and are known to be proarrhythmic. Most recent data have even shown an association between shocks and overall mortality. As opposed to other defibrillator-related complications, the rate of inappropriate and unnecessary shocks can (and should) be decreased with adequate programming. This review focuses on the different programming strategies and tips available to reduce the rate of shocks in primary prevention patients with left ventricular dysfunction implanted with a defibrillator, as well as some of the manufacturers' device specificities.

  4. Poor perceived social support in implantable cardioverter defibrillator (ICD) patients and their partners

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Spinder, Helle; Erdman, Ruud A M;

    2009-01-01

    Social support is a known buffer of psychological distress and has also been shown to influence adverse medical outcomes.......Social support is a known buffer of psychological distress and has also been shown to influence adverse medical outcomes....

  5. Reliability and Validity of the Self Efficacy Expectations and Outcome Expectations After ICD Implantation Scales

    OpenAIRE

    DOUGHERTY, CYNTHIA M.; Johnston, Sandra K.; Thompson, Elaine Adams

    2007-01-01

    The purpose of this study was to assess the reliability and validity characteristics of two new scales that measure self-efficacy expectations (SE-ICD) and outcome expectations (OE-ICD) in survivors (n=168) of sudden cardiac arrest (SCA), all of whom received an implantable cardioverter defibrillator (ICD). Cronbach's alpha reliability demonstrated good internal consistency (SE-ICD α = 0.93 and OE-ICD α = 0.81). Correlations with other self-efficacy instruments (general self-efficacy and soci...

  6. Does ICD indication affect quality of life and levels of distress?

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Sears, Samuel F; Burg, Matthew M;

    2009-01-01

    on patients' lives, particularly whether primary prophylaxis implantation may impact adversely on patient-centered outcomes such as quality of life (QoL) and distress. We examined the evidence for a role of ICD indication on these patient-centered outcomes. A literature search was conducted on PubMed and Web......The implantable cardioverter defibrillator (ICD) is the treatment of choice for life-threatening arrhythmias, with ICD indications having recently been extended to include primary prophylaxis. Despite the medical benefits of the ICD, there is an ongoing debate as to the impact of the ICD...

  7. Nursing care of patients receiving implantable cardioverter defibrillator implantation//%心脏转复除颤器植入术患者的护理

    Institute of Scientific and Technical Information of China (English)

    李燕林; 丁莉; 陈琴

    2011-01-01

    Objective To summarize the main nursing measures of implantable cardioverter defibrillator (ICD) implantation and to highlight the maneuvers of commonly seen complications. Methods Seven cases were successfully resuscitated after sudden cardiac death. They received ICD implantation. Before the procedure, patients were closely monitored with ECG and observed; after the procedure, patients had ECG and blood pressure monitoring, and the changes in heart rates and rhythm were closely observed.Nurses instructed patients to have good rest, gave diet guidance, helped them handle pain, and kept close eyes on vital signs and delivered health education. Nurses also handled complications and accidents timely. Results The 7 patients had a hospital stay of 1430 d. All patients were symptomatic in New York Heart Association Functional Class Ⅱ or Ⅲ at discharge. Patients were followed up 2-52 months. One cases died from lung infection and pump failure. The other six patients experienced 4 times of ICD shock delivery, 3 ventricular tachycardia, 1 supraventricular tachycardia. The quick-beating heart turned into sinus rhythm after shock delivery. One case developed hallucinations of electric shock; one case had effusion of the pouch. Both the above cases received symptomatic treatment. Conclusion The complications of ICD implantation be reduced by strengthening observation of vital signs of patients, giving scrupulous fundamental nursing and psychological nursing, and taking preventive precautions, which also lengthens the service life of the ICD system.%目的 总结植入型心脏转复除颤器(1CD)植入术的护理要点和常见并发症的处理方法.方法 对收治的心源性猝死抢救成功的7例患者行ICD植入术,术前加强心电监护及病情观察;术后持续心电、血压监测,尤其注意观察心率、心律的变化,做好休息与饮食、疼痛及生命体征护理和健康教育,及时处理常见并发症和意外.结果 7例患者住院14

  8. Implantable Cardiac Defibrillator Lead Failure and Management.

    Science.gov (United States)

    Swerdlow, Charles D; Kalahasty, Gautham; Ellenbogen, Kenneth A

    2016-03-22

    The implantable-cardioverter defibrillator (ICD) lead is the most vulnerable component of the ICD system. Despite advanced engineering design, sophisticated manufacturing techniques, and extensive bench, pre-clinical, and clinical testing, lead failure (LF) remains the Achilles' heel of the ICD system. ICD LF has a broad range of adverse outcomes, ranging from intermittent inappropriate pacing to proarrhythmia leading to patient mortality. ICD LF is often considered in the context of design or construction defects, but is more appropriately considered in the context of the finite service life of a mechanical component placed in chemically stressful environment and subjected to continuous mechanical stresses. This clinical review summarizes LF mechanisms, assessment, and differential diagnosis of LF, including lead diagnostics, recent prominent lead recalls, and management of LF and functioning, but recalled leads. Despite recent advances in lead technology, physicians will likely continue to need to understand how to manage patients with transvenous ICD leads.

  9. Implantable Cardiac Defibrillator Lead Failure and Management.

    Science.gov (United States)

    Swerdlow, Charles D; Kalahasty, Gautham; Ellenbogen, Kenneth A

    2016-03-22

    The implantable-cardioverter defibrillator (ICD) lead is the most vulnerable component of the ICD system. Despite advanced engineering design, sophisticated manufacturing techniques, and extensive bench, pre-clinical, and clinical testing, lead failure (LF) remains the Achilles' heel of the ICD system. ICD LF has a broad range of adverse outcomes, ranging from intermittent inappropriate pacing to proarrhythmia leading to patient mortality. ICD LF is often considered in the context of design or construction defects, but is more appropriately considered in the context of the finite service life of a mechanical component placed in chemically stressful environment and subjected to continuous mechanical stresses. This clinical review summarizes LF mechanisms, assessment, and differential diagnosis of LF, including lead diagnostics, recent prominent lead recalls, and management of LF and functioning, but recalled leads. Despite recent advances in lead technology, physicians will likely continue to need to understand how to manage patients with transvenous ICD leads. PMID:26988958

  10. Late Development of a Bronchocutaneous Fistula due to an Epicardial Cardioverter-Defibrillator Lead

    Directory of Open Access Journals (Sweden)

    Vasileios Patris

    2015-10-01

    Full Text Available Cutaneous complications caused by a pacemaker or defibrillator are widely documented, but the development of a bronchocutaneous fistula has never been described before. We report the case of a 79-year-old man who was admitted to our hospital because of a seemingly superficial cutaneous infection, externalized defibrillator leads, and hemoptysis. Bronchoscopical investigation proved the existence of the fistula, which connected the epicardium, the left main bronchus, and the aforementioned site of skin infection. The patient refused an operation for the complete removal of the epicardial defibrillator and was treated conservatively. This case demonstrated that the long-term presence of foreign bodies in the epicardium may cause serious complications

  11. [Implantation of a biventricular ICD in a patient with dextrocardia with situs inversus].

    Science.gov (United States)

    Vurgun, Veysel Kutay; Gerede, Menekşe; Altın, Ali Timuçin; Candemir, Başar; Akyürek, Ömer

    2015-01-01

    In order to reduce sudden cardiac death and heart failure symptoms, biventricular implantable cardioverter defibrillator (ICD) implantation is a treatment method commonly used in selected patients with cardiomyopathy. The frequency of dextrocardia in congenital heart defects is approximately 0.4/10000. In this group, the frequency of cardiomyopathy development is rare. In this case report we present a patient with dextrocardia undergoing implantation of biventricular ICD.

  12. Trajectories of Patient-Reported Health Status in Patients With an Implantable Cardioverter Defibrillator

    DEFF Research Database (Denmark)

    Mastenbroek, Mirjam H; Denollet, Johan; Versteeg, Henneke;

    2015-01-01

    failure, ICD shock, psychotropic medication, negative affectivity, and type D personality were identified as independent determinants of poorer physical health status. For mental health status, 6 trajectories were identified. Younger age, low educational level, symptomatic heart failure, renal failure......, no use of ACE inhibitors, psychotropic medication, negative affectivity, and type D personality were identified as independent determinants of poorer mental health status. In conclusion, the population with an ICD seems to be heterogeneous in terms of patient-reported physical and mental health status....... Patients with an ICD who present with poor health status and a distressed personality profile should be timely identified and monitored as they may benefit from cardiac rehabilitation in combination with behavioral intervention....

  13. Clinical observation and nursing of implantable cardioverter-defibrillator patients with oral anticoagulants in the peroperative period%ICD围术期未停口服抗凝药的临床观察和护理

    Institute of Scientific and Technical Information of China (English)

    孙丽; 冯婕; 陆敬平; 徐冬梅

    2012-01-01

    目的 探讨植入型心律转复除颤器(ICD)围术期未停口服抗凝药的临床观察和护理.方法 回顾ICD植入术35例患者,其中围术期未停抗凝药15例,总结护理要点和并发症的处理方法.结果 35例行ICD植入术患者均痊愈出院,随访患者无不良反应和并发症.结论 术前全面评估患者围术期是否停用或替代抗凝剂,同时做好患者教育及凝血监测工作,术后严密观察术区情况,发现异常及时处理.%Objective To explore the clinical manifestations and nursing of implantable car-dioverter- defibrillator (ICD) patients with oral anticoagulants in the peroperative period. Methods The clinical data of 35 ICD patients were reviewed. Among them, 15 patients continued the oral anticoagulants. The nursing highlights and the ways to deal with complications have been summarized. Results All patients were discharged from hospital with good recovery. Follow-up showed that there were no adverse reactions and complications. Conclusion Comprehensive assessment should be done to identify whether patients has discontinued oral anticoagulants or other substitutes in the perioperative period before surgery. Meanwhile, health education and coagulation should be properly managed. The progression of disease should be closely observed after surgery in case of e-mergencies.

  14. Clinical and psychological impact of prophylactic implantable cardioverter-defibrillators in a community heart failure population.

    LENUS (Irish Health Repository)

    Arnous, S

    2012-02-01

    AIMS: ICD implantation for primary prevention of sudden cardiac death in patients with left ventricular systolic dysfunction (ejection fraction <\\/= 35%) has increased since the publication of the SCD-HEFT and MADIT-II data. The aim of this study is to examine the effectiveness and safety of prophylactic ICD use in a community heart failure population and to assess the impact on patient\\'s quality of life. METHODS AND RESULTS: Seventy-one ICDs were inserted between the years 2002 and 2006. The mean follow-up from time of insertion was 24 +\\/- 11 months. Eighteen patients (25%) had potentially life-saving therapy. Seven (10%) patients received inappropriate shocks. Complications were encountered in five patients (7%). CONCLUSION: In a community heart failure population, prophylactic ICD implantation is associated with a high incidence of life-saving therapy, a low complication rate and a high level of tolerability. These data indicate translation of clinical trial benefits to the general heart failure population.

  15. Effects of an alert system on implantable cardioverter defibrillator-related anxiety

    DEFF Research Database (Denmark)

    Duru, Firat; Dorian, Paul; Favale, Stefano;

    2010-01-01

    failing to receive needed therapy for the same reason. New devices include programmable vibrating patient notifiers (PN), which, by warning patients of a possible device dysfunction, might lower device-related anxiety. PAtient NOtifier feature for Reduction of Anxiety: a Multicentre ICD study (PANORAMIC......) is a multicentre, randomized, clinical trial designed to examine the effects of the awareness of an active vibrating alert system on device-related anxiety....

  16. Management of radiation oncology patients with implanted cardiac pacemakers or implant able cardioverter defibrilators; Tratamiento de pacientes en radioterapia con marcapasos o desfibriladores automaticos implantables

    Energy Technology Data Exchange (ETDEWEB)

    Martin Martin, G.

    2012-07-01

    The increase in life expectancy along with the technological development in the last decades has resulted in an increase in the number of patients requiring pacemaker implants or implantable cardioverter defibrillators worldwide. An increase in the number of patients with implanted cardiac devices in radiotherapy is also expected due to the risk factors in common between heart disease and cancer. In 1994 the American Association of Physicists in Medicine (AAPM) released a report about the management of radiation oncology patients with implanted cardiac pacemakers. The addition of new technologies, both in radiotherapy units and in the manufacturing process of heart devices, has shown the need for an updated protocol for the management of these patients. In this work, the most important articles published after the report of the AAPM have been compiled, in order to analyze the effects not previously studied such as dose rate, scattered radiation, electromagnetic interference or random failures produced by neutrons and protons. Additionally, the latest recommendations given by the manufacturers have been analyzed and, finally, some indications are given as an updated guide for the management of radiation oncology patients with pacemakers or cardioverter defibrillators implanted. (Author)

  17. Cost-effectiveness of implantable defibrillator as first-choice therapy versus electrophysiologically guided, tiered strategy in postinfarct sudden death survivors - A randomized study

    NARCIS (Netherlands)

    Hauer, RNW; Schrijvers, G; vanCapelle, FJL; Tijssen, JGP; Crijns, HJGM; Algra, A; Ramanna, H; Bakker, PFA; deMedina, EOR; Wever, Eric F. D.

    1996-01-01

    Background Rising costs of health care, partly as a result of costly therapeutic innovations, are of concern to both the medical profession and healthcare authorities. The implantable cardioverter-defibrillator or (ICD) is still not remunerated by Dutch healthcare insurers. The aim of this study was

  18. Erfahrung mit der Extraktion von transvenösen Kardioverter-Defibrillator (ICD Sonden

    Directory of Open Access Journals (Sweden)

    Dörnberger V

    1999-01-01

    Full Text Available Die ICD-Therapie ist ein bewährtes Verfahren zur Behandlung lebensbedrohlicher ventrikulärer Herzrhythmusstörungen. Defekte der komplex aufgebauten transvenösen Sondensysteme sind beschrieben. Meist ist eine komplette Entfernung defekter Sonden sinnvoll. Wir berichten über unsere Erfahrung mit der Entfernung von 13 transvenösen Elektrodensystemen. In 7 Fällen handelt es sich um eine Endotak C 0072 Sonde (CPI/Guidant und in 6 Fällen um eine Medtronic Transvene 6936 Elektrode. Das Sondenalter zum Zeitpunkt der Extraktion lag zwischen 1,5 und 77,6 Monaten (Mittelwert 36,3 ± 18. Als Extraktionshilfen wurden das VascoExtor Stylet S (Vascomed in 6 Fällen und das Byrd Locking-Stylet 0.017 (0.018 inches (Cook in 4 Fällen verwendet. Alle Extraktionen erfolgten unter transösophagealem Echokardiographie-Monitoring (TEE und Herz-Lungenmaschinen-Bereitschaft (HLM. Ohne Dilatations-Sheath war eine Extraktion nur innerhalb der ersten 3 Monate nach Implantation möglich (n = 3. Ein besonderes Problem stellt der im Vergleich zum Sondenkörper größere Durchmesser der Schockwendel dar, da die Sonde im Verlauf von einem Bindegewebsmantel fest umschlossen und mit der Venenwand verwachsen ist. Mit dem Byrd Dilatator-Schleusenset 10,0 Fr, 11,5 Fr und 13,0 Fr war in allen Fällen eine Lösung von der Venenwand möglich. Eine Extraktion einer Sonde (Medtronic Transvene war nach auswärtigen Vorversuchen mit Zerstörung der inneren Wendel nicht mehr möglich. In einem weiteren Fall konnten zwar die venösen Wandadhäsionen gelöst werden, die distale Schockwendel war jedoch in voller Länge mit dem Endokard verwachsen und konnte nur in einer offenen Herzoperation entfernt werden. In keinem Fall kam es zu einem bedeutsamen Perikarderguß. Kein Patient verstarb in Folge der Sondenextraktion. Zusammenfassend ist die Extraktion von ICD Sonden auch lange nach Implantation möglich. Trotz unserer relativ guten Erfahrung mit der Extraktion von ICD Sonden sollte

  19. Sexual concerns and practices after ICD implantation

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Elleman-Jensen, Line; Zwisler, Ann-Dorthe;

    2013-01-01

    given about sexual activity, (b) the areas of patient concerns related to sexual function and the ICD, and (c) changes in sexual behavior.Methods:A randomized controlled trial including 196 patients (1:1) was designed, including 12 weeks of exercise training and 1 year of psycho-educational follow......Background:Studies show that patients with implantable cardioverter defibrillators (ICD) frequently experience sexual dysfunction. These experiences are often linked to exercise intolerance, side-effects of medication, and psychological problems.Objective:To describe (a) the level of information......-up focusing on modifiable factors associated with poor outcomes, including sexual functioning. The Sex After ICD Survey was administered 6 months after the randomization as part of the planned explorative outcomes. 141 patients responded.Results:The analyses showed that 37 of the 69 (55.2%) patients...

  20. Painless Implanted Cardioverter Defibrillator Therapy: Have We Taken It Seriously?%植入式心脏复律除颤器的无痛性治疗:我们重视了吗?

    Institute of Scientific and Technical Information of China (English)

    宿燕岗

    2011-01-01

    Shocking therapy of implanted cardioverter defibrillator (ICD) has been criticized for its causing myocardium damage and inducing electrical storm. Instead the anti-tachycardia pacing (ATP) function has been introduced as the main pain-free therapy of ICD, which could terminate about 3/4 ventricular tachycardia ( VT) events, without raising the risk of syncope or accelerated VT. The main concerns of ATP include differential identification of supraventricular tachycardia, re-confirmation of charging, settings of fast VT zone, strategies for optimization, and ATP while or before charging etc. , and the parameters should be adjusted individually during follow up. More concern should be paid to pain-free ICD therapy in clinical practice.%电击治疗可导致包括心肌损伤及诱发植入式心脏复律除颤器电风暴等弊端.植入式心脏复律除颤器的无痛性治疗主要是指其抗心动过速起搏功能.抗心动过速起搏能成功终止约3/4的室性心动过速事件,不增加晕厥或加速室性心动过速.无痛性治疗的主要策略包括室上性心动过速的鉴别程序、充电时的再确认、设定快速室性心动过速区、抗心动过速起搏策略优化、充电中和充电前抗心动过速起搏等.这些参数设置应个体化并在随访中进行调整.应重视植入式心脏复律除颤器无痛性治疗在临床上的应用.

  1. Adding the implantable cardioverter-defibrillator to cardiac resynchronization therapy is associated with improved long-term survival in ischaemic, but not in non-ischaemic cardiomyopathy

    DEFF Research Database (Denmark)

    Witt, Christoffer Tobias; Kronborg, Mads Brix; Nohr, Ellen Aagaard;

    2015-01-01

    Hospital, Denmark from 2000 to 2010 were included. Baseline characteristics were retrieved from patient files and survival data were obtained from the Danish Civil Registration System. The primary outcome was all-cause mortality. The effect of ICD backup was estimated using Cox proportional hazards model...... to ischaemic cardiomyopathy (ICM) or non-ischaemic cardiomyopathy (NICM) treated with a CRT device with or without defibrillator backup. METHODS AND RESULTS: In this observational study, consecutive patients with an ejection fraction ≤35% and QRS width ≥120 ms receiving a CRT device at Aarhus University...

  2. Primary Prevention of Sudden Cardiac Death in Adults with Transposition of the Great Arteries: A Review of Implantable Cardioverter-Defibrillator Placement.

    Science.gov (United States)

    Sodhi, Sandeep S; Cedars, Ari M

    2015-08-01

    Transposition of the great arteries encompasses a set of structural congenital cardiac lesions that has in common ventriculoarterial discordance. Primarily because of advances in medical and surgical care, an increasing number of children born with this anomaly are surviving into adulthood. Depending upon the subtype of lesion or the particular corrective surgery that the patient might have undergone, this group of adult congenital heart disease patients constitutes a relatively new population with unique medical sequelae. Among the more common and difficult to manage are cardiac arrhythmias and other sequelae that can lead to sudden cardiac death. To date, the question of whether implantable cardioverter-defibrillators should be placed in this cohort as a preventive measure to abort sudden death has largely gone unanswered. Therefore, we review the available literature surrounding this issue. PMID:26413012

  3. Statins Decrease Oxidative Stress and ICD Therapies

    Directory of Open Access Journals (Sweden)

    Heather L. Bloom

    2010-01-01

    Full Text Available Recent studies demonstrate that statins decrease ventricular arrhythmias in internal cardioverter defibrillator (ICD patients. The mechanism is unknown, but evidence links increased inflammatory and oxidative states with increased arrhythmias. We hypothesized that statin use decreases oxidation. Methods. 304 subjects with ICDs were surveyed for ventricular arrhythmia. Blood was analyzed for derivatives of reactive oxygen species (DROMs and interleukin-6 (IL-6. Results. Subjects included 252 (83% men, 58% on statins, 20% had ventricular arrhythmias. Average age was 63 years and ejection fraction (EF 20%. ICD implant duration was 29 ± 27 months. Use of statins correlated with lower ICD events (r=0.12, P=.02. Subjects on statins had lower hsCRP (5.2 versus 6.3; P=.05 and DROM levels (373 versus 397; P=.03. Other factors, including IL-6 and EF did not differ between statin and nonstatin use, nor did beta-blocker or antiarrhythmic use. Multivariate cross-correlation analysis demonstrated that DROMs, statins, IL-6 and EF were strongly associated with ICD events. Multivariate regression shows DROMs to be the dominant predictor. Conclusion. ICD event rate correlates with DROMs, a measure of lipid peroxides. Use of statins is associated with reduced DROMs and fewer ICD events, suggesting that statins exert their effect through reducing oxidation.

  4. 除颤电极导线故障判断与植入起搏感知电极的处理效果%Efficacy Analysis of Pace/Sense Lead Implantation in Management of Cardioverter-Defibrillator Lead Malfunction

    Institute of Scientific and Technical Information of China (English)

    于海波; 王冬梅; 梁延春; 许国卿; 刘荣; 王祖禄; 韩雅玲

    2015-01-01

    目的:评价植入起搏感知电极处理埋藏式心律转复除颤器( implantable cardioverter defibrillator, ICD)电极导线功能故障的效果。方法回顾性分析4例植入ICD患者发生除颤电极导线功能故障的原因及处理方法。结果4例均因右心室除颤电极导线功能故障出现ICD误感知及误电击,高压阻抗均在正常范围,其中3例有术侧不适当用力情况。分析故障原因,3例为起搏感知电极断裂,1例为除颤电极早期磨损。4例均经腋静脉入路重新植入一根起搏感知电极,其中电池耗竭1例术中更换ICD。随访观察7~70个月,均未再出现ICD误感知及误电击事件,导线参数变化均在正常范围。结论术侧过度用力可能是除颤电极导线功能故障发生的主要原因,在除颤功能正常的情况下,植入起搏感知电极可解决该故障。%Objective To evaluate the efficacy and safety of pace/sense lead implantation in management of implant-able cardioverter defibrillator ( ICD) lead failure. Methods 4 patients were implanted with pace/sense lead to manage defib-rillation lead malfunction. Cause of the lead failure was analyzed, and the efficacy and safety of pace/sense lead replacement were evaluated. Results 4 patients with defibrillation lead malfunction in the right ventricle underwent inappropriate detec-tion and shocks. Among them, the high voltage impedance of defibrillation leads of all the patients were in the normal range. 3 cases experienced inappropriate force on the operation side. The cause of lead malfunction might be fraction of pace/sense lead in 3 patients and early abrasion of pace/sense in 1 patient. An additional pace/sense lead was implanted through trans-axillary venous for 4 patients, and the patients were then followed up for 7-70 months and no more inappropriate sense and shocks recurred, and all the changes of lead parameters were within the normal range. Conclusion A possible main cause for lead malfunction

  5. Effect of Cardiac Rehabilitation in Patients with ICD

    DEFF Research Database (Denmark)

    Christensen, Anne Vinggaard; Zwisler, Ann-Dorthe; Svendsen, Jesper Hastrup;

    2015-01-01

    in physical component scale, mental component scale, social functioning, physical functioning, bodily pain, vitality, mental health, and QoL with men having higher scores. Among men only, significant differences were found in VO2 (rehabilitation: 20.9 mL/min/kg [standard deviation (SD) 8.1] vs 23.4 m......BACKGROUND: The COPE-ICD (Copenhagen Outpatient ProgrammE-implantable cardioverter defibrillator) trial studied comprehensive cardiac rehabilitation for patients with ICDs. The purpose of this paper was to explore: (1) gender differences in self-rated health and quality of life (QoL) at hospital...... discharge after ICD implantation, (2) gender differences in effect of cardiac rehabilitation, and (3) predictors of effect of cardiac rehabilitation. METHODS: Patients with first-time ICD implantation were randomized to comprehensive cardiac rehabilitation versus usual care. Gender differences in self...

  6. Subcutaneous chronic implantable defibrillation systems in humans.

    Science.gov (United States)

    Cappato, Riccardo; Smith, Warren M; Hood, Margaret A; Crozier, Ian G; Jordaens, Luc; Spitzer, Stefan G; Ardashev, Andrey V; Boersma, Lucas; Lupo, Pierpaolo; Grace, Andrew A; Bardy, Gust H

    2012-09-01

    The recent introduction of subcutaneous implantable cardioverter defibrillator (S-ICD) has raised attention about the potential of this technology for clinical use in daily clinical practice. We review the methods and results of the four studies conducted in humans for approval of this innovative technology for daily practice. Two studies using a temporary S-ICD system (acute human studies) were conducted to search for an appropriate lead configuration and energy requirements. For this purpose, 4 S-ICD configurations were tested in 78 patients at the time of transvenous (TV)-ICD implantation. The optimal configuration was tested in 49 more patients to comparatively assess the subcutaneous defibrillation threshold (S-DFT) versus the standard TV-ICD. Long-term implants were evaluated in 55 patients using an implanted system (chronic human study). The acute humans studies led to an optimal S-ICD configuration comprising a parasternal electrode and left anterolateral thoracic pulse generator. Both configurations successfully terminated 98% of induced ventricular fibrillation (VF), but significantly higher energy levels were required with S-ICD than with TV-ICD systems (36.6 ± 19.8 J vs. 11.1 ± 8.5 J). In the chronic study, all 137 VF episodes induced at time of implant were detected with a 98% conversion rate. Two pocket infections and four lead revisions were required during 10 ± 1 months of follow-up. During this period, survival was 98%, and 12 spontaneous ventricular tachyarrhythmias were detected and treated by the device. These data show that the S-ICD systems here consistently detected and converted VF induced at time of implant as well as sustained ventricular tachyarrhythmias occurring during follow-up (248). PMID:22426601

  7. The association between biventricular pacing and cardiac resynchronization therapy-defibrillator efficacy when compared with implantable cardioverter defibrillator on outcomes and reverse remodelling

    DEFF Research Database (Denmark)

    Ruwald, Anne-Christine; Kutyifa, Valentina; Ruwald, Martin H;

    2015-01-01

    : Using Kaplan-Meier plots, we estimated the threshold of BIV pacing percentage needed for CRT-D to be superior to ICD on the end-point of heart failure (HF) or death in 1219 left bundle branch block (LBBB) patients in the MADIT-CRT trial. Patients were censored at the time of crossover. In multivariable...

  8. Anxiety Predicts Mortality in ICD Patients

    DEFF Research Database (Denmark)

    Kikkenborg Berg, Selina; Caspar Thygesen, Lau; Hastrup Svendsen, Jesper;

    2014-01-01

    BACKGROUND: Although highly effective in preventing arrhythmic death, patients receiving an implantable cardioverter defibrillator (ICD) may still experience psychological difficulties such as anxiety, depression, and reduced quality of life. The objectives of this study were to describe patient...... receiving ICD between January 1, 2011 and June 30, 2011 (n = 499). The following instruments were used: SF-36, Hospital Anxiety and Depression Scale, HeartQoL, EQ-5D, and the Multidimensional Fatigue Inventory. RESULTS: The response rate was 72%. Mean age was 65.5 years and 82% patients were males. Fifty...... of perceived health, quality of life, and fatigue; for example, physical health 39.8 versus 44.3 points, compared to secondary prevention indication. Anxiety, poor perceived health, fatigue, and low quality of life were all predictors of mortality, anxiety being the strongest with an adjusted odds ratio of 4...

  9. The distressed (Type D) personality. A risk marker for poor health outcomes in ICD patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Schiffer, A A

    2011-01-01

    personality on psychological distress, quality of life, ventricular tachyarrhythmias, and mortality in implantable cardioverter-defibrillator (ICD) patients and examines the relative influence of this vulnerability factor compared to ICD shocks and markers of disease severity in relation to these outcomes.......The distressed (Type D) personality is an emerging risk marker for poor health outcomes in patients with cardiovascular disease. Patients with this personality disposition are typified by a general propensity to experience psychological distress. The contribution focuses on the impact of Type D...

  10. Implantable cardioverter defibrillator and application in cardiac rehabilitation%植入式自动心律转复除颤器及其在心脏康复中的应用

    Institute of Scientific and Technical Information of China (English)

    李之明; 张彩举; 于钦军

    2004-01-01

    植入式自动心律转复除颤器(implantable cardioverter defibrillator,ICD)作为一种治疗严重心律失常的设备,具有高效、安全、实用的特点,能显著降低室性心律失常患者猝死的风险和死亡率,在国际上受到广泛关注。

  11. Wearable defibrillator use in heart failure (WIF: results of a prospective registry

    Directory of Open Access Journals (Sweden)

    Kao Andrew C

    2012-12-01

    Full Text Available Abstract Background Heart failure (HF patients have a high risk of death, and implantable cardioverter defibrillators (ICDs are effective in preventing sudden cardiac death (SCD. However, a certain percentage of patients may not be immediate candidates for ICDs, particularly those having a short duration of risk or an uncertain amount of risk. This includes the newly diagnosed patients, as well as those on the cardiac transplant list or NYHA class IV heart failure patients who do not already have an ICD. In these patients, a wearable cardioverter defibrillator (WCD may be used until long term risk of SCD is defined. The purpose of this study was to determine the incidence of SCD in this population, and the efficacy of early defibrillation by a WCD. Methods Ten enrolling centers identified 89 eligible HF patients who were either listed for cardiac transplantation, diagnosed with dilated cardiomyopathy, or receiving inotropic medications. Data collected included medical history, device records, and outcomes (including 90 day mortality. Results Out of 89 patients, final data on 82 patients has been collected. Patients wore the device for 75±58 days. Mean age was 56.8±13.2, and 72% were male. Most patients (98.8% were diagnosed with dilated cardiomyopathy with a low ejection fraction ( Conclusions In conclusion, the WCD monitored HF patients until further assessment of risk. The leading reasons for end of WCD use were improvement in left ventricular ejection fraction (LVEF or ICD implantation if there was no significant improvement in LVEF.

  12. Unusual Cause of Inappropriate Implantable Cardioverter Defibrillators’ Shock: Tremor

    Directory of Open Access Journals (Sweden)

    Mustafa Oylumlu

    2013-08-01

    Full Text Available Implantable cardioverter defibrillators are widely used for primary and secondary prevention from sudden death. These devices terminate attacks of ventricular tachycardia and ventricular fibrillation by applying direct current shock, if it necessary. Despite these benefical effects, inappropriate shocks are important side effects of implantable cardioverter defibrillators. Inappropriate implantable cardioverter defibrillator shocks impair life quality by causing pain and psychological side-effects, and even induce new arrhytmias. In this paper we present a case of inappropriate implantable cardioverter defibrillator shock due to tremor.

  13. Predictors of appropriate ICD therapy in patients with arrhythmogenic right ventricular cardiomyopathy: long term experience of a tertiary care center.

    Directory of Open Access Journals (Sweden)

    Pia K Schuler

    Full Text Available INTRODUCTION: Arrhythmogenic right ventricular cardiomyopathy (ARVC is a rare genetically transmitted disease prone to ventricular arrhythmias. We therefore investigated the clinical, echocardiographical and electrophysiological predictors of appropriate implantable cardioverter defibrillator (ICD therapy in patients with ARVC. METHODS: A retrospective analysis was performed in 26 patients (median age of 40 years at diagnosis, 21 males and 5 females with ARVC who underwent ICD implantation. RESULTS: Over a median (range follow-up period of 10 (2.7, 37 years, appropriate ICD therapy for ventricular arrhythmias was documented in 12 (46% out of 26 patients. In all patients with appropriate ICD therapy the ICD was originally inserted for secondary prevention. Median time from ICD implantation to ICD therapy was 9 months (range 3.6, 54 months. History of heart failure was a significant predictor of appropriate ICD therapy (p = 0.033. Left ventricular disease involvement (p = 0.059 and age at implantation (p = 0.063 were borderline significant predictors. Patients with syncope at time of diagnosis were significantly less likely to receive ICD therapy (p = 0.02. Invasive electrophysiological testing was not significantly associated with appropriate ICD therapy. CONCLUSION: In our cohort of patients with ARVC, history of heart failure was a significant predictor of appropriate ICD therapy, whereas left ventricular involvement and age at time of ICD implantation were of borderline significance. These predictors should be tested in larger prospective cohorts to optimize ICD therapy in this rare cardiomyopathy.

  14. Relation of symptomatic heart failure and psychological status to persistent depression in patients with implantable cardioverter-defibrillator

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Hoogwegt, Madelein T; Jordaens, Luc;

    2011-01-01

    months after implantation. Information on ICD therapies was obtained by device interrogation. At 3 months after implantation, 52 (14%) of the 386 patients had persistent depression (HADS cutoff ≥8 before and 3 months after implantation). Heart failure (odds ratio [OR] 2.29; 95% confidence interval [CI] 1...

  15. Risk of pacemaker or implantable cardioverter defibrillator after radiotherapy for early-stage breast cancer in Denmark, 1982-2005

    DEFF Research Database (Denmark)

    Rehammar, Jens Christian; Johansen, Jens Brock; Jensen, Maj-Britt;

    2016-01-01

    (RT). MATERIAL AND METHODS: All women treated for early-stage BC in Denmark from 1982 to 2005 were identified from the Danish Breast Cancer Cooperative Group. By record linkage to the Danish Pacemaker and ICD Registry information was retrieved on CIED implants subsequent to RT. Standardized incidence...

  16. Incidence of ineffective safety margin testing (J) and efficacy of routine subcutaneous array insertion during implantable cardioverter defibrillator implantation.

    Science.gov (United States)

    Ohlow, Marc-Alexander; Roos, Marcus; Lauer, Bernward; Geller, J Christoph

    2016-01-01

    The purpose of this study was to assess (1) the incidence of safety margin testing J (SMT) and (2) the efficacy/safety of routinely adding a subcutaneous array (SQA) (Medtronic 6996SQ) for these patients. Patients with SMT smaller than a 10-J safety margin from maximum output were considered to have very high readings and underwent SQA insertion. These patients were compared with the rest of the patients who had acceptable SMT (≥10 J). A total of 616 patients underwent ICD implantation during the analysis period. Of those, 16 (2.6%) had SMT J. By univariate analysis, younger age, and non-ischemic cardiomyopathy, were all significant predictors of SMT J (p J; p J occur in about 2.6% of patients undergoing ICD implantation. SQA insertion corrects this problem without procedural/mid-term complications.

  17. Electrical Storm after Implantation of Implantable Cardioverter Defibrillator and Its treatment%植入型心律转复除颤器植入术后电风暴发生及其治疗进展

    Institute of Scientific and Technical Information of China (English)

    茅魁; 蔡鑫

    2013-01-01

    近年来,植入型心律转复除颤器治疗恶性心律失常的疗效明确,但术后电风暴诱发因素的治疗进展和预后愈来愈受到临床重视,现就近年的研究进展进行综述.%In recent years, the efficacy of implantable cardioverter defibrillator has been proved definite in treatment of nausea arrhythmia, and the treatment of postoperative electrical storm and its prognosis have been attached more and more importance to. This paper reviews its recent research progress.

  18. Prophylactic left thoracic sympathectomy to prevent electrical storms in CPVT patients needing ICD placement.

    Science.gov (United States)

    Moray, Amol; Kirk, Edwin P; Grant, Peter; Camphausen, Christoph

    2011-11-01

    Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), a life threatening arrhythmia induced by sympathetic stimulation in susceptible individuals is often refractory to antiarrhythmic agents. First line of treatment, beta-blockers can be ineffective in up to 50% with implantable cardioverter-defibrillator (ICD) placement for refractory cases. Paradoxically ICD can be arryhthmogenic from shock-associated sympathetic stimulation, initiating more shocks and "electrical storms". This has led to the use of more effective beta blockade offered by left sympathectomy, now performed by minimally invasive video assisted thoracoscopic surgery (VATS). Sympathectomy has been traditionally performed long after ICD placement, after the patient has experienced multiple shocks, thus necessitating two procedures. We report simultaneous ICD insertion and thoracoscopic sympathectomy in a 10 year-old boy with CPVT, and suggest it as a better approach than sequential procedures. To our knowledge this is first such reported case.

  19. Combined etiology of anaphylactic cardiogenic shock: Amiodarone, epinephrine, cardioverter defibrillator, left ventricular assist devices and the Kounis syndrome

    Directory of Open Access Journals (Sweden)

    Nicholas G Kounis

    2015-01-01

    Full Text Available Anaphylactic shock is a life-threatening condition which needs detailed and mediculous clinical assessment and thoughtful treatment. Several causes can join forces in order to degranulate mast cells. Amiodarone which is an iodine-containing highly lipophilic benzofuran can induce allergic reactions and anaphylactic shock in sensitized patients. Epinephrine is a life saving drug, but in sulfite allergic patients it should be given with caution due its metabisulfite preservative. Metals covering cardiac defibrillators and pacemakers can act as antigens attached to serum proteins and induce allergic reactions. In anaphylactic shock, myocardial involvement due to vasospasm-induced coronary blood flow reduction manifesting as Kounis syndrome should be always considered. Clinically, combined treatment targeting the primary cause of anaphylaxis together with protection of cardiac tissue seems to be of paramount importance.

  20. Custo-efetividade de cardiodesfibriladores implantáveis no Brasil nos setores público e privado Cost-effectiveness of implantable cardioverter defibrillators in Brazil in the public and private sectors

    Directory of Open Access Journals (Sweden)

    Rodrigo Antonini Ribeiro

    2010-10-01

    Full Text Available FUNDAMENTO: Vários ensaios clínicos randomizados demonstraram a efetividade do cardiodesfibrilador implantável (CDI na redução de morte de pacientes com insuficiência cardíaca congestiva (ICC. Estudos de países desenvolvidos já avaliaram a custo-efetividade do CDI, porém as informações não são transferíveis para o Brasil. OBJETIVO: Avaliar a custo-efetividade do CDI em pacientes com ICC sob duas perspectivas: pública e saúde suplementar. MÉTODOS: Um modelo de Markov foi criado para analisar a relação de custo-efetividade incremental (RCEI do CDI, comparado à terapia convencional, em pacientes com ICC. Efetividade foi medida em anos de vida ajustados para qualidade (QALY. Na literatura, buscaram-se dados de efetividade e complicações. Custos foram extraídos das tabelas do SUS e de valores praticados pelos convênios, assim como médias de internações hospitalares. Análises de sensibilidade univariadas foram feitas em todas as variáveis do modelo. RESULTADOS: A RCEI foi de R$ 68.318/QALY no cenário público e R$ 90.942/QALY no privado. Esses valores são superiores aos sugeridos como pontos de corte pela Organização Mundial da Saúde, de três vezes o PIB per capita (R$ 40.545 no Brasil. Variáveis mais influentes na análise de sensibilidade foram: custo do CDI, intervalo de troca do gerador e efetividade do CDI. Em simulação de cenário semelhante ao MADIT-I, as relações foram de R$ 23.739/QALY no cenário público e R$ 33.592/QALY no privado. CONCLUSÃO: Para a população em geral com ICC, a relação de RCEI do CDI, tanto na perspectiva pública como na privada, é elevada. Resultados mais favoráveis ocorrem em pacientes com alto risco de morte súbita.BACKGROUND: Many randomized clinical trials have demonstrated the effectiveness of the implantable cardioverter-defibrillator (ICDs in death reduction of chronic heart failure (CHF patients. Some developed countries studies have evaluated its cost

  1. Modulatory effects of cognitive behavior therapy on depression and anxiety in patients with implantable cardioverter defibrillator%认知行为疗法对心律转复除颤器植入患者抑郁焦虑症状的调节作用

    Institute of Scientific and Technical Information of China (English)

    祁述善; 方臻飞; 刘启明; 周胜华

    2005-01-01

    BACKGROUND: 60% of the patients receiving implantable cardioverter defibrillator(ICD) believe their quality of life has been improved. However,about 30% to 50% of the patients suffer from postoperative depression and anxiety; especially those patients receive electroconvulsive therapy (ECT).OBJECTIVE: To probe into the modulatory effects of cognitive behavior therapy(CBT) on depression and anxiety in patients with ICD.DESIGN: A retrospective case analysis based on ICD patients SETTING: Room of Cardiac Catheterization, Department of Cardiology, Xiangya Second Hospital PARTICIPANTS: The study was conducted in the Room of Cardiac Catheterization of the Department of Cardiology, Xiangya Second Hospital,Central South University from October 2000 to August 2001. Inclusive criteria: ICD patients that had ineffective medicine therapy for paroxysmal ventricular tachycardia and/or ventricular fibrillation complicated with cardiac syncope. Exclusive criteria: incoorperative patients or patients who unable to receive periodical follow up. A total of 6 patients were involved including 4 male and 2 female patients aged from 45 to 71 years old with an average age of (57.3 ± 2.4) years old. All of the patients received Micro Jewell Ⅱ 7223 ICD made by Medtronic Company. Diagnoses of basic disease:2 cases of coronary heart disease, 2 cases of right ventricular myocardial disease, 1 case of paroxysmal ventricular tachycardia due to unknown reason,and 1 case of Brugada syndrome.METHODS: "Morita therapy" technique was used. Patients were asked to transfer their spirit energies into feasible objectives of their real life, which would be helpful to the rapid improvement of their symptoms. symptom checklist-90(SCL-90) scale was used to evaluate the psychological symptoms before and after the therapy.MAIN OUTCOME MEASURES: Comparison of the scores gained in SCL-90 between before and after CBT.RESULTS: There were significant differences in the items of somatization,compulsion, sensitive

  2. DDD-ICD: discrimination of supraventricular tachyarrhythmias

    Directory of Open Access Journals (Sweden)

    REVISHVILI Amiran R.

    1999-01-01

    Full Text Available Background: Dual Chamber Implantable Cardioverter Defibrillator (ICD in addition to providing hemodynamically improved bradycardia support can also reduce the incidence of inappropriate ventricular shocks owing to episodes of Supraventricular Tachycardia (SVT, with reported incidence of up to 41% of patients. An atrio-ventricular (AV discrimination algorithm is needed in dual chamber implantable cardioverter-defibrillators (ICD to avoid these inappropriate shocks. Methods: An AV discrimination algorithm, SMART DetectionTM, has been developed to differentiate between episodes of ventricular tachycardia (VT and SVT. It relies on the concept that the chamber with the higher rate is the origin of the tachycardia. The ventricular rate stability criterion is also used to detect concurrent VT during an episode of SVT. Other parameters used in the discrimination algorithm are: atrial and ventricular rhythm multiplicity, P-R regularity, sudden onset. The SMART DetectionTM algorithm has been implemented in the Biotronik Phylax® AV dual chamber ICD. The original SMART DetectionTM has been improved recently with the addition of active detection in the case of 1:1 AV conduction. Results: 10 patients were implanted with Phylax® AV's at the Bakoulev Institute. Analyses of stored dual chamber intracardiac electrogram (IEGM indicate that all episodes of VTs and Ventricular Fibrillations (VF were terminated following appropriate therapies. No episode of Atrial Flutter (Afl or Atrial Fibrillation (AF was treated even though the majority of patients have a history of SVTs. In one patient, an episode of Sinus Tachycardia (ST was inappropriately treated. Increasing the sudden onset criterion, which is used only in the case of stable 1:1 rhythms, was sufficient to prevent recurrence of inappropriate therapy. To avoid the necessity of setting the, not very reliable, sudden onset criterion an active detection procedure was developed. Isolated Premature Ventricular

  3. Subcutaneous Implantable Cardioverter-Defibrillator

    Science.gov (United States)

    ... LIBRARY Hello, Guest! My alerts Sign In Join Facebook Twitter Home About this Journal Editorial Board General Statistics Circulation Cover Doodle → Blip the Doodle Go Red For Women's Issue Information for Advertisers Author Reprints Commercial Reprints Customer Service and Ordering ...

  4. A comparison of the health status and psychological distress of partners of patients with a left ventricular assist device versus an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Brouwers, Corline; Caliskan, Kadir; de Jonge, Nicolaas;

    2014-01-01

    therefore an important aspect in the care of LVAD and ICD patients. METHODS: Multi-center prospective observational study with 6 months follow-up of 33 LVAD partners (27% men; mean age = 54 ± 10 years) and 414 ICD partners (22% men; mean age = 60 ± 12 years). RESULTS: LVAD partners reported better physical...

  5. A questionable indication for ICD extraction after successful VT ablation

    Directory of Open Access Journals (Sweden)

    Luca Segreti, MD; Andrea Di Cori, MD; Giulio Zucchelli, MD, PhD; Ezio Soldati, MD; Giovanni Coluccia, MD; Stefano Viani, MD; Luca Paperini, MD; Maria Grazia Bongiorni, MD, FESC

    2015-04-01

    Full Text Available Sustained ventricular tachyarrhythmias represent a kind of complication shared by a number of clinical presentations of heart disease, sometimes leading to sudden cardiac death. Many efforts have been made in the fight against such a complication, mainly being represented by the implantable cardioverter defibrillator (ICD. In recent years, catheter ablation has grown as a means to effectively treat patients with sustained ventricular arrhythmias, in the contest of different cardiac substrates. Since carrying an ICD is associated with a potential risk deriving from its possible infective or malfunctioning complications, and given the current effectiveness of lead extraction procedures, it has been thought not to be unreasonable to ask ourselves about how to deal with ICD patients who have been successfully treated by means of ablation of their ventricular arrhythmias. In this paper we will review the current evidence about ICD therapy, catheter ablation of ventricular arrhythmias and lead extraction, trying to outline some considerations about how to face this new clinical issue.

  6. Traumatic Tension Pneumothorax as a Cause of ICD Failure: A Case Report and Review of the Literature.

    Science.gov (United States)

    Ul Haq, Ehtesham; Omar, Bassam

    2014-01-01

    Background. Tension pneumothorax can infrequently cause ventricular arrhythmias and increase the threshold of defibrillation. It should be suspected whenever there is difficulty in defibrillation for a ventricular arrhythmia. Purpose. To report a case of traumatic tension pneumothorax leading to ventricular tachycardia and causing defibrillator failure. Case. A 65-year-old African-American female was brought in to our emergency department complaining of dyspnea after being forced down by cops. She had history of mitral valve replacement for severe mitral regurgitation and biventricular implantable cardioverter defibrillator inserted for nonischemic cardiomyopathy. Shortly after arrival, she developed sustained ventricular tachycardia, causing repetitive unsuccessful ICD shocks. She was intubated and ventricular tachycardia resolved with amiodarone. Chest radiograph revealed large left sided tension pneumothorax which was promptly drained. The patient was treated for congestive heart failure; she was extubated on the third day of admission, and the chest tube was removed. Conclusion. Prompt recognition of tension pneumothorax is essential, by maintaining a high index of suspicion in patients with an increased defibrillation threshold causing ineffective defibrillations. PMID:25400953

  7. Optimal tachycardia programming in ICDs : Recommendations in the post-MADIT-RIT era.

    Science.gov (United States)

    Israel, Carsten W; Burmistrava, Tatsiana

    2016-09-01

    Optimal implantable cardioverter-defibrillator (ICD) programming can reduce the incidence of inappropriate shock therapy and improve prognosis in patients with an ICD. Only after results from randomized trials became available was the "safety first" feeling overcome that mandated early shock therapy, waived the use of antitachycardia pacing and forced shock therapy after a time of 30 s expired, even if tachycardia discriminators would have withheld the therapy. The strong evidence to limit ICD therapy to longer ventricular tachycardia (VT) should not result in individually dangerous ICD programming, particularly in patients with a high risk of slow VT (known monomorphic VT, post VT ablation, during treatment with amiodarone, very dilated left ventricle). Monitoring zones may aid to detect unexpected slow VT and to explain symptoms such as presyncope without exposing the patient to an unnecessary risk of inappropriate therapy. This review summarizes our current knowledge on optimal ICD programming and explains exactly how we should program device parameters in practice in single- or dual-chamber ICDs by different manufacturers and in different groups of patients. PMID:27624808

  8. Optimal tachycardia programming in ICDs : Recommendations in the post-MADIT-RIT era.

    Science.gov (United States)

    Israel, Carsten W; Burmistrava, Tatsiana

    2016-09-01

    Optimal implantable cardioverter-defibrillator (ICD) programming can reduce the incidence of inappropriate shock therapy and improve prognosis in patients with an ICD. Only after results from randomized trials became available was the "safety first" feeling overcome that mandated early shock therapy, waived the use of antitachycardia pacing and forced shock therapy after a time of 30 s expired, even if tachycardia discriminators would have withheld the therapy. The strong evidence to limit ICD therapy to longer ventricular tachycardia (VT) should not result in individually dangerous ICD programming, particularly in patients with a high risk of slow VT (known monomorphic VT, post VT ablation, during treatment with amiodarone, very dilated left ventricle). Monitoring zones may aid to detect unexpected slow VT and to explain symptoms such as presyncope without exposing the patient to an unnecessary risk of inappropriate therapy. This review summarizes our current knowledge on optimal ICD programming and explains exactly how we should program device parameters in practice in single- or dual-chamber ICDs by different manufacturers and in different groups of patients.

  9. Insulation Failure of the Linox Defibrillator Lead: A Case Report and Retrospective Review of a Single Center Experience.

    Science.gov (United States)

    Howe, Andrew J; McKeag, Nicholas A; Wilson, Carol M; Ashfield, Kyle P; Roberts, Michael J

    2015-06-01

    Implantable cardioverter defibrillator (ICD) lead insulation failure and conductor externalization have been increasingly reported. The 7.8F silicon-insulated Linox SD and Linox S ICD leads (Biotronik, Berlin, Germany) were released in 2006 and 2007, respectively, with an estimated 85,000 implantations worldwide. A 39-year-old female suffered an out-of-hospital ventricular fibrillation (VF) arrest with successful resuscitation. An ICD was implanted utilizing a single coil active fixation Linox(Smart) S lead (Biotronik, Berlin, Germany). A device-triggered alert approximately 3 years after implantation confirmed nonphysiological high rate sensing leading to VF detection. A chest X-ray showed an abnormality of the ICD lead and fluoroscopic screening confirmed conductor externalization proximal to the defibrillator coil. In view of the combined electrical and fluoroscopic abnormalities, urgent lead extraction and replacement were performed. A review of Linox (Biotronik) and Vigila (Sorin Group, Milan, Italy) lead implantations within our center (n = 98) identified 3 additional patients presenting with premature lead failure, 2 associated with nonphysiological sensed events and one associated with a significant decrease in lead impedance. All leads were subsequently removed and replaced. This case provides a striking example of insulation failure affecting the Linox ICD lead and, we believe, is the first to demonstrate conductor externalization manifesting both electrical and fluoroscopic abnormalities. PMID:25711237

  10. Incidence and causes of inappropriate detection and therapy by implantable defibrillators of cardioversion in patients with ventricular tachyarrhythmia

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background Implantable cardioverter defibrillator (ICD) is the only effective therapy in patients with life threatening ventricular arrhythmias. Inappropriate detection and therapy by ICDs are the most common causes of side effects that affect the quality of life in ICD recipients. This study evaluated the incidence and causes of inappropriate detection and therapy by ICDs in patients in our hospital.Methods From January 2000 to December 2005, fifty patients who received ICD implantation for ventricular arrhythmias for prevention of sudden cardiac death were evaluated in this study. Each ICD was programmed using clinical arrhythmic and cardiac data of the patient before discharge. Patients were followed up by standard schedule after implantation and all data retrieved from each device were collected and saved for further analysis. Results No arrhythmic event was detected in 12/50 (24%) patients during the period of follow-up. Among the remaining patients, 11 (22%) experienced inappropriate detections and therapies during follow-up in this study. ICD detected 383 ventricular tachyarrhythmia (VT) and 108 ventricular fibrillation (VF) episodes and delivered 678 therapies. In VT group, ICD delivered 413 antitachycardiac pacings (ATPs) and 118 shocks, among which 78 ATPs and 9 shocks were initiated by 55/383 (14.3%) inappropriate detections. In VF group ICD delivered 147 shocks, among which 56 shocks were initiated by 28/108 (26.9%) inappropriate detections. Overall, more than 50% of these episodes were caused by atrial fibrillation (AF) with rapid ventricular response, followed by electromagnetic or myopotential interference. In addition, most inappropriate therapies occurred within one year after ICD implantation.Conclusions About one fifth of patients experienced ICD inappropriate detection and therapy after implantation. The main cause was AF with rapid ventricular response, followed by electromagnetic or myopotential interference.

  11. An ICD Programming Study for Patients with Electrical Storm after Implantation of Implantable Cardioverter Defib-rillator%除颤器植入患者发生心室电风暴慢室速时参数设置的研究

    Institute of Scientific and Technical Information of China (English)

    王召军; 郑蕾; 陈家亮; 曲秀芬; 李晶洁

    2014-01-01

    目的:探讨植入型心律转复除颤器( implantable cardioverter defibrillator, ICD)植入患者发生心室电风暴慢室性心动过速(慢室速,150~180/min)时合理的ICD工作模式的参数设置。方法对我院ICD植入以心室电风暴慢室速急诊入院的11例常规予抗室速药物治疗,慢室速的治疗工作模式均随机选择抗心动过速起搏( ATP)的短阵快速起搏(BURST)5次后不转复即予体内电击(SHOCK)治疗(B5方案)和BURST 1次后不转复即予低能量SHOCK治疗( S1方案)。 B5方案和S1方案,每种方案工作24 h,然后轮换,观察2周内慢室速总发作次数,B5方案和S1方案的总工作次数、复律成功率、室速治疗开始到成功的时间及患者耐受情况。结果本组共记录188 d,其中B5方案、S1方案各94 d。 ICD共检测到慢室速204次,其中室速监测未治疗(VT-monitored)82次(有3次事件在ATP治疗前自行终止),室速监测并治疗122次(治疗应用B5方案65次,S1方案57次)。住院期间无死亡患者,B5方案和S1方案的转复成功率和SHOCK发生率比较差异无统计学意义(P>0.05),但B5方案总ICD治疗时间较S1方案明显增加(P0. 05), but the treatment time was increased in B5 scheme than that in S1 scheme (P <0. 01). Conclusion Patients with ICD implantation during ventricular electrical storm should be pro-grammed individually. Excessive pursuit of ATP painless therapy may increase the risk of heart failure.

  12. 植入除颤器患者的双腔起搏或心室后备起搏双腔和VVI植入型除颤器(DAVID)试验%Dual-Chamber Pacing or Ventricular Backup Pacing in Patients With an Implantable Defibrillator The Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial

    Institute of Scientific and Technical Information of China (English)

    The DAVID Trial Investigators

    2003-01-01

    @@ 背景:有后备心室起搏的植入型心律转复除颤器(implant-able cardioverter defibrillator,ICD)可使有危及生命的室性心律失常患者的生存率提高.最新的植入型ICD绝大多数具有双腔起搏治疗功能.在该人群,死亡率的最常见原因是充血性心力衰竭.

  13. Impact of implantable defibrillators and resynchronization therapy on outcome in patients with left ventricular dysfunction--a meta-analysis

    DEFF Research Database (Denmark)

    Abdulla, Jawdat; Haarbo, Jens; Køber, Lars;

    2006-01-01

    BACKGROUND: The clinical benefits of cardiac resynchronization therapy (CRT) and primary prophylactic implantable cardioverter defibrillator (ICD) in patients with left ventricular systolic dysfunction (LVSD) are debated. OBJECTIVE: To evaluate by a meta-analysis the effect of CRT and prophylactic...... ICD therapy in patients with LVSD. METHODS: Eligible trials evaluating the effect of CRT vs. no-CRT, ICD vs. no-ICD and adding ICD to CRT vs. no-ICD were selected and meta-analyzed. The outcomes were: all cause mortality, cardiac mortality, hospitalization for heart failure and change in exercise...... tolerance and New York Heart Association class. RESULTS: Implantation of CRT reduced all cause mortality odds ratio (OR) = 0.73 (0.60-0.89) p = 0.002 and hospitalization for heart failure OR = 0.60 (0.45, 0.80) p = 0.001, increased peak oxygen consumption by 1.77 (0.32-3.22) ml/kg/min p = 0.017 and improved...

  14. Differential effects of defibrillation on systemic and cardiac sympathetic activity

    OpenAIRE

    Bode, F; U. Wiegand; Raasch, W; Richardt, G.; Potratz, J

    1998-01-01

    Objective—To assess the effect of defibrillation shocks on cardiac and circulating catecholamines.
Design—Prospective examination of myocardial catecholamine balance during dc shock by simultaneous determination of arterial and coronary sinus plasma concentrations. Internal countershocks (10-34 J) were applied in 30 patients after initiation of ventricular fibrillation for a routine implantable cardioverter defibrillator test. Another 10 patients were externally cardioverted (50-360 J) for at...

  15. Implantable defibrillator lead extraction with optimized standard extraction techniques

    Institute of Scientific and Technical Information of China (English)

    Xian-Ming Chu; Xue-Bin Li; Ping Zhang; Yi An; Jiang-Bo Duan; Long Wang; Ding Li; Bing Li; Ji-Hong Guo

    2013-01-01

    Background Implantable cardioverter-defibrillator (ICD) leads might not be extracted especially in developing countries because of the high cost and lack of specialized tools. We aimed to evaluate transvenous extraction of ICD leads using optimized standard techniques. Methods We prospectively analyzed clinical characteristics, optimized extraction techniques and the feasibility of extraction for 40 patients (33 males; mean age 47.9 ± 16.1 years) with 42 ICD leads. Results Complete procedural success rate was 95.2% (40/42), and the clinical success rate was 97.6% (41/42). One ICD lead required cardiothoracic surgery. Minor complications occurred in three cases (7.5%), and no major complications or death occurred. Locking stylets were used to extract most leads (34, 81.0%) and almost half of the leads (20, 47.6%) required mechanical dilatation to free fibrotic adhesions; these leads had been implanted for a longer period of time than the others (43.7 ± 18.2 vs. 18.4 ± 13.4 months, P < 0.05). Three-quarters of the leads (30, 71.4%) were extracted with locking stylets plus manual traction (12, 28.6%), or mechanical dilatation with counter-traction (18, 42.8%) by the superior vena cava approach and one-quarter of the leads (11, per lead. Linear regression analysis showed that the extraction time was significantly correlated with implant duration (r = 0.70, P < 0.001). optimized procedure for transvenous extraction of ICD leads provides a practical and low-cost method for standard procedures.

  16. Cause analysis of imappropriate detection or treatment episodes of im-plantable cardioverter defibrillator%埋藏式心脏转复除颤器不适当识别或治疗事件原因分析及处理

    Institute of Scientific and Technical Information of China (English)

    何冉; 韩战营; 张杰; 卢文杰; 宋红星; 陈晓杰; 邱春光; 刘怀霖

    2014-01-01

    Aim:To analyze the causes of imappropriate detection or treatment of implantable cardioverter defibrillator (ICD).Methods:Since 2008 to 2013,42 patients were implanted ICD,clinic materials of 9 patients who subjected imap-propriate detection or treatment were reviewed .Results:Nine(26.5%) patients happened in 41 imappropriate detection or treatment episodes,the average follow-up time was (18.5 ±11.7) months.Twelve imappropriate detections in 4 patients and 29 imappropriate discharges in 7 patients occurred(2 patient was double counted ).Among the total,there are 14 imap-propriate discharge events in 4 patients for sustain VT/FVT with stable hemodynamics ,11 imappropriate discharges and 2 imappropriate detections in one patient for T wave oversensing ,3 imappropriate discharges in one patient for P/R wave double count ,1 imappropriate discharge for electromagnetic interference ,1 imappropriate detection for electromagnetic inter-ference and 1 imappropriate detection for sinus tachycardia .Conclusion:After ICD was implanted ,the incidence of imap-propriate detection or treatment episode is higher , it is necessary to strengthen programing follow-up for prompt abnormal discovery ,therapeutic change and sufficient ATP treatment without pain under a safe condition ,it will profit to reduce imap-propriate discharge and improve the quality of life .%目的:分析埋藏式心脏转复除颤器( ICD)不适当识别或治疗事件的原因。方法:回顾2008年至2013年42例ICD植入患者发生不适当识别或治疗的临床资料。结果:34例随访(18.5±11.7)个月,9例(26.5%)共发生41次不适当识别或治疗事件(其中单腔ICD 2台,双腔ICD 1台,CRT-D 6台)。4例发生不适当识别12次,7例发生不适当治疗29次,其中2例不适当识别或治疗共存。1例发生3次血流动力学稳定的室性心动过速( VT )事件,经抗心动过速起搏(ATP)失败后给予电击治疗6次;3例发生

  17. Renal infarction due to atrial fibrillation after implantation of implantable cardioverter-defibrillator:a case report and review of literature%心房颤动患者植入植入式心脏复律除颤器术后肾梗死1例及文献复习

    Institute of Scientific and Technical Information of China (English)

    黄樱硕; 孙颖; 邢云利; 王翠英; 黄蔚; 李清清; 吴永全; 马清

    2014-01-01

    1例合并阵发性心房颤动(AF)的老年女性因室性心动过速(VT)而植入植入式心脏复律除颤器(ICD),围术期为避免出血风险,未予抗凝治疗,术后7d出现发热、腹痛,完善检查后诊断为肾梗死,立即开始规律抗凝治疗。目前针对AF患者植入心脏节律装置(CRD)围术期不同抗凝策略的安全性及有效性仍有争议。AF患者合并肾梗死相对少见,且该患者临床表现不典型,增加了早期诊断的难度。该病例带给我们的启示是:(1)对于卒中高危的AF患者,在植入CRD的围术期,抗凝治疗是必要的,但是采用何种抗凝策略尚有争议;(2)对于卒中高危的AF患者,在无抗凝的情况下,出现急腹症等表现时,应考虑腹腔脏器急性栓塞梗死的可能性。%We reported an elderly female (76 years old) accompanied with paroxysmal atrial fibrillation (AF) who underwent the implantation of implantable cardioverter-defibrillator (ICD) due to ventricular tachycardia (VT) in our department. No peri-operative anticoagulation was given to her in consideration of risk for hemorrhage. The patient was found to have fever and abdominal pain at the 7th day after surgery, and then right renal infarction was confirmed after diagnosis. Then the patient was given standard anticoagulant therapy. In present, it is a controversial issue on the efficacy and safety of anticoagulation strategy during perioperation of implantation of cardiac rhythm device (CRD). Renal infarction due to AF is relatively rare and the atypical clinical manifestations make early diagnosis for this patient more difficult. The revelation of this case includes:for patients with AF and high risk of stroke, anticoagulation therapy is necessary, but the strategy of anticoagulation remains controversial;for patients with AF and moderate risk of stroke, acute embolic infarction of abdominal organs should be taken into account when acute abdominal

  18. 采用植入式除颤器预防非缺血性心肌病患者发生死亡随机对照试验汇总分析%Implantable Defibrillators for the Prevention of Mortality in Patients With Nonischemic Cardiomyopathy A Meta-analysis of Randomized Controlled Trials

    Institute of Scientific and Technical Information of China (English)

    Akshay S. Desai; James C. Fang; William H. Maisel; 顾佳

    2005-01-01

    @@ 背景:植入式心脏复律除颤器(implantable cardioverter defibrillator,ICD)能有效预防(包括一级预防和二级预防)心脏射血分数(ejection fraction)下降的陈旧性心肌梗死患者发生心源性猝死.但是,目前仍缺乏证据肯定该疗法能提高非缺血性心肌病(nonischemic cardiomyopathy,NICM)患者的生存率.

  19. Infarct size and recurrence of ventricular arrhythmias after defibrillator implantation

    Energy Technology Data Exchange (ETDEWEB)

    Sutter, J. de; Tavernier, R.; Kazmierckzak, J.; Buyzere, M. de; Clement, D.L. [Department of Cardiology, University Hospital Gent, Gent (Belgium); Wiele, C. van de; Dierckx, R.A. [Department of Nuclear Medicine, University Hospital Gent (Belgium); Jordaens, L. [Thoraxcenter, University Hospital Rotterdam-Dijkzigt (Netherlands)

    2000-07-01

    Infarct size as determined by perfusion imaging is an independent predictor of mortality after implantable cardioverter defibrillator (ICD) implantation in patients with coronary artery disease (CAD) and life-threatening ventricular arrhythmias (VA). However, its value as a predictor of VA recurrence and hospitalisation after ICD implantation is unknown. Therefore, the objective of this study was to evaluate whether infarct size as determined by perfusion imaging can help to identify patients who are at high risk for recurrence of VA and hospitalisation after ICD implantation. We studied 56 patients with CAD and life-threatening VA. Before ICD implantation, all patients underwent a uniform study protocol including a thallium-201 stress-redistribution perfusion study. A defect score as a measurement of infarct size was calculated using a 17-segment 5-point scoring system. Study endpoints during follow-up were documented episodes of appropriate anti-tachycardia pacing and/or shocks for VA and cardiac hospitalisation for electrical storm (defined as three or more appropriate ICD interventions within 24 h), heart failure or angina. After a mean follow-up of 470{+-}308 days, 22 patients (39%) had recurrences of VA. In univariate analysis, predictors for recurrence were: (a) ventricular tachycardia (VT) as the initial presenting arrhythmia (86% vs 59% for patients without ICD therapy, P=0.04), (b) treatment with {beta}-blockers (36% vs 68%, P=0.03) and (c) a defect score (DS) {>=}20 (64% vs 32%, P=0.03). In multivariate analysis, VT as the presenting arrhythmia ({chi}2=5.51, P=0.02) and a DS {>=}20 ({chi}2=4.22, P=0.04) remained independent predictors. Cardiac hospitalisation was more frequent in patients with a DS {>=}20 (44% vs 13% for patients with DS <20, P=0.015) and this was particularly due to more frequent hospitalisations for electrical storm (24% vs 3% for patients with DS<20, P=0.037). The extent of scarring determined by perfusion imaging can separate

  20. Subpectoral implantation of ICD generators: long-term follow-up.

    Science.gov (United States)

    Thakur, R K; Ip, J H; Mehta, D; Jung, J Y; Collar, A; Camunas, J; Gomes, J A

    1995-01-01

    A nonthoracotomy surgical approach using an endocardial electrode and combined implantation of a subcutaneous patch and the implantable cardioverter defibrillator (ICD) generator in a subpectoral pocket has been described. We report the long-term follow-up results in patients undergoing implantation using this approach. The patient population consisted of 28 patients (22 men and 6 women) with a mean age of 59 +/- 12 years. The underlying heart disease consisted of coronary artery disease in 20 patients and dilated cardiomyopathy in 8 patients. Sustained ventricular tachycardia was the mode of presentation in 16 patients and sudden cardiac death in 12 patients. The mean left ventricular ejection fraction was 31% +/- 6%. The lead system consisted of an 8 French bipolar passive fixation rate sensing lead positioned at the right ventricular apex, an 11 French spring coil electrode positioned at the superior vena cava-right atrial junction (surface area 700 mm2), and submuscular placement of a large patch (surface area 28 cm2) on the anterolateral chest wall near the cardiac apex via a submammary incision. A defibrillation threshold of submammary incision, and the large patch was placed epicardially. The mean R wave amplitude was 12 +/- 3 mV, the mean pacing threshold was 1.0 +/- 0.5 V at 0.5 msec, and the mean defibrillation threshold was 12.6 +/- 3 J. ICD generators implanted were the Ventak-P in 17, PCD-7217 in 5, and the Cadence V-100 in 6 patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7724391

  1. The Curious Case of the De-ICD: Negotiating the Dynamics of Autonomy and Paternalism in Complex Clinical Relationships.

    Science.gov (United States)

    Pullman, Daryl; Hodgkinson, Kathleen

    2016-08-01

    This article discusses the response of our ethics consultation service to an exceptional request by a patient to have his implantable cardioverter defibrillator (ICD) removed. Despite assurances that the device had saved his life on at least two occasions, and cautions that without it he would almost certainly suffer a potentially lethal cardiac event within 2 years, the patient would not be swayed. Although the patient was judged to be competent, our protracted consultation process lasted more than 8 months as we consulted, argued with, and otherwise cajoled him to change his mind, all to no avail. Justifying our at times aggressive paternalistic intervention helped us to reflect on the nature of autonomy and the dynamics of the legal, moral, and personal relationships in the clinical decision-making process. PMID:27366835

  2. A study to improve communication between clinicians and patients with advanced heart failure: methods and challenges behind the working to improve discussions about defibrillator management trial.

    Science.gov (United States)

    Goldstein, Nathan E; Kalman, Jill; Kutner, Jean S; Fromme, Erik K; Hutchinson, Mathew D; Lipman, Hannah I; Matlock, Daniel D; Swetz, Keith M; Lampert, Rachel; Herasme, Omarys; Morrison, R Sean

    2014-12-01

    We report the challenges of the Working to Improve Discussions About Defibrillator Management trial, our novel, multicenter trial aimed at improving communication between cardiology clinicians and their patients with advanced heart failure (HF) who have implantable cardioverter defibrillators (ICDs). The study objectives are (1) to increase ICD deactivation conversations, (2) to increase the number of ICDs deactivated, and (3) to improve psychological outcomes in bereaved caregivers. The unit of randomization is the hospital, the intervention is aimed at HF clinicians, and the patient and caregiver are the units of analysis. Three hospitals were randomized to usual care and three to intervention. The intervention consists of an interactive educational session, clinician reminders, and individualized feedback. We enroll patients with advanced HF and their caregivers, and then we regularly survey them to evaluate whether the intervention has improved communication between them and their HF providers. We encountered three implementation barriers. First, there were institutional review board concerns at two sites because of the palliative nature of the study. Second, we had difficulty in creating entry criteria that accurately identified an HF population at high risk of dying. Third, we had to adapt our entry criteria to the changing landscape of ventricular assist devices and cardiac transplant eligibility. Here we present our novel solutions to the difficulties we encountered. Our work has the ability to enhance conduct of future studies focusing on improving care for patients with advanced illness.

  3. Contemporary strategies for risk stratification and prevention of sudden death with the implantable defibrillator in hypertrophic cardiomyopathy.

    Science.gov (United States)

    Maron, Barry J; Maron, Martin S

    2016-05-01

    Hypertrophic cardiomyopathy (HCM) is regarded as the most common nontraumatic cause of sudden death (SD) in young people (including trained athletes). Introduction of implantable cardioverter-defibrillators (ICD) to HCM 15 years ago represented a new paradigm for clinical practice and probably the most significant advance in management of this disease. ICDs offer protection against SD by terminating potentially lethal ventricular tachyarrhythmias (11%/year secondary and 4%/year primary prevention), although implant decisions are weighed against the possibility of device-related complications (5%/year). ICDs have altered the natural history of HCM, creating the opportunity for extended or normal longevity for many patients. However, assessing SD risk and targeting appropriate candidates for prophylactic device therapy can be compounded by unpredictability of the underlying arrhythmogenic substrate, evident by delays ≥10 years between implant and first ICD intervention. Multiple or a single strong risk marker within the clinical profile of an individual HCM patient can justify consideration for a primary-prevention ICD when combined with physician judgment and shared decision making. The role of the mathematical SD risk score proposed by the European Society of Cardiology to identify patients who benefit from ICD therapy is incompletely resolved. Contemporary treatment interventions and advanced risk stratification using ≥1 conventional markers have served the HCM patient population well, with reduced disease-related mortality rates across all age groups to <1%/year, due largely to the penetration of ICDs into HCM practice. Prevention of SD has now become an integral, albeit challenging, component of HCM management, contributing importantly to its emergence as a contemporary treatable cardiac disease. PMID:26749314

  4. AUTOMATIC IMPLANTABLE CARDIOVERTER DEFIBRILLATOR - COST-EFFECTIVENESS

    NARCIS (Netherlands)

    HAUER, RNW; WEVER, EFD; CRIJNS, HJGM

    1993-01-01

    Unexpected out-of-hospital cardiac arrest is in most cases due to ventricular fibrillation or rapid ventricular tachycardia. The usual therapeutic strategy in survivors starts with drug treatment, in case of failure followed by nonpharmacological therapy, which may include catheter ablation, ablativ

  5. [The clinical practice guidelines of the Sociedad Española de Cardiología on the automatic implantable defibrillator].

    Science.gov (United States)

    Pérez-Villacastín, J; Carmona Salinas, J R; Hernández Madrid, A; Marín Huerta, E; Merino Llorens, J L; Ormaetxe Merodio, J; Moya i Mitjans, A

    1999-12-01

    Since the first implantation in man in 1980 implantable cardioverter defibrillator technology has greatly improved and the number of devices implanted has increased considerably every year. Non thoracotomy lead systems and biphasic shocks are now the approach of choice, offering an almost 100% success rate. This document reviews the recommendations for qualification of personnel and for the centres implanting and carrying out follow-ups on defibrillators. The current indications for the implantation of implantable cardioverter defibrillator are also addressed.

  6. Impacto da parada cardíaca induzida nas funções cognitivas após o implante de cardiodesfibrilador Impacto de la parada cardíaca inducida en las funciones cognitivas después del implante de desfibrilador cardiaco Impact of induced cardiac arrest on cognitive function after implantation of a cardioverter-defibrillator

    Directory of Open Access Journals (Sweden)

    Mauro Prado da Silva

    2009-02-01

    1980 y se considera el tratamiento estándar para individuos bajo el riesgo de desarrollar arritmias ventriculares fatales. Con el interés de garantizar el funcionamiento adecuado del desfibrilador cardiaco, la energía necesaria para el término de la taquicardia ventricular o de la fibrilación ventricular, debe ser determinada durante el implante, siendo este procedimiento llamado test del límite de desfibrilación. Para la realización del test es necesario que se haga la inducción de la fibrilación ventricular, para que el aparato pueda identificar el ritmo cardíaco y tratarlo. El objetivo de este estudio fue verificar la incidencia de disfunción cognitiva 24 horas después del implante del desfibrilador cardiaco. MÉTODO: Se seleccionó una muestra consecutiva de 30 pacientes con indicación de colocación de desfibrilador cardiaco implantable (DCI y 30 pacientes con indicación de implante de marca-paso (MP. Los pacientes fueron evaluados en los siguientes momentos: 24 horas antes de la colocación del DCI o MP con ficha de evaluación preanestésica, Mini-Examen del Estado Mental (MEEM y Confusion Assessment Method (CAM. Durante el implante del DCI o MP fueron medidas las variables: número de paradas cardíacas y tiempo total de parada cardíaca. Veinte y cuatro horas después de la colocación del DCI o MP, se evaluaron las variables: MEEM y CAM. RESULTADOS: El test de Fisher mostró que no había diferencia de la frecuencia de puntuaciones alteradas del MEEM y del CAM entre los grupos antes y después de los implantes. El tiempo promedio de PCR 7,06, con máximos y mínimos de 15,1 y 4,7 segundos. CONCLUSIONES: La inducción de parada cardíaca durante el test del límite de desfibrilación, no conllevó a la disfunción cognitiva veinte y cuatro horas después del implante del desfibrilador cardiaco.BACKGROUND AND OBJECTIVES: Implantable cardioverter-defibrillators (ICD were introduced in clinical practice in 1980 and they are considered the standard

  7. Improved survival of patients with coronary artery disease and low ejection fraction with ICD implantation versus conventional therapy in a real world survey

    Directory of Open Access Journals (Sweden)

    Aschenbrenner Timo

    2012-07-01

    Full Text Available Abstract Background Coronary artery disease (CAD is associated with an increased risk for sudden cardiac death. Randomized controlled trials have shown that implantable cardioverter defibrillators (ICD improve life expectancy unless they are implanted within the first days after an acute myocardial infarction and guidelines recommend their use. We aimed to validate that these results also apply to patients of a typical community hospital in Germany. Methods This was a retrospective analysis of patients undergoing coronary angiography in the Lippe-Detmold Hospital between 2003 and 2006. They had to have significant CAD and an ejection fraction (EF ≤ 35% and no acute myocardial infarction within 28 days of implantation and no history of ventricular fibrillation. Results 213 patients were included; 70 of which received an ICD. Patients with an ICD implantation were younger (64.8 ± 9.9 vs. 67.9 ± 9.8 years; p = 0.034, had single vessel CAD more frequently (22.9 vs. 11.2%; p = 0.025 and a lower EF (26.7 ± 6.3 vs. 29.1 ± 4.6%; p = 0.006. Hospital readmissions were comparable between the ICD and the control group (68.6 vs. 72.0%; p = 0.602. ICD therapy was associated with a considerable survival benefit compared to conventional therapy (HR 0.52; 95%CI 0.29-0.93; p = 0.027 in a Cox-Proportional Hazards Regression analysis. Conclusions Appreciating the potential limitations of retrospective studies, we found that ICD use was associated with improved survival in patients with significant CAD and an EF

  8. Defibrillation lead placement using a transthoracic transatrial approach in a case without transvenous access due to lack of the right superior vena cava.

    Science.gov (United States)

    Otsuka, Yosuke; Okamura, Hideo; Sato, Syunsuke; Nakajima, Ikutaro; Ishibashi, Kohei; Miyamoto, Kouji; Noda, Takashi; Aiba, Takeshi; Kamakura, Shiro; Kobayashi, Junjiro; Yasuda, Satoshi; Ogawa, Hisao; Kusano, Kengo

    2015-06-01

    A 65-year-old woman with a history of syncope was diagnosed with hypertrophic cardiomyopathy. She had previously undergone mastectomy of the left breast owing to breast cancer. Holter electrocardiogram (ECG) and monitor ECG revealed sick sinus syndrome (Type II) and non-sustained ventricular tachycardia. Sustained ventricular tachycardia and ventricular fibrillation were induced in an electrophysiological study. Although the patient was eligible for treatment with a dual chamber implantable cardioverter defibrillator (ICD), venography revealed lack of the right superior vena cava (R-SVC). Lead placement from the left subclavian vein would have increased the risk of lymphedema owing to the patient׳s mastectomy history. Consequently, the defibrillation lead was placed in the right ventricle by direct puncture of the right auricle through the tricuspid valve. The atrial lead was sutured to the atrial wall, and the postoperative course was unremarkable. Defibrillation lead placement using a transthoracic transatrial approach can be an alternative method in cases where a transvenous approach for lead placement is not feasible.

  9. A prospective study of anxiety in ICD patients with a pilot randomized controlled trial of cognitive behavioral therapy for patients with moderate to severe anxiety

    DEFF Research Database (Denmark)

    Qintar, Mohammed; George, Jason J; Panko, Melanie;

    2015-01-01

    PURPOSE: Stress and anxiety are potential consequences from arrhythmias and implantable cardioverter defibrillator (ICD) shocks that can contribute to substantial morbidity. We assessed anxiety associated with an ICD and whether cognitive behavioral therapy (CBT) reduces anxiety. METHODS: The study......) psychometric tests. Part 2 (N = 29) was a pilot randomized controlled trial of CBT (three sessions in 3 months) vs. usual care (UC) in patients with BAI ≥ 19 from part 1. RESULTS: The median BAI and GAD-7 scores were 5 and 2, respectively. By BAI scores, 64.5 % had minimal and 3.9 % had severe anxiety. By GAD.......019). In the pilot trial of CBT, median BAI scores decreased from 24.5 to 11 at 1 year (p = 0.031) in the CBT group and GAD-7 scores from 12.5 to 7 (p = 0.063); no significant changes in anxiety scores were observed in the UC group. CONCLUSIONS: Severe anxiety was present in a small proportion of ICD patients...

  10. Estudo clínico de um sistema cardioversor-desfibrilador implantável que apresenta limiares de desfibrilação baixos usando eletrodos de estrutura fractal Clinical studies of an implantable cardioversor - defibrillators system providing low defibrillation thresholds as well as high signal amplitudes due to fractal coated electrodes

    Directory of Open Access Journals (Sweden)

    Fernando A. LUCCHESE

    1999-01-01

    Full Text Available Em função do contínuo desenvolvimento tecnológico, a geração atual de cardioversores-desfibriladores implantáveis (CDI garante um alto grau de segurança e eficiência na detecção e reversão de taquiarritmias ventriculares. O presente trabalho sumariza os resultados clínicos obtidos com 1058 CDI de câmara única (Phylax 6, Phylax XM, Biotronik utilizando eletrodo único e tecnologia de carcaça ativa, SPS e Kainox RV (com uma mola intracavitária de choque, SL-ICD e Kainox SL (com duas molas intracavitárias de choque, Biotronik. Na quase totalidade dos pacientes, com exceção de 3 (> 99%, foram obtidos limiares de desfibrilação com baixa energia usando apenas um eletrodo transvenoso. Isto tem permitido substituir o teste de limiar de desfibrilação usual por um teste simples durante o implante, afim de minimizar os riscos associados com repetidas induções de fibrilação e conseqüente extensão do período de anestesia.Due to continuously improved technologies, the present generation of implantable cardioverter-defibrillators (ICD guarantees a high degree of safety and efficacy for detecting and terminating ventricular tachyarrhythmias. This paper summarizes the clinical results obtained with 1058 single-chamber ICD (Phylax 6, Phylax XM, Biotronik employing single-lead and active housing technology (SPS and Kainox RV (single coil, SL-ICD and Kainox SL (double coil, Biotronik. In all but 3 patients (> 99%, reliable low-energy defibrillation was achieved using transvenous leads only. This has led to the trend to replace DFT testing by a short function test during implantation in order to minimize the risks associated with repeated induction of fibrillation and extended anesthesia.

  11. Incidência de choques e qualidade de vida em jovens com cardioversor-desfibrilador implantável Incidence of shock and quality of life in young patients with implantable cardioverter-defibrillator

    Directory of Open Access Journals (Sweden)

    Roberto Costa

    2007-03-01

    Full Text Available OBJETIVOS: Avaliar a incidência e a causa de choques de CDI em crianças e adolescentes e sua repercussão na qualidade de vida (QV. MÉTODOS: De março/1997 a fevereiro/2006, 29 pacientes (15,7±5,4 anos foram submetidos a implante de CDI. Parada cardiorrespiratória recuperada (41,5%, taquicardia ventricular sustentada (27,6% e profilaxia primária de morte súbita cardíaca (30,9% motivaram os implantes. O número de terapias foi avaliado por entrevista e pela telemetria dos CDI. A QV foi avaliada pela aplicação do questionário SF-36 e comparada à de indivíduos saudáveis. Empregou-se o método de Kaplan-Meier para análise da sobrevida livre de choques. RESULTADOS: Após 2,6±1,8 anos de seguimento, 8 (27,6% pacientes receberam 141 choques apropriados em razão de TV polimórfica (6 ou FV (2, e 11 (37,9% sofreram 152 choques inapropriados em razão de taquiarritmias supraventriculares (8 ou oversensing (3. A expectativa de sobrevida livre de choques apropriados foi de 74,2%±9,0 após um ano, e de 66,7%±10,7 após três anos. Observou-se diminuição da QV nos aspectos físicos (61,7±28,7, na vitalidade (64,7±19,1, na saúde mental (65,9±22,7 e nos aspectos emocionais (66,7±38,5. Medo e preocupações relacionados ao CDI foram referidos por todos os pacientes. CONCLUSÃO: A despeito da grande eficácia dessa terapêutica, a incidência elevada de choques interferiu na QV e na adaptação ao dispositivo.OBJECTIVES: To analyze the incidence and causes of ICD therapies in children and young adults and verify their impact on the quality of life (QoL. METHODS: From March/1977 to February/2006, 29 patients (15.7±5.4 years old were submitted to ICD implants. Aborted cardiac arrest (41.5%, sustained ventricular tachycardia (27.6% and primary prophylaxis of sudden cardiac death (30.9% indicated device therapy. The number of therapies was evaluated by interviewing patients and by ICD diagnostic data. The SF-36 questionnaire was used to

  12. A Comparison of the Quality of Life of Patients With an Entirely Subcutaneous Implantable Defibrillator System Versus a Transvenous System (from the EFFORTLESS S-ICD Quality of Life Substudy)

    DEFF Research Database (Denmark)

    Pedersen, Susanne S; Mastenbroek, Mirjam H; Carter, Nathan;

    2016-01-01

    .8157) and mental QoL scores (p = 0.9080) across baseline, 3, and 6 months after implantation in adjusted analyses. The evolution in physical (p = 0.0503) and mental scores (p = 0.3772) during follow-up was similar for both cohorts, as indicated by the nonsignificant interaction effect for ICD system by time. Both...

  13. Prevention of sudden death in hypertrophic cardiomyopathy (HCM):implanted defibrillators in HCM%肥厚型心肌病猝死预防:肥厚型心肌病患者除颤器置入

    Institute of Scientific and Technical Information of China (English)

    Barry J Maron; Paolo Spirito

    2009-01-01

    Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death in young people. The implantable cardioverter-defibrillator (ICD), has recently proved to be a safe and effective therapeutic intervention in patients with HCM, both for the primary and secondary prevention of sudden death. Based on recent substantial experience, the ICD intervenes appropriately to termiante ventricular tachycardia/fibrillation (VT/VF), at a rate of 5.5%/year. ICD discharge rate is 4%/year in those patients implanted prophylactically due to one or more major risk markers, but often with considerable delays of up to 10 years before the device is required to intervene appropriately to terminate potentially letal ventricular tachyarrhythmias. Primary prevention of VT/VF occurs with similar frequency in high-risk patients having either 1,2 or ≥ 3 noninvasive risk markers, and about one-third of patients with appropriate device interventions had been implanted for only one risk factor. The ICD has proved reliable in HCM despite the extreme and complex phenotypes often present with massive degrees of left vcntricular hypertrophy, microvascular ischemia, diastolic dysfunction, or dynamic left ventricular outflow tract obstruction. Failure to convert life-threatening ventrieular tachyarrhythmias to normal rhythm is extraordinarily rare. In conclusion, in high-risk HCM patients, ICDs perform in a highly effective fashion,frequently preventing sudden death by aborting primary life-threatening ventricular tachyarrhythmias. A single marker of high risk can be sufficient evidence to justify the recommendation for a prophylactic ICD in selected patients with HCM.

  14. Polymorphisms associated with ventricular tachyarrhythmias: rationale, design, and endpoints of the 'diagnostic data influence on disease management and relation of genomics to ventricular tachyarrhythmias in implantable cardioverter/defibrillator patients (DISCOVERY)' study

    DEFF Research Database (Denmark)

    Garcia, Javier; Wieneke, Heinrich; Spencker, Sebastian;

    2010-01-01

    (SNPs) are DNA sequence variations occurring when a single nucleotide in the genome differs among members of a species. A novel concept has emerged being that these common genetic variations might modify the susceptibility of a certain population to specific diseases. Thus, genetic factors may also...... modulate the risk for arrhythmias and sudden cardiac death, and identification of common variants could help to better identify patients at risk. The DISCOVERY study is an interventional, longitudinal, prospective, multi-centre diagnostic study that will enrol 1287 patients in approximately 80 European...... centres. In the genetic part of the DISCOVERY study, candidate gene polymorphisms involved in coding of the G-protein subunits will be correlated with the occurrence of ventricular arrhythmias in patients receiving an ICD for primary prevention. Furthermore, in order to search for additional sequence...

  15. A patch in the pectoral position lowers defibrillation threshold.

    Science.gov (United States)

    Karasik, P; Solomon, A; Verdino, R; Moore, H; Rodak, D; Hannan, R; Fletcher, R

    1997-06-01

    Implantable pacemaker cardioverter defibrillators are now available with biphasic waveforms, which have been shown to markedly improve defibrillation thresholds (DFTs). However, in a number of patients the DFT remains high. Also, DFT may increase after implantation, especially if antiarrhythmic drugs are added. We report on the use of a subcutaneous patch in the pectoral position in 15 patients receiving a transvenous defibrillator as a method of easily reducing the DFT. A 660-mm2 patch electrode was placed beneath the generator in a pocket created on the pectoral fascia. The energy required for defibrillation was lowered by 56% on average, and the system impedance was lowered by a mean of 25%. This maneuver allowed all patients to undergo a successful implant with adequate safety margin.

  16. Prevención primaria y secundaria de muerte súbita en un hospital de la Seguridad Social de Costa Rica: reporte del registro de pacientes con desfibrilador automático implantable, 2007-2011 Primary and secondary prevention of sudden cardiac death in a hospital of the social security system in Costa Rica: report from the registry of patients with implantable cardioverter-defibrillators, 2007-2011

    Directory of Open Access Journals (Sweden)

    Hugo Arguedas-Jiménez

    2013-03-01

    Full Text Available Justificación y objetivo: diversos estudios han demostrado la eficacia de los desfibriladores automáticos implantables en la prevención de la muerte súbita cardiaca. La aplicación de dicha evidencia debe ser evaluada mediante registros. El objetivo de este estudio fue describir las principales características epidemiológicas y clínicas y las complicaciones de los pacientes a quienes se les implanta un desfibrilador automático implantable en un hospital de tercer nivel en Costa Rica. Métodos: estudio observacional de cohorte, retrospectivo, que incluyó la totalidad de pacientes a quienes se les implantó un desfibrilador automático implantable en el hospital “Dr. Rafael Ángel Calderón Guardia” entre 2007 y 2011. Resultados: se incluyó 23 pacientes. La edad media fue de 55 ± 18 años. La cardiopatía isquémica fue la etiología más frecuente (10 pacientes. Veinte pacientes estaban en clase funcional I o II; la fracción de eyección media fue 0,38 ± 0,17. En los 18 pacientes el desfibrilador automático se implantó por prevención secundaria. Cinco pacientes presentaron una complicación temprana, todos ellos con dispositivos bicamerales: 2 hematomas menores, una disección del seno coronario, un desplazamiento del electrodo atrial derecho y un ictus cardioembólico. Hubo un total de 101 terapias (en 8 pacientes, de las cuales 94 fueron apropiadas (en 5 pacientes y 7 inapropiadas (en 3 pacientes; dos de estos últimos habían tenido episodios previos de fibrilación atrial. Conclusión: este registro muestra que la mayoría de los implantes de desfibriladores automáticos se realizan por prevención secundaria, con una alta tasa de terapias adecuadas y una baja tasa de terapias inadecuadas y de complicaciones; además, permite evaluar las indicaciones y las complicaciones asociadas con esta terapia.Aim: Several studies have demonstrated the efficacy of implantable cardioverter-defibrillators in the prevention of sudden

  17. Uniform pacemaker and ICD information system in the Netherlands

    NARCIS (Netherlands)

    Hooijschuur, CAM; Dijk, WA; van der Velde, W; Sanon, B; Ammeraal, C; Dassen, WRM; Spruijt, HJ; Murray, A

    2002-01-01

    In the Netherlands the Central Pacemaker Patient Registry (CPPR) collects information of pacemaker and ICD (Implantable Cardio Defibrillator) patients from all 109 Dutch hospitals. Many pacemaker clinics are using a computer to store their implant and follow-up data in a database. Because the device

  18. Towards Low Energy Atrial Defibrillation

    Directory of Open Access Journals (Sweden)

    Philip Walsh

    2015-09-01

    Full Text Available A wireless powered implantable atrial defibrillator consisting of a battery driven hand-held radio frequency (RF power transmitter (ex vivo and a passive (battery free implantable power receiver (in vivo that enables measurement of the intracardiac impedance (ICI during internal atrial defibrillation is reported. The architecture is designed to operate in two modes: Cardiac sense mode (power-up, measure the impedance of the cardiac substrate and communicate data to the ex vivo power transmitter and cardiac shock mode (delivery of a synchronised very low tilt rectilinear electrical shock waveform. An initial prototype was implemented and tested. In low-power (sense mode, >5 W was delivered across a 2.5 cm air-skin gap to facilitate measurement of the impedance of the cardiac substrate. In high-power (shock mode, >180 W (delivered as a 12 ms monophasic very-low-tilt-rectilinear (M-VLTR or as a 12 ms biphasic very-low-tilt-rectilinear (B-VLTR chronosymmetric (6ms/6ms amplitude asymmetric (negative phase at 50% magnitude shock was reliably and repeatedly delivered across the same interface; with >47% DC-to-DC (direct current to direct current power transfer efficiency at a switching frequency of 185 kHz achieved. In an initial trial of the RF architecture developed, 30 patients with AF were randomised to therapy with an RF generated M-VLTR or B-VLTR shock using a step-up voltage protocol (50–300 V. Mean energy for successful cardioversion was 8.51 J ± 3.16 J. Subsequent analysis revealed that all patients who cardioverted exhibited a significant decrease in ICI between the first and third shocks (5.00 Ω (SD(σ = 1.62 Ω, p < 0.01 while spectral analysis across frequency also revealed a significant variation in the impedance-amplitude-spectrum-area (IAMSA within the same patient group (|∆(IAMSAS1-IAMSAS3[1 Hz − 20 kHz] = 20.82 Ω-Hz (SD(σ = 10.77 Ω-Hz, p < 0.01; both trends being absent in all patients that failed to cardiovert

  19. 78 FR 43533 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Science.gov (United States)

    2013-07-19

    ..., Ninth Revision, Clinical Modification ICD Implantable cardioverter defibrillator ICU Intensive care unit...: Cardiac Rehabilitation Measure: Patient Referral From an Outpatient Setting D. Quality Measures...

  20. 基于有限元方法的心脏除颤仿真研究%Simulation Study of Heart Defibrillation Based on Finite Element Method

    Institute of Scientific and Technical Information of China (English)

    杨圣均; 郑懿; 邬小玫; 魏大名; 方祖祥

    2011-01-01

    临床动物电击除颤实验无法精确测量放电电场在心脏上的实际分布情况,且存在诸多不便利和不安全因素.鉴于此,提出了一种基于心脏建模及有限元求解的心脏除颤电场分布仿真研究方法,心脏模型包含了完整的心房心室解剖结构和左右心腔,考虑了心肌细胞和血液的电阻率,然后采用有限元方法进行分析,并使用Abaqus集成环境进行求解,求解结果与文献报道的参考标准进行对比.仿真结果在除颤电压阈值和能量阈值方面与目前的植入式心脏复律除颤器( ICD)的临床应用效果具有相当的吻合度,能量阈值相对误差仅为10%,验证了所提出方法的可行性.%Clinical animal defibrillation experiments can not measure the electrical field distribution of heart precisely, also with inconvenience and unsafety. Thereby, a method for studying heart defibrillation electric field distribution based on heart modeling and finite element solution was proposed in this paper. The heart model covers integrated anatomy of atria and ventricles, with taking resistivity of cardiac muscle cells and blood into account. And then, finite element method and Abaqus Integrated Environment was adopted. Lastly, the result was put into contrast with the benchmark. In defibrillation voltage and energy threshold, the simulation result coincided with the clinical effect of Implantable Cardioverter Defibrillator (ICD) very well, with the relative error of energy threshold limited to 10% , which verified the feasibility of the proposed method.

  1. Sexual Health for Patients with an Implantable Cardioverter Defibrillator

    Science.gov (United States)

    ... LIBRARY Hello, Guest! My alerts Sign In Join Facebook Twitter Home About this Journal Editorial Board General Statistics Circulation Cover Doodle → Blip the Doodle Go Red For Women's Issue Information for Advertisers Author Reprints Commercial Reprints Customer Service and Ordering ...

  2. How to Respond to an Implantable Cardioverter-Defibrillator Recall

    Science.gov (United States)

    ... LIBRARY Hello, Guest! My alerts Sign In Join Facebook Twitter Home About this Journal Editorial Board General Statistics Circulation Cover Doodle → Blip the Doodle Go Red For Women's Issue Information for Advertisers Author Reprints Commercial Reprints Customer Service and Ordering ...

  3. Updated care guidelines for patients with automatic implantable cardioverter defibrillators.

    Science.gov (United States)

    Moser, S A; Crawford, D; Thomas, A

    1993-04-01

    Since its clinical introduction, AICD therapy has gained significant acceptance. Some physicians consider it the "gold standard" in treating malignant tachyarrhythmias associated with sudden cardiac death. As the technology and therapy application have grown, nursing responsibilities have evolved as well. And, with the forthcoming combinations of technology such as AICDs with antitachycardia pacing and bradycardia pacing, the sophistication of the therapy is expected to increase. However, the most critical role for nurses in AICD patient care remains education. Increased utilization has made AICD implants more common, but many patients still lack the initial information and acceptance needed for therapeutic success. Health-care professionals who continue to update and share their understanding of this life-saving technology make invaluable contributions to the care of these patients who have received a second chance at life.

  4. Prevention of sudden cardiac death by the implantable cardioverter defibrilator

    OpenAIRE

    Kovačević Dragan V.; Stojišić-Milosavljević Anastazija; Topalov Vasilije; Mihajlović Bogoljub; Sakač Dejan; Kozlovački Živa

    2011-01-01

    Introduction. Sudden cardiac death or, as it is also called, a modern man’s killer occurs a few hours after the beginning of the disease. Sudden death is the one that happens within an hour from the onset of the subjective discomforts regardless of the existence of any previous disease. According to modern statistics, 450.000 people die suddenly in the USA and 150,000 in Germany. Causes of sudden death. The most frequent causes of sudden death are cardiologic or, in other words, a heart...

  5. Complications after cardiac implantable electronic device implantations

    DEFF Research Database (Denmark)

    Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nohr, Ellen Aagaard;

    2013-01-01

    Complications after cardiac implantable electronic device (CIED) treatment, including permanent pacemakers (PMs), cardiac resynchronization therapy devices with defibrillators (CRT-Ds) or without (CRT-Ps), and implantable cardioverter defibrillators (ICDs), are associated with increased patient...

  6. 具有"起死回生"功能的ICD

    Institute of Scientific and Technical Information of China (English)

    曾治宇; 王方正

    2004-01-01

    @@ ICD全称植入型心律转复除颤器(implantable cardioverter-defibrillator),是一种可埋植于人体内的能够自动识别恶性心律失常并予终止的器械,因其特殊的治疗价值,近年来在世界范围内特别是发达国家得到了越来越广泛的应用.

  7. Converting ICD-9 to ICD-10.

    Science.gov (United States)

    Stephens, James H; Ledlow, Gerald R; Fockler, Thomas V

    2016-01-01

    Implementing the International Classification of Diseases, Ninth Revision (ICD-9) to International Classification of Diseases, Tenth Revision (ICD-10) conversion on October 1, 2015, in the United States has been a long-term goal. While most countries in the world converted more than 10 years ago, the United States was still using ICD-9. Many countries in the world have a single-payer healthcare system, while there are thousands of different healthcare organizations (providers and payers) that presently exist in the United States. With so many different software platforms for healthcare providers and payers, the conversion had become that much more complicated and capital intensive for all healthcare organizations in the country. A few of the present delay reasons to the ICD-10 conversion in past years were the concurrent timelines for meeting meaningful use requirements for the electronic health record, testing with external payers and upgrades from vendors which added complexities and extra costs. The authors examine the reasoning behind the conversion as well as the delays, before making the conversion on October 1, 2015, and review the question regarding whether the government's decision to push the date back a year would have been helpful. PMID:26980201

  8. Statin therapy reduces inappropriate shock in non-ischemic patients with mild heart failure

    DEFF Research Database (Denmark)

    Ruwald, Anne-Christine H.; Zareba, Wojciech; Jons, Christian;

    2013-01-01

    BACKGROUND: The relationship between diabetes mellitus and risk of inappropriate or appropriate therapy in patients receiving an implantable cardioverter-defibrillator (ICD) and resynchronization therapy has not been investigated thoroughly. The effect of innovative ICD programming on therapy del...

  9. Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

    International Nuclear Information System (INIS)

    Current clinical guidelines for the management of radiotherapy patients having either a pacemaker or implantable cardioverter defibrillator (both CIEDs: Cardiac Implantable Electronic Devices) do not cover modern radiotherapy techniques and do not take the patient’s perspective into account. Available data on the frequency and cause of CIED failure during radiation therapy are limited and do not converge. The Dutch Society of Radiotherapy and Oncology (NVRO) initiated a multidisciplinary task group consisting of clinical physicists, cardiologists, radiation oncologists, pacemaker and ICD technologists to develop evidence based consensus guidelines for the management of CIED patients. CIED patients receiving radiotherapy should be categorised based on the chance of device failure and the clinical consequences in case of failure. Although there is no clear cut-off point nor a clear linear relationship, in general, chances of device failure increase with increasing doses. Clinical consequences of device failures like loss of pacing, carry the most risks in pacing dependent patients. Cumulative dose and pacing dependency have been combined to categorise patients into low, medium and high risk groups. Patients receiving a dose of less than 2 Gy to their CIED are categorised as low risk, unless pacing dependent since then they are medium risk. Between 2 and 10 Gy, all patients are categorised as medium risk, while above 10 Gy every patient is categorised as high risk. Measures to secure patient safety are described for each category. This guideline for the management of CIED patients receiving radiotherapy takes into account modern radiotherapy techniques, CIED technology, the patients’ perspective and the practical aspects necessary for the safe management of these patients. The guideline is implemented in The Netherlands in 2012 and is expected to find clinical acceptance outside The Netherlands as well

  10. Ventricular Arrhythmias in Apparently Normal Hearts: Who Needs an Implantable Cardiac Defibrillator?

    Science.gov (United States)

    Tan, Alex Y; Ellenbogen, Kenneth

    2016-09-01

    Idiopathic ventricular tachycardia is often considered a benign form of ventricular arrhythmia in patients without apparent structural heart disease. However, a subset of patients may develop malignant ventricular arrhythmias and present with syncope and sudden cardiac arrest. Survivors of cardiac arrest are candidates for implantable cardiac defibrillators (ICDs). The indications for ICDs in patients with less than a full-blown cardiac arrest presentation but with electrocardiographically high-risk ectopy features remain uncertain. This article addresses some of the uncertainties and pitfalls in ICD risk stratification in this patient group and explores potential mechanisms for malignant conversion of benign premature ventricular complexes to sustained arrhythmia.

  11. Ventricular Arrhythmias in Apparently Normal Hearts: Who Needs an Implantable Cardiac Defibrillator?

    Science.gov (United States)

    Tan, Alex Y; Ellenbogen, Kenneth

    2016-09-01

    Idiopathic ventricular tachycardia is often considered a benign form of ventricular arrhythmia in patients without apparent structural heart disease. However, a subset of patients may develop malignant ventricular arrhythmias and present with syncope and sudden cardiac arrest. Survivors of cardiac arrest are candidates for implantable cardiac defibrillators (ICDs). The indications for ICDs in patients with less than a full-blown cardiac arrest presentation but with electrocardiographically high-risk ectopy features remain uncertain. This article addresses some of the uncertainties and pitfalls in ICD risk stratification in this patient group and explores potential mechanisms for malignant conversion of benign premature ventricular complexes to sustained arrhythmia. PMID:27521094

  12. 经胸双相波除颤的进展

    Institute of Scientific and Technical Information of China (English)

    RogerDWhiteMD

    2005-01-01

    In 1996 the United States Food and Drug Administration approved the first biphasic waveform for external defibrillation after the safety and efficacy of biphasic waveforms had been well-established for defibrillation with internal cardioverter-defibrillators (ICDs). The first approved waveform was incorporated in an automated external defibrillator (AED) marketed as the ForeRunner ((Philips Medical Systems,

  13. Plötzlicher Herztod und ICD-Therapie

    Directory of Open Access Journals (Sweden)

    Schirdewahn P

    2004-01-01

    Full Text Available Der plötzliche Herztod ist die häufigste Todesursache bei Erwachsenen. Da zwei Drittel auf ventrikuläre Tachykardien oder Kammerflimmern zurückzuführen sind, spielt der implantierbare Defibrillator (ICD in der Primär- und Sekundärprophylaxe eine wichtige Rolle. Die Ergebnisse zahlreicher Studien zur Prävention des plötzlichen Herztodes führten zu einer erheblichen Ausweitung der Indikationen, insbesondere in der Primärprophylaxe bei ischämischer Kardiomyopathie. In der vorliegenden Arbeit sollen die wesentlichen Studien dargestellt und kritisch gewertet werden.

  14. Public Access Defibrillation

    DEFF Research Database (Denmark)

    Agerskov, Marianne; Nielsen, Anne Møller; Hansen, Carolina Malta;

    2015-01-01

    BACKGROUND: In Copenhagen, a volunteer-based Automated External Defibrillator (AED) network provides a unique opportunity to assess AED use. We aimed to determine the proportion of Out-of-Hospital Cardiac Arrest (OHCA) where an AED was applied before arrival of the ambulance, and the proportion o...

  15. Interference from a hand held radiofrequency remote control causing discharge of an implantable defibrillator.

    Science.gov (United States)

    Man, K C; Davidson, T; Langberg, J J; Morady, F; Kalbfleisch, S J

    1993-08-01

    A 46-year-old man with a history of sustained monomorphic ventricular tachycardia underwent an implantation of a third generation multiprogrammable implantable cardioverter defibrillator. One year post implant, while manipulating a remote control to a radiofrequency modulated toy car, the patient experienced a defibrillator discharge not preceded by an arrhythmia prodrome. Subsequent interrogation of the defibrillator revealed that a 34-joule shock had been delivered and had been preceded by RR intervals ranging from 141-406 msec, consistent with sensing lead noise. The remote control utilizes a 12-volt battery and has a carrier frequency of 75.95 MHz and a modulating frequency of 50 Hz. Evaluation of the remote control and defibrillator interaction revealed that the remote control was able to trigger tachyarrhythmia sensing and reproduce the clinical episode. Interference was present only when the remote control was within 8 cm of the pulse generator and at specific angles relative to the device and only when the antenna length was > 45 cm. Interference was eliminated when a ground wire was attached to the antenna and when an aluminium shield was placed between the pulse generator and the remote control. This case report suggests that patients with third generation multiprogrammable defibrillators should be cautioned against close contact with potential sources of electromagnetic interference, such as remote control units.

  16. Defibrillation thresholds are lower with smaller storage capacitors.

    Science.gov (United States)

    Leonelli, F M; Kroll, M W; Brewer, J E

    1995-09-01

    Present implantable cardioverter defibrillators use a wide range of capacitance values for the storage capacitor. However, the optimal capacitance value is unknown. We hypothesized that a smaller capacitor, by delivering its charge in a time closer to the heart chronaxie, should lower the defibrillation threshold (DFT). We compared the energy required to defibrillate 10 open-chest dogs, after 15 seconds of ventricular fibrillation, with a monophasic, time-truncated waveform delivered from either a 85-microF or a 140-microF capacitor. Shocks were delivered through a pair of 14-cm2 epicardial patch electrodes: The two capacitors were randomly tested twice with each dog using a modified 3-reversal method for each DFT determination. The average stored and delivered DFT energies for the 85-microF capacitor were 6.0 +/- 1.7 joules and 5.2 +/- 1.5 joules, respectively, compared to 6.7 +/- 1.7 joules and 6.0 +/- 1.5 joules for the 140-microF capacitor (P = 0.01 and P = 0.004, respectively). The mean leading edge voltages were higher, the pulse duration shorter, and the mean impedance lower for the 85-microF capacitor. The impedance was inversely related to the pulse duration and the voltage decay suggesting that, at least in part, the mechanism of improved defibrillation could be accounted for by the waveform electrical characteristics. There was an equal number of episodes of postshock bradyarrhythmias and tachyarrhythmias following discharges from each capacitor. Moreover, there was no relationship between the likelihood of these arrhythmias and either the initial voltage or the delivered current nor there was a higher number of episodes of postshock hypotension following the smaller capacitor discharges.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7491309

  17. Pacemaker, implanted cardiac defibrillator and irradiation: Management proposal in 2010 depending on the type of cardiac stimulator and prognosis and location of cancer; Pacemaker, defibrillateur et radiotherapie: propositions de conduite a tenir en 2010 en fonction du type de stimulateur cardiaque, du pronostic et du site du cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lambert, P. [Service d' anesthesie reanimation, hopital Nord, centre hospitalier universitaire de Saint-etienne, 42055 Saint-etienne cedex 2 (France); Da Costa, A. [Service de cardiologie, hopital Nord, centre hospitalier universitaire de Saint-etienne, 42055 Saint-etienne cedex 2 (France); Marcy, P.Y. [Departement de radiologie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2 (France); Universite Nice Sophia-Antipolis, 33, avenue de Valombrose, 06189 Nice cedex 2 (France); Kreps, S. [Service de radiotherapie Corad, centre regional universitaire de cancerologie Henry-S.-Kaplan, hopital Bretonneau-2, CHU de Tours, boulevard Tonnelle, 37000 Tours (France); Angellier, G.; Marcie, S.; Bondiau, P.Y. [Universite Nice Sophia-Antipolis, 33, avenue de Valombrose, 06189 Nice cedex 2 (France); Departement de radiotherapie oncologie, centre CyberKnife, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2 (France); Briand-Amoros, C. [Service de radiotherapie, hopital europeen Georges-Pompidou, 20, rue Leblanc, 75015 Paris (France); Thariat, J. [Universite Nice Sophia-Antipolis, 33, avenue de Valombrose, 06189 Nice cedex 2 (France); Departement de radiotherapie oncologie, centre CyberKnife, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2 (France); IBDC CNRS UMR 6543, centre Antoine-Lacassagne, universite Sophia-Antipolis, 33, avenue de Valombrose, 06189 Nice cedex 2 (France)

    2011-06-15

    Ionizing radiation may interfere with electric components of pacemakers or implantable cardioverter defibrillators. The type, severity and extent of radiation damage to pacemakers, have previously been shown to depend on the total dose and dose rate. Over 300,000 new cancer cases are treated yearly in France, among which 60% are irradiated in the course of their disease. One among 400 of these patients has an implanted pacemaker or defibrillator. The incidence of pacemaker and implanted cardioverter defibrillator increases in an ageing population. The oncologic prognosis must be weighted against the cardiologic prognosis in a multidisciplinary and transversal setting. Innovative irradiation techniques and technological sophistications of pacemakers and implantable cardioverter-defibrillators (with the introduction of more radiosensitive complementary metal-oxide-semiconductors since 1970) have potentially changed the tolerance profiles. This review of the literature studied the geometric, dosimetric and radiobiological characteristics of the radiation beams for high energy photons, stereotactic irradiation, proton-therapy. Standardized protocols and radiotherapy optimization (particle, treatment fields, energy) are advisable in order to improve patient management during radiotherapy and prolonged monitoring is necessary following radiation therapy. The dose received at the pacemaker/heart should be calculated. The threshold for the cumulated dose to the pacemaker/implantable cardioverter-defibrillator (2 to 5 Gy depending on the brand), the necessity to remove/displace the device based on the dose-volume histogram on dosimetry, as well as the use of lead shielding and magnet are discussed. (authors)

  18. Effects of drugs on defibrillation threshold%药物对除颤阈值的影响

    Institute of Scientific and Technical Information of China (English)

    黄震华

    2009-01-01

    Implantable cardioverter-defibrillator possesses vital value for preventing sudden cardiac death. For patients with already implantable cardioverter-defibrillator, some cardiovascular drugs especially the anti-arrhythmic ones are still inevitably needed. Some evidences showed that sotalol, and β-adrenergic receptor antagonists may decrease defibrillation threshold, and amiodarone, lidocaine, mexiletine, moracizine, verapamil may increase defibrillation threshold.%埋藏式心脏复律除颤器对于预防心源性猝死具有重要价值.对于已安装埋藏式心脏复律除颤器的病人,不可避免地仍需使用一些心血管药物,特别是抗心律失常药物.一些证据表明,索他洛尔、肾上腺素β受体阻滞药可降低除颤阈值,而胺碘酮、利多卡因、美西律、莫雷西嗪、维拉帕米等可提高除颤阈值.

  19. Questionnaire in patients and doctors with ICD indication%植入型心律转复除颤器适应证患者及主管医生的问卷调查

    Institute of Scientific and Technical Information of China (English)

    宿燕岗; 吴妍; 柏瑾; 王蔚; 葛均波

    2010-01-01

    Objective Aim to understand the extraordinary low application of implantable cardioverter defibrillator(ICD) in China. Methods patients with ICD indication,their families and the attending doctors in Zhongshan Hospital of Fudan University were investigated by questionnaire from the period of June ,2007 to Janu-ary 2008. In addition, the basic information, examination results and treatment state were collected. Results There were 122 patients enrolled in this study,including 89 patients(73.0%)with the indication of primary pre-vention for SCD,which is 2.7 times compared with the patients of the secondary prevention. Non-ischemic heart diseases are the most common underlying cause in both primary and secondary SCD prevention. 42.4% of sec-ondary prevention patients accepted ICD/CRT-D implantation,while only 2.2% of primary prevention patients re-ceived device-based therapy. Age and education has no effect on the attitude of accepting ICD treatment. In the aspect of the recognition of suffered heart diseases, sudden cardiac death (SCD)and the acceptance of ICD,patients of secondary prevention are much better than the primary prevention ones(P<0.001). When come along with mak-ing the decision of whether accepted ICD implantation, the suggestion of physicians plays the most important role. The state of illness don't need ICD treatment other than economic issue is the main reason of the patients rejecting ICD implantation. The most physicians(93.3%)never introduced ICD to their primary prevention patients due to the same reason,which is much higher(21.1%)than the secondary prevention(P<0.001). Conclusions The clinical applications of ICD are far below its indication range at present,especial in the primary prevention. The lack of un-derstanding SCD and ICD in both physician and patient is the main reason for the low implantation of ICD in China.%目的 通过对植入型心律转复除颤器(ICD)适应证患者及主管医生的问卷调查探讨国内ICD

  20. Therapeutic options in chronic heart failure. Findings on chest X-ray; Nicht medikamentoese Therapieoptionen der chronischen Herzinsuffizienz. Befunde in der Projektionsradiografie des Thorax

    Energy Technology Data Exchange (ETDEWEB)

    Granitz, M.R.; Meissnitzer, T.; Meissnitzer, M.W.; Hergan, K.; Altenberger, J.; Granitz, C. [Uniklinikum Salzburg - Landeskrankenhaus (Austria)

    2016-05-15

    The contribution covers drugless therapeutic options for chronic heart failure: the implantable cardioverter/defibrillator (ICD), the cardiac resynchronization therapy (CRT), the interventional catheter treatment of functional mitral insufficiency, and mechanical heart supporting systems and heart transplantation.

  1. 78 FR 74825 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Science.gov (United States)

    2013-12-10

    ..., Clinical Modification ICD Implantable cardioverter defibrillator ICU Intensive care unit IHS Indian Health... (APC 0415) b. Direct Laryngoscopy (APC 0074) c. Pulmonary Rehabilitation Services (APC 0077) 10. Other... OP-24: Cardiac Rehabilitation Measure: Patient Referral from an Outpatient Setting D....

  2. Co-constructing IT and Healthcare

    DEFF Research Database (Denmark)

    Andersen, Tariq; Bansler, Jørgen; Bjørn, Pernille;

    The CITH project (Co-constructing IT and Healthcare) is an ongoing 4-year interdisciplinary research project, which investigates while intervenes in the collaborative practices involved in disease management of chronic heart patients with an ICD (Implantable Cardioverter Defibrillator)....

  3. Therapeutic options in chronic heart failure. Findings on chest X-ray

    International Nuclear Information System (INIS)

    The contribution covers drugless therapeutic options for chronic heart failure: the implantable cardioverter/defibrillator (ICD), the cardiac resynchronization therapy (CRT), the interventional catheter treatment of functional mitral insufficiency, and mechanical heart supporting systems and heart transplantation.

  4. State of the art of ICD programming

    DEFF Research Database (Denmark)

    Mastenbroek, M H; Pedersen, Susanne S.; Versteeg, H;

    2014-01-01

    of the on-going ENHANCED-ICD study. The ENHANCED-ICD study is a prospective, safety monitoring study enrolling 60 primary and secondary prophylactic ICD patients at the University Medical Center Utrecht. Patients implanted with any type of ICD with SmartShock technology(TM), and between 18-80 years of age...

  5. Electrostriction Effects During Defibrillation

    CERN Document Server

    Fritz, Michelle M; Roth, Bradley J

    2011-01-01

    Background-The electric field applied to the heart during defibrillation causes mechanical forces (electrostriction), and as a result the heart deforms. This paper analyses the physical origin of the deformation, and how significant it is. Methods-We represent the heart as an anisotropic cylinder. This simple geometry allows us to obtain analytical solutions for the potential, current density, charge, stress, and strain. Results-Charge induced on the heart surface in the presence of the electric field results in forces that deform the heart. In addition, the anisotropy of cardiac tissue creates a charge density throughout the tissue volume, leading to body forces. These two forces cause the tissue to deform in a complicated manner, with the anisotropy suppressing radial displacements in favor of tangential ones. Quantitatively, the deformation of the tissue is small, although it may be significant when using some imaging techniques that require the measurement of small displacements. Conclusions-The anisotrop...

  6. 21 CFR 870.5325 - Defibrillator tester.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Defibrillator tester. 870.5325 Section 870.5325...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Therapeutic Devices § 870.5325 Defibrillator tester. (a) Identification. A defibrillator tester is a device that is connected to the output of...

  7. Symbolic Dynamics Analysis of Short Data Sets: an Application to Heart Rate Variability from Implantable Defibrillator Devices

    Science.gov (United States)

    Zebrowski, Jan J.; Baranowski, Rafal; Przybylski, Andrzej

    2003-07-01

    A method is described for the assessment of the complexity of short data sets by nonlinear dynamics. The method was devised for and tested on human heart rate recordings approximately 2000 to 9000 RR intervals long which were extracted from the memory of implantable defibrillator devices (ICD). It is, however, applicable in a more general context. The ICDs are meant to control life-threatening episodes of ventricular tachycardia and/or ventricular fibrillation by applying a electric shock to the heart through intracardiac electrodes. It is well known that conventional ICD algorithms yield approximately 20--30 % of spurious interventions. The main aim of this work is to look for nonlinear dynamics methods to enhance the appropriateness of the ICD intervention. We first showed that nonlinear dynamics methods first applied to 24-hour heart rate variability analysis were able to detect the need for the ICD intervention. To be applicable to future ICD use, the methods must also be low in computational requirements. Methods to analyse the complexity of the short and non-stationary sets were devised. We calculated the Shannon entropy of symbolic words obtained in a sliding 50 beat window and analysed the dependence of this complexity measure on the time. Precursors were found extending much earlier time than the time the standard ICD algorithms span.

  8. AED (Automated External Defibrillator) Programs: Questions and Answers

    Science.gov (United States)

    ... live. What is an AED ? The automated external defibrillator ( AED ) is a computerized medical device. An AED ... AED or another defibrillation device (semiautomatic or manual defibrillator). The AHA also supports placing AEDs in targeted ...

  9. Management of radiation therapy patients with cardiac defibrillator or pacemaker.

    Science.gov (United States)

    Salerno, Francesca; Gomellini, Sara; Caruso, Cristina; Barbara, Raffaele; Musio, Daniela; Coppi, Tamara; Cardinale, Mario; Tombolini, Vincenzo; de Paula, Ugo

    2016-06-01

    The increasing growth of population with cardiac implantable electronic devices (CIEDs) such as Pacemaker (PM) and Implantable Cardiac Defibrillators (ICD), requires particular attention in management of patients needing radiation treatment. This paper updates and summarizes some recommendations from different international guidelines. Ionizing radiation and/or electromagnetic interferences could cause device failure. Current approaches to treatment in patients who have these devices vary among radiation oncology centres. We refer to the German Society of Radiation Oncology and Cardiology guidelines (ed. 2015); to the Society of Cardiology Australia and New Zealand Statement (ed. 2015); to the guidelines in force in the Netherlands (ed. 2012) and to the Italian Association of Radiation Oncology recommendations (ed. 2013) as reported in the guidelines for the treatment of breast cancer in patients with CIED. Although there is not a clear cut-off point, risk of device failure increases with increasing doses. Cumulative dose and pacing dependency have been combined to categorize patients into low-, medium- and high-risk groups. Measures to secure patient safety are described for each category. The use of energy ≤6MV is preferable and it's strongly recommended not to exceed a total dose of 2 Gy to the PM and 1 Gy for ICD. Given the dangers of device malfunction, radiation oncology departments should adopt all the measures designed to minimize the risk to patients. For this reason, a close collaboration between cardiologist, radiotherapist and physicist is necessary.

  10. Long-term mortality risk in patients with an implantable cardioverter-defibrillator

    DEFF Research Database (Denmark)

    Hoogwegt, Madelein T; Theuns, Dominic A M J; Pedersen, Susanne S.;

    2014-01-01

    .9)). The impact of heart rate and QRS duration on time to all-cause mortality was separately assessed with Cox proportional hazard regression analysis, adjusting for clinical factors and symptoms of depression and anxiety. RESULTS: Mean (SD) heart rate was 68.0 ± 13.3 bpm and mean QRS duration was 130.9 ± 36.9 ms....... Heart rate of ≥80 bpm was associated with increased risk of mortality (HR=1.86; 95% CI=1.15-3.00; p=.011) in unadjusted analysis. In adjusted analyses, this relationship remained significant both with depression (HR=1.86, 95% CI=1.12-3.09; p=.017) and anxiety (HR=1.82, 95% CI=1.10-3.03; p=.021...

  11. Coping with Trauma and Stressful Events As a Patient with an Implantable Cardioverter-Defibrillator

    Science.gov (United States)

    ... LIBRARY Hello, Guest! My alerts Sign In Join Facebook Twitter Home About this Journal Editorial Board General Statistics Circulation Cover Doodle → Blip the Doodle Go Red For Women's Issue Information for Advertisers Author Reprints Commercial Reprints Customer Service and Ordering ...

  12. My Child Needs or Has an Implantable Cardioverter-Defibrillator: What Should I Do?

    Science.gov (United States)

    ... it is important to provide open, honest, and age-appropriate information to provide the tools for adaptation. You can ... 502 Boston, MA 02118 email: circ@circulationjournal.org Information for: Advertisers Subscribers Subscriber ... National Center 7272 Greenville Ave. Dallas, TX 75231 Customer Service 1-800-AHA-USA-1 1-800- ...

  13. Low disease prevalence and inappropriate implantable cardioverter defibrillator shock rate in Brugada syndrome

    DEFF Research Database (Denmark)

    Holst, Anders Gaarsdal; Jensen, Henrik Kjærulf; Eschen, Ole;

    2012-01-01

    Brugada syndrome (BrS) is an inherited channelopathy that predisposes to malignant ventricular arrhythmias and thereby syncope and sudden cardiac death. Prior studies characterizing BrS patients have used highly selected referral populations from tertiary centres and prevalence estimates have bee...

  14. Echocardiography and cardiac MRI in mutation-negative hypertrophic cardiomyopathy in an older patient: a case defining the need for ICD.

    Science.gov (United States)

    Rodriguez, Fatima; Degnan, Kathleen O; Seidman, Christine E; Mangion, Judy R

    2014-08-01

    We report the case of a 67-year-old man with hypertrophic cardiomyopathy who presented for a second opinion about implantable cardio-defibrillator (ICD) placement after a witnessed syncopal episode. Despite his older age, being mutation-negative, and having a maximal septal thickness of 2.2 cm on echocardiography, he demonstrated rapid progression of myocardial fibrosis on cardiac MRI, correlating to ventricular tachyarrhythmias and syncope. We review the role of echocardiography and cardiac MRI in optimizing medical care for such patients who may not otherwise meet criteria for an ICD placement or further interventions. PMID:24816179

  15. Use of Automated External Defibrillators

    Energy Technology Data Exchange (ETDEWEB)

    Gregory K Christensen

    2009-02-01

    In an effort to improve survival from cardiac arrest, the American Heart Association (AHA) has promoted the Chain of Survival concept, describing a sequence of prehospital steps that result in improved survival after sudden cardiac arrest. These interventions include immediate deployment of emergency medical services, prompt cardiopulmonary resuscitation, early defibrillation when indicated, and early initiation of advanced medical care. Early defibrillation has emerged as the most important intervention with survival decreasing by 10% with each minute of delay in defibrillation. Ventricular Fibrillation (VF) is a condition in which there is uncoordinated contraction of the heart cardiac muscle of the ventricles in the heart, making them tremble rather than contract properly. VF is a medical emergency and if the arrhythmia continues for more than a few seconds, blood circulation will cease, and death can occur in a matter of minutes. During VF, contractions of the heart are not synchronized, blood flow ceases, organs begin to fail from oxygen deprivation and within 10 minutes, death will occur. When VF occurs, the victim must be defibrillated in order to establish the heart’s normal rhythm. On average, the wait for an ambulance in populated areas of the United States is about 11 minutes. In view of these facts, the EFCOG Electrical Safety Task Group initiated this review to evaluate the potential value of deployment and use of automated external defibrillators (AEDs) for treatment of SCA victims. This evaluation indicates the long term survival benefit to victims of SCA is high if treated with CPR plus defibrillation within the first 3-5 minutes after collapse. According to the American Heart Association (AHA), survival rates as high as 74% are possible if treatment and defibrillation is performed in the first 3 minutes. In contrast survival rates are only 5% where no AED programs have been established to provide prompt CPR and defibrillation. ["CPR statistics

  16. The Power of Exercise-Induced T-wave Alternans to Predict Ventricular Arrhythmias in Patients with Implanted Cardiac Defibrillator

    Directory of Open Access Journals (Sweden)

    Laura Burattini

    2013-01-01

    Full Text Available The power of exercise-induced T-wave alternans (TWA to predict the occurrence of ventricular arrhythmias was evaluated in 67 patients with an implanted cardiac defibrillator (ICD. During the 4-year follow-up, electrocardiographic (ECG tracings were recorded in a bicycle ergometer test with increasing workload ranging from zero (NoWL to the patient's maximal capacity (MaxWL. After the follow-up, patients were classified as either ICD_Cases (n = 29, if developed ventricular tachycardia/fibrillation, or ICD_Controls (n = 38. TWA was quantified using our heart-rate adaptive match filter. Compared to NoWL, MaxWL was characterized by faster heart rates and higher TWA in both ICD_Cases (12-18 μ V vs. 20-39 μ V; P < 0.05 and ICD_Controls (9-15 μ V vs. 20-32 μ V; P < 0.05. Still, TWA was able to discriminate the two ICD groups during NoWL (sensitivity = 59-83%, specificity = 53-84% but not MaxWL (sensitivity = 55-69%, specificity = 39-74%. Thus, this retrospective observational case-control study suggests that TWA's predictive power for the occurrence of ventricular arrhythmias could increase at low heart rates.

  17. The Effect of ICD Programming on Inappropriate and Appropriate ICD Therapies in Ischemic and Nonischemic Cardiomyopathy

    DEFF Research Database (Denmark)

    Sedláček, Kamil; Ruwald, Anne-Christine; Kutyifa, Valentina;

    2015-01-01

    INTRODUCTION: The MADIT-RIT trial demonstrated reduction of inappropriate and appropriate ICD therapies and mortality by high-rate cut-off and 60-second-delayed VT therapy ICD programming in patients with a primary prophylactic ICD indication. The aim of this analysis was to study effects of MADIT......-RIT ICD programming in patients with ischemic and nonischemic cardiomyopathy. METHODS AND RESULTS: First and total occurrences of both inappropriate and appropriate ICD therapies were analyzed by multivariate Cox models in 791 (53%) patients with ischemic and 707 (47%) patients with nonischemic......-rate cut-off (arm B) and delayed VT therapy ICD programming (arm C) compared with conventional (arm A) ICD programming were associated with a significant risk reduction of first inappropriate and appropriate ICD therapy in patients with ischemic and nonischemic cardiomyopathy (HR range 0.11-0.34, P

  18. Mexiletine as an adjunctive therapy to amiodarone reduces the frequency of ventricular tachyarrhythmia events in patients with an implantable defibrillator.

    Science.gov (United States)

    Gao, Dongsheng; Van Herendael, Hugo; Alshengeiti, Lamia; Dorian, Paul; Mangat, Iqwal; Korley, Victoria; Ahmad, Kamran; Golovchiner, Gregory; Aves, Theresa; Pinter, Arnold

    2013-08-01

    The most effective pharmacological management of frequent ventricular tachyarrhythmia events in patients with an implantable defibrillator who failed or did not tolerate amiodarone is unknown. The aim of this retrospective cohort study was to assess the efficacy and tolerability of mexiletine in such patients. The patients served as self-controls. The number of treated ventricular tachyarrhythmia episodes (primary outcome); mortality, shocks from the defibrillator, and electrical storm events (secondary outcomes) during mexiletine therapy was compared with a matched duration of observation just before initiating mexiletine in 29 patients who were treated with a median dose of 300 mg/d of mexiletine and were followed for a median of 12 months. None of the patients had to stop mexiletine due to side effect. There was a significant reduction in the incidence of ventricular tachycardia/fibrillation episodes (median 2 vs. 12 events, P = 0.001) and shocks (median 0 vs. 2 events, P = 0.003) in the first 3 months of treatment, but long-term efficacy was only observed among patients who continued amiodarone therapy. In conclusion, mexiletine, when added to amiodarone in case of amiodarone inefficacy, reduces ventricular tachycardia/fibrillation events and appropriate therapies in patients with an implantable cardioverter defibrillator. A randomized trial should validate the efficacy and safety of mexiletine as an adjunctive therapy to amiodarone. PMID:23609328

  19. A second defibrillator chest patch electrode will increase implantation rates for nonthoracotomy defibrillators.

    Science.gov (United States)

    Solomon, A J; Swartz, J F; Rodak, D J; Moore, H J; Hannan, R L; Tracy, C M; Fletcher, R D

    1996-09-01

    Nonthoracotomy defibrillator systems can be implanted with a lower morbidity and mortality, compared to epicardial systems. However, implantation may be unsuccessful in up to 15% of patients, using a monophasic waveform. It was the purpose of this study to prospectively examine the efficacy of a second chest patch electrode in a nonthoracotomy defibrillator system. Fourteen patients (mean age 62 +/- 11 years, ejection fraction = 0.29 +/- 0.12) with elevated defibrillation thresholds, defined as > or = 24 J, were studied. The initial lead system consisted of a right ventricular electrode (cathode), a left innominate vein, and subscapular chest patch electrode (anodes). If the initial defibrillation threshold was > or = 24 J, a second chest patch electrode was added. This was placed subcutaneously in the anterior chest (8 cases), or submuscularly in the subscapular space (6 cases). This resulted in a decrease in the system impedance at the defibrillation threshold, from 72.3 +/- 13.3 omega to 52.2 +/- 8.6 omega. Additionally, the defibrillation threshold decreased from > or = 24 J, with a single patch, to 16.6 +/- 2.8 J with two patches. These changes were associated with successful implantation of a nonthoracotomy defibrillator system in all cases. In conclusion, the addition of a second chest patch electrode (using a subscapular approach) will result in lower defibrillation thresholds in patients with high defibrillation thresholds, and will subsequently increase implantation rates for nonthoracotomy defibrillators.

  20. The use of variability of repolarization for monitoring of arrhythmic risk : "the rocking of the boat"

    NARCIS (Netherlands)

    Oosterhoff, P.

    2011-01-01

    The majority of deaths in the western world are of cardiovascular origin. Approximately 60% of these cardiovascular deaths are sudden. Implantation of an implantable cardioverter defibrillator (ICD) has been proven effective in preventing sudden cardiac death in patients at increased risk. An ICD ca

  1. A viewpoint on the impact of device advisories on patient-centered outcomes

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; van den Berg, Martha; Theuns, Dominic A M J

    2009-01-01

    Device advisories due to potential hardware failure comprise one of the downsides of implantable cardioverter defibrillator (ICD) therapy. The impact of advisories on patient-centered outcomes has largely been overlooked. We examined the impact of ICD advisories on patient-centered outcomes via a...

  2. Electrical Heart Defibrillation with Ion Channel Blockers

    Science.gov (United States)

    Feeney, Erin; Clark, Courtney; Puwal, Steffan

    Heart disease is the leading cause of mortality in the United States. Rotary electrical waves within heart muscle underlie electrical disorders of the heart termed fibrillation; their propagation and breakup leads to a complex distribution of electrical activation of the tissue (and of the ensuing mechanical contraction that comes from electrical activation). Successful heart defibrillation has, thus far, been limited to delivering large electrical shocks to activate the entire heart and reset its electrical activity. In theory, defibrillation of a system this nonlinear should be possible with small electrical perturbations (stimulations). A successful algorithm for such a low-energy defibrillator continues to elude researchers. We propose to examine in silica whether low-energy electrical stimulations can be combined with antiarrhythmic, ion channel-blocking drugs to achieve a higher rate of defibrillation and whether the antiarrhythmic drugs should be delivered before or after electrical stimulation has commenced. Progress toward a more successful, low-energy defibrillator will greatly minimize the adverse effects noted in defibrillation and will assist in the development of pediatric defibrillators.

  3. Reliability of clinical ICD-10 schizophrenia diagnoses

    DEFF Research Database (Denmark)

    Jakobsen, Klaus D; Frederiksen, Julie N; Hansen, Thomas;

    2005-01-01

    Concern has been expressed as to the reliability of clinical ICD-10 diagnosis of schizophrenia. This study was designed to assess the diagnostic reliability of the clinical ICD-10 diagnosis of schizophrenia in a random sample of Danish in- and outpatients with a history of psychosis. A sample of ...... was seen between OPCRIT-derived ICD-10 and DSM-IV diagnoses (kappa=0.87). Thus, this study demonstrates high reliability of the clinical diagnosis of schizophrenia and even more so of the diagnosis of schizophrenia-spectrum disorder....

  4. Automated external defibrillators, life vest defibrillator, or both%体外自动除颤器、救生衣除颤器的使用或两者同时使用?

    Institute of Scientific and Technical Information of China (English)

    C.RichardConti; 杨渊; 丁荣晶

    2012-01-01

    As most understand,survival of cardiac arrest victims falls significantly if cardioversion is not performed promptly.The standard of practice for out-of-hospital defibrilhtion is the implantable cardiac defibrillator; however, much has been written and discussed about the use of automated external defibrillators.Not as much has been written about life vest wearable defibrillators.How to use these devices will be reviewed in this article.%医院外除颤临床上推荐使用埋藏式心律转复除颤器(Implantable cardiac defibrillator,ICD),关于体外自动除颤器(automated external defibrillators,AED)的使用和讨论也比较多,救生衣除颤器的报道则较少.Winkle[1]在近期综述指出,美国每年有数十万的院外患者死于心脏骤停.众所周知,心脏骤停患者如果未及时得到心脏电复律,生存的机会非常低.电生理学家在给患者置入ICD后,常通过诱发心室颤动并立即除颤来检测ICD功能.这强调了早期除颤是提高生存率的关键.一般来说,除非ICD不能正常工作,置入ICD的患者不需要心肺复苏.

  5. From syncope to ICD: clinical paths of the Brugada syndrome

    Directory of Open Access Journals (Sweden)

    Ivan Comelli

    2010-09-01

    Full Text Available This review summarizes the evidences in the literature on the management of the Brugada syndrome (BS, an arrhythmogenic disease caused by genetic channelopathies, predisposing to syncope and sudden cardiac death in young, apparently healthy, typically male subjects, in the third and fourth decade of their life. Sudden cardiac death (SCD is defined as natural death from cardiac causes, heralded by abrupt loss of consciousness within one hour of the onset of symptoms. It ranks among the main causes of death in the western world, with an incidence ranging from 0.36 and 1.28‰ inhabitants per year, equal to 300,000 cases a year in the USA. In the majority of the cases it is due to the onset of arrhythmia in subjects with structural cardiac diseases, especially ischemic heart disease. However, in a non-negligible percentage of the cases, about 5-10%, the SCD arises in relatively young individuals in whom cardiac anomalies cannot be detected using traditional diagnostic techniques. About 20% of these cases can be attributed to SB. In spite of the many efforts produced to identify an effective pharmacological treatment, to date the only aid to reduce the mortality rate in subjects with SB is an implantable cardio-defibrillator (ICD. Since this approach often entails complications, the efforts of the scientific community is now focused on the assessment of the arrhythmic risk. The identification of high-risk subjects is one of the chief objectives in the therapeutic decision-making process. ABSTRACT clinica e terapia emergency

  6. 鱼油对心脏复律除颤器植入患者室性快速性心律失常及死亡的影响ω-3脂肪酸与室性心律失常随机试验研究(SOFA)%Effect of Fish Oil on Ventricular Tachyarrhythmia and Death in Patients With Implantable Cardioverter Defibrillators The Study on Omega-3 Fatty Acids and Ventricular Arrhythmia (SOFA) Randomized Trial

    Institute of Scientific and Technical Information of China (English)

    Ingeborg A. Brouwer; Peter L. Zock; A. John Camm; 顾佳

    2007-01-01

    背景:人们认为,鱼体内的长链多元不饱和脂肪酸(ω-3PUFAs)可减少心律失常的发生,从而降低猝死的风险.目的:比较鱼油保健品及安慰剂对室性快速性心律失常及死亡的影响.设计、地点及患者:"ω-3脂肪酸与室性心律失常关系研究"(Study on Omega-3 Fatty acids and ventricular Arrhythmia,SOFA)是在欧洲26家心脏诊所中开展的一项随机、平行、安慰剂对照、双盲试验.自2001年10月起至2004年8月止,共有546名携有植入式心脏复律除颤器(implantable cardioverterdefibrillators,ICDs)的恶性室性心动过速(ventricular tachycardia,VT)患者和心室纤颤(ventricular fibrillation,VF)患者纳入研究.这些患者随机服用鱼油(2 g/d,n=273)或安慰剂(n=273),平均356天(范围为14~379天).主要观测指标:VT或VF患者接受ICD干预的情况以及全因死亡率.结果:主要研究终点见于81例(30%)服用鱼油的患者和90例(33%)服用安慰剂的患者(风险比[hazard ratio,HR],0.86;95%可信区间[confidence interval,CI],0.64~1.16;P=0.33).特定的亚组分析显示,有411例患者在纳入研究前一年内出现了VT,有332例患者既往曾患有心肌梗死,其中服用鱼油者与服用安慰剂者相比HR分别为0.91(95%CI,0.66~1.26)和0.76(95%CI,0.52~1.11).结论:我们的结果显示,摄入鱼油中的ω-3 PUFAs并不能对携有ICDs的室性心律失常患者产生强有力的保护作用.

  7. Non-nearest neighbour ICD in clusters

    Science.gov (United States)

    Fasshauer, E.

    2016-04-01

    Interatomic Coulombic decay (ICD) is an electronic decay process of excited, ionized systems. It has been shown to occur in a multitude of small and large systems. The effects of more than one possible decay partner are discussed in detail illustrated by simulated ICD electron spectra of NeAr clusters and pure Ne clusters. Hereby, the mostly underestimated contribution of decay with non-nearest neighbours is highlighted. In the neon clusters, the lifetime of the bulk atoms is found to be in excellent agreement with experiment (Jahnke et al 2004 Phys. Rev. Lett. 93 173401) while the lifetimes of the surface atoms differ significantly. Hence, the experimental lifetime can not purely be explained by the effect of the number of neighbours. We propose the possibility to investigate the transition from small clusters to the solid state by using the ICD electron spectra to distinguish between icosahedral and cuboctahedral cluster structures.

  8. OPS und ICD-10-GM 2009

    OpenAIRE

    DIMDI-Pressestelle

    2007-01-01

    Das DIMDI nimmt ab sofort Änderungsvorschläge zu den Klassifikationen ICD-10-GM (Internationale Klassifikation der Krankheiten) und OPS (Operationen- und Prozedurenschlüssel) für die Versionen 2009 entgegen. Der Redaktionsschluss ist am 29. Februar 2008.

  9. OPS und ICD-10-GM 2008

    OpenAIRE

    DIMDI-Pressestelle

    2006-01-01

    Das DIMDI nimmt ab sofort Änderungsvorschläge zu den Klassifikationen ICD-10-GM (Internationale Klassifikation der Krankheiten) und OPS (Operationen- und Prozedurenschlüssel) für die Versionen 2008 entgegen. Der Redaktionsschluss ist am 28. Februar 2007.

  10. Reliability of clinical ICD-10 schizophrenia diagnoses

    DEFF Research Database (Denmark)

    Jakobsen, Klaus D; Frederiksen, Julie N; Hansen, Thomas;

    2005-01-01

    of 100 subjects was assessed using the operational criteria OPCRIT checklist for psychotic and affective illness. The most recent principal and clinical ICD-10 diagnosis was compared with diagnoses generated by the OPCRIT instrument. Data documented very high sensitivity (93%) and positive predictive...

  11. COPE-ICD: Patient experience of participation in an ICD specific rehabilitation programme

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Pedersen, Birthe Dagmar; Svendsen, Jesper Hastrup;

    2012-01-01

    PURPOSE: Evaluating rehabilitation programmes from the patient's perspective is much needed, as the patients are the most important stakeholders in the health care system. A comprehensive rehabilitation programme, COPE-ICD programme, consists of exercise training and nursing consultations during...... transcribed. The analysis was inspired by Ricoeur's theory of interpretation, which consists of three levels: naive reading, structured analysis and critical interpretation and discussion. RESULTS: The overall concept was that participating in the COPE-ICD programme meant feeling inspired and secure through...

  12. Long-term follow-up of patients with familial electric disorder cardiomyopathy without ICD implantation%家族性电紊乱性心脏病未植入心律转复除颤器患者的长期随访研究

    Institute of Scientific and Technical Information of China (English)

    刘金秋; 潘晓杰; 张树龙; 杨延宗; 刘莹; 高连君; 夏云龙; 董颖雪; 李真; 杨东辉; 王莹琦; 洪丽

    2008-01-01

    Objective To evaluate the long-term prophylactics of high-risk patients with hereditary arrhythmia at absence of implantable cardioverter defibrillator(ICD) treatment. Methods Eleven cases of congenital tong QT syndrome (LQTS) and 2 cases Brugada syndrome were enrolled,4 male,9 female with average age (44 ± 19)years. Routine clinical investigation and electrocardiography(ECG) were delivered. All patients experienced syncope or aborted cardiac arrest. Six cases (46%) were hospitalized due to cardiac arrest. Four patients with LQTS were implanted pacemakers. Patients were educated to avoid trigger factors of cardiac events and families were trained with cardiac pulmonary resuscitation. Results LQTS patients still experienced syncope or cardiac arrest after propranolol and pacemaker therapy but attacks occurred less than before. One LQTS had her first cardiac arrest. Five LQTS(39%) had cardiac arrest again during follow-up. Two LQTS cases died. One (0. 8%)died of sudden cardiac attack. The other died of cerebral hemorrhage. Both Brugada syndrome patients had cardiac arrest and survived again. One case experienced 5 times cardiac arrest and was saved by his wife's cardiac pulmonary resuscitations. Conclusiou LQTS and Brugada syndrome patients are in high risk for sudden cardiac death. Β-blocker and pacemaker may be effective to improve symptoms. With or without ICD implantation, patients should be educated to avoid trigger factors of cardiac evens and was families should be trained with cardiac pulmonary resuscitation.%目的 研究家族性电紊乱性心脏病高危患者,未植入心律转复除颤器(ICD)的长期预后.方法 13例患者中11例长QT综合征(LQTS)、2例Brugada综合征,均有心脏性晕厥.男性4例,女性9例,平均年龄(44±19)岁.6例(46%)因心跳骤停住院治疗.4例LQTS植入起搏器,平均随访(7±4)年.结果 11例(85%)患者仍然发作晕厥,1例心脏骤停首次入院,5例(39%)心脏骤停再入院,2例LQTS死亡,其中1

  13. 75 FR 70015 - External Defibrillators; Public Workshop

    Science.gov (United States)

    2010-11-16

    ... cardiac arrest can cause death. External defibrillators are important, life-saving devices. However, over... life-saving devices designed to restore normal heart rhythms following sudden cardiac arrest. Each year, nearly 300,000 Americans collapse from sudden cardiac arrest. In sudden cardiac arrest, the...

  14. Defibrillator-Induced Tricuspid Abscess Presenting as Diabetic Ketoacidosis and Wound Ulceration.

    Science.gov (United States)

    Khan, Rafay; Arshed, Sabrina; Ahmed, Amar; Sen, Shuvendu; Yousif, Abdalla

    2016-01-01

    Right-sided endocarditis is predominantly seen in patients with a history of intravenous drug abuse. However, it is well shown in the literature to be associated with patients containing foreign bodies such as pacemakers, central venous lines, and in those with congenital heart disease. In patients with pacemaker leads and in those with automatic implantable cardioverter defibrillators (AICDs), it is important to suspect foreign body infection when there are signs and indications of bacteremia. When these leads become infected, they can spread the infection to the tricuspid valve resulting in vegetations. The proper management is removal of the infected lead and foreign body along with a prolonged course of antibiotics. However, it is unusual and a relatively rare entity to see foreign body infection resulting from a wound ulcer resulting in not only endocarditis but also abscess formation on the tricuspid valve. Here we report a case of a 60-year-old male with recent AICD placement presenting as diabetic ketoacidosis due to tricuspid abscess formation as a result of a foot ulcer. PMID:26668682

  15. 植入ICD的患者均需使用抗心律失常药吗?%Antiarrhythmic Drugs for All Patients With an ICD?

    Institute of Scientific and Technical Information of China (English)

    Richard L. Page; 王琳

    2007-01-01

    通常认为,在应用植入式复律除颤器(implantable cardioverter defibrillator,ICD)早期联合应用抗心律失常药物是多余的,这就像用了腰带又加吊带。直到不久前人们才发现,随着时间的推移,许多病人最终仍需在ICD的基础上使用抗心律失常药。在JAMA杂志中,Connolly及其同事报告了“植入式复律除颤器病人最佳药物治疗试验”(Optimal Pharmacological Therapy in Cardioverter Defibrillator Patients,OPTIC)。他们提出这样一个问题,即在植入ICD时是否应该应用抗心律失常药物并加上一种β-阻滞剂,以减少ICD放电。为了回答这个问题,关键是要了解ICD和抗心律失常药物的相互作用以及联合应用的效果。

  16. Attrition and Adherence in a Web-Based Distress Management Program for Implantable Cardioverter Defibrillator Patients (WEBCARE): Randomized Controlled Trial

    DEFF Research Database (Denmark)

    Habibovic, M.; Cuijpers, P.; Alings, M.;

    2014-01-01

    . Conclusions: Current findings underline the importance of focusing on adherence and dropout, as this remains a significant problem in behavioral Web-based trials. Examining possibilities to address barriers indicated by patients might enhance treatment engagement and improve patient outcomes....

  17. Small bowel capsule endoscopy in patients with cardiac pacemakers and implantable cardioverter defibrillators: Outcome analysis using telemetry review

    OpenAIRE

    2012-01-01

    AIM: To determine if there were any interactions between cardiac devices and small bowel capsules secondary to electromagnetic interference (EMI) in patients who have undergone small bowel capsule endoscopy (SBCE).

  18. A challenging case of ventricular arrhythmia in a patient with myocarditis: ICD yes/no after ablation

    Directory of Open Access Journals (Sweden)

    Maria L Narducci; Teresa Rio; Francesco Perna; Domenico D�Amario; Biagio Merlino; Riccardo Marano; Gianluigi Bencardino; Frediano Inzani; Gemma Pelargonio; Filippo Crea

    2014-10-01

    Full Text Available In patients with myocarditis, early diagnosis and appropriate therapy are mandatory, as well as close clinical and strumental follow-up with particular regard on progression of disease and ventricular arrhythmias relapse. The management of ventricular arrhythmias should follow current guidelines for ICD implantation, but new therapeutic options could be evaluated in these patients as combined epicardial/endocardial ablation and external wereable defibrillator. Particularly, left ventricular ejection fraction (LVEF represented the only risk stratifier for sudden cardiac death currently used in myocarditis, although the use of single risk factor have limited utility. On this regard, combined analysis of structural myocardial tissue definition by cardiac magnetic resonance (CMR and endomyocardial biopsy, in association with resting cardiac systolic function could improve predictive accuracy for sudden death in patients with myocarditis.

  19. Reliability systems for implantable cardiac defibrillator batteries

    Energy Technology Data Exchange (ETDEWEB)

    Takeuchi, E.S. [Wilson Greatbatch Ltd., Clarence, NY (United States)

    1995-03-01

    The reliability of the power sources used in implantable cardiac defibrillators is critical due to the life-saving nature of the device. Achieving a high reliability power source depends on several systems functioning together. Appropriate cell design is the first step in assuring a reliable product. Qualification of critical components and of the cells using those components is done prior to their designation as implantable grade. Product consistency is assured by control of manufacturing practices and verified by sampling plans using both accelerated and real-time testing. Results to date show that lithium/silver vanadium oxide cells used for implantable cardiac defibrillators have a calculated maximum random failure rate of 0.005% per test month. (orig.)

  20. Reliability systems for implantable cardiac defibrillator batteries

    Science.gov (United States)

    Takeuchi, Esther S.

    The reliability of the power sources used in implantable cardiac defibrillators is critical due to the life-saving nature of the device. Achieving a high reliability power source depends on several systems functioning together. Appropriate cell design is the first step in assuring a reliable product. Qualification of critical components and of the cells using those components is done prior to their designation as implantable grade. Product consistency is assured by control of manufacturing practices and verified by sampling plans using both accelerated and real-time testing. Results to date show that lithium/silver vanadium oxide cells used for implantable cardiac defibrillators have a calculated maximum random failure rate of 0.005% per test month.

  1. Legal aspects in implantable defibrillator extraction.

    Science.gov (United States)

    D'Ovidio, C; Costantini, S; Vellante, P; Carnevale, A

    2013-10-01

    At the Institute of Legal Medicine in Chieti, a case of iatrogenic superior vena cava perforation was observed during laser extraction of an infected biventricular implantable cardiac defibrillator. The presentation of this particular case represented a starting point for studying the occurrence of similar complications in literature, since their knowledge and understanding should induce resolution of any organisation problems, aid in increasing physicians' training and impose the availability of cardiac surgeons during such operations.

  2. Poor health status and distress in cardiac patients

    DEFF Research Database (Denmark)

    Habibović, Mirela; Versteeg, Henneke; Pelle, Aline J M;

    2013-01-01

    Implantable cardioverter defibrillator (ICD) therapy, which includes the risk of shocks, is considered the primary culprit of reductions in patient reported outcomes (PROs; e.g. health status and distress), thereby negating the role of underlying disease severity. We examined the relative influence...

  3. Does electrophysiological testing have any role in risk stratification for sudden cardiac death?

    Institute of Scientific and Technical Information of China (English)

    Fei Lü; Wei Hua

    2010-01-01

    @@ Introduction Implantation of implantable cardioverter defibrillators (ICD) has widely been accepted for secondary prevention of sudden cardiac death (SCD) in cardiac arrest survivors.1 Currently there are increasing interests in primary prevention of SCD in selected high risk patients who have not experienced cardiac arrest.1

  4. Effect of obesity on the effectiveness of cardiac resynchronization to reduce the risk of first and recurrent ventricular tachyarrhythmia events

    OpenAIRE

    Szepietowska, Barbara; Polonsky, Bronislava; Sherazi, Saadia; Biton, Yitschak; Kutyifa, Valentina; McNitt, Scott; AKTAS, Mehmet; Moss, Arthur J.; Zareba, Wojciech

    2016-01-01

    Background Obesity is associated with multiple adverse cardiovascular conditions and may increase the risk of ventricular tachyarrhythmias (VT/VF). There is limited data on the association between obesity and risk of VT/VF requiring appropriate implantable cardioverter-defibrillator (ICD) therapies and the effectiveness of cardiac resynchronization therapy (CRT) to reduce risk for VT/VF. The multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy (MADIT-C...

  5. Preparing for ICD-10 and conforming your documentation.

    Science.gov (United States)

    Buckholtz, Rhonda

    2013-01-01

    There are many unknowns right now with the implementation of ICD-10-CM. However, tackling a few obstacles early on along with a keen sense of ICD-10 awareness will put you ahead of the game and able to continue on after October 1, 2014. Waiting until the last minute in hopes of delays will surely hinder the financial stability of your practice. This article will take you through what is needed for ICD-10 implementation and help you jumpstart your efforts.

  6. ICDS database: interrupted CoDing sequences in prokaryotic genomes.

    Science.gov (United States)

    Perrodou, Emmanuel; Deshayes, Caroline; Muller, Jean; Schaeffer, Christine; Van Dorsselaer, Alain; Ripp, Raymond; Poch, Olivier; Reyrat, Jean-Marc; Lecompte, Odile

    2006-01-01

    Unrecognized frameshifts, in-frame stop codons and sequencing errors lead to Interrupted CoDing Sequence (ICDS) that can seriously affect all subsequent steps of functional characterization, from in silico analysis to high-throughput proteomic projects. Here, we describe the Interrupted CoDing Sequence database containing ICDS detected by a similarity-based approach in 80 complete prokaryotic genomes. ICDS can be retrieved by species browsing or similarity searches via a web interface (http://www-bio3d-igbmc.u-strasbg.fr/ICDS/). The definition of each interrupted gene is provided as well as the ICDS genomic localization with the surrounding sequence. Furthermore, to facilitate the experimental characterization of ICDS, we propose optimized primers for re-sequencing purposes. The database will be regularly updated with additional data from ongoing sequenced genomes. Our strategy has been validated by three independent tests: (i) ICDS prediction on a benchmark of artificially created frameshifts, (ii) comparison of predicted ICDS and results obtained from the comparison of the two genomic sequences of Bacillus licheniformis strain ATCC 14580 and (iii) re-sequencing of 25 predicted ICDS of the recently sequenced genome of Mycobacterium smegmatis. This allows us to estimate the specificity and sensitivity (95 and 82%, respectively) of our program and the efficiency of primer determination.

  7. Neurodevelopmental Disorders (ASD and ADHD): DSM-5, ICD-10, and ICD-11.

    Science.gov (United States)

    Doernberg, Ellen; Hollander, Eric

    2016-08-01

    Neurodevelopmental disorders, specifically autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have undergone considerable diagnostic evolution in the past decade. In the United States, the current system in place is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), whereas worldwide, the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) serves as a general medical system. This review will examine the differences in neurodevelopmental disorders between these two systems. First, we will review the important revisions made from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) to the DSM-5, with respect to ASD and ADHD. Next, we will cover the similarities and differences between ASD and ADHD classification in the DSM-5 and the ICD-10, and how these differences may have an effect on neurodevelopmental disorder diagnostics and classification. By examining the changes made for the DSM-5 in 2013, and critiquing the current ICD-10 system, we can help to anticipate and advise on the upcoming ICD-11, due to come online in 2017. Overall, this review serves to highlight the importance of progress towards complementary diagnostic classification systems, keeping in mind the difference in tradition and purpose of the DSM and the ICD, and that these systems are dynamic and changing as more is learned about neurodevelopmental disorders and their underlying etiology. Finally this review will discuss alternative diagnostic approaches, such as the Research Domain Criteria (RDoC) initiative, which links symptom domains to underlying biological and neurological mechanisms. The incorporation of new diagnostic directions could have a great effect on treatment development and insurance coverage for neurodevelopmental disorders worldwide. PMID:27364515

  8. Nationwide Fluoroscopic Screening of Recalled Riata Defibrillator Leads in Denmark

    DEFF Research Database (Denmark)

    Larsen, Jacob Mosgaard; Riahi, Sam; Nielsen, Jens C.;

    2013-01-01

    The natural history of insulation defects with inside-out conductor externalization in recalled St Jude Medical Riata defibrillator leads is not well understood.......The natural history of insulation defects with inside-out conductor externalization in recalled St Jude Medical Riata defibrillator leads is not well understood....

  9. Causes and management of implantable cardiac defibrillator lead failure%植入型心律转复除颤器除颤电极导线功能故障的原因及处理

    Institute of Scientific and Technical Information of China (English)

    汤益民; 沈法荣; 孙国建; 陈建明; 何浪; 金红峰

    2011-01-01

    Objective To examine the incidence, causes, and management of defibrillation leads failure of implanted cardiac defibrillators (ICD) and cardiac resynchronization therapy plus defibrillator (CRT- D) devices.Methods One hundred and sixty- six patients with implanted ICD or CRT- D were followed up.Results Five out of 166 patients presented defibrillation lead failure with a incidence rate of 3.01%.Among 5 cases 1 had insulation defects, 1 had lead functional failure and 3 had T- wave suppression feature.New defibrillation lead was implanted in 2 patients and active- fixation pacing lead was implanted in another 2 patients.Conclusion Defibrillator lead failure can cause inappropriate shocks.It can be prevented by implantation of new defibrillatior lead.%目的 探讨植入型心律转复除颤器(ICD)及心脏再同步化心律转复除颤器(CRT-D)除颤电极导线功能故障的发生率、可能原因及处理方法.方法 对166例植入ICD或CRT-D的患者进行长期跟踪随访,统计除颤电极导线功能故障发生率,分析其可能原因及处理方法.结果 166例患者中出现除颤电极导线功能故障5例,发生率为3.01%.其中电极导线绝缘层破裂1例,ICD导线功能障碍1例,R波感知逐渐降低3例.其中2例予以更换除颤电极导线,2例予以植入普通主动固定电极导线,余1例随访中待择期处理.结论 植入ICD或CRT-D的患者,除颤电极导线功能障碍可引起ICD不适当放电,随访中若发现除颤电极导线功能障碍,应及时更换导线.

  10. Impact of the Transition to ICD-10 on Medicare Payment

    Data.gov (United States)

    U.S. Department of Health & Human Services — Although the transition from the ICD-9-CM to the ICD-10 version of MS-DRGs resulted in 1.68 percent of the patients being assigned to a different MS-DRG, payment...

  11. Identification of ICD Codes Suggestive of Child Maltreatment

    Science.gov (United States)

    Schnitzer, Patricia G.; Slusher, Paula L.; Kruse, Robin L.; Tarleton, Molly M.

    2011-01-01

    Objective: In order to be reimbursed for the care they provide, hospitals in the United States are required to use a standard system to code all discharge diagnoses: the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9). Although ICD-9 codes specific for child maltreatment exist, they do not identify all…

  12. [ICD diagnoses in university polyclinic naturopathy consultation].

    Science.gov (United States)

    Hentschel, C; Lindner, M; Brinkhaus, B; Nagel, M R; Hahn, E G; Kohnen, R

    1996-08-01

    In a special consulting office for complementary medicine, ambulatory patients interested in receiving adjuvant treatment with complementary medicine can obtain a relevant advice and critical information regarding non-evaluated therapies. Within the framework of a retrospective statistical analysis, the diagnosis documented over a period of 24 months in accordance with the 4-digit ICD code were evaluated. In particular patients with chronic and/or functional illnesses had additional treatment needs. The exponential growth in the numbers of patients during the course of the observation period illustrates the increasing importance of complementary medical measures. However, in view of the considerable political significance of the cost factor and the possible risks of the treatment, only properly evaluated complementary medical therapies should be employed.

  13. Where Does It Lead? Imaging Features of Cardiovascular Implantable Electronic Devices on Chest Radiograph and CT

    Energy Technology Data Exchange (ETDEWEB)

    Lanzman, Rotem S.; Blondin, Dirk; Furst, Gunter; Scherer, Axel; R Miese, Falk; Kroepil, Patric [University of Duesseldorf, Medical Faculty, 40225 Duesseldorf (Germany); Winter, Joachim [University Hospital Duesseldorf, 40225 Duesseldorf (Germany); Abbara, Suhny [Massachusetts General Hospital, Boston, MA (US)

    2011-10-15

    Pacemakers and implantable cardioverter defibrillators (ICDs) are being increasingly employed in patients suffering from cardiac rhythm disturbances. The principal objective of this article is to familiarize radiologists with pacemakers and ICDs on chest radiographs and CT scans. Therefore, the preferred lead positions according to pacemaker types and anatomic variants are introduced in this study. Additionally, the imaging features of incorrect lead positions and defects, as well as complications subsequent to pacemaker implantation are demonstrated herein.

  14. L'efecte dels camps elèctrics de freqüència extremadament baixa (ELF) en el desfibril·lador automàtic implantable (DAI)

    OpenAIRE

    González Sosa, Jarold Aurelio

    2012-01-01

    Projecte realitzat en el marc d'un programa de mobilitat amb la Tampere University of Technology. [ANGLÈS] Through research and technological advances, modern society has developed a variety of implantable devices that helps to optimize human's life quality. One of these devices is the implantable cardioverter defibrillator (ICD). Our unit, ERP Environmental Health, in previous investigations has found that, in some cases, the ICD receives certain disturbances under the power lines. Theref...

  15. Ventricular fibrillation triggered by marijuana use in a patient with ischemic cardiomyopathy: a case report

    OpenAIRE

    Baranchuk, Adrian; Johri, Amer M; Simpson, Christopher S.; Methot, Michelle; Damian P. Redfearn

    2008-01-01

    Background A 60-year-old man presented to the emergency department with a left eye orbital rupture sustained during a fall due to syncope shortly after smoking more than his usual amount of marijuana. Case presentation The patient reported experiencing a shock from his implantable cardioverter-defibrillator (ICD) device prior to the loss of consciousness. There was no biochemical, electrocardiographic, or clinical evidence of ischemia. ICD interrogation revealed one episode of ventricular fib...

  16. Where Does It Lead? Imaging Features of Cardiovascular Implantable Electronic Devices on Chest Radiograph and CT

    OpenAIRE

    Lanzman, Rotem S.; Winter, Joachim; Blondin, Dirk; Fürst, Günter; Scherer, Axel; Miese, Falk R; Abbara, Suhny; Kröpil, Patric

    2011-01-01

    Pacemakers and implantable cardioverter defibrillators (ICDs) are being increasingly employed in patients suffering from cardiac rhythm disturbances. The principal objective of this article is to familiarize radiologists with pacemakers and ICDs on chest radiographs and CT scans. Therefore, the preferred lead positions according to pacemaker types and anatomic variants are introduced in this study. Additionally, the imaging features of incorrect lead positions and defects, as well as complica...

  17. Semantic Alignment between ICD-11 and SNOMED CT.

    Science.gov (United States)

    Rodrigues, Jean-Marie; Robinson, David; Della Mea, Vincenzo; Campbell, James; Rector, Alan; Schulz, Stefan; Brear, Hazel; Üstün, Bedirhan; Spackman, Kent; Chute, Christopher G; Millar, Jane; Solbrig, Harold; Brand Persson, Kristina

    2015-01-01

    Due to fundamental differences in design and editorial policies, semantic interoperability between two de facto standard terminologies in the healthcare domain--the International Classification of Diseases (ICD) and SNOMED CT (SCT), requires combining two different approaches: (i) axiom-based, which states logically what is universally true, using an ontology language such as OWL; (ii) rule-based, expressed as queries on the axiom-based knowledge. We present the ICD-SCT harmonization process including: a) a new architecture for ICD-11, b) a protocol for the semantic alignment of ICD and SCT, and c) preliminary results of the alignment applied to more than half the domain currently covered by the draft ICD-11. PMID:26262160

  18. 肠炎的ICD-10编码%The ICD-10 coding of enteritis

    Institute of Scientific and Technical Information of China (English)

    褚云生

    2012-01-01

    Although enteritis is a kind of common and frequent occurred disease in digestive system , there are many difficulties existing in its cod ing . In our country , enteritis supposed to be no infectious are coding in K 52 .9 according to the rules of the first edition of ICD-10 . As the canceling of assumed classification rules in the second edition of ICD-10 , there are as many as dozens of coding of enteritis and different pathogenesis can lead to different coding . So the coders should pay great attention when coding enteritis and avoid haste work as the bigger difficulty comes .%肠炎是消化系统中的常见病、多发病,但对肠炎的编码却存在诸多难点.ICD-10第1版执行假定分类原则,在我国肠炎假定为非传染性的均编码于K52.9.ICD-10第2版取消假定分类原则,意味着分类规则的改变,分类时应依照肠炎的发病病因,病因不同时,肠炎所对应的编码也不同,多达几十个不同编码.相当于增加了编码难度,编码员在对肠炎进行编码时应引起重视,切忌草率编码.

  19. Primärprävention des plötzlichen Herztodes mit implantierbaren Cardioverter-Defibrillatoren - Vernünftig oder MADIT?

    Directory of Open Access Journals (Sweden)

    Steinwender C

    2004-01-01

    Full Text Available Mehrere in jüngerer Zeit publizierte Studien belegen die Überlegenheit des implantierbaren Cardioverter-Defibrillators gegenüber einer medikamentösen Therapie in der Primärprävention des plötzlichen Herztodes. Die Kollektive dieser Untersuchungen bestanden aus den bekannten Hochrisikopatienten im Postinfarktstadium mit höher- bis höchstgradig eingeschränkter Linksventrikelfunktion. MADIT II war die erste Studie, die auf eine aufwendige rhythmologische Risikostratifizierung verzichtete und dennoch in sämtlichen Subgruppen einen therapeutischen Benefit durch die Defibrillatortherapie nachwies. Die sich hierdurch ergebende Evidenz fand rasch Eingang in die Richtlinien der großen kardiologischen Gesellschaften. Ungelöst bleiben vorerst zwei große Probleme: 1. die Frage der Finanzierung einer Umsetzung dieser Richtlinien; 2. die weitere Strategie zur effektiven Primärprävention des plötzlichen Herztodes, da durch oben genannte Studien nur ein kleiner Prozentsatz der möglichen künftigen Opfer abgedeckt wird. Als Lösungsansatz bietet sich eine kostengünstige, auf die Erfordernisse der Primärprävention abgestimmte Defibrillator-Technologie an, die gemeinsam mit einer Vereinfachung der Implantationsprozedur die Kosteneffektivität zugunsten der Prophylaxe beeinflussen kann. Weiters müssen zusätzlich große Anstrengungen zur Identifizierung von zukünftigen Opfern des plötzlichen Herztodes vor ihrer ersten Arrhythmie-Episode unternommen werden.

  20. [ILCOR recommendation on signage of automated external defibrillators (AEDs)].

    Science.gov (United States)

    Truhlár, A

    2010-05-01

    Early defibrillation is a determinant of survival in both out-of-hospital and in-hospital cardiac arrests from ventricular fibrillation and pulseless ventricular tachycardia. The review summarizes importance of early defibrillation with automated external defibrillators (AED) and presents the International Liaison Committee on Resuscitation (ILCOR) recommendation for universal AED sign. The aim of the recommendation is to unify the AED signs worldwide and to spread the knowledge of this. The public in general, but healthcare professionals particularly, should be able to recognize AED location and use the device immediately in case of cardiac arrest.

  1. Genoplivning med automatisk ekstern defibrillator på hospital

    DEFF Research Database (Denmark)

    Løfgren, Bo; Wahlgreen, Claus; Hoffmann, Anne Mette;

    2009-01-01

    Early defibrillation is a determinant of survival in cardiac arrest. We report a Danish case of successful in-hospital resuscitation using an automated external defibrillator (AED). This case illustrates important aspects of implementation of in-hospital use of an AED, i.e. location of the AED......, education of the staff, systematic registration and data collection and technical aspects of AED use. If in-hospital AED implementation is carefully executed, its use may provide a safe and effective way of obtaining early defibrillation. Udgivelsesdato: 2009-Jan-26...

  2. Many People with Implantable Defibrillators Can Participate in Vigorous Sports

    Science.gov (United States)

    ... people with implantable defibrillators can participate in vigorous sports May 20, 2013 Categories: Heart News Study Highlights : ... may safely participate in a number of vigorous sports. The study challenges some current science recommendations advising ...

  3. Patient ECG recording control for an automatic implantable defibrillator

    Science.gov (United States)

    Fountain, Glen H. (Inventor); Lee, Jr., David G. (Inventor); Kitchin, David A. (Inventor)

    1986-01-01

    An implantable automatic defibrillator includes sensors which are placed on or near the patient's heart to detect electrical signals indicative of the physiology of the heart. The signals are digitally converted and stored into a FIFO region of a RAM by operation of a direct memory access (DMA) controller. The DMA controller operates transparently with respect to the microprocessor which is part of the defibrillator. The implantable defibrillator includes a telemetry communications circuit for sending data outbound from the defibrillator to an external device (either a patient controller or a physician's console or other) and a receiver for sensing at least an externally generated patient ECG recording command signal. The patient recording command signal is generated by the hand held patient controller. Upon detection of the patient ECG recording command, DMA copies the contents of the FIFO into a specific region of the RAM.

  4. ICD and DSM: neuroplasticity and staging are still missing.

    Science.gov (United States)

    Pallanti, Stefano

    2016-08-01

    The two main diagnostic systems, the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM), have undergone a number of revisions since their first editions: whereas the fifth edition of the DSM has been published in 2013, the eleventh revision of the ICD is expected by 2018. Although the process of harmonization between the 2 systems is still a debated topic, the forthcoming revision of the ICD is seemingly converging toward the DSM approach in regard to the reclassification of a number of disorders. Nevertheless, the 2 systems still exhibit considerable differences, partly due to their different purposes, development and revision processes, and target audiences. Furthermore, while alternative and innovative classification approaches are emerging with the aim of integrating the latest findings from neuroscience and genomics, both the DSM and ICD still fail to incorporate core concepts such as the clinical staging of psychiatric disorders and "neuroprogression," as well as an adequate consideration of endophenotypes. PMID:27503571

  5. Body-focused repetitive behavior disorders in ICD-11

    OpenAIRE

    Grant, Jon E.; Dan J Stein

    2014-01-01

    This article addresses the question of how body-focused repetitive behavior disorders (e.g., trichotillomania and skin-picking disorder) should be characterized in ICD-11. The article reviews the historical nosology of the two disorders and the current approaches in DSM-5 and ICD-10. Although data are limited and mixed regarding the optimal relationship between body-focused repetitive behavior disorders and nosological categories, these conditions should be included within the obsessive-compu...

  6. Emergency department coding of bicycle and pedestrian injuries during the transition from ICD-9 to ICD-10

    Science.gov (United States)

    Karkhaneh, M; Hagel, B E; Couperthwaite, A; Saunders, L D; Voaklander, D C

    2011-01-01

    Background The international classification of diseases version 10 (ICD-10) uses alphanumeric expanded codes and external cause of injury codes (E-codes). Objective To examine the reliability and validity of emergency department (ED) coders in applying E-codes in ICD-9 and -10. Methods Bicycle and pedestrian injuries were identified from the ED information system from one period before and two periods after transition from ICD-9 to -10 coding. Overall, 180 randomly selected bicycle and pedestrian injury charts were reviewed as the reference standard (RS). Original E-codes assigned by ED coders (ICD-9 in 2001 and ICD-10 in 2004 and 2007) were compared with charts (validity) and also to ICD-9 and -10 codes assigned from RS chart review, to each case by an independent (IND) coder (reliability). Sensitivity, specificity, simple, and chance-corrected agreements (κ statistics) were calculated. Results Sensitivity of E-coding bicycle injuries by the IND coder in comparison with the RS ranged from 95.1% (95% CI 86.3 to 99.0) to 100% (95% CI 94.0 to 100.0) for both ICD-9 and -10. Sensitivity of ED coders in E-coding bicycle injuries ranged from 90.2% (95% CI 79.8 to 96.3) to 96.7% (95% CI 88.5 to 99.6). The sensitivity estimates for the IND coder ranged from 25.0% (95% CI 14.7 to 37.9) to 45.0% (95% CI 32.1 to 58.4) for pedestrian injuries for both ICD-9 and -10. Conclusion Bicycle injuries are coded in a reliable and valid manner; however, pedestrian injuries are often miscoded as falls. These results have important implications for injury surveillance research. PMID:21705466

  7. The Choice of ICD-10 Code to Granuloma%肉芽肿的ICD-10编码选择

    Institute of Scientific and Technical Information of China (English)

    孙凯; 李春秀

    2011-01-01

    0bjectives to make sure correct ICD-10 code for different granuloma.Methods learning relevant know ledge of different granulom a giving the correct ICD-10 code for them according to classification rules.Results choosing correct code according to causes of disease and location.Conclusions Coder notonly should master ICD-10 coding know ledge, not also need to learn related medical know ledge.They also need to read medical records carefully therefore can im prove the correction of coding and disease classification coding quality in order to provide reliable inform ation materials for clinical scientific research and teaching.%目的确定各类肉芽肿的正确的ICD-10编码.方法学习各类肉芽肿的相关知识,按照分类原则给予正确的ICD-10编码.结果根据病因、部位选择肉芽肿的正确编码.结论编码员不仅要掌握ICD-10编码知识,也要学习相关的医学知识,并仔细阅读病案,才能提高编码的准确性,提高疾病分类编码质量,为临床科研、教学等提供可靠的信息资料.

  8. The assessment of stress reactions of patients with implanted defibrillators

    Directory of Open Access Journals (Sweden)

    Daria Schneider-Matyka

    2016-02-01

    Full Text Available Background. Although they save life, implantable defibrillators have psychological side effects and increase the number of patients who experience anxiety, depressive symptoms and, in extreme cases, post-traumatic stress disorder (PT SD. Escalation of PT SD symptoms depends on patients’ ability to cope with stress. Objectives . The aim of this study was to assess the reactions of patients after defibrillator implantation, and their ways to cope with stress, as well as to analyze the relationship between the ways of coping with stress and PT SD symptoms. Material and methods. The study was conducted using the Mini-Cope, the Impact of Event Scale-Revised (IES-R, and the author’s questionnaire. It involved 111 patients with implanted defibrillators at the mean age of 60 years, including 88 (79.3% men. The majority of the patients had secondary education – 38 (34.2% and were married – 85 (76.6%. 51 (45.9% were one year after defibrillator implantation. Results. It was demonstrated that 49 (44.1% of the surveyed experienced intracardiac discharges, out of whom 8 (17.1% went through an ‘electrical storm’. This group obtained higher PT SD scores in all three IES-R domains comparing to those without implanted defibrillators. The most common strategy to cope with stress was acceptance of the situation and searching for emotional support. Conclusions . 1. Intracardiac discharges are the vital problem of patients after defibrillator implantation. 2. Searching for emotional support and acceptance of the situation are the most common strategies to cope with stress. 3. There is a relationship between PT SD symptoms occurring in patients after implantation of a defibrillator and their strategies to cope with stress.

  9. Implementation and impact of ICD-10 (Part II

    Directory of Open Access Journals (Sweden)

    Gazanfar Rahmathulla

    2014-01-01

    Full Text Available Background: The transition from the International Classification of Disease-9 th clinical modification to the new ICD-10 was all set to occur on 1 October 2015. The American Medical Association has previously been successful in delaying the transition by over 10 years and has been able to further postpone its introduction to 2015. The new system will overcome many of the limitations present in the older version, thus paving the way to more accurate capture of clinical information. Methods: The benefits of the new ICD-10 system include improved quality of care, potential cost savings, reduction of unpaid claims, and improved tracking of healthcare data. The areas where challenges will be evident include planning and implementation, the cost to transition, a shortage of qualified coders, training and education of the healthcare workforce, and a loss of productivity when this occurs. The impacts include substantial costs to the healthcare system, but the projected long-term savings and benefits will be significant. Improved fraud detection, accurate data entry, ability to analyze cost benefits with procedures, and enhanced quality outcome measures are the most significant beneficial factors with this change. Results: The present Current Procedural Terminology and Healthcare Common Procedure Coding System code sets will be used for reporting ambulatory procedures in the same manner as they have been. ICD-10-PCS will replace ICD-9 procedure codes for inpatient hospital services. The ICD-10-CM will replace the clinical code sets. Our article will focus on the challenges to execution of an ICD change and strategies to minimize risk while transitioning to the new system. Conclusion: With the implementation deadline gradually approaching, spine surgery practices that include multidisciplinary health specialists have to anticipate and prepare for the ICD change in order to mitigate risk. Education and communication is the key to this process in spine

  10. Diet Survey Of Icds Children In Pune City

    Directory of Open Access Journals (Sweden)

    Pratinidhi A.K

    1998-01-01

    Full Text Available Research question: What is the protein & calorie intake of children getting supplementary nutrition under ICDS? Objectives: I To study the protein and calorie intake of children covered under ICDS. ii To study the protein & caloric content of supplementary nutrition. Study design: Cross- sectional. Setting: ICDS project of Pune city. Participants: Children aged 1-6 years, receiving supplementary nutrition from anganwadis. Sample size: 165 children aged 1-<6 tears. Study variables: Knowledge and perception of ICDS, Protein and calorie intake of children, nutritive value of ICDS supplementary foods. Results: There was a gross deficiency of proteins and calories in majority of the children. The protein and calorie intake was less than 50% of recommended daily allowance in 38.2% and 35.7% children respectively. Only 13.9% of children had a protein intake of ³90% of RDA while 12.7% had a calorie consumption of ³90% of RDA. 71.6% of children aged 3-<6 years took the food to their homes and shared with other family members thus depriving them the total benefit of supplementary nutrition. 46.1% mothers perceived the supplementary nutrition to be a substitude. The supplement given at anganwadi had an average nutritive value of 213 calories and 5.1 gm protein as compared to recommended values of 300 calories & 10 gms protein.

  11. Use a defibrillator, save a life

    CERN Multimedia

    Joannah Caborn Wengler

    2012-01-01

    With the work for Long Shutdown 1 looming on the horizon, the CERN Fire Brigade is anticipating a heavy workload: more people working at CERN means more call-outs. So the more trained first-aiders around to help out before the paramedics arrive, the better. Would you know what to do in a medical emergency?   It could happen at any time: two colleagues are having a coffee at work, when one suddenly clutches his or her chest and falls to the floor unconscious. What would you do? Run to find a first-aider? Call the ambulance and wait, finishing your coffee? Neither response is entirely correct. On Monday 11 June in Building 40 the CMS safety group, in collaboration with the Fire Brigade and the Medical Service, demonstrated the recommended, potentially life-saving response to cardiac arrest (see the video), including the correct use of a defibrillator, ten of which were recently installed in key CERN locations (the Bulletin reported).     “In countries where...

  12. A new approach to optimization-based defibrillation.

    Science.gov (United States)

    Muzdeka, S; Barbieri, E

    2001-01-01

    The purpose of this paper is to develop a new model for optimal cardiac defibrillation, based on simultaneous minimization of energy consumption and defibrillation time requirements. In order to generate optimal defibrillation waveforms that will accomplish the objective stated above, one parameter rho has been introduced as a part of the performance measure to weigh the relative importance of time and energy. All the results of this theoretical study have been obtained for the proposed model, under the assumption that cardiac tissue can be represented by a simple parallel resistor-capacitor circuit. It is well known from modern control theory that the selection of a numerical value of the weight factor is the matter of subjective judgment of a designer. However, it has been shown that defining a cost function can help in selecting a value for rho. Some results of the mathematical development of the algorithm and computer simulations will be included in the paper. PMID:11347410

  13. Praehospital-hjertestopbehandling med semiautomatisk defibrillator--Heartstart 2000

    DEFF Research Database (Denmark)

    Fonsmark, L; Sandøe, E; Kastrup, J;

    1989-01-01

    In order to test the efficacy of a semiautomatic defibrillator (Heartstart 2000) in connection with cardiac arrest outside hospital, the apparatus was installed in two of the ambulances belonging to the Copenhagen Fire Service. The ambulance district involved was also equipped with an ambulance...... staffed by a doctor. A total of 48 patients with cardiac arrest were found and 16 of these had ventricular fibrillation. Six of the 16 patients have since been discharged from hospital (37.5%). The defibrillator had a high diagnostic certainty with a sensitivity of 96.5% and a specificity of 100%. No...... practical problems of note occurred in connection with employment of the defibrillator. The ambulance staffs underwent six hours of training and this appeared to be adequate. It is concluded that Heartstart 2000 functions well and effectively in connection with revival of patients with cardiac arrest...

  14. Representing ICD-11 JLMMS Using IHTSDO Representation Formalisms.

    Science.gov (United States)

    Mamou, Marzouk; Rector, Alan; Schulz, Stefan; Campbell, James; Solbrig, Harold; Rodrigues, Jean-Marie

    2016-01-01

    It is investigated whether the content of the Joint Linearization for Mortality and Morbidity Statistics of the 11th ICD revision can be semantically represented by formalisms acting on the clinical terminology SNOMED CT, viz. the IHTSDO Compositional Grammar (CG) and the Expression Constraint Language (ECL). Whereas CG provides a composition syntax for building coordinated SNOMED CT expressions, ECL provides a powerful query mechanism. Both formalisms can be leveraged to guarantee inter-operation between an ontology-based terminology like SNOMED CT and a statistical classification like ICD, characterized by single hierarchies and exhaustive, mutually exclusive classes. We test the feasibility of the method on the circulatory chapter of ICD-11 JLMMS. PMID:27577419

  15. [Functional dysphonia: relation with personality and ICD-10 criteria].

    Science.gov (United States)

    Carvajal, C; Sanfuentes, M T; Eva, P; Jara, C; Lolas Stepke, F

    1992-03-01

    The International Classification of Diseases, 10th. revision (ICD-10) in the category F45 defines the somatoform disorder as a mental disease characterized by the reiterative presentation of somatic symptoms in absence of an organic disease, or the somatic pathology being insufficient to explain the intensity of the symptoms as well as the discomfort and preoccupation of the patient. Fifteen female teachers with functional dysphonia were studied by means of a semistructured interview and psychometric evaluations. Considering dysphonia as the principal symptom, the most frequent diagnosis, in accordance with ICD-10 was "Other somatoform disorder" (F-45.8)(9/15). Five patients were diagnosed as motor dissociative disorder (F-44.4). All the patients had some abnormality of personality (5 with personality disorder and 10 with exacerbation of personality traits). The criteria of ICD-10 to classify the functional dysphonia as Somatoform disorder are discussed. It is suggested that certain personality traits are facilitators for somatization.

  16. ICD-10 coding algorithms for defining comorbidities of acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Evans Dewey

    2006-12-01

    Full Text Available Background With the introduction of ICD-10 throughout Canada, it is important to ensure that Acute Myocardial Infarction (AMI comorbidities employed in risk adjustment methods remain valid and robust. Therefore, we developed ICD-10 coding algorithms for nine AMI comorbidities, examined the validity of the ICD-10 and ICD-9 coding algorithms in detection of these comorbidities, and assessed their performance in predicting mortality. The nine comorbidities that we examined were shock, diabetes with complications, congestive heart failure, cancer, cerebrovascular disease, pulmonary edema, acute renal failure, chronic renal failure, and cardiac dysrhythmias. Methods Coders generated a comprehensive list of ICD-10 codes corresponding to each AMI comorbidity. Physicians independently reviewed and determined the clinical relevance of each item on the list. To ensure that the newly developed ICD-10 coding algorithms were valid in recording comorbidities, medical charts were reviewed. After assessing ICD-10 algorithms' validity, both ICD-10 and ICD-9 algorithms were applied to a Canadian provincial hospital discharge database to predict in-hospital, 30-day, and 1-year mortality. Results Compared to chart review data as a 'criterion standard', ICD-9 and ICD-10 data had similar sensitivities (ranging from 7.1 – 100%, and specificities (above 93.6% for each of the nine AMI comorbidities studied. The frequencies for the comorbidities were similar between ICD-9 and ICD-10 coding algorithms for 49,861 AMI patients in a Canadian province during 1994 – 2004. The C-statistics for predicting 30-day and 1 year mortality were the same for ICD-9 (0.82 and for ICD-10 data (0.81. Conclusion The ICD-10 coding algorithms developed in this study to define AMI comorbidities performed similarly as past ICD-9 coding algorithms in detecting conditions and risk-adjustment in our sample. However, the ICD-10 coding algorithms should be further validated in external databases.

  17. New/Surface-Modified Biocompatible Polymer for ICD Lead Insulation

    OpenAIRE

    Pisarek, Rubin Berek

    2011-01-01

    The average lifetime of an implanted pacemaker or defibrillator cable (lead) is approximately 10 years. One of the main lead failure mechanisms is deterioration of the insulation, which can be caused by chemical, biological, and mechanical processes. Each time lead failure occurs, an operation for its prompt replacement is required, in order to guarantee the patients' well-being. Since lead failure poses a health risk for the patients, and replacement...

  18. Breast calcifications following electrical defibrillation: An unusual mammographic appearance.

    Science.gov (United States)

    Westphal, Steven M; Jani, Manish; Badve, Sunil

    2010-01-01

    We present a case of a 57-year-old woman with a past medical history of end-stage renal disease and a recent history of electrical defibrillation who arrived for her annual mammogram with no breast-related complaints. The mammogram showed interval development of unusual clusters of heterogeneous calcifications. The patient underwent stereotactic core-needle biopsy for definitive diagnosis. The pathologic evaluation revealed fibrosis, abnormal adipocytes, and calcifications with no evidence of malignancy. The constellation of findings was consistent with fat necrosis and fibrosis related to tissue damage sustained during the recent defibrillation. PMID:27307857

  19. 心脏除颤器的质量控制%Quality Control of Cardiac Defibrillator/Defibrillation Monitor

    Institute of Scientific and Technical Information of China (English)

    崔亮; 崔骊; 苏燕平

    2012-01-01

    目的:通过对心脏除颤器/除颤监护仪进行质量控制检测,分析检测中发现的问题,提出解决方案,以确保该设备的安全使用.方法:采用除颤器检定仪检测,并分析失准设备的检测数据.结果:通过分析心脏除颤器/除颤监护仪的失准原因,及时维修,解决了检测中出现的问题,保障了除颤器/除颤监护仪的临床使用安全.结论:对除颤器/除颤监护仪进行质量控制非常必要,可以预防因设备失准而引起的医疗事故.%Objective: Through quality control testing to the cardiac defibrillator/defibrilLation monitor, we can analyze the problems of testing and propose solutions to ensure the use of safety in the clinical. Methods: Through the detector to detect the defibrillator, so we can analyze the data of misalignment equipment. Results: Trough analyzing and solving the problems in the testing, ensure the safety of the defibrillator. Conclusion: It is very necessary to test the cardiac defibrillator/defibrillation monitor that can prevent the medical accident, which caused by misalignment of medical equipment.

  20. Chopper Is Prodeath Regardless of the Effect of p75ICD on Sensitivity to Oxidative Stress

    Directory of Open Access Journals (Sweden)

    Alliya Qazi

    2011-01-01

    Full Text Available Background. The intracellular domain (ICD of the neurotrophin receptor, p75NTR, exhibits variably pro- and antiapoptotic activity and has been implicated in neurodegenerative and neurodestructive disease. The molecular determinants of these cellular effects are not completely understood. The “Chopper” domain of p75ICD has been shown to be proapoptotic in in vitro systems in which p75ICD is proapoptotic. The effects of Chopper in systems in which p75ICD is antiapoptotic and, therefore, whether or not Chopper accounts for the variability of the cellular effects of p75ICD are not known. We therefore examined the effects of deletion of Chopper on the effects of p75ICD on in vitro cell culture systems in which p75ICD is pro- or antiapoptotic, respectively. Results. In HN33.11 murine neuroblastoma-hippocampal neuron hybrid cells, p75ICD is antiapoptotic. In NIH 3T3 cells, p75ICD is proapoptotic. In both cell lines deletion of the Chopper domain from p75ICD decreases the incidence of apoptosis resulting from oxidative stress. Thus, irrespective of the nature of the effects of p75ICD on the cell, its Chopper domain is proapoptotic. Conclusions. Expression of p75ICD can enhance or attenuate oxidative induction of apoptosis. Variability of the effects of p75ICD is not related to variability of the effects of its Chopper domain.

  1. Worldwide experience with a totally subcutaneous implantable defibrillator

    DEFF Research Database (Denmark)

    Lambiase, Pier D; Barr, Craig; Theuns, Dominic A M J;

    2014-01-01

    patient population collected as part of the EFFORTLESS S-ICD Registry. METHODS AND RESULTS: The EFFORTLESS S-ICD Registry is a non-randomized, standard of care, multicentre Registry designed to collect long-term, system-related, clinical, and patient reported outcome data from S-ICD implanted patients...... shock rate was 7% with the vast majority occurring for oversensing (62/73 episodes), primarily of cardiac signals (94% of oversensed episodes). CONCLUSION: The first large cohort of real-world data from an International patient S-ICD population demonstrates appropriate system performance with clinical...... since June 2009. Follow-up data are systematically collected over 60-month post-implant including Quality of Life. The study population of 472 patients of which 241 (51%) were enrolled prospectively has a mean follow-up duration of 558 days (range 13-1342 days, median 498 days), 72% male, mean age of 49...

  2. Impact of shocks on mortality in patients with ischemic or dilated cardiomyopathy and defibrillators implanted for primary prevention.

    Directory of Open Access Journals (Sweden)

    Florian Streitner

    Full Text Available BACKGROUND: Emerging interest is seen in the paradox of defibrillator shocks for ventricular tachyarrhythmia and increased mortality risk. Particularly in patients with dilated cardiomyopathy (DCM, the prognostic importance of shocks is unclear. The purpose of this study was to compare the outcome after shocks in patients with ischemic cardiomyopathy (ICM or DCM and defibrillators (ICD implanted for primary prevention. METHODS AND RESULTS: Data of 561 patients were analyzed (mean age 68.6±10.6 years, mean left ventricular ejection fraction 28.6±7.3%. During a median follow-up of 49.3 months, occurrence of device therapies and all-cause mortality were recorded. 74 out of 561 patients (13.2% experienced ≥1 appropriate and 51 out of 561 patients (9.1% ≥1 inappropriate shock. All-cause mortality was 24.2% (136 out of 561 subjects. Appropriate shock was associated with a trend to higher mortality in the overall patient population (HR 1.48, 95% CI 0.96-2.28, log rank p = 0.072. The effect was significant in ICM patients (HR 1.61, 95% CI 1.00-2.59, log rank p = 0.049 but not in DCM patients (HR 1.03, 95% CI 0.36-2.96, log rank p = 0.96. Appropriate shocks occurring before the median follow-up revealed a much stronger impact on mortality (HR for the overall patient population 2.12, 95% CI 1.24-3.63, p = 0.005. The effect was driven by ICM patients (HR 2.48, 95% CI 1.41-4.37, p = 0.001, as appropriate shocks again did not influence survival of DCM patients (HR 0.63, 95% CI 0.083-4.75, p = 0.65. Appropriate shocks occurring after the median follow-up and inappropriate shocks occurring at any time revealed no impact on survival in any of the groups (p = ns. CONCLUSION: Appropriate shocks are associated with reduced survival in patients with ICM but not in patients with DCM and ICDs implanted for primary prevention. Furthermore, the negative effect of appropriate shocks on survival in ICM patients is only evident within the

  3. Psychotic disorders in DSM-5 and ICD-11.

    Science.gov (United States)

    Biedermann, Falko; Fleischhacker, W Wolfgang

    2016-08-01

    The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was published by the American Psychiatric Association (APA) in 2013, and the Work Group on the Classification of Psychotic disorders (WGPD), installed by the World Health Organization (WHO), is expected to publish the new chapter about schizophrenia and other primary psychotic disorders in 2017. We reviewed the available literature to summarize the major changes, innovations, and developments of both manuals. If available and possible, we outline the theoretical background behind these changes. Due to the fact that the development of ICD-11 has not yet been completed, the details about ICD-11 are still proposals under ongoing revision. In this ongoing process, they may be revised and therefore have to be seen as proposals. DSM-5 has eliminated schizophrenia subtypes and replaced them with a dimensional approach based on symptom assessments. ICD-11 will most likely go in a similar direction, as both manuals are planned to be more harmonized, although some differences will remain in details and the conceptual orientation. Next to these modifications, ICD-11 will provide a transsectional diagnostic criterion for schizoaffective disorders and a reorganization of acute and transient psychotic and delusional disorders. In this manuscript, we will compare the 2 classification systems. PMID:27418328

  4. Uniform pacemaker and ICD information system in the Netherlands

    NARCIS (Netherlands)

    Cam, H; Wa, D; Callaos, N; Farsi, D; EshaghianWilner, M; Hanratty, T; Rishe, N

    2003-01-01

    The Central Pacemaker Patient Registry (CPPR) in the Netherlands (founded in 1977) collects information of pacemaker patients from all 110 Dutch hospitals. It contains data of over 98.000 patients, 118.500 pacemakers, 1.950 ICD's and 131.000 leads. Initially data was entered manually. As local datab

  5. Time to choose – DSM-5, ICD-11 or both?

    Directory of Open Access Journals (Sweden)

    Tyrer, Peter

    2014-09-01

    Full Text Available DSM-5 was published in May 2013, and ICD 11 is not due to be published until the end of 2015 at the earliest. Nevertheless, it is possible to make a comparison at this early stage as much of the main decisions have been made with both classifications. DSM-5 aimed to make a paradigm shift by providing objective, independent measures of classification, but in this respect it clearly failed. It did respond to previous criticisms that there were too many diagnoses in the classification and that eliminated some conditions in favour of larger groupings (eg, autism spectrum disorder, but it has still come in for heavy criticism. ICD 11 deviates from DSM-5 in radically different classifications of personality and stress disorders and in general has pursued a different pathway, concentrating on clinical utility as the main guide to the classification. It is up to practitioners to choose which they prefer, but ICD 11 will be in a much stronger position than ICD 10 was when it was published in 1999.

  6. Hvor er den automatiske eksterne defibrillator? Udvikling og uddannelse

    DEFF Research Database (Denmark)

    Løfgren, Bo; Grove, Erik; Krarup, Niels Henrik

    2009-01-01

    The International Liaison Committee on Resuscitation has presented a universal sign to indicate the presence of automated external defibrillators (AED). To disseminate the knowledge of this important signage, a review in a Danish context is presented. It is essential that the public in general...

  7. Advantage of four-electrode over two-electrode defibrillators.

    Science.gov (United States)

    Bragard, J; Šimić, A; Laroze, D; Elorza, J

    2015-12-01

    Defibrillation is the standard clinical treatment used to stop ventricular fibrillation. An electrical device delivers a controlled amount of electrical energy via a pair of electrodes in order to reestablish a normal heart rate. We propose a technique that is a combination of biphasic shocks applied with a four-electrode system rather than the standard two-electrode system. We use a numerical model of a one-dimensional ring of cardiac tissue in order to test and evaluate the benefit of this technique. We compare three different shock protocols, namely a monophasic and two types of biphasic shocks. The results obtained by using a four-electrode system are compared quantitatively with those obtained with the standard two-electrode system. We find that a huge reduction in defibrillation threshold is achieved with the four-electrode system. For the most efficient protocol (asymmetric biphasic), we obtain a reduction in excess of 80% in the energy required for a defibrillation success rate of 90%. The mechanisms of successful defibrillation are also analyzed. This reveals that the advantage of asymmetric biphasic shocks with four electrodes lies in the duration of the cathodal and anodal phase of the shock. PMID:26764786

  8. Advantage of four-electrode over two-electrode defibrillators

    Science.gov (United States)

    Bragard, J.; Šimić, A.; Laroze, D.; Elorza, J.

    2015-12-01

    Defibrillation is the standard clinical treatment used to stop ventricular fibrillation. An electrical device delivers a controlled amount of electrical energy via a pair of electrodes in order to reestablish a normal heart rate. We propose a technique that is a combination of biphasic shocks applied with a four-electrode system rather than the standard two-electrode system. We use a numerical model of a one-dimensional ring of cardiac tissue in order to test and evaluate the benefit of this technique. We compare three different shock protocols, namely a monophasic and two types of biphasic shocks. The results obtained by using a four-electrode system are compared quantitatively with those obtained with the standard two-electrode system. We find that a huge reduction in defibrillation threshold is achieved with the four-electrode system. For the most efficient protocol (asymmetric biphasic), we obtain a reduction in excess of 80% in the energy required for a defibrillation success rate of 90%. The mechanisms of successful defibrillation are also analyzed. This reveals that the advantage of asymmetric biphasic shocks with four electrodes lies in the duration of the cathodal and anodal phase of the shock.

  9. 21 CFR 870.5310 - Automated external defibrillator.

    Science.gov (United States)

    2010-04-01

    ... device with a rhythm recognition detection system that delivers into a 50 ohm test load an electrical shock of a maximum of 360 joules of energy used for defibrillating (restoring normal heart rhythm) the atria or ventricles of the heart. An AED analyzes the patient's electrocardiogram, interprets...

  10. 76 FR 51985 - ICD-9-CM Coordination and Maintenance Committee Meeting

    Science.gov (United States)

    2011-08-19

    ... HUMAN SERVICES Centers for Disease Control and Prevention ICD-9-CM Coordination and Maintenance... Standards Staff, announces the following meeting. Name: ICD-9-CM Coordination and Maintenance Committee....hhs.gov ), for questions about the registration process. Purpose: The ICD-9-CM Coordination...

  11. 77 FR 8877 - ICD-9-CM Coordination and Maintenance (C&M) Committee Meeting

    Science.gov (United States)

    2012-02-15

    ... HUMAN SERVICES Centers for Disease Control and Prevention ICD-9-CM Coordination and Maintenance (C&M... Standards Staff, announces the following meeting. Name: ICD-9-CM Coordination and Maintenance (C&M... ), for questions about the registration process. Purpose: The ICD-9-CM Coordination and...

  12. An administrative data merging solution for dealing with missing data in a clinical registry: adaptation from ICD-9 to ICD-10

    Directory of Open Access Journals (Sweden)

    Galbraith P Diane

    2008-01-01

    Full Text Available Abstract Background We have previously described a method for dealing with missing data in a prospective cardiac registry initiative. The method involves merging registry data to corresponding ICD-9-CM administrative data to fill in missing data 'holes'. Here, we describe the process of translating our data merging solution to ICD-10, and then validating its performance. Methods A multi-step translation process was undertaken to produce an ICD-10 algorithm, and merging was then implemented to produce complete datasets for 1995–2001 based on the ICD-9-CM coding algorithm, and for 2002–2005 based on the ICD-10 algorithm. We used cardiac registry data for patients undergoing cardiac catheterization in fiscal years 1995–2005. The corresponding administrative data records were coded in ICD-9-CM for 1995–2001 and in ICD-10 for 2002–2005. The resulting datasets were then evaluated for their ability to predict death at one year. Results The prevalence of the individual clinical risk factors increased gradually across years. There was, however, no evidence of either an abrupt drop or rise in prevalence of any of the risk factors. The performance of the new data merging model was comparable to that of our previously reported methodology: c-statistic = 0.788 (95% CI 0.775, 0.802 for the ICD-10 model versus c-statistic = 0.784 (95% CI 0.780, 0.790 for the ICD-9-CM model. The two models also exhibited similar goodness-of-fit. Conclusion The ICD-10 implementation of our data merging method performs as well as the previously-validated ICD-9-CM method. Such methodological research is an essential prerequisite for research with administrative data now that most health systems are transitioning to ICD-10.

  13. ICD-11 and SNOMED CT Common Ontology: circulatory system.

    Science.gov (United States)

    Rodrigues, Jean-Marie; Schulz, Stefan; Rector, Alan; Spackman, Kent; Millar, Jane; Campbell, James; Ustün, Bedirhan; Chute, Christopher G; Solbrig, Harold; Della Mea, Vincenzo; Persson, Kristina Brand

    2014-01-01

    The improvement of semantic interoperability between data in electronic health records and aggregated data for health statistics requires efforts to carefully align the two domain terminologies ICD and SNOMED CT. Both represent a new generation of ontology-based terminologies and classifications. The proposed alignment of these two systems and, in consequence, the validity of their cross-utilisation, requires a specific resource, named Common Ontology. We present the ICD-11 SNOMED CT Common Ontology building process including: a) the principles proposed for aligning the two systems with the help of a common model of meaning, b) the design of this common ontology, and c) preliminary results of the application to the diseases of the circulatory system. PMID:25160347

  14. Risk factors and the effect of cardiac resynchronization therapy on cardiac and non-cardiac mortality in MADIT-CRT

    DEFF Research Database (Denmark)

    Perkiomaki, Juha S; Ruwald, Anne-Christine; Kutyifa, Valentina;

    2015-01-01

    causes, 108 (63.9%) deemed cardiac, and 61 (36.1%) non-cardiac. In multivariate analysis, increased baseline creatinine was significantly associated with both cardiac and non-cardiac deaths [hazard ratio (HR) 2.97, P ...AIMS: To understand modes of death and factors associated with the risk for cardiac and non-cardiac deaths in patients with cardiac resynchronization therapy with implantable cardioverter-defibrillator (CRT-D) vs. implantable cardioverter-defibrillator (ICD) therapy, which may help clarify...... the action and limitations of cardiac resynchronization therapy (CRT) in relieving myocardial dysfunction. METHODS AND RESULTS: In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), during 4 years of follow-up, 169 (9.3%) of 1820 patients died of known...

  15. Non-linear dynamical signal characterization for prediction of defibrillation success through machine learning

    OpenAIRE

    Shandilya Sharad; Ward Kevin; Kurz Michael; Najarian Kayvan

    2012-01-01

    Abstract Background Ventricular Fibrillation (VF) is a common presenting dysrhythmia in the setting of cardiac arrest whose main treatment is defibrillation through direct current countershock to achieve return of spontaneous circulation. However, often defibrillation is unsuccessful and may even lead to the transition of VF to more nefarious rhythms such as asystole or pulseless electrical activity. Multiple methods have been proposed for predicting defibrillation success based on examinatio...

  16. Induction of atrial fibrillation with rapid high voltage ventricular pacing for ventricular fibrillation conversion testing

    OpenAIRE

    Schuchert, A; Kuhl, M; Ruppel, R; Meinertz, T

    2000-01-01

    OBJECTIVE—To assess whether rapid high voltage ventricular pacing can also induce atrial fibrillation, and whether the induction of atrial fibrillation during ventricular fibrillation conversion testing is related to the patient's heart disease.
DESIGN—Prospective study of 50 patients who received the dual chamber implantable cardioverter-defibrillator (ICD) Ventak AV II DR (Guidant) as a first implant. This device can record atrial activity even during a ventricular fibrillation episode and ...

  17. Sex Differences in Utilisation and Response to Implantable Device Therapy

    OpenAIRE

    Narasimha, Deepika; Curtis, Anne B.

    2015-01-01

    Multiple studies have demonstrated that implantable cardioverter-defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) provide significant mortality and morbidity benefits to eligible patients irrespective of gender. However, female patients are less likely to receive this life-saving therapy and are significantly under-represented in cardiac device trials. Various performance improvement programmes have proved that this gender disparity can be reduced and these therapies should b...

  18. Transient loss of consciousness in a patient with a Brugada like ECG

    OpenAIRE

    Belinda Sandler; Steve Furniss; Eric McWilliams

    2011-01-01

    Syncope in a patient with a Brugada syndrome channelopathy carries significant prognostic implications and warrants consideration of implantable cardioverter defibrillator (ICD) implantation. We report a case of a 62- year-old gentleman who presented with a transient loss of consciousness and an electrocardiogram (ECG) suggestive of type 1 Brugada syndrome. Further investigation revealed evidence of a silent myocardial infarction and negative ventricular tachycardia stimulation and Ajmaline t...

  19. Mutationsanalyse an 14 Kandidatengenen für autosomal-dominant vererbte arrhythmogene rechtsventrikuläre Kardiomyopathie (ARVD5)

    OpenAIRE

    Brandt, Kalina

    2011-01-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by fibrofatty replacement of the right ventricular free wall and leads to ventricular arrhythmias, heart failure, and sudden cardiac death. Genetics gains in importance due to the possibility of preventing sudden death by implantation of a cardioverter defibrillator (ICD) in asymptomatic patients with familial history of ARVC. The aim of this thesis was to identify the mutation for autosomal dominant inherited ARVD5 o...

  20. 对埋藏式心脏复律除颤器植入患者的护理

    Institute of Scientific and Technical Information of China (English)

    叶枫; 华雨

    2011-01-01

    @@ 心源性猝死是现代医学所面临的一个重要问题.多个大规模临床试验已证明.埋藏式心脏复律除颤器(Implantable Card-ioverter Defibrillator,ICD)对防治室性心动过速和室颤所致的猝死有明显疗效.

  1. The Cause and Mechanism of Cardiac Electrical Instability. Defibrillation Mechanism

    Directory of Open Access Journals (Sweden)

    Rustam G. Habchabov

    2012-06-01

    Full Text Available The reason for the ominous arrhythmias pathway, causing sudden somatic death from cardiovascular diseases is still not clear, cardiological examinations of this phenomenon are conducted throughout the world. Laceration of connective insulating tissue membrane of heart pathway with ectopic nodes oxidation may cause ominous arrhythmias; nobody has considered this cause as a cardiac electrical instability before. Defibrillator electric discharges cannot penetrate into myocardium due to the connective insulating tissue membrane, nobody has considered nervous system, transmitting electricity.

  2. Basal genoplivning af voksne og automatisk ekstern defibrillering

    DEFF Research Database (Denmark)

    Berlac, P.A.; Lippert, F.K.; Torp-Pedersen, Christian Tobias

    2008-01-01

    The new ERC guidelines on resuscitation emphasize the importance of quality CPR. BLS should be started as early as possible. Lay rescuers should not check for a pulse, they should call for help and start chest compressions immediately. Compression depth should be 4-5 cm at a rate of 100 compressi...... ventilations followed by a compression-ventilation ratio of 15:2. Automatic External Defibrillation should be used as early as possible Udgivelsesdato: 2008/11/17...

  3. Breast calcifications following electrical defibrillation: An unusual mammographic appearance

    OpenAIRE

    Westphal, Steven M.; Jani, Manish; BADVE, SUNIL

    2015-01-01

    We present a case of a 57-year-old woman with a past medical history of end-stage renal disease and a recent history of electrical defibrillation who arrived for her annual mammogram with no breast-related complaints. The mammogram showed interval development of unusual clusters of heterogeneous calcifications. The patient underwent stereotactic core-needle biopsy for definitive diagnosis. The pathologic evaluation revealed fibrosis, abnormal adipocytes, and calcifications with no evidence of...

  4. Estimation of current density distribution under electrodes for external defibrillation

    Directory of Open Access Journals (Sweden)

    Papazov Sava P

    2002-12-01

    Full Text Available Abstract Background Transthoracic defibrillation is the most common life-saving technique for the restoration of the heart rhythm of cardiac arrest victims. The procedure requires adequate application of large electrodes on the patient chest, to ensure low-resistance electrical contact. The current density distribution under the electrodes is non-uniform, leading to muscle contraction and pain, or risks of burning. The recent introduction of automatic external defibrillators and even wearable defibrillators, presents new demanding requirements for the structure of electrodes. Method and Results Using the pseudo-elliptic differential equation of Laplace type with appropriate boundary conditions and applying finite element method modeling, electrodes of various shapes and structure were studied. The non-uniformity of the current density distribution was shown to be moderately improved by adding a low resistivity layer between the metal and tissue and by a ring around the electrode perimeter. The inclusion of openings in long-term wearable electrodes additionally disturbs the current density profile. However, a number of small-size perforations may result in acceptable current density distribution. Conclusion The current density distribution non-uniformity of circular electrodes is about 30% less than that of square-shaped electrodes. The use of an interface layer of intermediate resistivity, comparable to that of the underlying tissues, and a high-resistivity perimeter ring, can further improve the distribution. The inclusion of skin aeration openings disturbs the current paths, but an appropriate selection of number and size provides a reasonable compromise.

  5. Percutaneous Extraction of Transvenous Permanent Pacemaker/Defibrillator Leads

    Directory of Open Access Journals (Sweden)

    Stylianos Paraskevaidis

    2014-01-01

    Full Text Available Background. Widespread use of cardiovascular implantable electronic devices has inevitably increased the need for lead revision/replacement. We report our experience in percutaneous extraction of transvenous permanent pacemaker/defibrillator leads. Methods. Thirty-six patients admitted to our centre from September 2005 through October 2012 for percutaneous lead extraction were included. Lead removal was attempted using Spectranetics traction-type system (Spectranetics Corp., Colorado, CO, USA and VascoExtor countertraction-type system (Vascomed GmbH, Weil am Rhein, Germany. Results. Lead extraction was attempted in 59 leads from 36 patients (27 men, mean ± SD age 61±5 years, with permanent pacemaker (n=25, defibrillator (n=8, or cardiac resynchronisation therapy (n=3 with a mean ± SD implant duration of 50±23 months. The indications for lead removal included pocket infection (n=23, endocarditis (n=2, and ventricular (n=10 and atrial lead dysfunction (n=1. Traction device was used for 33 leads and countertraction device for 26 leads. Mean ± SD fluoroscopy time was 4±2 minutes/lead for leads implanted 48 months (n=21, P=0.03. Complete procedural success rate was 91.7% and clinical procedural success rate was 100%, while lead procedural success rate was 95%. Conclusions. In conclusion, percutaneous extraction of transvenous permanent pacemaker/defibrillator leads using dedicated removal tools is both feasible and safe.

  6. Effect of Fish Oil on Ventricular Tachyarrhythmia and Death in Patients With Implantable Cardioverter Defibrillators: The Study on Omega-3 Fatty Acids and Ventricular Arrhythmia (SOFA) Randomized Trial

    NARCIS (Netherlands)

    Brouwer, I.A.; Zock, P.L.; Camm, A.J.; Bocker, D.; Hauer, R.N.W.; Wever, E.F.D.; Dullemeijer, C.; Ronden, J.E.; Katan, M.B.; Lubinski, A.; Buschler, H.; Schouten, E.G.

    2006-01-01

    Context Very-long-chain n-3 polyunsaturated fatty acids (omega-3 PUFAs) from fish are thought to reduce risk of sudden death, possibly by reducing susceptibility to cardiac arrhythmia. Objective To study the effect of supplemental fish oil vs placebo on ventricular tachyarrhythmia or death. Design,

  7. The CopenHeartSF trial—comprehensive sexual rehabilitation programme for male patients with implantable cardioverter defibrillator or ischaemic heart disease and impaired sexual function

    DEFF Research Database (Denmark)

    Johansen, Pernille Palm; Zwisler, Ann-Dorthe; Svendsen, Jesper Hastrup;

    2013-01-01

    Sexuality is an important part of people's physical and mental health. Patients with heart disease often suffer from sexual dysfunction. Sexual dysfunction has a negative impact on quality of life and well-being in persons with heart disease, and sexual dysfunction is associated with anxiety...

  8. Potential demographic and baselines variables for risk stratification of high-risk post-myocardial infarction patients in the era of implantable cardioverter-defibrillator - a prognostic indicator

    DEFF Research Database (Denmark)

    Yap, Yee Guan; Duong, Trinh; Bland, Martin;

    2008-01-01

    BACKGROUND: Risk stratification after myocardial infarction (MI) remains expensive and disappointing. We designed a prognostic indicator using demographic information to select patients at risk of dying after MI. METHOD AND RESULTS: We combined individual patient data from the placebo arms of EMIAT...... containing only significant variables. The prognostic index was the sum of the individual contribution from the risk factors. 2707 patients were pooled (age: 66 (23-92) years, 78.8% M) with 480 deaths at 2-years (44% arrhythmic and 35.6% non-arrhythmic cardiac deaths). Variables predicting mortality were age...

  9. Location of cardiac arrest in a city center: strategic placement of automated external defibrillators in public locations

    DEFF Research Database (Denmark)

    Folke, Fredrik; Lippert, Freddy; Nielsen, Søren Loumann;

    2009-01-01

    BACKGROUND: Public-access defibrillation with automated external defibrillators (AEDs) is being implemented in many countries worldwide with considerable financial implications. The potential benefit and economic consequences of focused or unfocused AED deployment are unknown. METHODS AND RESULTS...

  10. Transthoracic electrical impedance during external defibrillation: comparison of measured and modelled waveforms.

    Science.gov (United States)

    Al Hatib, F; Trendafilova, E; Daskalov, I

    2000-02-01

    The transthoracic electrical impedance is an important defibrillation parameter, affecting the defibrillating current amplitude and energy, and therefore the defibrillation efficiency. A close relationship between transthoracic impedance and defibrillation success rate was observed. Pre-shock measurements (using low amplitude high frequency current) of the impedance were considered a solution for selection of adequate shock voltages or for current-based defibrillation dosage. A recent approach, called 'impedance-compensating defibrillation' was implemented, where the pulse duration was controlled with respect to the impedance measured during the initial phase of the shock. These considerations raised our interest in reassessment of the transthoracic impedance characteristics and the corresponding measurement methods. The purpose of this work is to study the variations of the transthoracic impedance by a continuous measurement technique during the defibrillation shock and comparing the data with results obtained by modelling. Voltage and current impulse waveforms were acquired during cardioversion of patients with atrial fibrillation or flutter. The same type of defibrillation pulse was taken from dogs after induction of fibrillation. The electrodes were located in the anterior position, for both the patients and animals.

  11. ICD-10: are you ready for a brave new world?

    Science.gov (United States)

    Cannon, Barbara A; Strubler, Diana L

    2014-09-01

    The ICD-10 transition will be an evolutionary process. Relying on the EHR or certified coding staff alone will not be sufficient. The EHR can facilitate easy search tools that assist the provider in selecting a diagnosis. Billing staff are an invaluable resource to help validate that coding and documentation are in sync but the burden will clearly rest on the provider. The provider will be juggling a new code structure, drilling down to new levels of complexity and ensuring their documentation supports the specificity of the new codes selected, all while managing a full patient schedule. Education for the provider will be of paramount importance as they navigate this brave new world.

  12. Tourette and tic disorders in ICD-11: standing at the diagnostic crossroads

    OpenAIRE

    Woods, Douglas W; Thomsen, Per H.

    2014-01-01

    This article reflects discussion by the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders. After reviewing the historical classification of tic disorders, this article discusses their placement in ICD-11. Existing problems with diagnostic labels and criteria, appropriate placement of the tic disorders category within the ICD-11 system, and pragmatic factors affecting classification are reviewed. The article ends with recommendations to (a) maintain c...

  13. ICD-10在中国的引进和推广%Introduction and Promotion of ICD-10 in China

    Institute of Scientific and Technical Information of China (English)

    于欣

    2009-01-01

    在1948年世界卫生组织出版的《国际疾病分类第六版》中,精神障碍被首次纳入。在1975年颁布ICD-9后,WHO着手开始ICD-10的筹备工作。筹备工作是以几项重大的科研计划开展为标志的:①编制了“复合性国际诊断交谈检查(CIDI)”,适用于在不同国家的一般人群中进行精神障碍的流行病学研究,目前CIDI的版本已经更新到3.0;②编制了适用于临床工作者使用的评定工具“神经精神病学临床评定表(SCAN)”,用于专业人员临床评估病人;③编制了适用于不同国家的人格障碍评定工具“国际人格障碍检查”(International Personality Disorder Examination,IPDE)。

  14. Trends in Gastroenteritis-associated Mortality in the United States 1985-2005: Variations by ICD-9 and ICD-10 Codes

    Science.gov (United States)

    BackgroundTrends in gastroenteritis-associated mortality are changing over time with development of antibiotic resistant strains of certain pathogens, improved diagnostic methods, and changing healthcare. In 1999, ICD-10 coding was introduced for mortality records which can also ...

  15. Estimation of the Alpha Factor Parameters Using the ICDE Database

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Dae Il; Hwang, M. J.; Han, S. H

    2007-04-15

    Detailed common cause failure (CCF) analysis generally need for the data for CCF events of other nuclear power plants because the CCF events rarely occur. KAERI has been participated at the international common cause failure data exchange (ICDE) project to get the data for the CCF events. The operation office of the ICDE project sent the CCF event data for EDG to the KAERI at December 2006. As a pilot study, we performed the detailed CCF analysis of EDGs for Yonggwang Units 3 and 4 and Ulchin Units 3 and 4 using the ICDE database. There are two onsite EDGs for each NPP. When an offsite power and the two onsite EDGs are not available, one alternate AC (AAC) diesel generator (hereafter AAC) is provided. Two onsite EDGs and the AAC are manufactured by the same company, but they are designed differently. We estimated the Alpha Factor and the CCF probability for the cases where three EDGs were assumed to be identically designed, and for those were assumed to be not identically designed. For the cases where three EDGs were assumed to be identically designed, double CCF probabilities of Yonggwang Units 3/4 and Ulchin Units 3/4 for 'fails to start' were estimated as 2.20E-4 and 2.10E-4, respectively. Triple CCF probabilities of those were estimated as 2.39E-4 and 2.42E-4, respectively. As each NPP has no experience for 'fails to run', Yonggwang Units 3/4 and Ulchin Units 3/4 have the same CCF probability. The estimated double and triple CCF probabilities for 'fails to run' are 4.21E-4 and 4.61E-4, respectively. Quantification results show that the system unavailability for the cases where the three EDGs are identical is higher than that where the three EDGs are different. The estimated system unavailability of the former case was increased by 3.4% comparing with that of the latter. As a future study, a computerization work for the estimations of the CCF parameters will be performed.

  16. Apical aneurysm and myocardial bridging in a patient with hypertrophic cardiomyopathy: association or consequence of the myocardial bridging?

    Science.gov (United States)

    Foucault, Anthony; Hilpert, Loic; Hédoire, Francois; Saloux, Eric; Gomes, Sophie; Pellissier, Arnaud; Scanu, Patrice; Champ-Rigot, Laure; Milliez, Paul

    2012-01-01

    The identification of high-risk patients with hypertrophic cardiomyopathy (HC) for primary prevention of sudden cardiac death (SCD) remains a challenging issue, since major risk factors sometimes lack specificity. We report the case of a patient with HC and association of apical aneurysm and myocardial bridging who had been initially not implanted because she had only one major risk factor. She subsequently experienced a sustained ventricular tachycardia that finally motivated the implantation. We conclude that it is never an easy decision to implant a preventive implantable cardioverter-defibrillator (ICD). Nevertheless, additional criteria for a better selection of patients who would benefit from an ICD implant are certainly useful.

  17. Catheter ablation of a monofocal premature ventricular complex triggering idiopathic ventricular fibrillation.

    Science.gov (United States)

    Takatsuki, S; Mitamura, H; Ogawa, S

    2001-07-01

    A 62 year old man was admitted for evaluation of recurrent episodes of syncope. A surface ECG showed frequent repetitive premature ventricular complexes of right ventricular outflow tract origin. Ventricular fibrillation was inducible by programmed electrical stimulation but otherwise cardiac evaluation was unremarkable. A diagnosis of idiopathic ventricular fibrillation was made and an implantable cardioverter-defibrillator (ICD) was installed. However, spontaneous ventricular fibrillation recurred, requiring repeated ICD discharges. The ventricular fibrillation was reproducibly triggered by a single premature ventricular complex with a specific QRS morphology. Radiofrequency catheter ablation was carried out to eradicate this complex. No ventricular fibrillation has developed after this procedure, and the patient does not require drug treatment.

  18. ICD-10-GM 2006: Endgültige Fassungen beim DIMDI veröffentlicht

    OpenAIRE

    DIMDI, P

    2005-01-01

    Das DIMDI hat die endgültige Fassung der Internationalen Klassifikation der Krankheiten (deutsche Modifikation: ICD-10-GM) Version 2006 auf seinen Internetseiten veröffentlicht. Wichtige Erkrankungen werden in der neuen ICD-Version differenzierter als bisher verschlüsselt.

  19. Expanding the definition of addiction: DSM-5 vs. ICD-11.

    Science.gov (United States)

    Grant, Jon E; Chamberlain, Samuel R

    2016-08-01

    While considerable efforts have been made to understand the neurobiological basis of substance addiction, the potentially "addictive" qualities of repetitive behaviors, and whether such behaviors constitute "behavioral addictions," is relatively neglected. It has been suggested that some conditions, such as gambling disorder, compulsive stealing, compulsive buying, compulsive sexual behavior, and problem Internet use, have phenomenological and neurobiological parallels with substance use disorders. This review considers how the issue of "behavioral addictions" has been handled by latest revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD), leading to somewhat divergent approaches. We also consider key areas for future research in order to address optimal diagnostic classification and treatments for such repetitive, debilitating behaviors. PMID:27151528

  20. Bipolar and related disorders in DSM-5 and ICD-10.

    Science.gov (United States)

    Kaltenboeck, Alexander; Winkler, Dietmar; Kasper, Siegfried

    2016-08-01

    Bipolar disorders are a group of psychiatric disorders with profound negative impact on affected patients. Even if their symptomatology has long been recognized, diagnostic criteria have changed over time and diagnosis often remains difficult. The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), issued in May 2013, comprises several changes regarding the diagnosis of bipolar disorders compared to the previous edition. Diagnostic categories and criteria for bipolar disorders show some concordance with the internationally also widely used Tenth Edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). However, there are also major differences that are worth highlighting. The aim of the following text is to depict and discuss those. PMID:27378177

  1. On the road to DSM-V and ICD-11.

    Science.gov (United States)

    Kupfer, David J; Regier, Darrel A; Kuhl, Emily A

    2008-11-01

    Development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has been ongoing since 1994, though official release will not occur for another 4 years. Potential revisions are being derived from multiple sources, including building on perceived limitations of DSM-IV; broad-based literature reviews; secondary and primary data analyses; and discussions between global members of the mental health community. The current focus on aligning DSM with the International Classification of Diseases-11 (ICD-11) speaks to the importance of creating a unified text that embraces cross-cutting issues of diagnostics, such as developmental, age-related, and cultural phenomena. International discourse is vital to this process and has been fostered by a National Institutes of Health-sponsored conference series on diagnosis-specific topics. From this series, the DSM-V Task Force developed the following set of revision principals to guide the efforts of the DSM-V Work Groups: grounding recommendations in empirical evidence; maintaining continuity with previous editions of DSM; removing a priori limitations on the amount of changes DSM-V may incur; and maintaining DSM's status as a living document. With work group formation complete, members are currently carrying out the research and revision recommendations proposed during the conference series. Ongoing activities include adding specialized advisors to each work group; completing literature reviews and planning data analyses; and forming study groups to discuss integration of cross-cutting issues (e.g., developmental lifespan factors; formation of diagnostic spectra). The road to DSM-V and ICD-11 has been challenging, but members continue to work diligently in their goal of constructing the most harmonious, scientifically sound, and clinically relevant DSM to date.

  2. ICD-10 Coding Idea of Warthin Tumor%Warthin瘤的ICD-10编码思路

    Institute of Scientific and Technical Information of China (English)

    赵正慧

    2016-01-01

    Warthin瘤是临床常见诊断名称,90%以上发生于腮腺,属于涎腺的良性肿瘤。多数患者表现为无痛性肿块。本文通过其发病机理和病理学诊断。分析病例内容,探讨该疾病的 ICD-10编码。按照国际疾病的分类和查找方法,甄选和变通主导词进行查询。分别以人名沃辛、腺瘤、淋巴瘤为主导词查找,未获得准确编码;最后以瘤为主导词,下一级修饰词直接找到人名沃辛,以又名腺淋巴瘤为主导词,均能得到Warthin瘤的正确编码D11.0 M8561/0。通过Warthin瘤的ICD-10编码思路,建议在编码的过程中,编码人员要注意经验总结与积累,认真阅读病案资料,熟练掌握编码原则,并养成与临床医师、病理医师多沟通交流的好习惯,确保疾病编码的准确性、科学性。%Warthin tumor is a common clinical diagnosis name, more than 90% occurred in parotid gland, belong to benign tumor of salivary gland. Most patients presented with a painless mass. This paper analyzes cases, discusses the disease of ICD-10 code according to the pathogenesis and pathology diagnosis. Select and change leading words according to the international classification of diseases and search method. Search code with leading word names such as worthing, adenoma, lymphoma respectively, but without obtain accurate coding;Finally, take tumor as the leading word, directly find worthing in the next modifier level, or take lymphoma and gland as the leading word,all can get the correct coding D11.0 M8561/0. It is suggested that in the process of coding, coding staffs must pay attention to the experience summary and accumulation, read the medical records, familiar with coding principle, and develop the good habit of communication with pathology and clinical physicians, physician, ensure the accuracy and scientific of disease coding.

  3. Systematic review of validated case definitions for diabetes in ICD-9-coded and ICD-10-coded data in adult populations

    Science.gov (United States)

    Khokhar, Bushra; Jette, Nathalie; Metcalfe, Amy; Cunningham, Ceara Tess; Kaplan, Gilaad G; Butalia, Sonia; Rabi, Doreen

    2016-01-01

    Objectives With steady increases in ‘big data’ and data analytics over the past two decades, administrative health databases have become more accessible and are now used regularly for diabetes surveillance. The objective of this study is to systematically review validated International Classification of Diseases (ICD)-based case definitions for diabetes in the adult population. Setting, participants and outcome measures Electronic databases, MEDLINE and Embase, were searched for validation studies where an administrative case definition (using ICD codes) for diabetes in adults was validated against a reference and statistical measures of the performance reported. Results The search yielded 2895 abstracts, and of the 193 potentially relevant studies, 16 met criteria. Diabetes definition for adults varied by data source, including physician claims (sensitivity ranged from 26.9% to 97%, specificity ranged from 94.3% to 99.4%, positive predictive value (PPV) ranged from 71.4% to 96.2%, negative predictive value (NPV) ranged from 95% to 99.6% and κ ranged from 0.8 to 0.9), hospital discharge data (sensitivity ranged from 59.1% to 92.6%, specificity ranged from 95.5% to 99%, PPV ranged from 62.5% to 96%, NPV ranged from 90.8% to 99% and κ ranged from 0.6 to 0.9) and a combination of both (sensitivity ranged from 57% to 95.6%, specificity ranged from 88% to 98.5%, PPV ranged from 54% to 80%, NPV ranged from 98% to 99.6% and κ ranged from 0.7 to 0.8). Conclusions Overall, administrative health databases are useful for undertaking diabetes surveillance, but an awareness of the variation in performance being affected by case definition is essential. The performance characteristics of these case definitions depend on the variations in the definition of primary diagnosis in ICD-coded discharge data and/or the methodology adopted by the healthcare facility to extract information from patient records. PMID:27496226

  4. Reliability of clinical ICD-10 diagnoses among electroconvulsive therapy patients with chronic affective disorders

    Directory of Open Access Journals (Sweden)

    Klaus Damgaard Jakobsen

    2008-09-01

    Full Text Available Background and Objectives: Diagnostic reliability is of major concern both to clinicians and researchers. The aim has been to investigate the trustworthiness of clinical ICD-10 affective disorder diagnoses for research purpose. Methods: 150 ECT patients with chronic affective disorders were investigated. A standardized schema for basic anamnesis and the Operational Criteria Checklist for Psychotic and Affective Illness (OPCRIT were used. The sensitivity, specificity, positive and negative predictive values of clinical affective disorder ICD-10 diagnoses and the formal agreement between clinical ICD-10, OPCRIT ICD-10 and DSM-IV diagnoses were determined using unweighted κ-statistics. Results: The sensitivity, specificity, positive and negative predictive values of the clinical bipolar diagnoses was 0.55, 0.75, 0.42 and 0.84, respectively. The sensitivity, specificity, positive and negative predictive values of the clinical unipolar diagnoses was 0.79, 0.55, 0.77 and 0.58, respectively. The agreement between clinical ICD-10 and OPCRIT ICD-10 bipolar vs. non-bipolar diagnoses was low, κ = 0.28. The agreement between clinical ICD-10 and OPCRIT ICD-10 unipolar vs. non-unipolar diagnoses was low, κ = 0.35. The agreement between OPCRIT ICD-10 and DSM-IV diagnoses on bipolar vs. non-bipolar disorders was high, κ = 0.91, and the agreement on unipolar vs. non-unipolar disorders was fairly high, κ = 0.78. Conclusions: This study demonstrates that the reliability of clinical ICD-10 diagnoses of affective disorders from chronic subjects with a history of ECT is problematic despite sample homogeneity on basic clinical, demographic and epidemiological parameters.

  5. The Effect of Compressor-Administered Defibrillation on Peri-shock Pauses in a Simulated Cardiac Arrest Scenario

    Directory of Open Access Journals (Sweden)

    Joshua Glick

    2014-03-01

    Full Text Available Introduction: Coordination of the tasks of performing chest compressions and defibrillation can lead to communication challenges that may prolong time spent off the chest. The purpose of this study was to determine whether defibrillation provided by the provider performing chest compressions led to a decrease in peri-shock pauses as compared to defibrillation administered by a second provider, in a simulated cardiac arrest scenario. Methods: This was a randomized, controlled study measuring pauses in chest compressions for defibrillation in a simulated cardiac arrest model. We approached hospital providers with current CPR certification for participation between July, 2011 and October, 2011. Volunteers were randomized to control (facilitator-administered defibrillation or experimental (compressor-administered defibrillation groups. All participants completed one minute of chest compressions on a mannequin in a shockable rhythm prior to administration of defibrillation. We measured and compared pauses for defibrillation in both groups. Results: Out of 200 total participants, we analyzed data from 197 defibrillations. Compressor-initiated defibrillation resulted in a significantly lower pre-shock hands-off time (0.57 s; 95% CI: 0.47-0.67 compared to facilitator-initiated defibrillation (1.49 s; 95% CI: 1.35-1.64. Furthermore, compressor-initiated defibrillation resulted in a significantly lower peri-shock hands-off time (2.77 s; 95% CI: 2.58-2.95 compared to facilitator-initiated defibrillation (4.25 s; 95% CI: 4.08-4.43. Conclusion: Assigning the responsibility for shock delivery to the provider performing compressions encourages continuous compressions throughout the charging period and decreases total time spent off the chest. However, as this was a simulation-based study, clinical implementation is necessary to further evaluate these potential benefits. [West J Emerg Med. 2014;15(2:246–250.

  6. Development of standard test methods for evaluating defibrillation recovery characteristics of disposable ECG electrodes.

    Science.gov (United States)

    Schoenberg, A A; Booth, H E; Lyon, P C

    1979-01-01

    A clinically relevant test for the measurement of defibrillation overload recovery of prefilled disposable ECG electrodes was developed and is proposed for use in an ECG electrode standard under development by AAMI. Defibrillation overload voltages and currents, as well as electrode polarization recovery voltages, were first measured in animal tests on 12 types of electrodes to allow correlation with various bench tests using a capacitor discharge at 10, 200, or 1000 V. Current overloads absorbed by the electrodes under worst conditions in animal tests were in the range of 2 percent of the defibrillation current flowing through the chest. These overloads were absorbed by most Ag-AgCl electrodes without excessive polarization. However, stainless steel, brass, and tin electrodes tended to polarize to levels that would saturate many ECG monitors. A standard bench test using a 200-V 10-muF capacitor was recommended for inclusion in the AAMI standard to determine whether electrodes are acceptable for use during defibrillation.

  7. Use of automated external defibrillators in a Brazilian airline. A 1-year experience

    Directory of Open Access Journals (Sweden)

    Alves Paulo Magalhães

    2001-01-01

    Full Text Available After the incorporation of automated external defibrilators by other airlines and the support of the Brazilian Society of cardiology, Varig Airlines Began the onboard defibrilation program with the initial purpose of equiping wide-body aircrafts frequently used in international flights and that airplanes use in the Rio - São Paulo route. With all fight attendants trained, the automated. External defibrilation devides were incorporated to 34 airplanes of a total pleet of 80 aircrats. The devices were intalled in the bagage compartments secured with velero straps and 2 pairs of electrods, one or which pre-conected to the device to minimize application time. Later, a portable monitor was addres to the ressocitation kit in the long flights. The expansion of the knowledge of the basic life support fundamentors and the correted implantation of the survival chain and of the automated external defibrilators will increase the extense of recovery of cardiorespiratory arrest victins in aircrafts.

  8. Implantable Defibrillators Improve Survival in Patients With Mildly Symptomatic Heart Failure Receiving Cardiac Resynchronization Therapy

    DEFF Research Database (Denmark)

    Gold, Michael R; Daubert, Jean-Claude; Abraham, William T;

    2013-01-01

    Cardiac resynchronization therapy (CRT) decreases mortality, improves functional status, and induces reverse left ventricular remodeling in selected populations with heart failure. These benefits have been noted with both CRT-pacemakers as well as those devices with defibrillator backup (CRT...

  9. Sikkerhed af magnetisk resonans-skanning hos patienter med pacemaker og implanterbar defibrillator

    DEFF Research Database (Denmark)

    Al-Sabagh, Kifah Hekmat; Christensen, Britta Ege; Thøgersen, Anna Margrethe;

    2010-01-01

    INTRODUCTION: The presence of a cardiac implantable device is ICD considered an absolute contraindication to magnetic resonance imaging (MRI). The purpose of this study was to evaluate the safety of performing MRI in patients with cardiac pacemakers and ICDs that had a compelling clinical need fo...... pacemakers with an acceptable risk-benefit ratio, while MRI of patients with ICDs must still be considered an experimental procedure. Udgivelsesdato: 2010-Jun...

  10. The impact of proposed changes to ICD-11 on estimates of PTSD prevalence and comorbidity.

    Science.gov (United States)

    Wisco, Blair E; Miller, Mark W; Wolf, Erika J; Kilpatrick, Dean; Resnick, Heidi S; Badour, Christal L; Marx, Brian P; Keane, Terence M; Rosen, Raymond C; Friedman, Matthew J

    2016-06-30

    The World Health Organization's posttraumatic stress disorder (PTSD) work group has published a proposal for the forthcoming edition of the International Classification of Diseases (ICD-11) that would yield a very different diagnosis relative to DSM-5. This study examined the impact of the proposed ICD-11 changes on PTSD prevalence relative to the ICD-10 and DSM-5 definitions and also evaluated the extent to which these changes would accomplish the stated aim of reducing the comorbidity associated with PTSD. Diagnostic prevalence estimates were compared using a U.S. national community sample and two U.S. Department of Veterans Affairs clinical samples. The ICD-11 definition yielded prevalence estimates 10-30% lower than DSM-5 and 25% and 50% lower than ICD-10 with no reduction in the prevalence of common comorbidities. Findings suggest that by constraining the diagnosis to a narrower set of symptoms, the proposed ICD-11 criteria set would substantially reduce the number of individuals with the disorder. These findings raise doubt about the extent to which the ICD-11 proposal would achieve the aim of reducing comorbidity associated with PTSD and highlight the public health and policy implications of such a redefinition. PMID:27124207

  11. Body dysmorphic disorder and olfactory reference disorder: proposals for ICD-11

    Directory of Open Access Journals (Sweden)

    David Veale

    2014-01-01

    Full Text Available The article reviews the historical background and symptoms of body dysmorphic disorder (BDD and olfactory reference disorder, and describes the proposals of the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders related to these categories. This paper examines the possible classification of BDD symptoms in ICD-10. Four different possible diagnoses are found (hypochondriacal disorder, schizotypal disorder, delusional disorder, or other persistent delusional disorder. This has led to significant confusion and lack of clear identification in ICD-10. Olfactory reference disorder can also be classified as a delusional disorder in ICD-10, but there is no diagnosis for non-delusional cases. The Working Group reviewed the classification and diagnostic criteria of BDD in DSM-5, as well as cultural variations of BDD and olfactory reference disorder that include Taijin Kyofusho. The Working Group has proposed the inclusion of both BDD and olfactory reference disorder in ICD-11, and has provided diagnostic guidelines and guidance on differential diagnosis. The Working Group's proposals for ICD-11 related to BDD and olfactory reference disorder are consistent with available global evidence and current understanding of common mechanisms in obsessive-compulsive and related disorders, and resolve considerable confusion inherent in ICD-10. The proposals explicitly recognize cultural factors. They are intended to improve clinical utility related to appropriate identification, treatment, and resource allocation related to these disorders.

  12. Intracellular fragment of NLRR3 (NLRR3-ICD) stimulates ATRA-dependent neuroblastoma differentiation

    Energy Technology Data Exchange (ETDEWEB)

    Akter, Jesmin [Laboratory of Innovative Cancer Therapeutics, Chiba Cancer Center Research Institute, Chiba 260-8717 (Japan); Takatori, Atsushi, E-mail: atakatori@chiba-cc.jp [Laboratory of Cancer Genetics, Chiba Cancer Center Research Institute, Chiba 260-8717 (Japan); Islam, Md. Sazzadul [Laboratory of Innovative Cancer Therapeutics, Chiba Cancer Center Research Institute, Chiba 260-8717 (Japan); Nakazawa, Atsuko [Department of Pathology, National Center for Child Health and Development, Tokyo (Japan); Ozaki, Toshinori, E-mail: tozaki@chiba-cc.jp [Laboratory of DNA Damage Signaling, Chiba Cancer Center Research Institute, Chiba 260-8717 (Japan); Nagase, Hiroki [Laboratory of Cancer Genetics, Chiba Cancer Center Research Institute, Chiba 260-8717 (Japan); Nakagawara, Akira [Saga Medical Centre, 840-8571 (Japan)

    2014-10-10

    Highlights: • NLRR3 is a membrane protein highly expressed in favorable neuroblastoma. • NLRR3-ICD was produced through proteolytic processing by secretases. • NLRR3-ICD was induced to be translocated into cell nucleus following ATRA exposure. • NLRR3-ICD plays a pivotal role in ATRA-mediated neuroblastoma differentiation. - Abstract: We have previously identified neuronal leucine-rich repeat protein-3 (NLRR3) gene which is preferentially expressed in favorable human neuroblastomas as compared with unfavorable ones. In this study, we have found for the first time that NLRR3 is proteolytically processed by secretases and its intracellular domain (NLRR3-ICD) is then released to translocate into cell nucleus during ATRA-mediated neuroblastoma differentiation. According to our present observations, NLRR3-ICD was induced to accumulate in cell nucleus of neuroblastoma SH-SY5Y cells following ATRA treatment. Since the proteolytic cleavage of NLRR3 was blocked by α- or γ-secretase inhibitor, it is likely that NLRR3-ICD is produced through the secretase-mediated processing of NLRR3. Intriguingly, forced expression of NLRR3-ICD in neuroblastoma SK-N-BE cells significantly suppressed their proliferation as examined by a live-cell imaging system and colony formation assay. Similar results were also obtained in neuroblastoma TGW cells. Furthermore, overexpression of NLRR3-ICD stimulated ATRA-dependent neurite elongation in SK-N-BE cells. Together, our present results strongly suggest that NLRR3-ICD produced by the secretase-mediated proteolytic processing of NLRR3 plays a crucial role in ATRA-mediated neuronal differentiation, and provide a clue to develop a novel therapeutic strategy against aggressive neuroblastomas.

  13. Discussion on Bone Cement Implantation Syndrome ICD-10 Coding%骨水泥植入综合征ICD-10编码的探讨

    Institute of Scientific and Technical Information of China (English)

    刘颖

    2016-01-01

    Clinical syndrome is a variety of clinical manifestations characterized diagnosis name caused by different causes of unknown etiology. As an independent disease diagnosis, it brings certain difficulty of ICD coding. In this paper, we take bone cement implantation syndrome for example. We had not been found the corresponding code after looking for the main word "Syndrome", "disease" and "disorder" in ICD-10 book Ⅲ index table. Through referring to the relevant medical information, and timely communicating with the clinician, we had the further understanding for its etiology, pathogenesis, clinical manifestations, etc, stripping external representation and dig the nature of the disease, find out the most main pathogenesis of bone cement implantation syndrome, follow the ICD coding rules, eventually give correct classification of diseases T88.7. This article discussed ICD-10 code process of bone cement implantation syndrome, in order to communicate with peers, and improve the quality of diagnostic codes.%临床综合征是以病因不明或不同病因并存而引起的多种临床表现为特征的诊断名称,作为非独立的疾病诊断,给 ICD 编码的查找工作带来一定难度.本文以骨水泥植入综合征为例,在 ICD-10 卷三索引表中对主导词"综合征"、"病"、"疾患"等查询,均未查到与之对应的编码.通过查阅相关医学资料,并及时与临床医师沟通,对其病因、发病机制、临床表现等方面有了进一步了解,剥去外在表象探索疾病的本质,找出引起骨水泥植入综合征最主要的发病机制,遵循 ICD 编码规则,最终给予正确疾病分类 T88.7.通过对骨水泥植入综合征的 ICD-10 编码过程加以阐述,以期与同行交流,提高疾病诊断编码质量.

  14. A Discussion on the Code of Brugada's Syndrome in ICD-10%Brugada综合征的ICD-10编码探讨

    Institute of Scientific and Technical Information of China (English)

    刘红云

    2008-01-01

    目的 探讨Brugada综合征的正确ICD-10编码.方法 通过分析了解Brugada综合征病因以及临床特征,找寻Brugada综合征对应的ICD-10疾病编码.结论 对于新生病种要通过多方面查找资料,以确保编码的准确性和唯一性.

  15. ICD-10-GM 2008: DIMDI veröffentlicht die endgültige Fassung

    OpenAIRE

    DIMDI-Pressestelle

    2007-01-01

    Das DIMDI hat die endgültige Fassung der ICD-10-GM Version 2008 (Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, German Modification) auf seinen Internetseiten veröffentlicht.

  16. Epidemiology, course and outcome of acute polymorphic psychotic disorder: implications for ICD-11

    DEFF Research Database (Denmark)

    Castagnini, Augusto; Foldager, Leslie

    2014-01-01

    Background: The proposed revision of the ICD-10 category of ‘acute and transient psychotic disorders' (ATPDs), subsuming polymorphic, schizophrenic or predominantly delusional syndromes, would restrict their classification to acute polymorphic psychotic disorder, reminiscent of the clinical conce...

  17. Intrinsic HER4/4ICD transcriptional activation domains are required for STAT5A activated gene expression.

    Science.gov (United States)

    Han, Wen; Sfondouris, Mary E; Semmes, Eleanor C; Meyer, Alicia M; Jones, Frank E

    2016-10-30

    The epidermal growth factor receptor family member HER4 undergoes proteolytic processing at the cell surface to release the HER4 intracellular domain (4ICD) nuclear protein. Interestingly, 4ICD directly interacts with STAT5 and functions as an obligate STAT5 nuclear chaperone. Once in the nucleus 4ICD binds with STAT5 at STAT5 target genes, dramatically potentiating STAT5 transcriptional activation. These observations raise the possibility that 4ICD directly coactivates STAT5 gene expression. Using both yeast and mammalian transactivation reporter assays, we performed truncations of 4ICD fused to a GAL4 DNA binding domain and identified two independent 4ICD transactivation domains located between residues 1022 and 1090 (TAD1) and 1192 and 1225 (TAD2). The ability of the 4ICD DNA binding domain fusions to transactivate reporter gene expression required deletion of the intrinsic tyrosine kinase domain. In addition, we identified the 4ICD carboxyl terminal TVV residues, a PDZ domain binding motif (PDZ-DBM), as a potent transcriptional repressor. The transactivation activity of the HER4 carboxyl terminal domain lacking the tyrosine kinase (CTD) was significantly lower than similar EGFR or HER2 CTD. However, deletion of the HER4 CTD PDZ-DBM enhanced HER4 CTD transactivation to levels equivalent to the EGFR and HER2 CTDs. To determine if 4ICD TAD1 and TAD2 have a physiologically relevant role in STAT5 transactivation, we coexpressed 4ICD or 4ICD lacking TAD2 or both TAD1 and TAD2 with STAT5 in a luciferase reporter assay. Our results demonstrate that each 4ICD TAD contributes additively to STAT5A transactivation and the ability of STAT5A to transactivate the β-casein promoter requires the 4ICD TADs. Taken together, published data and our current results demonstrate that both 4ICD nuclear chaperone and intrinsic coactivation activities are essential for STAT5 regulated gene expression. PMID:27502417

  18. Validation of ICD-9-CM coding algorithm for improved identification of hypoglycemia visits

    OpenAIRE

    Lieberman Rebecca M; Blanc Phillip G; Ginde Adit A; Camargo Carlos A

    2008-01-01

    Abstract Background Accurate identification of hypoglycemia cases by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes will help to describe epidemiology, monitor trends, and propose interventions for this important complication in patients with diabetes. Prior hypoglycemia studies utilized incomplete search strategies and may be methodologically flawed. We sought to validate a new ICD-9-CM coding algorithm for accurate identification of hypoglyc...

  19. Body dysmorphic disorder and olfactory reference disorder: proposals for ICD-11

    OpenAIRE

    David Veale; Hisato Matsunaga

    2014-01-01

    The article reviews the historical background and symptoms of body dysmorphic disorder (BDD) and olfactory reference disorder, and describes the proposals of the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders related to these categories. This paper examines the possible classification of BDD symptoms in ICD-10. Four different possible diagnoses are found (hypochondriacal disorder, schizotypal disorder, delusional disorder, or other persistent delu...

  20. Nuclear Ep-ICD expression is a predictor of poor prognosis in "low risk" prostate adenocarcinomas.

    Directory of Open Access Journals (Sweden)

    Jasmeet Assi

    Full Text Available Molecular markers for predicting prostate cancer (PCa that would have poor prognosis are urgently needed for a more personalized treatment for patients. Regulated intramembrane proteolysis of Epithelial cell adhesion molecule results in shedding of the extracellular domain (EpEx and release of its intracellular domain (Ep-ICD which triggers oncogenic signaling and might correlate to tumor aggressiveness. This study aimed to explore the potential of Ep-ICD and EpEx to identify PCa that have poor prognosis.Immunohistochemical analysis of Ep-ICD and EpEx was carried out in normal prostate tissues (n = 100, benign prostate hyperplasia (BPH, n = 83, and prostate cancer (n = 249 using domain specific antibodies. The expression of Ep-ICD and EpEx was correlated with clinico- pathological parameters and disease free survival (DFS.Reduced expression of nuclear Ep-ICD and membrane EpEx was observed in PCa in comparison with BPH and normal prostate tissues (p = 0.006, p < 0.001 respectively. For patients who had PCa with Gleason Score less than 7, preserved nuclear Ep-ICD emerged as the most significant marker in multivariate analysis for prolonged DFS, where these patients did not have recurrence during follow up of up to 12 years (p = 0.001.Reduced expression of nuclear Ep-ICD was associated with shorter disease free survival in patients with a Gleason Score less than 7 and may be useful in identifying patients likely to have aggressive tumors with poor prognosis. Furthermore, nuclear Ep-ICD can differentiate between normal and prostate cancer tissues for ambiguous cases.

  1. Women Literacy and Infant Feeding Practices in Rural Integrated Child Development Scheme (ICDS) Block of Delhi

    OpenAIRE

    Davey Sanjeev , Davey Anuradha

    2012-01-01

    Background: Infant feeding practices have significant effect on the child nutrition, which largely dependent upon the mothers correct knowledge and awareness for the same. Objective: To find out effect of rural women empowerment through literacy on infant feeding practices in an ICDS block. Material and Methodology: Interview of the mothers of registered children up to 6 years in the rural ICDS block for the feeding practices and recording of the weight of those registered children by the sal...

  2. Sikkerhed af magnetisk resonans-skanning hos patienter med pacemaker og implanterbar defibrillator

    DEFF Research Database (Denmark)

    Al-Sabagh, Kifah Hekmat; Christensen, Britta Ege; Thøgersen, Anna Margrethe;

    2010-01-01

    INTRODUCTION: The presence of a cardiac implantable device is ICD considered an absolute contraindication to magnetic resonance imaging (MRI). The purpose of this study was to evaluate the safety of performing MRI in patients with cardiac pacemakers and ICDs that had a compelling clinical need fo...

  3. Intracellular fragment of NLRR3 (NLRR3-ICD) stimulates ATRA-dependent neuroblastoma differentiation.

    Science.gov (United States)

    Akter, Jesmin; Takatori, Atsushi; Islam, Md Sazzadul; Nakazawa, Atsuko; Ozaki, Toshinori; Nagase, Hiroki; Nakagawara, Akira

    2014-10-10

    We have previously identified neuronal leucine-rich repeat protein-3 (NLRR3) gene which is preferentially expressed in favorable human neuroblastomas as compared with unfavorable ones. In this study, we have found for the first time that NLRR3 is proteolytically processed by secretases and its intracellular domain (NLRR3-ICD) is then released to translocate into cell nucleus during ATRA-mediated neuroblastoma differentiation. According to our present observations, NLRR3-ICD was induced to accumulate in cell nucleus of neuroblastoma SH-SY5Y cells following ATRA treatment. Since the proteolytic cleavage of NLRR3 was blocked by α- or γ-secretase inhibitor, it is likely that NLRR3-ICD is produced through the secretase-mediated processing of NLRR3. Intriguingly, forced expression of NLRR3-ICD in neuroblastoma SK-N-BE cells significantly suppressed their proliferation as examined by a live-cell imaging system and colony formation assay. Similar results were also obtained in neuroblastoma TGW cells. Furthermore, overexpression of NLRR3-ICD stimulated ATRA-dependent neurite elongation in SK-N-BE cells. Together, our present results strongly suggest that NLRR3-ICD produced by the secretase-mediated proteolytic processing of NLRR3 plays a crucial role in ATRA-mediated neuronal differentiation, and provide a clue to develop a novel therapeutic strategy against aggressive neuroblastomas.

  4. Screening and risk evaluation for sudden cardiac death in ischaemic and non-ischaemic cardiomyopathy

    DEFF Research Database (Denmark)

    Proclemer, Alessandro; Lewalter, Thorsten; Bongiorni, Maria Grazia;

    2013-01-01

    The purpose of this EHRA survey was to examine the current clinical practice of screening and risk evaluation for sudden cardiac death in ischaemic and non-ischaemic cardiomyopathy with a focus on selection of candidates for implantable cardioverter-defibrillator (ICD) therapy, timing of ICD...... implantation, and use of non-invasive and invasive diagnostic tests across Europe. A systematic screening programme for sudden cardiac death existed in 19 out of 31 centres (61.3%). Implantation of ICDs according to the inclusion criteria of MADIT-II and SCD-HeFT trials was reported in 30 and 29% of centres......, respectively, followed by MADIT-CRT (18%), COMPANION (16%), and combined MADIT and MUSTT (7%) indications. In patients with severe renal impairment, ICD implantation for primary prevention of sudden death was always avoided in 8 centres (33.3%), was not used only if creatinine level was >2.5 mg/dL in 10...

  5. COPE-ICD: a randomised clinical trial studying the effects and meaning of a comprehensive rehabilitation programme for ICD recipients -design, intervention and population

    DEFF Research Database (Denmark)

    Berg, Selina K; Svendsen, Jesper H; Zwisler, Ann-Dorthe;

    2011-01-01

    Growing evidence exists that living with an ICD can lead to fear and avoidance behaviour including the avoidance of physical activity. It has been suggested that psychological stress can increase the risk of shock and predict death. Small studies have indicated a beneficial effect arising from ex...

  6. COPE-ICD: a randomised clinical trial studying the effects and meaning of a comprehensive rehabilitation programme for ICD recipients -design, intervention and population

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Svendsen, Jesper H; Zwisler, Ann-Dorthe;

    2011-01-01

    Growing evidence exists that living with an ICD can lead to fear and avoidance behaviour including the avoidance of physical activity. It has been suggested that psychological stress can increase the risk of shock and predict death. Small studies have indicated a beneficial effect arising from ex...... exercise training and psychological intervention, therefore a large-scale rehabilitation programme was set up....

  7. Line of Thinking in ICD-10 Coding of Abdominal Compartment Syndrome%腹腔间隔室综合征的ICD-10编码探讨

    Institute of Scientific and Technical Information of China (English)

    伍英; 彭志刚; 陈红; 黄俐明

    2015-01-01

    本文从概念、定义和ICD1-10编码规则入手,对室隔综合征的临床分型(创伤性骨筋膜室综合征、青光眼、颅内高压综合征、心包填塞、腹腔间隔室综合征)和ICD-10分类之间关系进行了分析对比,提出腹腔间隔室综合征也应与其他室隔综合征同理,编码到消化系统疾病相应章节,即K92.8亚目下。%Based on the concepts, definitions, and coding rules of ICD-10, our studying analyzed and compared the relationship between clinical types and ICD-10 clas ifications of abdominal compartment syndrome, and discus ed the thinking line in ICD-10 Coding of abdominal compartment syndrome . Compartment syndrome divided into the fol owing groups: abdominal compartment syndrome, intracompartment syndrome,intracranial hypertension syndrome, glaucoma, cardiac tamponade. Intracompartment syndrome should be coded to T79.6, intracranial hypertension syndrome:G93.2. glaucoma:H40.0-H40.9,H42.0-H42.8. cardiac tamponade:131.9, so abdominal compartment syndrome should be coded to K92.8 based its interestinal system .

  8. Evaluation oF FactORs ImpacTing CLinical Outcome and Cost EffectiveneSS of the S-ICD: Design and Rationale of the EFFORTLESS S-ICD Registry

    DEFF Research Database (Denmark)

    Pedersen, Susanne S; Lambiase, Pier; Boersma, Lucas V A;

    2012-01-01

    or in the vasculature. We present the rationale and study design of the Evaluation oF FactORs ImpacTing CLinical Outcome and Cost EffectiveneSS of the S-ICD (EFFORTLESS S-ICD) Registry which was designed to evaluate the long-term performance of the S-ICD including patient quality of life and long-term resource...

  9. 单双线圈除颤电极临床效果的Meta分析%A Meta analysis of clinical efficiency of single and dual-coil coil defibrillation leads

    Institute of Scientific and Technical Information of China (English)

    童琳; 蔡琳; 邓晓奇; 李锦

    2016-01-01

    Objective To analyze the clinical efficiency of single - coil and dual - coil defibrillation lead. Methods From the Cochrane library,Medline,Embase and CBM,VIP,CNKI database,collect relevant literatures on the clinical efficiency comparement of single - coil and dual - coil defibrillation lead by two evaluators,in accordance with the relevant qualification screened out into standard documents,using Rev-Man5. 3 Meta analysis. Results A total of 13 clinical study with 6273 patients were included in the analysis,there are 6 items are randomized controlled trials,the rest is a randomized controlled trial. Threshold test results suggested single - coil defibrillation threshold value was higher than the dual - coil groups(95% CI:0. 2 ~ 1. 29,P = 0. 2)and single - coil set high defibrillation threshold rate was higher than the dual - coil group (95% CI,1. 29 to 5. 08;P = 1. 29),single and dual - coil group of ventricular tachycardia/ ventricular fibrillation implantable defibrillator (ICD)at a time when there was no significant difference between defibrillation success rate(95% CI:0. 96 ~ 1. 05,P = 0. 96),single - coil to-tal mortality slightly was higher than that of dual - coil group,but the difference was not significant(95% CI:0. 75 ~ 1. 26,P = 0. 75),single and dual - coil group lead failure rate had no significant difference(95% CI:0. 48 ~ 18. 44,P = 0. 48). Conclusion Single - coil defibrillation lead in the threshold test defibrillation threshold value is higher than dual - coil lead,at the same time single - coil of defibrillation lead high threshold percentage is higher than that of dual - coil group,both in the ventricular tachycardia/ ventricular fibrillation when a defibrillation success rate,total mortality,lead failure rate have no significant differences. But 6 items included in the study are randomized controlled trials,therefore, it still need a certain amount,high quality randomized controlled trials to make further verification.%目的:分析单线

  10. Development of Automated External Defibrillator%体外自动除颤器的研制

    Institute of Scientific and Technical Information of China (English)

    惠杰; 朱宗成; 谷云飞; 邬小玫; 方祖祥; 蒋文平

    2013-01-01

    Automatic external defibrillator (AED) is independently designed and developed and evaluated ventricular tachycardia ( VT/VF ) recognition sensitivity, specificity and defibrillation effect through animal experiment. The result shows that this device has advantages of convenient carrying, fast operation and accuracy, and has higher recognition sensitivity, specificity and defibrillation effect.%  自主设计和研制体外自动除颤器(AED),并通过动物实验评价该AED对室速/室颤(VT/VF)识别的敏感性、特异性以及除颤效果。实验结果表明该设备具有较高的识别敏感性、特异性和除颤效果,且便于携带、操作快捷和工作精确的优点。

  11. Cardiomyopathy and the use of implanted cardio-defibrillators in children.

    Science.gov (United States)

    Kaminer, S J; Pickoff, A S; Dunnigan, A; Sterba, R; Wolff, G S

    1990-05-01

    Children and adults with cardiomyopathy and ventricular dysrhythmias have a uniformly poor prognosis, despite medical therapy. The use of automatic implantable cardio-defibrillators in adult patients with medically resistant ventricular dysrhythmias has resulted in a positive impact on survival. Because of its size and former lack of programmability, the device has been used rarely in children. Four patients with cardiomyopathy, in whom refractory ventricular dysrhythmias were managed with automatic implantable cardio-defibrillators, are presented. Two of these children are the youngest and smallest known in whom the device has been used; one of them received the first programmable model. The use of the automatic implantable cardio-defibrillator may enhance survival in selected young patients. PMID:1693196

  12. Gender incongruence of childhood in the ICD-11: controversies, proposal, and rationale.

    Science.gov (United States)

    Drescher, Jack; Cohen-Kettenis, Peggy T; Reed, Geoffrey M

    2016-03-01

    As part of the development of the eleventh revision of the International Classification of Diseases (ICD-11), WHO appointed a Working Group on Sexual Disorders and Sexual Health to recommend changes necessary in the classification of mental and behavioural disorders in ICD-10 that are related to sexuality and gender identity. This Personal View focuses on the Working Group's proposals to include the diagnosis gender incongruence of childhood in ICD-11 and to move gender incongruence of childhood out of the mental and behavioural disorders chapter of ICD-11. We outline the history of ICD and DSM child gender diagnoses, expert consensus, knowledge gaps, and controversies related to the diagnosis and treatment of extremely gender-variant children. We argue that retaining the gender incongruence of childhood category is justified as a basis to structure clinical care and to ensure access to appropriate services for this vulnerable population, which provides opportunities for education and informed consent, the development of standards and pathways of care to help guide clinicians and family members, and a basis for future research efforts. PMID:26946394

  13. Use and benefits of public access defibrillation in a nation-wide network

    DEFF Research Database (Denmark)

    Nielsen, Anne Møller; Folke, Fredrik; Lippert, Freddy Knudsen;

    2013-01-01

    BACKGROUND: Automated External Defibrillators (AEDs) are known to increase survival after out-of-hospital cardiac arrest (OHCA). The aim of this study was to examine the use and benefit of public-access defibrillation (PAD) in a nation-wide network. We primarily sought to assess survival at 1 month...... to an OHCA victim prior to the arrival of Emergency Medical Services (EMS) in 48 instances. Ten percent of bystanders were off-duty healthcare professionals. Shockable arrests (N=31, 70%) were significantly more likely to be witnessed (94% vs. 54%) to occur at sports facilities (74% vs. 31%), in relation...

  14. Obsessive compulsive and related disorders: comparing DSM-5 and ICD-11.

    Science.gov (United States)

    Marras, Anna; Fineberg, Naomi; Pallanti, Stefano

    2016-08-01

    Obsessive-compulsive disorder (OCD) has been recognized as mainly characterized by compulsivity rather than anxiety and, therefore, was removed from the anxiety disorders chapter and given its own in both the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the Beta Draft Version of the 11th revision of the World Health Organization (WHO) International Classification of Diseases (ICD-11). This revised clustering is based on increasing evidence of common affected neurocircuits between disorders, differently from previous classification systems based on interrater agreement. In this article, we focus on the classification of obsessive-compulsive and related disorders (OCRDs), examining the differences in approach adopted by these 2 nosological systems, with particular attention to the proposed changes in the forthcoming ICD-11. At this stage, notable differences in the ICD classification are emerging from the previous revision, apparently converging toward a reformulation of OCRDs that is closer to the DSM-5. PMID:27401060

  15. Tourette and tic disorders in ICD-11: standing at the diagnostic crossroads.

    Science.gov (United States)

    Woods, Douglas W; Thomsen, Per H

    2014-01-01

    This article reflects discussion by the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders. After reviewing the historical classification of tic disorders, this article discusses their placement in ICD-11. Existing problems with diagnostic labels and criteria, appropriate placement of the tic disorders category within the ICD-11 system, and pragmatic factors affecting classification are reviewed. The article ends with recommendations to (a) maintain consistency with the DSM-5 diagnostic labels for tic disorders, (b) add a minimum duration guideline for a provisional tic disorder diagnosis, (c) remove the multiple motor tic guideline for the diagnosis of Tourette disorder, and (d) co-parent the tic disorder diagnoses in the disorders of the nervous system and the mental and behavioral disorders categories, with secondary co-parenting in the obsessive-compulsive and related disorders and neurodevelopmental disorders sections. PMID:25388612

  16. Tourette and tic disorders in ICD-11: standing at the diagnostic crossroads

    Directory of Open Access Journals (Sweden)

    Douglas W. Woods

    2014-01-01

    Full Text Available This article reflects discussion by the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders. After reviewing the historical classification of tic disorders, this article discusses their placement in ICD-11. Existing problems with diagnostic labels and criteria, appropriate placement of the tic disorders category within the ICD-11 system, and pragmatic factors affecting classification are reviewed. The article ends with recommendations to (a maintain consistency with the DSM-5 diagnostic labels for tic disorders, (b add a minimum duration guideline for a provisional tic disorder diagnosis, (c remove the multiple motor tic guideline for the diagnosis of Tourette disorder, and (d co-parent the tic disorder diagnoses in the disorders of the nervous system and the mental and behavioral disorders categories, with secondary co-parenting in the obsessive-compulsive and related disorders and neurodevelopmental disorders sections.

  17. Migration to the ICD-10 coding system: A primer for spine surgeons (Part 1

    Directory of Open Access Journals (Sweden)

    Gazanfar Rahmathulla

    2014-01-01

    Full Text Available Background: On 1 October 2015, a new federally mandated system goes into effect requiring the replacement of the International Classification of Disease-version 9-Clinical Modification (ICD-9-CM with ICD-10-CM. These codes are required to be used for reimbursement and to substantiate medical necessity. ICD-10 is composite with as many as 141,000 codes, an increase of 712% when compared to ICD-9. Methods: Execution of the ICD-10 system will require significant changes in the clinical administrative and hospital-based practices. Through the transition, diminished productivity and practice revenue can be anticipated, the impacts of which the spine surgeon can minimizeby appropriate education and planning. Results: The advantages of the new system include increased clarity and more accurate definitions reflecting patient condition, information relevant to ambulatory and managed care encounters, expanded injury codes, laterality, specificity, precise data for safety and compliance reporting, data mining for research, and finally, enabling pay-for-performance programs. The disadvantages include the cost per physician, training administrative staff, revenue loss during the learning curve, confusion, the need to upgrade hardware along with software, and overall expense to the healthcare system. Conclusions: With the deadline rapidly approaching, gaps in implementation result in delayed billing, delayed or diminished reimbursements, and absence of quality and outcomes data. It is thereby essential for spine surgeons to understand their role in transitioning to this new environment. Part I of this article discusses the background, coding changes, and costs as well as reviews the salient features of ICD-10 in spine surgery

  18. Quality control of cardiac defibrillator/defibrillation monitor%心脏除颤器/除颤监护仪的质量控制

    Institute of Scientific and Technical Information of China (English)

    崔亮; 崔骊; 黄韬

    2011-01-01

    目的:确保除颤器临床使用的安全性.方法:采用除颤器检定仪检测;结果:分析并解决了检测中出现的问题,保障了除颤器的安全使用.结论:对除颤器进行质量控制,可以预防因医疗设备失准而引起的医疗事故.%Objective: To ensure the safety of defibrillator that is usually used in clinical practice. Methods: The detector was used for examination of the defibriilator. Results: The problems in the testing were analyzed and solved to ensure the safety of the defibrillator. Conclusion: The medical accident that caused by misalignment of medical equipment can be prevented through the quality control.

  19. The role of the partner atom and resonant excitation energy in ICD in rare gas dimers

    Science.gov (United States)

    O'Keeffe, Patrick; Ripani, Enrico; Bolognesi, Paola; Coreno, Marcello; Avaldi, Lorenzo; Devetta, Michele; Callegari, Carlo; Di Praia, Michele; Prince, Kevin; Richter, Robert; Alagial, Michele; Kivimäkil, Antti

    2014-04-01

    We show experimental evidence for Interatomic Coulombic Decay (ICD) in mixed rare gas dimers following resonant Auger decay. A velocity map imaging apparatus together with a cooled supersonic beam containing Ar2, ArNe and ArKr dimers was used to record electron VMI images in coincidence with two mass selected ions following excitation on five resonances converging to the Ar+ 2p-11/2 and 2p-13/2 thresholds using the synchrotron radiation. The results show that the kinetic energy distribution of the ICD electrons observed in coincidence with the ions from Coulomb explosion of the dimers depends on the partner ion and resonant photon energy.

  20. Pseudodefects in SPET myocardium imaging after placement of a defibrillator patch electrode; Pseudodefekte bei der Myokard-SPECT durch implantierte Defibrillator-Patches: Phantommessungen mit SPECT und PET

    Energy Technology Data Exchange (ETDEWEB)

    Buchert, R. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. fuer Nuklearmedizin der Radiologischen Klinik; Rickers, C. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. Kardiologie der Klinik fuer Innere Medizin; Fuchs, C. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. fuer Nuklearmedizin der Radiologischen Klinik; Nienaber, C.A. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. Kardiologie der Klinik fuer Innere Medizin; Luebeck, M. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. fuer Nuklearmedizin der Radiologischen Klinik

    1996-12-01

    Aim and Methods: In order to estimate the effect of an epicardial or subcutan defibrillator patch electrode on the imaging of myocardium with SPET and PET we performed measurements with a body phantom and two different patch electrodes. Results: We found that in {sup 201}Tl-SPET with epicardial placing one electrode causes significant pseudodefects, which might lead to the impression of an infarction (`pseudoinfarction`), particularly in the case of reduced myocardial wall thickness. Measurements with {sup 99m}Tc show the same pseudodefects. In case of subcutaneous placing the electrodes are much less likely to cause relevant absorption effects. With PET even epicardially placed both patch electrodes do not produce pseudodefects. Therefore the risk of false-positive findings is very small with PET. Conclusion: In order to avoid false positive findings in cardiovascular nuclear medicine caused by defibrillator patch electrodes, patients with patch electrodes should be referred to PET, if available. (orig.) [Deutsch] Ziel und Methoden: Um den Effekt eines epikardial oder subkutan implantierten Defibrillator-Patches bei der nuklearmedizinischen Herzdiagnostik mittels SPECT und PET abzuschaetzen, wurden Messungen an einem Koerperphantom mit zwei verschiedenen Patchelektroden durchgefuehrt. Ergebnisse: Es zeigte sich, dass bei der {sup 201}Tl-SPECT bei epikardialer Plazierung eine der beiden Elektroden Pseudodefekte verursacht, die insbesondere im Falle duennwandiger Herzen die Beurteilung erschweren oder sogar zu falsch-positiven Befunden (`Pseudoinfarkte`) fuehren koennen. Bei Messungen mit {sup 99m}Tc findet man dieselben Pseudodefekte in nahezu gleicher Auspraegung. Im Falle subkutaner Plazierung sind beide Elektroden sowohl bei der {sup 201}Tl-SPECT als auch bei der {sup 99m}Tc-SPECT unkritisch. Bei der PET stellen die untersuchten Patchelektroden selbst bei epikardialer Plazierung keine erkennbare Stoerung dar, so dass hier die Gefahr eines falsch

  1. Out-of-hospital cardiac arrest and placement of automated external defibrillators in the community

    DEFF Research Database (Denmark)

    Folke, Fredrik

    2010-01-01

    INDLEDNING Chancen for at overleve et hjertestop udenfor hospital er i de første minutter efter kollaps afhængig af hjælpen fra nærmeste tilstedeværende. Dette har faciliteret strategier for placering af automatiske eksterne defibrillatorer (AED) i det offentlige rum og muliggjort hurtig defibril...

  2. Automated external defibrillator rescues among children with diagnosed and treated long QT syndrome.

    NARCIS (Netherlands)

    Pundi, K.N.; Bos, J.M.; Cannon, B.C.; Ackerman, M.J.

    2015-01-01

    BACKGROUND: Long QT syndrome (LQTS) is a potentially lethal yet highly treatable cardiac channelopathy. A comprehensive LQTS-directed treatment program often includes an automated external defibrillator (AED). OBJECTIVE: The purpose of this study was to determine the incidence of AED rescues among c

  3. 78 FR 17890 - Effective Date of Requirement for Premarket Approval for Automated External Defibrillator System.

    Science.gov (United States)

    2013-03-25

    ... 8, 2004 (69 FR 10615). B. Device Subject to This Proposal--Automated External Defibrillator (Sec... order (74 FR 16214, April 9, 2009) requiring manufacturers to submit information about a number of...-month period has expired (see 68 FR 61342, October 28, 2003). If a PMA is not filed for such...

  4. Data management in automated external defibrillators: a call for a standardised solution

    DEFF Research Database (Denmark)

    Nielsen, Anne Møller; Rasmussen, L S

    2011-01-01

    The ECG data stored in automated external defibrillators (AEDs) may be valuable for establishing a final diagnosis and deciding further diagnostics and treatment. Different data management systems are used and this may create significant problems for data storage and access for physicians treating...

  5. OPS und ICD-10-GM Versionen 2006: Redaktionsschluss für Änderungsvorschläge

    OpenAIRE

    Müller, W.

    2004-01-01

    Zur Weiterentwicklung des G-DRG-Systems werden die Klassifikationen OPS und ICD-10-GM kontinuierlich bearbeitet und angepasst. Änderungsvorschläge zu den Klassifikationen nimmt das DIMDI entgegen. Der Redaktionsschluss für Änderungsvorschläge zu den OPS- und ICD-10-Versionen des Jahres 2006 ist am 31. März 2005.

  6. ICD-10-GM 2009: Vorabversion beim DIMDI veröffentlicht

    OpenAIRE

    DIMDI-Pressestelle

    2008-01-01

    Die vorläufige Fassung der ICD-10-GM 2009 steht als Vorabversion ab sofort auf den Internetseiten des DIMDI bereit. Bitte beachten Sie, dass es in der endgültigen amtlichen Fassung noch Änderungen gegenüber dieser Vorabversion geben kann.

  7. ICD-10-GM und OPS: Neue Versionen für das Jahr 2005

    OpenAIRE

    Müller, W.

    2004-01-01

    Das Deutsche Institut für Medizinische Dokumentation und Information (DIMDI) teilt mit: Für das DRG-Vergütungssystem beginnt am 1. Januar 2005 die Konvergenzphase. Zur Vorbereitung darauf hat das DIMDI die neuen Versionen 2005 der Internationalen Klassifikation der Krankheiten (ICD-10-GM) und des Operationen- und Prozedurenschlüssels (OPS) auf seinen Internetseiten veröffentlicht.

  8. ICD-10-GM 2008: Vorabversion beim DIMDI veröffentlicht

    OpenAIRE

    DIMDI-Pressestelle

    2007-01-01

    Die vorläufige Fassung der ICD-10-GM 2008 steht als Vorabversion ab sofort auf den Internetseiten des DIMDI bereit. Bitte beachten Sie, dass gegenüber der endgültigen Fassung noch Änderungen möglich sind.

  9. DIMDI veröffentlicht Vorabversionen von OPS Version 2010 und ICD-10-GM 2010

    OpenAIRE

    DIMDI-Pressestelle

    2009-01-01

    Die vorläufigen Fassungen des OPS 2010 und des ICD-10-GM werden ab sofort auf den Internetseiten des DIMDI publiziert. Bitte beachten Sie, dass es in der endgültigen amtlichen Fassung noch Änderungen gegenüber diesen Vorabversionen geben kann.

  10. DIMDI veröffentlicht Vorabversion der ICD-10-GM 2012

    OpenAIRE

    DIMDI-Pressestelle

    2011-01-01

    Die vorläufige Fassung der ICD-10-GM 2012 finden Sie ab sofort auf den Internetseiten des DIMDI. Bitte beachten Sie, dass es in der endgültigen amtlichen Fassung noch Änderungen gegenüber dieser Vorabversion geben kann.

  11. Reliability of clinical ICD-10 diagnoses among electroconvulsive therapy patients with chronic affective disorders

    DEFF Research Database (Denmark)

    Jakobsen, Klaus Damgaard; Hansen, Thomas Folkmann; Dam, Henrik;

    2008-01-01

    investigated. A standardized schema for basic anamnesis and the Operational Criteria Checklist for Psychotic and Affective Illness (OPCRIT) were used. The sensitivity, specificity, positive and negative predictive values of clinical affective disorder ICD-10 diagnoses and the formal agreement between clinical...

  12. 77 FR 48985 - Notice of Meeting of the ICD-9-CM Coordination and Maintenance Committee

    Science.gov (United States)

    2012-08-15

    .... Please register to attend the meeting on-line at: http://www.cms.hhs.gov/apps/events/ . Please contact...-Procedure Coding System. Matters To Be Discussed: Tentative agenda items include: September 19, 2012. ICD-10...-cervical region and coding of spinal cord injuries Multifocal motor neuropathy Parity to supervision...

  13. Minding the body: situating gender identity diagnoses in the ICD-11.

    Science.gov (United States)

    Drescher, Jack; Cohen-Kettenis, Peggy; Winter, Sam

    2012-12-01

    The World Health Organization (WHO) is in the process of revising the International Statistical Classification of Diseases and Related Health Problems (ICD) and ICD-11 has an anticipated publication date of 2015. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) is charged with evaluating clinical and research data to inform the revision of diagnostic categories related to sexuality and gender identity that are currently included in the mental and behavioural disorders chapter of ICD-10, and making initial recommendations regarding whether and how these categories should be represented in the ICD-11. The diagnostic classification of disorders related to (trans)gender identity is an area long characterized by lack of knowledge, misconceptions and controversy. The placement of these categories has shifted over time within both the ICD and the American Psychiatric Association's Diagnostic and Statistical Manual (DSM), reflecting developing views about what to call these diagnoses, what they mean and where to place them. This article reviews several controversies generated by gender identity diagnoses in recent years. In both the ICD-11 and DSM-5 development processes, one challenge has been to find a balance between concerns related to the stigmatization of mental disorders and the need for diagnostic categories that facilitate access to healthcare. In this connection, this article discusses several human rights issues related to gender identity diagnoses, and explores the question of whether affected populations are best served by placement of these categories within the mental disorders section of the classification. The combined stigmatization of being transgender and of having a mental disorder diagnosis creates a doubly burdensome situation for this group, which may contribute adversely to health status and to the attainment and enjoyment of human rights. The ICD-11 Working Group on the Classification of Sexual Disorders and

  14. Metrics and tools for consistent cohort discovery and financial analyses post-transition to ICD-10-CM.

    Science.gov (United States)

    Boyd, Andrew D; Li, Jianrong John; Kenost, Colleen; Joese, Binoy; Yang, Young Min; Kalagidis, Olympia A; Zenku, Ilir; Saner, Donald; Bahroos, Neil; Lussier, Yves A

    2015-05-01

    In the United States, International Classification of Disease Clinical Modification (ICD-9-CM, the ninth revision) diagnosis codes are commonly used to identify patient cohorts and to conduct financial analyses related to disease. In October 2015, the healthcare system of the United States will transition to ICD-10-CM (the tenth revision) diagnosis codes. One challenge posed to clinical researchers and other analysts is conducting diagnosis-related queries across datasets containing both coding schemes. Further, healthcare administrators will manage growth, trends, and strategic planning with these dually-coded datasets. The majority of the ICD-9-CM to ICD-10-CM translations are complex and nonreciprocal, creating convoluted representations and meanings. Similarly, mapping back from ICD-10-CM to ICD-9-CM is equally complex, yet different from mapping forward, as relationships are likewise nonreciprocal. Indeed, 10 of the 21 top clinical categories are complex as 78% of their diagnosis codes are labeled as "convoluted" by our analyses. Analysis and research related to external causes of morbidity, injury, and poisoning will face the greatest challenges due to 41 745 (90%) convolutions and a decrease in the number of codes. We created a web portal tool and translation tables to list all ICD-9-CM diagnosis codes related to the specific input of ICD-10-CM diagnosis codes and their level of complexity: "identity" (reciprocal), "class-to-subclass," "subclass-to-class," "convoluted," or "no mapping." These tools provide guidance on ambiguous and complex translations to reveal where reports or analyses may be challenging to impossible.Web portal: http://www.lussierlab.org/transition-to-ICD9CM/Tables annotated with levels of translation complexity: http://www.lussierlab.org/publications/ICD10to9.

  15. Constructing a classification of hypersensitivity/allergic diseases for ICD-11 by crowdsourcing the allergist community.

    Science.gov (United States)

    Tanno, L K; Calderon, M A; Goldberg, B J; Gayraud, J; Bircher, A J; Casale, T; Li, J; Sanchez-Borges, M; Rosenwasser, L J; Pawankar, R; Papadopoulos, N G; Demoly, P

    2015-06-01

    The global allergy community strongly believes that the 11th revision of the International Classification of Diseases (ICD-11) offers a unique opportunity to improve the classification and coding of hypersensitivity/allergic diseases via inclusion of a specific chapter dedicated to this disease area to facilitate epidemiological studies, as well as to evaluate the true size of the allergy epidemic. In this context, an international collaboration has decided to revise the classification of hypersensitivity/allergic diseases and to validate it for ICD-11 by crowdsourcing the allergist community. After careful comparison between ICD-10 and 11 beta phase linearization codes, we identified gaps and trade-offs allowing us to construct a classification proposal, which was sent to the European Academy of Allergy and Clinical Immunology (EAACI) sections, interest groups, executive committee as well as the World Allergy Organization (WAO), and American Academy of Allergy Asthma and Immunology (AAAAI) leaderships. The crowdsourcing process produced comments from 50 of 171 members contacted by e-mail. The classification proposal has also been discussed at face-to-face meetings with experts of EAACI sections and interest groups and presented in a number of business meetings during the 2014 EAACI annual congress in Copenhagen. As a result, a high-level complex structure of classification for hypersensitivity/allergic diseases has been constructed. The model proposed has been presented to the WHO groups in charge of the ICD revision. The international collaboration of allergy experts appreciates bilateral discussion and aims to get endorsement of their proposals for the final ICD-11. PMID:25736171

  16. Constructing a classification of hypersensitivity/allergic diseases for ICD-11 by crowdsourcing the allergist community.

    Science.gov (United States)

    Tanno, L K; Calderon, M A; Goldberg, B J; Gayraud, J; Bircher, A J; Casale, T; Li, J; Sanchez-Borges, M; Rosenwasser, L J; Pawankar, R; Papadopoulos, N G; Demoly, P

    2015-06-01

    The global allergy community strongly believes that the 11th revision of the International Classification of Diseases (ICD-11) offers a unique opportunity to improve the classification and coding of hypersensitivity/allergic diseases via inclusion of a specific chapter dedicated to this disease area to facilitate epidemiological studies, as well as to evaluate the true size of the allergy epidemic. In this context, an international collaboration has decided to revise the classification of hypersensitivity/allergic diseases and to validate it for ICD-11 by crowdsourcing the allergist community. After careful comparison between ICD-10 and 11 beta phase linearization codes, we identified gaps and trade-offs allowing us to construct a classification proposal, which was sent to the European Academy of Allergy and Clinical Immunology (EAACI) sections, interest groups, executive committee as well as the World Allergy Organization (WAO), and American Academy of Allergy Asthma and Immunology (AAAAI) leaderships. The crowdsourcing process produced comments from 50 of 171 members contacted by e-mail. The classification proposal has also been discussed at face-to-face meetings with experts of EAACI sections and interest groups and presented in a number of business meetings during the 2014 EAACI annual congress in Copenhagen. As a result, a high-level complex structure of classification for hypersensitivity/allergic diseases has been constructed. The model proposed has been presented to the WHO groups in charge of the ICD revision. The international collaboration of allergy experts appreciates bilateral discussion and aims to get endorsement of their proposals for the final ICD-11.

  17. [The trends of mood disorders in ICD-11: bipolar and depressive disorders].

    Science.gov (United States)

    Kurumaji, Akeo

    2013-01-01

    The international classification of diseases 11th (ICD-11) revision is due by 2015. The ICD-11 beta draft has recently been released, which includes a prospective change in the content of mood disorders. The ICD-11 may separate the disorders into bipolar and depressive disorders as a consequence of an evaluation for the feasibility of a meta-structure for mental and behavioral disorders. In addition, the bipolar disorders may be divided into type I and II disorders. The depressive disorders may include new diseases, i. e., disruptive mood dysregulation disorder, mixed depressive anxiety, and premenstrual dysphoric disorder. Our epidemiological data from patients with mood disorders diagnosed using the ICD-10 or DSM-IV have proven their utility in clinical use, and suggested a required revision for the criteria of the diagnosis. A part of persistent mood disorders, such as cyclothymia and dysthymia, seem to be the prodromal state of bipolar disorders. For an accurate assessment of manic and hypomanic episodes, a precise estimation of the physiological effects of antidepressants as well as a sufficient review of clinical information from family members of patients are mandatory. The mixed affective episode may be deleted in the new version, because our data also indicate that this episode is a very rare clinical state. Moreover, it appears that inpatients with bipolar II disorder diagnosed by the DSM-IV in our hospital showed heterogeneous clinical properties, such as the onset age and interval between the first depressive and first hypomanic episode. After a worldwide and intensive discussion, it appears that the newly revised ICD-11 will be an advanced scientific tool for psychiatry. PMID:23691796

  18. Selection and collection of multi parameter physiological data for cardiac rhythm diagnostic algorithm development

    Science.gov (United States)

    Bostock, J.; Weller, P.; Cooklin, M.

    2010-07-01

    Automated diagnostic algorithms are used in implantable cardioverter-defibrillators (ICD's) to detect abnormal heart rhythms. Algorithms misdiagnose and improved specificity is needed to prevent inappropriate therapy. Knowledge engineering (KE) and artificial intelligence (AI) could improve this. A pilot study of KE was performed with artificial neural network (ANN) as AI system. A case note review analysed arrhythmic events stored in patients ICD memory. 13.2% patients received inappropriate therapy. The best ICD algorithm had sensitivity 1.00, specificity 0.69 (pcollected from 65 patients during cardiac electrophysiological studies. 5 incomplete datasets were due to technical failures. We concluded that KE successfully guided selection of parameters and ANN produced a usable system and that complex data collection carries greater risk of technical failure, leading to data loss.

  19. Stratification of the Risk of Sudden Death in Nonischemic Heart Failure

    Directory of Open Access Journals (Sweden)

    Maurício Pimentel

    2014-10-01

    Full Text Available Despite significant therapeutic advancements, heart failure remains a highly prevalent clinical condition associated with significant morbidity and mortality. In 30%-40% patients, the etiology of heart failure is nonischemic. The implantable cardioverter-defibrillator (ICD is capable of preventing sudden death and decreasing total mortality in patients with nonischemic heart failure. However, a significant number of patients receiving ICD do not receive any kind of therapy during follow-up. Moreover, considering the situation in Brazil and several other countries, ICD cannot be implanted in all patients with nonischemic heart failure. Therefore, there is an urgent need to identify patients at an increased risk of sudden death because these would benefit more than patients at a lower risk, despite the presence of heart failure in both risk groups. In this study, the authors review the primary available methods for the stratification of the risk of sudden death in patients with nonischemic heart failure.

  20. Arrhythmia risk stratification of patients after myocardial infarction using personalized heart models.

    Science.gov (United States)

    Arevalo, Hermenegild J; Vadakkumpadan, Fijoy; Guallar, Eliseo; Jebb, Alexander; Malamas, Peter; Wu, Katherine C; Trayanova, Natalia A

    2016-01-01

    Sudden cardiac death (SCD) from arrhythmias is a leading cause of mortality. For patients at high SCD risk, prophylactic insertion of implantable cardioverter defibrillators (ICDs) reduces mortality. Current approaches to identify patients at risk for arrhythmia are, however, of low sensitivity and specificity, which results in a low rate of appropriate ICD therapy. Here, we develop a personalized approach to assess SCD risk in post-infarction patients based on cardiac imaging and computational modelling. We construct personalized three-dimensional computer models of post-infarction hearts from patients' clinical magnetic resonance imaging data and assess the propensity of each model to develop arrhythmia. In a proof-of-concept retrospective study, the virtual heart test significantly outperformed several existing clinical metrics in predicting future arrhythmic events. The robust and non-invasive personalized virtual heart risk assessment may have the potential to prevent SCD and avoid unnecessary ICD implantations. PMID:27164184

  1. [Ventricular tachyarrhythmias. A retrospective analysis of etiology, demography and treatment

    DEFF Research Database (Denmark)

    Christensen, A.H.; Henningsen, K.; Svendsen, Jesper Hastrup

    2008-01-01

    INTRODUCTION: The aim of this study was to investigate the age, sex, etiology, frequency of implantable cardioverter-defibrillator (ICD) and previous cardiac arrest among patients discharged from the Department of Cardiology, Rigshospitalet (Copenhagen University Hospital), Denmark, due to...... average age of 59 years (ranging 15-95 years) with a majority of males (76%). Among the patients with known etiology ischemic heart disease (60%), dilated cardiomyopathy (6%) and arrhythmogenic right ventricular cardiomyopathy (6%) were the most frequent. A substantial number of the patients (15%) had...... unknown etiology; 492 (50%) of the patients overall had an ICD implanted, the majority of whom had been categorized as having ventricular tachycardia (92%); 168 patients had previous cardiac arrest, 127 of whom did not have a potential reversible cause. Of this group 75 (59%) had an ICD implanted...

  2. The ERα coactivator, HER4/4ICD, regulates progesterone receptor expression in normal and malignant breast epithelium

    Directory of Open Access Journals (Sweden)

    Howard Beatrice A

    2010-06-01

    Full Text Available Abstract The HER4 intracellular domain (4ICD is a potent estrogen receptor (ERα coactivator with activities in breast cancer and the developing mammary gland that appear to overlap with progesterone receptor (PgR. In fact, 4ICD has recently emerged as an important regulator and predictor of tamoxifen response, a role previously thought to be fulfilled by PgR. Here we investigated the possibility that the 4ICD coactivator regulates PgR expression thereby providing a mechanistic explanation for their partially overlapping activities in breast cancer. We show that 4ICD is both sufficient and necessary to potentiate estrogen stimulation of gene expression. Suppression of HER4/4ICD expression in the MCF-7 breast tumor cell line completely eliminated estrogen stimulated expression of PgR. In addition, the HER4/4ICD negative MCF-7 variant, TamR, failed to express PgR in response to estrogen. Reintroduction of wild-type HER4 but not the γ-secretase processing mutant HER4V673I into the TamR cell line restored PgR expression indicating that 4ICD is an essential PgR coactivator in breast tumor cells. These results were substantiated in vivo using two different physiologically relevant experimental systems. In the mouse mammary gland estrogen regulates expression of PgR-A whereas expression of PgR-B is estrogen independent. Consistent with a role for 4ICD in estrogen regulated PgR expression in vivo, PgR-A, but not PgR-B, expression was abolished in HER4-null mouse mammary glands during pregnancy. Coexpression of PgR and 4ICD is also commonly observed in ERα positive breast carcinomas. Using quantitative AQUA IHC technology we found that 4ICD potentiated PgR expression in primary breast tumors and the highest levels of PgR expression required coexpression of ERα and the 4ICD coactivator. In summary, our results provide compelling evidence that 4ICD is a physiologically important ERα coactivator and 4ICD cooperates with ERα to potentiate PgR expression

  3. Acute and long term outcomes of catheter ablation using remote magnetic navigation for the treatment of electrical storm in patients with severe ischemic heart failure

    DEFF Research Database (Denmark)

    Jin, Qi; Jacobsen, Peter Karl; Pehrson, Steen;

    2015-01-01

    BACKGROUND: Catheter ablation with remote magnetic navigation (RMN) can offer some advantages compared to manual techniques. However, the relevant clinical evidence for how RMN-guided ablation affects electrical storm (ES) due to ventricular tachycardia (VT) in patients with severe ischemic heart...... failure (SIHF) is still limited. METHODS: Forty consecutive SIHF patients (left ventricular ejection fraction, 21 ± 6.9%) presenting with ES underwent ablation using RMN. All the patients received implantable cardioverter-defibrillators (ICDs) either before or after ablation. Acute ablation success...... before ablation (30% vs 69%, PRMN is safe and effective to suppress ES in SIHF patients. RMN...

  4. Designing Shared Electronic Records for Chronic Care

    DEFF Research Database (Denmark)

    Bansler, Jørgen Peter; Havn, Erling C.; Mønsted, Troels

    2010-01-01

    ICDs (implantable cardioverter-defibrillator). These are chronic patients who usually see several different healthcare providers on a regular basis. The main findings so far are: (1) Most of the data produced and recorded as part of the care process are context-specific and often difficult to interpret......) In addition, there appears to be a need for creating new types of data specifically designed to meet the coordination needs across different contexts and expert domains. (4) The dilemma is, however, that the production of these new types of data must not require too much extra work....

  5. Loeffler endocarditis: silent right ventricular myocardium!

    Science.gov (United States)

    Çetin, Süha; Heper, Gülümser; Gökhan Vural, Mustafa; Hazirolan, Tuncay

    2016-07-01

    We present the case of a 54-year-old male patient with Loeffler endocarditis. It is a rare disorder characterized by fibrous thickening of the endocardium leading to apical obliteration and restrictive cardiomyopathy resulting in heart failure, thromboembolic events or atrial fibrillation. To the best of our knowledge, this is the first case reporting the electrical silence of the right ventricular (RV) apex caused by fibrothrombotic thickening of this area. Under these circumstances RV apical implantation of an implantable cardioverter defibrillator (ICD) or pacemaker electrode may lead to unsuccessful stimulation of these devices. PMID:26980214

  6. 033 移动电话对ICD的影响

    Institute of Scientific and Technical Information of China (English)

    陈元秀; 黄从新

    2000-01-01

    @@ Eraldo测试了移动电话(手机)对30例植入除颤器(implantable cardioverter defibrillator;ICD)患者的影响.30例患者中男26例,女4例.ICD型号包括Telectronics7例;CPI 7例,Medtronic 7例,Ventritex 5例;Ela medical 4例.测试过程中连续监测体表心电图改变.

  7. Transient loss of consciousness in a patient with a Brugada like ECG

    Directory of Open Access Journals (Sweden)

    Belinda Sandler

    2011-11-01

    Full Text Available Syncope in a patient with a Brugada syndrome channelopathy carries significant prognostic implications and warrants consideration of implantable cardioverter defibrillator (ICD implantation. We report a case of a 62- year-old gentleman who presented with a transient loss of consciousness and an electrocardiogram (ECG suggestive of type 1 Brugada syndrome. Further investigation revealed evidence of a silent myocardial infarction and negative ventricular tachycardia stimulation and Ajmaline testing. Careful review of the ECG’s subsequently showed the type 1 pattern was present in only V1.

  8. 心脏自动复律除颤器的临床应用

    Institute of Scientific and Technical Information of China (English)

    李爱国

    2005-01-01

    @@ 心脏性猝死是目前世界上尚未解决的医学难题.美国每年约有45万人死于该病,几乎每分钟死亡1人,而恶性室性快速性心律失常为其主要原因,约占心脏性猝死的87%.植入型心律转复除颤器(Implantable cardioverter defibrillator,ICD)的应用为恶性室性心律失常的治疗开辟了一个新领域.

  9. [Biventricular resynchronization in the management of severe cardiac insufficiency].

    Science.gov (United States)

    Chine, Samira; Kammoun, Ikram; Ben Halima, Afef; Lefi, Abdelatif; Chaabène, Olfa; Zouaoui, Walid; Essmatt, Wajih; Marrakchi, Sonia; Gargouri, Sami; Keskes, Hend; Kachboura, Salem

    2004-01-01

    Heart failure is a major problem of public health, it represents a frequent status among patients with heart disease, and its implications in term of mortality and cost are high. Non Pharmacological treatment of heart failure most commonly designed as cardiac resynchronization therapy (CRT) has demonstrate efficacy to improve functional class, exertion capacity, left ventricular ejection fraction, reduction of mitral regurgitation, and probably mortality at midterm. The most recent studies emphasize on the role of implantable cardioverter defibrillate or (ICD) combined with CRT to reduce mortality. More trials are needed to valid this concept.

  10. Integration of Attributes from Non-Linear Characterization of Cardiovascular Time-Series for Prediction of Defibrillation Outcomes.

    Directory of Open Access Journals (Sweden)

    Sharad Shandilya

    Full Text Available The timing of defibrillation is mostly at arbitrary intervals during cardio-pulmonary resuscitation (CPR, rather than during intervals when the out-of-hospital cardiac arrest (OOH-CA patient is physiologically primed for successful countershock. Interruptions to CPR may negatively impact defibrillation success. Multiple defibrillations can be associated with decreased post-resuscitation myocardial function. We hypothesize that a more complete picture of the cardiovascular system can be gained through non-linear dynamics and integration of multiple physiologic measures from biomedical signals.Retrospective analysis of 153 anonymized OOH-CA patients who received at least one defibrillation for ventricular fibrillation (VF was undertaken. A machine learning model, termed Multiple Domain Integrative (MDI model, was developed to predict defibrillation success. We explore the rationale for non-linear dynamics and statistically validate heuristics involved in feature extraction for model development. Performance of MDI is then compared to the amplitude spectrum area (AMSA technique.358 defibrillations were evaluated (218 unsuccessful and 140 successful. Non-linear properties (Lyapunov exponent > 0 of the ECG signals indicate a chaotic nature and validate the use of novel non-linear dynamic methods for feature extraction. Classification using MDI yielded ROC-AUC of 83.2% and accuracy of 78.8%, for the model built with ECG data only. Utilizing 10-fold cross-validation, at 80% specificity level, MDI (74% sensitivity outperformed AMSA (53.6% sensitivity. At 90% specificity level, MDI had 68.4% sensitivity while AMSA had 43.3% sensitivity. Integrating available end-tidal carbon dioxide features into MDI, for the available 48 defibrillations, boosted ROC-AUC to 93.8% and accuracy to 83.3% at 80% sensitivity.At clinically relevant sensitivity thresholds, the MDI provides improved performance as compared to AMSA, yielding fewer unsuccessful defibrillations

  11. Data bank international of events of failure of common cause ICDE; Banco de datos internacional de sucesos de fallo de causa comum (ICDE)

    Energy Technology Data Exchange (ETDEWEB)

    Morales Castellanos, M. R.; Fernandez Andujar, B.; Pereira Pagan, M. B.

    2013-07-01

    Common Cause Failure (CCF) is a dependent event in which two or more components fail simultaneously or within a short space of time as a direct result of a shared common cause. Due to the low frequency of this type of events, some Member States of the Agency of Nuclear Energy (NEA) of the Organization for Cooperation and Economic Development (OECD) decided to create the project International Common-Cause Failure Data Exchange (ICDE) in order to encourage multilateral cooperation in the collection and analysis of data relating to CCF events.

  12. del Nido versus St. Thomas Cardioplegia Solutions: A Single-Center Retrospective Analysis of Post Cross-Clamp Defibrillation Rates.

    Science.gov (United States)

    Buel, Shane T; Striker, Carrie Whittaker; O'Brien, James E

    2016-06-01

    There are many cardioplegia solutions currently in use for pediatric cardiopulmonary bypass (CPB). The most common being del Nido solution. Another common cardioplegia solution used for pediatric CPB is St. Thomas. In October 2014, Children's Mercy Kansas City changed from the use of modified St. Thomas to del Nido. This study compared rates of post cross-clamp fibrillation requiring defibrillation between del Nido solution and modified St. Thomas solution stratified by weight at Children's Mercy Kansas City. This retrospective study consisted of 394 patients who underwent cardiac surgery requiring cardioplegia between January 1, 2014 and July 31, 2015. The outcome measured was defibrillation upon cross-clamp removal. Statistical significance was determined using Fishers exact test with a two-sided significance level of .05. Incidence of defibrillation post cross-clamp removal was 4.4% in the del Nido group and 26.8% in the St. Thomas group (p 60-kg category had an incidence of defibrillation of 16.7% in the del Nido group and 63% in the St. Thomas group (p < .0623). This study demonstrates a 6-fold decrease in the overall rate of defibrillation post cross-clamp removal between St. Thomas and del Nido cardioplegia solutions. Analyses of weight stratifications demonstrate a decrease in the rate of defibrillation post cross-clamp removal in all categories within the del Nido group. PMID:27578896

  13. Concordance of ICD-11 and DSM-5 definitions of alcohol and cannabis use disorders: a population survey.

    Science.gov (United States)

    Lago, Luise; Bruno, Raimondo; Degenhardt, Louisa

    2016-07-01

    The proposed criteria for alcohol and cannabis use disorders in the 11th edition of ICD (ICD-11) will be presented to the World Health Assembly in 2017, but the beta-phase descriptions have been released. We compared them with those in the tenth edition (ICD-10) and the American Psychiatric Association's DSM fourth edition (DSM-IV) and fifth edition (DSM-5), in a nationally representative sample of adult Australians. Disorders were assessed with the WHO World Mental Health Composite International Diagnostic Interview. The proportions classified as being dependent on alcohol and cannabis were similar with ICD-10, ICD-11, and DSM-IV, whereas for DSM-5, the proportion of lifetime users meeting the criteria for moderate to severe use (most comparable to dependence in the other systems) was far higher. We assessed whether criteria for alcohol and cannabis use described unidimensional syndromes for each, and all definitions seemed to do so. Classification of alcohol and cannabis use disorders, although simplified in ICD-11, was in almost perfect agreement with the classifications of ICD-10 and DSM-IV. With DSM-5, use disorder seemed to capture a different aspect of problematic use and selected a different group of individuals from the other systems. How the newest definitions will become used remains to be seen. The choice of classification might depend on the clinical population of interest. PMID:27371989

  14. Combining multiple ECG features does not improve prediction of defibrillation outcome compared to single features in a large population of out-of-hospital cardiac arrests

    OpenAIRE

    He, Mi; Gong, Yushun; Li, Yongqin; Mauri, Tommaso; Fumagalli, Francesca; Bozzola, Marcella; Cesana, Giancarlo; Latini, Roberto; Pesenti, Antonio; Ristagno, Giuseppe

    2015-01-01

    Introduction Quantitative electrocardiographic (ECG) waveform analysis provides a noninvasive reflection of the metabolic milieu of the myocardium during resuscitation and is a potentially useful tool to optimize the defibrillation strategy. However, whether combining multiple ECG features can improve the capability of defibrillation outcome prediction in comparison to single feature analysis is still uncertain. Methods A total of 3828 defibrillations from 1617 patients who experienced out-of...

  15. Evaluating Open-Source Full-Text Search Engines for Matching ICD-10 Codes.

    Science.gov (United States)

    Jurcău, Daniel-Alexandru; Stoicu-Tivadar, Vasile

    2016-01-01

    This research presents the results of evaluating multiple free, open-source engines on matching ICD-10 diagnostic codes via full-text searches. The study investigates what it takes to get an accurate match when searching for a specific diagnostic code. For each code the evaluation starts by extracting the words that make up its text and continues with building full-text search queries from the combinations of these words. The queries are then run against all the ICD-10 codes until a match indicates the code in question as a match with the highest relative score. This method identifies the minimum number of words that must be provided in order for the search engines choose the desired entry. The engines analyzed include a popular Java-based full-text search engine, a lightweight engine written in JavaScript which can even execute on the user's browser, and two popular open-source relational database management systems.

  16. The data quality of splenomegaly ICD-10 diagnoses in a population-based hospital discharge registry

    DEFF Research Database (Denmark)

    Rotbain, E. C.; Lund Hansen, Dennis; Frederiksen, H.

    2015-01-01

    Background Splenomegaly is a common finding in general medical patients. The cause of splenomegaly is often found outside the spleen and therefore an extensive diagnostic medical work-up is frequently required. There is very little data on the distribution of causal diagnoses and, to the best...... of our knowledge, accurate data on the risk of hematological malignancies, hepatic diseases and storage diseases among patients with splenomegaly have never been reported. The aim of this pilot study is to investigate the validity of the splenomegaly ICD-10 diagnoses, in order to ascertain...... if a nationwide registry study of the above stated risks can be undertaken, and to investigate which causal diagnoses are most common. Method The study was conducted as a cohort with data from the Danish health care system. Patients with an ICD-10 diagnosis of splenomegaly at Odense University Hospital (OUH) from...

  17. Determination of problematic ICD-9-CM subcategories for further study of coding performance: Delphi method.

    Science.gov (United States)

    Zeng, Xiaoming; Bell, Paul D

    2011-01-01

    In this study, we report on a qualitative method known as the Delphi method, used in the first part of a research study for improving the accuracy and reliability of ICD-9-CM coding. A panel of independent coding experts interacted methodically to determine that the three criteria to identify a problematic ICD-9-CM subcategory for further study were cost, volume, and level of coding confusion caused. The Medicare Provider Analysis and Review (MEDPAR) 2007 fiscal year data set as well as suggestions from the experts were used to identify coding subcategories based on cost and volume data. Next, the panelists performed two rounds of independent ranking before identifying Excisional Debridement as the subcategory that causes the most confusion among coders. As a result, they recommended it for further study aimed at improving coding accuracy and variation. This framework can be adopted at different levels for similar studies in need of a schema for determining problematic subcategories of code sets.

  18. 关于Fahr综合征及其ICD-10编码

    Institute of Scientific and Technical Information of China (English)

    佘璇瑜; 陈丹霞; 陈彩芳

    2011-01-01

    目的 探讨Fahr综合征的ICD-10编码.方法 通过阅读医学文献,深入了解Fahr综合征的临床与病因,按ICD-10分类规则进行编码.结果 对Fahr综合征的的临床与病因有了进一步的认识,并给予相应的编码.结论 编码员一定要按正确操作步骤进行编码,还要阅读病史,有疑问须多方查阅资料进行综合分析,并依据编码原则做出正确编码.

  19. Cost of a Recall of a Single-Center Experience Managing the Riata Defibrillator Lead

    OpenAIRE

    Hussain, Sarah; Moorman, Liza; Moorman, J. Randall; DiMarco, John P.; Malhotra, Rohit; Darby, Andrew; Bilchick, Kenneth; Mangrum, J. Michael; Ferguson, John D.; Mason, Pamela K.

    2014-01-01

    Riata and Riata ST defibrillator leads (St. Jude Medical, Sylmar, California) were recalled in 2011 due to increased risk of insulation failure leading to externalized cables. Fluoroscopic screening can identify insulation failure, although the relation between mechanical failure and electrical failure is unclear. At the time of the recall, the University of Virginia developed a screening program, including fluoroscopic evaluation, education sessions, device interrogation, and remote monitori...

  20. Study on the Switching Time-Variation of Simultaneously Controlled IGBT: Case of Defibrillators Design

    OpenAIRE

    Mudrov T.; Kostov J.

    2009-01-01

    Samples of integrated gain bipolar transistors (IGBT) of the same type but produced under different technologies were tested about the switching time-variation. This is of high importance when several IGBT are connected in series to commutate high voltage defibrillation shocks. Very often, a short voltage overload of one of the IGBT in group leads to electrical breakdown of all transistors, due to nonsynchronised driving of the gate-emitter circuits. The goal of the study was to check whether...

  1. Functional disorders in the Neurology section of ICD-11: A landmark opportunity.

    Science.gov (United States)

    Stone, Jon; Hallett, Mark; Carson, Alan; Bergen, Donna; Shakir, Raad

    2014-12-01

    Functional disorders are one of the most common diagnoses in neurologic practice, but this is not reflected in current classification systems. The 11th revision of the World Health Organization's International Classification of Diseases (ICD-11) in 2017 offers an opportunity for these disorders to appear within both neurologic and psychiatric categories for the first time. We discuss the rationale for this proposal and highlight the potential benefits for health professionals and patients.

  2. ICD-10-GM 2011: DIMDI veröffentlicht endgültige Fassung

    OpenAIRE

    Müller, W.; DIMDI-Pressestelle

    2010-01-01

    Das DIMDI hat die endgültige Fassung der ICD-10-GM Version 2011 (Internationale Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, German Modification) auf seinen Internetseiten veröffentlicht. In die neue Version flossen knapp 60 Vorschläge aus Fachgesellschaften und von Fachleuten aus Ärzteschaft, Krankenkassen und Kliniken ein sowie zahlreiche Änderungen der Weltgesundheitsorganisation (WHO). Die Klassifikation bildet die Basis für das pauschalierende Vergütungssystem G-DRG...

  3. ICD-10-GM 2012: DIMDI veröffentlicht endgültige Fassung

    OpenAIRE

    Müller, W.; DIMDI-Pressestelle

    2011-01-01

    Das DIMDI hat die endgültige Fassung der ICD-10-GM Version 2012 (Internationale Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, German Modification) auf seinen Internetseiten veröffentlicht. In die neue Version flossen knapp 80 Vorschläge aus Fachgesellschaften und von Fachleuten aus Ärzteschaft, Krankenkassen und Kliniken sowie Änderungen der Weltgesundheitsorganisation (WHO) ein. Die Klassifikation bildet die Basis für das pauschalierende Vergütungssystem G-DRG (German Di...

  4. DSM-III DIAGNOSTIC CATEGORIES FOR ICD-9 HYSTERIA: A STUDY ON 103 CASES

    OpenAIRE

    Saxena, Shekhar; Pachauri, Ravindra; Wig, Narendra N.

    1986-01-01

    SUMMARY Rediagnosing 103 ICD-9 Hysteria cases on DSM-III, the authors found Conversion Disorder and Atypical Dissociative Disorder to be the most common diagnosis. Somatization Disorder was diagnosed only in 8.7 per ant of cases. Twenty-nine per cent cases received double diagnoses. Limitations of using DSM-III on Hysteria patients are mentioned and a suggestion is made to include a new category of ‘Simple Dissociative Disorder’ in the DSM-III.

  5. Classification of feeding and eating disorders: review of evidence and proposals for ICD-11

    OpenAIRE

    Uher, Rudolf; Rutter, Michael,

    2012-01-01

    Current classification of eating disorders is failing to classify most clinical presentations; ignores continuities between child, adolescent and adult manifestations; and requires frequent changes of diagnosis to accommodate the natural course of these disorders. The classification is divorced from clinical practice, and investigators of clinical trials have felt compelled to introduce unsystematic modifications. Classification of feeding and eating disorders in ICD-11 requires substantial c...

  6. Authentication of Algorithm to Detect Metastases in Men with Prostate Cancer Using ICD-9 Codes

    Directory of Open Access Journals (Sweden)

    Matthew T. Dolan

    2012-01-01

    Full Text Available Background. Metastasis is a crucial endpoint for patients with prostate cancer (PCa, but currently lacks a validated claims-based algorithm for detection. Objective. To develop an algorithm using ICD-9 codes to facilitate accurate reporting of PCa metastases. Methods. Medical records from 300 men hospitalized at Robert Wood Johnson University Hospital for PCa were reviewed. Using the presence of metastatic PCa on chart review as the gold standard, two algorithms to detect metastases were compared. Algorithm A used ICD-9 codes 198.5 (bone metastases, 197.0 (lung metastases, 197.7 (liver metastases, or 198.3 (brain and spinal cord metastases to detect metastases, while algorithm B used only 198.5. Sensitivity, specificity, positive predictive value (PPV, and negative predictive value (NPV for the two algorithms were determined. Kappa statistics were used to measure agreement rates between claim data and chart review. Results. Algorithm A demonstrated a sensitivity, specificity, PPV, and NPV of 95%, 100%, 100%, and 98.7%, respectively. Corresponding numbers for algorithm B were 90%, 100%, 100%, and 97.5%, respectively. The agreement rate is 96.8% for algorithm A and 93.5% for algorithm B. Conclusions. Using ICD-9 codes 198.5, 197.0, 197.7, or 198.3 in detecting the presence of PCa metastases offers a high sensitivity, specificity, PPV, and NPV value.

  7. Typical Versus Atypical Anorexia Nervosa Among Adolescents: Clinical Characteristics and Implications for ICD-11.

    Science.gov (United States)

    Silén, Yasmina; Raevuori, Anu; Jüriloo, Elisabeth; Tainio, Veli-Matti; Marttunen, Mauri; Keski-Rahkonen, Anna

    2015-09-01

    There is scant research on the clinical utility of differentiating International Classification of Diseases (ICD) 10 diagnoses F50.0 anorexia nervosa (typical AN) and F50.1 atypical anorexia. We reviewed systematically records of 47 adolescents who fulfilled criteria for ICD-10 F50.0 (n = 34) or F50.1 (n = 13), assessing the impact of diagnostic subtype, comorbidity, background factors and treatment choices on recovery. Atypical AN patients were significantly older (p = 0.03), heavier (minimum body mass index 16.7 vs 15.1 kg/m(2) , p = 0.003) and less prone to comorbidities (38% vs 71%, p = 0.04) and had shorter, less intensive and less costly treatments than typical AN patients. The diagnosis of typical versus atypical AN was the sole significant predictor of treatment success: recovery from atypical AN was 4.3 times (95% confidence interval [1.1, 17.5]) as likely as recovery from typical AN. Overall, our findings indicate that a broader definition of AN may dilute the prognostic value of the diagnosis, and therefore, ICD-11 should retain its distinction between typical and atypical AN. PMID:26010207

  8. Typical Versus Atypical Anorexia Nervosa Among Adolescents: Clinical Characteristics and Implications for ICD-11.

    Science.gov (United States)

    Silén, Yasmina; Raevuori, Anu; Jüriloo, Elisabeth; Tainio, Veli-Matti; Marttunen, Mauri; Keski-Rahkonen, Anna

    2015-09-01

    There is scant research on the clinical utility of differentiating International Classification of Diseases (ICD) 10 diagnoses F50.0 anorexia nervosa (typical AN) and F50.1 atypical anorexia. We reviewed systematically records of 47 adolescents who fulfilled criteria for ICD-10 F50.0 (n = 34) or F50.1 (n = 13), assessing the impact of diagnostic subtype, comorbidity, background factors and treatment choices on recovery. Atypical AN patients were significantly older (p = 0.03), heavier (minimum body mass index 16.7 vs 15.1 kg/m(2) , p = 0.003) and less prone to comorbidities (38% vs 71%, p = 0.04) and had shorter, less intensive and less costly treatments than typical AN patients. The diagnosis of typical versus atypical AN was the sole significant predictor of treatment success: recovery from atypical AN was 4.3 times (95% confidence interval [1.1, 17.5]) as likely as recovery from typical AN. Overall, our findings indicate that a broader definition of AN may dilute the prognostic value of the diagnosis, and therefore, ICD-11 should retain its distinction between typical and atypical AN.

  9. DIMDI veröffentlicht endgültige Fassungen von ICD-10-GM 2010 und OPS Version 2010

    OpenAIRE

    Müller, W.

    2009-01-01

    Das DIMDI hat die endgültigen Fassungen der ICD-10-GM Version 2010 (Internationale Klassifikation der Krankheiten, German Modification) und des Operationen- und Prozedurenschlüssels (OPS) Version 2010 online veröffentlicht.

  10. An evaluation of ICD-11 PTSD and complex PTSD criteria in a sample of adult survivors of childhood institutional abuse

    Directory of Open Access Journals (Sweden)

    Matthias Knefel

    2013-12-01

    Full Text Available Background : The WHO recently launched the proposal for the 11th version of the International Classification of Diseases (ICD-11 that also includes two diagnoses related to traumatic stress. In contrast to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5, ICD-11 will probably, in addition to posttraumatic stress disorder (PTSD, also define a new diagnosis termed “complex posttraumatic stress disorder” (CPTSD. Objective : We aimed to apply the proposed ICD-11 criteria for PTSD and CPTSD and to compare their prevalence to the ICD-10 (International Classification of Diseases [10th revision] PTSD prevalence. In addition, we compiled a list of symptoms for CPTSD based on subthreshold PTSD so as to include a wider group of individuals. Methods : To evaluate the appropriateness of the WHO ICD-11 proposal compared to the criteria of ICD-10, we applied the newly introduced criteria for PTSD and CPTSD deriving from the Posttraumatic Stress Disorder Checklist – Civilian Version (PCL-C and the Brief Symptom Inventory (BSI scales, to a sample of adult survivors (N=229 of childhood institutional abuse. We evaluated the construct validity of CPTSD using confirmatory factor analysis (CFA. Results : More individuals fulfilled the criteria for PTSD according to ICD-10 (52.8% than the ICD-11 proposal (17% for PTSD only; 38.4% if combined with complex PTSD. The new version of PTSD neutralized the gender effects. The prevalence of CPTSD was 21.4%, and women had a significantly higher rate of CPTSD than men (40.4 and 15.8%, respectively. Those survivors who were diagnosed with CPTSD experienced institutional abuse for a longer time. CFA showed a strong model fit. Conclusion : CPTSD is a highly relevant classification for individuals with complex trauma history, but surprisingly, effects of gender were apparent. Further research should thus address gender effects.

  11. Comparison of ICD-10R, DSM-IV-TR and DSM-5 in an Adult Autism Spectrum Disorder Diagnostic Clinic

    Science.gov (United States)

    Wilson, C. Ellie; Gillan, Nicola; Spain, Deborah; Robertson, Dene; Roberts, Gedeon; Murphy, Clodagh M.; Maltezos, Stefanos; Zinkstok, Janneke; Johnston, Katie; Dardani, Christina; Ohlsen, Chris; Deeley, P. Quinton; Craig, Michael; Mendez, Maria A.; Happé, Francesca; Murphy, Declan G. M.

    2013-01-01

    An Autism Spectrum Disorder (ASD) diagnosis is often used to access services. We investigated whether ASD diagnostic outcome varied when DSM-5 was used compared to ICD-10R and DSM-IV-TR in a clinical sample of 150 intellectually able adults. Of those diagnosed with an ASD using ICD-10R, 56% met DSM-5 ASD criteria. A further 19% met DSM-5 (draft)…

  12. Non-linear dynamical signal characterization for prediction of defibrillation success through machine learning

    Directory of Open Access Journals (Sweden)

    Shandilya Sharad

    2012-10-01

    Full Text Available Abstract Background Ventricular Fibrillation (VF is a common presenting dysrhythmia in the setting of cardiac arrest whose main treatment is defibrillation through direct current countershock to achieve return of spontaneous circulation. However, often defibrillation is unsuccessful and may even lead to the transition of VF to more nefarious rhythms such as asystole or pulseless electrical activity. Multiple methods have been proposed for predicting defibrillation success based on examination of the VF waveform. To date, however, no analytical technique has been widely accepted. We developed a unique approach of computational VF waveform analysis, with and without addition of the signal of end-tidal carbon dioxide (PetCO2, using advanced machine learning algorithms. We compare these results with those obtained using the Amplitude Spectral Area (AMSA technique. Methods A total of 90 pre-countershock ECG signals were analyzed form an accessible preshosptial cardiac arrest database. A unified predictive model, based on signal processing and machine learning, was developed with time-series and dual-tree complex wavelet transform features. Upon selection of correlated variables, a parametrically optimized support vector machine (SVM model was trained for predicting outcomes on the test sets. Training and testing was performed with nested 10-fold cross validation and 6–10 features for each test fold. Results The integrative model performs real-time, short-term (7.8 second analysis of the Electrocardiogram (ECG. For a total of 90 signals, 34 successful and 56 unsuccessful defibrillations were classified with an average Accuracy and Receiver Operator Characteristic (ROC Area Under the Curve (AUC of 82.2% and 85%, respectively. Incorporation of the end-tidal carbon dioxide signal boosted Accuracy and ROC AUC to 83.3% and 93.8%, respectively, for a smaller dataset containing 48 signals. VF analysis using AMSA resulted in accuracy and ROC AUC of 64

  13. Concordances and discrepancies between ICD-10 and DSM-IV criteria for anxiety disorders in childhood and adolescence

    Directory of Open Access Journals (Sweden)

    Adornetto Carmen

    2012-12-01

    Full Text Available Abstract Background Mental disorders are classified by two major nosological systems, the ICD-10 and the DSM-IV-TR, consisting of different diagnostic criteria. The present study investigated the diagnostic concordance between the two systems for anxiety disorders in childhood and adolescence, in particular for separation anxiety disorder (SAD, specific phobia, social phobia, and generalized anxiety disorder (GAD. Methods A structured clinical interview, the Kinder-DIPS, was administered to 210 children and 258 parents. The percentage of agreement, kappa, and Yule’s Y coefficients were calculated for all diagnoses. Specific criteria causing discrepancies between the two classification systems were identified. Results DSM-IV-TR consistently classified more children than ICD-10 with an anxiety disorder, with a higher concordance between DSM-IV-TR and the ICD-10 child section (F9 than with the adult section (F4 of the ICD-10. This result was found for all four investigated anxiety disorders. The results revealed low to high levels of concordance and poor to good agreement between the classification systems, depending on the anxiety disorder. Conclusions The two classification systems identify different children with an anxiety disorder. However, it remains an open question, whether the research results can be generalized to clinical practice since DSM-IV-TR is mainly used in research while ICD-10 is widely established in clinical practice in Europe. Therefore, the population investigated by the DSM (research population is not identical with the population examined using the ICD (clinical population.

  14. Heart pacemaker

    Science.gov (United States)

    ... Elsevier Saunders; 2015:chap 36. Read More Arrhythmias Atrial fibrillation or flutter Cardiac ablation procedures Heart failure - overview Implantable cardioverter-defibrillator Sick sinus syndrome Wolff- ...

  15. Analysis of Clinical Application of Electric Defibrillation%电除颤的临床应用分析

    Institute of Scientific and Technical Information of China (English)

    李黎

    2015-01-01

    Objective To analyse the clinical application of electric defibril ation. Methods Our hospital admissions for patients with cardiac ar est in 78 cases as the research object, conform to the requirements of electric defibril ation indications, according to ventricular fibril ation cardiac arrest - time (T) divided into study group and control group, 40 cases in the study group, T 2min defibril ator. Comparative analysis of two groups of the successful rate of CPR and defibril ation ef iciency. Results The ef ective rate of the study group the successful rate of CPR and defibril ation were significantly higher than those in the control group ( 2min除颤。对比分析两组复苏成功率与除颤有效率。结果研究组复苏成功率与除颤有效率皆明显高于对照组(<0.05)。结论确保心脏骤停患者符合电除颤适应症且排除禁忌症情况下,尽早予以电除颤可提高复苏成功率与除颤有效率,值得借鉴。

  16. An Ep-ICD based index is a marker of aggressiveness and poor prognosis in thyroid carcinoma.

    Directory of Open Access Journals (Sweden)

    Helen C-H He

    Full Text Available BACKGROUND: Nuclear accumulation of the intracellular domain of epithelial cell adhesion molecule (Ep-ICD in tumor cells was demonstrated to predict poor prognosis in thyroid carcinoma patients in our earlier study. Here, we investigated the clinical significance of Ep-ICD subcellular localization index (ESLI in distinguishing aggressive papillary thyroid carcinoma (PTC from non-aggressive cases. METHODS: Using domain specific antibodies against the intracellular (Ep-ICD and extracellular (EpEx domains of epithelial cell adhesion molecule, 200 archived tissues from a new cohort of patients with benign thyroid disease as well as malignant aggressive and non aggressive PTC were analyzed by immunohistochemistry (IHC. ESLI was defined as sum of the IHC scores for accumulation of nuclear and cytoplasmic Ep-ICD and loss of membranous EpEx; ESLI = [Ep-ICD(nuc + Ep-ICD(cyt + loss of membranous EpEx]. RESULTS: For the benign thyroid tissues, non-aggressive PTC and aggressive PTC, the mean ESLI scores were 4.5, 6.7 and 11 respectively. Immunofluorescence double staining confirmed increased nuclear Ep-ICD accumulation and decreased membrane EpEx expression in aggressive PTC. Receiver-operating characteristic (ROC curve analysis showed an area under the curve (AUC of 0.841, 70.2% sensitivity and 83.9% specificity for nuclear Ep-ICD for differentiating aggressive PTC from non-aggressive PTC. ESLI distinguished aggressive PTC from non-aggressive cases with improved AUC of 0.924, 88.4% sensitivity and 85.5% specificity. Our study confirms nuclear accumulation of Ep-ICD and loss of membranous EpEx occurs in aggressive PTC underscoring the potential of Ep-ICD and ESLI to serve as diagnostic markers for aggressive PTC. Kaplan Meier survival analysis revealed significantly reduced disease free survival (DFS for ESLI positive (cutoff >10 PTC (p<0.05, mean DFS=133 months as compared to 210 months for patients who did not show positive ESLI. CONCLUSION: ESLI

  17. Defibrillation efficacy of a newly developed automated external defibrillator in a swine ventricular tachycardia/fibrillation model%自主研发体外自动除颤器的实验研究

    Institute of Scientific and Technical Information of China (English)

    惠杰; 蒋文平; 谷云飞; 邬小玫; 朱宗成; 宋建平; 杨向军; 刘志华; 蒋廷波; 方祖祥

    2009-01-01

    Objective The aim of this study was to evaluate the recognition and defibrillation efficiency of a newly developed automated extemal defibrillator (AED). Method Ventricular tachycardia (VT) /ventricular fibrillation (VF) was induced by alternating current (50 Hz) through an electrode placed on apex of right ventricle in 23 anesthetized swine and recorded, recognized and defibrillated by a newly developed AED. Results A total of 96 VF was induced and 145 defibrillations were recorded. We analyzed available 167 electrocardiosignal with a total length of 103 740 seconds. The accuracy, sensitivity and the specificity of the AED on VT/VF recognition are 99.5%, 98.2% and 99.6%, respectively. The success rate of defibrillation was 33.4% which increased in proportion to defibrillation energy. The defibrillation threshold of energy is 29.10-116.91 (78.75±35.64 ) J, the defibrillation threshold of electric quantity is (0.11±0.04)C and the defibrillation threshold of voltage is (1216.67±260.87) V. Conclusions This newly developed AED has high sensitivity and the specificity on recognizing VT/VF. The lower success rate of defibrillation of this AED is associated with the low defibrillation energy during defibrillation which needs to be improved on further development.%目的 评价自主设计和研制体外自动除颤器(AED)对室性心动过速(室速)/心室颤动(室颤)识别的敏感性、特异性以及除颤效果.方法 应用交流电刺激实验动物诱发室速/室颤,记录并分析AED对窜速/室颤的识别以及除颤放电的整个过程,评价其诊断识别和除颤性能.结果 诱颤96次,除颤145次,记录心电数据167段次,共计103 740 S.室速/室颤的识别准确性为99.5%,敏感性为98.2%,特异性为99.6%.除颤成功率和除颤能量呈正相关,成功除颤的能量阈值为(78.75±35.64)J,电量阈值为(0.11±0.04)C,电压阈值为(1216.67±260.87)V.结论 自主研制的AED具有较高的识别敏感性和特异性,其识别和

  18. Digoxin therapy and associated clinical outcomes in the MADIT-CRT trial

    DEFF Research Database (Denmark)

    Lee, Andy Y; Kutyifa, Valentina; Ruwald, Martin H;

    2015-01-01

    BACKGROUND: Digoxin's pharmacological, hemodynamic, and electrophysiological properties are well understood. However, in modern heart failure (HF) treatment, its effect has yet to be fully investigated. OBJECTIVE: The aim of the present study was to determine the effects of digoxin on outcomes...... in patients with mild HF implanted with an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy with defibrillator (CRT-D) device. METHODS: We investigated the effect of digoxin treatment on the end points of HF/death, HF alone, death alone, and ventricular tachycardia....... Multivariate Cox proportional hazards regression models were used to determine the effect of time-dependent digoxin usage on the end points. RESULTS: Digoxin therapy was not associated with an increased or decreased risk of HF/death (hazard ratio [HR] 1.07; 95% confidence interval [CI] 0.86-1.33; P = .0...

  19. Discussion on Quality Control of Defibrillator Monitor%除颤监护器质量控制探讨

    Institute of Scientific and Technical Information of China (English)

    朱悦; 尹钢; 廖云粤

    2016-01-01

    In reference to Calibration Specification for Defibrillator Monitor, this paper adopted the Fluke Impluse7000DP Defibrillator Analyzers to conduct quality control to test five parameters of cardiac de-fibrillator monitors in our hospital, including appearance and function, delivered energy, charging time, delay time under synchronizer, and heart rate value. Timely maintenance was carried out on defibrillators with certain problems to ensure the safe use of defibrillators in clinical practice. Meanwhile a compar-ative analysis was conducted on the results of quality control. The research explored a quality control program that was appropriate for defibrillator quality control in the context of clinical experience in the hospital.%本文参照国家对除颤监护器的校准规范,采用Fluke Impluse7000DP除颤器分析仪,对本院的全部除颤监护器进行了外观功能、释放能量准确性、充电时间、同步延时时间、心率示值这5个项目的质控检测,对存在问题的除颤器及时进行维修,保证了除颤器的临床使用安全。同时对质控检测结果进行了比较分析,并结合临床的使用体验,探索适合我院除颤监护器质量控制方案。

  20. ICD-10 and the clinical features of depressions: data of the CIRCADIAN-I program

    Directory of Open Access Journals (Sweden)

    O V Serdyuk

    2011-01-01

    Full Text Available The data of the CIRCADIAN-I trial suggest that depressions are unsatisfactorily diagnosed in psychiatric practice. Thus, some of the ICD-10 diagnoses used to denote depressive states (dysthymia, cyclothymia are made extremely rarely. Only comparatively short-term and reversible vital depressions are considered to be preferred for the categories of affective disorders (F.30-F.33. Any clinical deviations from this clinical presentation (sensitive, anxiety symptoms, a prolonged course, and no well-defined seasonal and circadian rhythms of mood worsening are regarded as a guide for ruling out the diagnosis of affective disorder. At the same time depressive states are classified as schizophrenia, adjustment disorders, etc.

  1. RELIABILITY OF THE ICD-10 INTERNATIONAL PERSONALITY DISORDER EXAMINATION (IPDE) (HINDI VERSION): A PRELIMINARY STUDY

    OpenAIRE

    Sharan, Pratap; Kulhara, P.; Verma, S. K.; Mohanty, Manju

    2002-01-01

    The study was aimed at estimating the joint-rater reliability and applicability of Hindi version of ICD-10 IPDE that was obtained following a standard translation protocol. The instrument was administered to 22 non-psychotic patients by two raters. The average intraclass correlation for each item (0.89), number of criteria met per disorder (0.92) and dimensional scores (0.98) was high. Kappa for definite (0.65-0.78) and probaole personality disorder (PD) (0.78-1.00) and for presence/absence o...

  2. TED-Time and life saving External Defibrillator for home-use.

    Science.gov (United States)

    Weiss, Teddy A; Rosenheck, Shimon; Gorni, Shraga; Katz, Ioni; Mendelbaum, Mendel; Gilon, Dan

    2014-06-01

    Sudden Cardiac Death--SCD --is a major unmet health problem that needs urgent and prompt solution. AICDs are very expensive, risky and indicated for a small group of patients, at the highest risk. AEDs--Automatic External Defibrillators--are designed for public places and although safe, cannot enter the home-market due to their cost and need for constant, high-cost maintenance. We developed TED, a low-cost AED that derives its energy off the mains, designed for home-use, to save SCD victims' lives. PMID:24721586

  3. Is there an Optimal Shape of the Defibrillation Shock: Constant Current vs. Pulsed Biphasic Waveforms

    OpenAIRE

    Ivan Dotsinsky; Tsvetan Mudrov; Vessela Krasteva; Jecho Kostov

    2013-01-01

    Three waveforms for transthoracic defibrillation are assessed and compared: the Pulsed Biphasic Waveform (PBW), the Rectilinear Biphasic Waveform (RBW), and the "lossless" constant current (LLCC) pulses. Two indices are introduced: 1) kf = W/W0 - the ratio between the delivered energy W and the energy W0 of a rectangular pulse with the same duration and electric charge; 2) ηC = W/WC0 - the level of utilizing the initially loaded capacitor energy WC0. The envisioned comparative study shows tha...

  4. Study on the Switching Time-Variation of Simultaneously Controlled IGBT: Case of Defibrillators Design

    Directory of Open Access Journals (Sweden)

    Mudrov T.

    2009-12-01

    Full Text Available Samples of integrated gain bipolar transistors (IGBT of the same type but produced under different technologies were tested about the switching time-variation. This is of high importance when several IGBT are connected in series to commutate high voltage defibrillation shocks. Very often, a short voltage overload of one of the IGBT in group leads to electrical breakdown of all transistors, due to nonsynchronised driving of the gate-emitter circuits. The goal of the study was to check whether compensation of the delays introduced throughout the IGBT control circuits might be efficient despite the own dispersion of the transistor parameters.

  5. Health Care Utilization and Expenditures Associated With Remote Monitoring in Patients With Implantable Cardiac Devices.

    Science.gov (United States)

    Ladapo, Joseph A; Turakhia, Mintu P; Ryan, Michael P; Mollenkopf, Sarah A; Reynolds, Matthew R

    2016-05-01

    Several randomized trials and decision analysis models have found that remote monitoring may reduce health care utilization and expenditures in patients with cardiac implantable electronic devices (CIEDs), compared with in-office monitoring. However, little is known about the generalizability of these findings to unselected populations in clinical practice. To compare health care utilization and expenditures associated with remote monitoring and in-office monitoring in patients with CIEDs, we used Truven Health MarketScan Commercial Claims and Medicare Supplemental Databases. We selected patients newly implanted with an implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy defibrillator (CRT-D), or permanent pacemaker (PPM), in 2009, who had continuous health plan enrollment 2 years after implantation. Generalized linear models and propensity score matching were used to adjust for confounders and estimate differences in health care utilization and expenditures in patients with remote or in-office monitoring. We identified 1,127; 427; and 1,295 pairs of patients with a similar propensity for receiving an ICD, CRT-D, or PPM, respectively. Remotely monitored patients with ICDs experienced fewer emergency department visits resulting in discharge (p = 0.050). Remote monitoring was associated with lower health care expenditures in office visits among patients with PPMs (p = 0.025) and CRT-Ds (p = 0.006) and lower total inpatient and outpatient expenditures in patients with ICDs (p monitoring of patients with CIEDs may be associated with reductions in health care utilization and expenditures compared with exclusive in-office care.

  6. Prevention of infections in cardiovascular implantable electronic devices beyond the antibiotic agent.

    Science.gov (United States)

    De Maria, Elia; Diemberger, Igor; Vassallo, Pier L; Pastore, Monica; Giannotti, Federica; Ronconi, Cinzia; Romandini, Andrea; Biffi, Mauro; Martignani, Cristian; Ziacchi, Matteo; Bonfatti, Federica; Tumietto, Fabio; Viale, Pierluigi; Boriani, Giuseppe

    2014-07-01

    The increase in incidence/prevalence of infections of implantable pacemakers and defibrillators (implantable cardioverter defibrillator, ICD) is outweighing that of the implanting procedures, mainly favored by the changes in patient profile. Despite the high impact on patient's outcome and related costs for healthcare systems, we lack specific evidence on the preventive measures with the exception of antibiotic prophylaxis. The aim of this study is to focus on common approaches to pacemaker/ICD implantation to identify the practical preventive strategies and choices that can (potentially) impact on the occurrence of this feared complication. After a brief introduction on clinical presentation, pathogenesis, and risk factors, we will present the results from a survey on the preventive strategies adopted by different operators from the 25 centers of the Emilia Romagna region in the northern Italy (4.4 million inhabitants). These data will provide the basis for reviewing available literature on this topic and identifying the gray areas. The last part of the article will cover the available evidence about pacemaker/ICD implantation, focusing on prophylaxis of pacemaker/ICD infection as a 'continuum' starting before the surgical procedure (from indications to patient preparation), which follows during (operator, room, and techniques) and after the procedure (patient and device follow-up). We will conclude by evaluating the relationship between adherence to the available evidence and the volume of procedures of the implanting centers or operators' experience according to the results of our survey. PMID:24838036

  7. 基于ICD-10的药用植物种类统计分析%Statistical Analysis of Medicinal Plants Based on ICD-10

    Institute of Scientific and Technical Information of China (English)

    杨林; 卢大丽; 袁万清; 钱津; 熊源新

    2013-01-01

    A total of 4 258 species of medicinal plants in Guizhou Province, are analyzed according to the Tenth Revision of International Classification of Diseases (ICD - 10) in the current investigation. Dominant families, genera, species of medical plants in Guizhou province are carried out statistical analysis. Twenty one families contain more than 50 species play a role in most diseases. The most proportion of dominant family is Polygonaceae. The genera of the most species including Polygonum, Rubus, Rhododendron etc. The most proportion of dominant genera including Asplenium and Selaginella. Among which 21 species including Aristolo-chia debilis, Polygonum chinense, Croton tiglium and Rhodomyrtus tomentosa etc show curative effect for more than 15 diseases.%根据世界卫生组织ICD-10(《国际疾病分类系统》第十次修订本International Classification of Diseases)的分类内容对贵州4258种药用植物进行了统计分析.对其中涉及疾病最多的科、属、种进行了分析;对重要的科、属、种涉及的疾病也进行了分析.含药用植物种数大于50种的有21科,涉及疾病最多、疾病种类比例最高的科是蓼科Polygonaceae.含药用植物种类最多的属包括蓼属(Polygonum)、悬钩子属(Rubus)、杜鹃花属(Rhododendron)等,涉及疾病种类属的比例最高的是铁角蕨属Asplenium和卷柏属Selaginella.能对15种以上的疾病有疗效的药用植物有21种,包括马兜铃Aristolochia debilis、火炭母Polygonum chinense、巴豆Croton tiglium、桃金娘Rhodomyrtus tomentosa等.

  8. Queer diagnoses revisited: The past and future of homosexuality and gender diagnoses in DSM and ICD.

    Science.gov (United States)

    Drescher, Jack

    2015-01-01

    The American Psychiatric Association (APA) recently completed a several year process of revising the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). During that time, there were objections raised to retaining DSM's gender identity disorder diagnoses and calls to remove them, just as homosexuality had been removed from DSM-II in 1973. At the conclusion of the DSM-5 revision process, the gender diagnoses were retained, albeit in altered form and bearing the new name of 'gender dysphoria'. The author of this paper was a member of the DSM-5 Workgroup on Sexual and Gender Identity Disorders and presently serves on the WHO Working Group on Sexual Disorders and Sexual Health. Both groups faced similar tasks: reconciling patients' needs for access to care with the stigma of being given a psychiatric diagnosis. The differing nature of the two diagnostic manuals led to two different outcomes. As background, this paper updates the history of homosexuality and the gender diagnoses in the DSM and in the International Statistical Classification of Diseases and Related Health Problems (ICD) as well as what is expected to happen to the homosexuality and gender diagnoses following the current ICD-11 revision process.

  9. Queer diagnoses revisited: The past and future of homosexuality and gender diagnoses in DSM and ICD.

    Science.gov (United States)

    Drescher, Jack

    2015-01-01

    The American Psychiatric Association (APA) recently completed a several year process of revising the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). During that time, there were objections raised to retaining DSM's gender identity disorder diagnoses and calls to remove them, just as homosexuality had been removed from DSM-II in 1973. At the conclusion of the DSM-5 revision process, the gender diagnoses were retained, albeit in altered form and bearing the new name of 'gender dysphoria'. The author of this paper was a member of the DSM-5 Workgroup on Sexual and Gender Identity Disorders and presently serves on the WHO Working Group on Sexual Disorders and Sexual Health. Both groups faced similar tasks: reconciling patients' needs for access to care with the stigma of being given a psychiatric diagnosis. The differing nature of the two diagnostic manuals led to two different outcomes. As background, this paper updates the history of homosexuality and the gender diagnoses in the DSM and in the International Statistical Classification of Diseases and Related Health Problems (ICD) as well as what is expected to happen to the homosexuality and gender diagnoses following the current ICD-11 revision process. PMID:26242413

  10. ICD 10: "what orthopedic surgeons should know, how it will affect them and the cost of implementation?".

    Science.gov (United States)

    Henley, M Bradford

    2013-09-01

    Orthopedic surgeons will be required to use ICD-10-CM codes for reimbursement and to substantiate the medical necessity for their services beginning October 1, 2014. Implementation of ICD10 will require significant changes in the clinical and administrative processes of orthopedic offices and hospital practices. As in other countries, implementation added costs and resulted in disruptions in physician practices with concomitant decreases in productivity and practice revenue. Through education and planning, orthopedic surgeons can mitigate the anticipated changes and reduce the potential impact these changes will have on their practices. Changes anticipated in the diagnostic part of the ICD10 coding system are reviewed with examples pertinent to orthopedic surgeons. Many will need to improve the accuracy and specificity of their documentation by using anatomically precise nomenclature and obtaining a more detailed history and physical examination. This will require eliciting external causes of patients' problems, the precise activity of causation, and the place of occurrence.

  11. DSM-5 AND ICD-11 DEFINITIONS OF POSTTRAUMATIC STRESS DISORDER: INVESTIGATING “NARROW” AND “BROAD” APPROACHES

    Science.gov (United States)

    Stein, Dan J.; McLaughlin, Katie A.; Koenen, Karestan C.; Atwoli, Lukoye; Friedman, Matthew J.; Hill, Eric D.; Maercker, Andreas; Petukhova, Maria; Shahly, Victoria; van Ommeren, Mark; Alonso, Jordi; Borges, Guilherme; de Girolamo, Giovanni; de Jonge, Peter; Demyttenaere, Koen; Florescu, Silvia; Karam, Elie G.; Kawakami, Norito; Matschinger, Herbert; Okoliyski, Michail; Posada-Villa, Jose; Scott, Kate M.; Viana, Maria Carmen; Kessler, Ronald C.

    2014-01-01

    Background The development of the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) and ICD-11 has led to reconsideration of diagnostic criteria for posttraumatic stress disorder (PTSD). The World Mental Health (WMH) Surveys allow investigation of the implications of the changing criteria compared to DSM-IV and ICD-10. Methods WMH Surveys in 13 countries asked respondents to enumerate all their lifetime traumatic events (TEs) and randomly selected one TE per respondent for PTSD assessment. DSMIV and ICD-10 PTSD were assessed for the 23,936 respondents who reported lifetime TEs in these surveys with the fully structured Composite International Diagnostic Interview (CIDI). DSM-5 and proposed ICD-11 criteria were approximated. Associations of the different criteria sets with indicators of clinical severity (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate the implications of using the different systems. Results A total of 5.6% of respondents met criteria for “broadly defined” PTSD (i.e., full criteria in at least one diagnostic system), with prevalence ranging from 3.0% with DSM-5 to 4.4% with ICD-10. Only one-third of broadly defined cases met criteria in all four systems and another one third in only one system (narrowly defined cases). Between-system differences in indicators of clinical severity suggest that ICD-10 criteria are least strict and DSM-IV criteria most strict. The more striking result, though, is that significantly elevated indicators of clinical significance were found even for narrowly defined cases for each of the four diagnostic systems. Conclusions These results argue for a broad definition of PTSD defined by any one of the different systems to capture all clinically significant cases of PTSD in future studies. PMID:24894802

  12. Prospective Nationwide Fluoroscopic and Electrical Longitudinal Follow-up of Recalled Riata Defibrillator Leads in Denmark

    DEFF Research Database (Denmark)

    Larsen, Jacob M.; Nielsen, Jens C; Johansen, Jens B;

    2014-01-01

    BACKGROUND Recalled St. Jude Medical Riata defibrillator leads are prone to insulation failures with externalized conductors (ECs). Longitudinal studies are needed to guide lead management. OBJECTIVE The purpose of this study was to describe the dynamic nature of EC and the association with elect......BACKGROUND Recalled St. Jude Medical Riata defibrillator leads are prone to insulation failures with externalized conductors (ECs). Longitudinal studies are needed to guide lead management. OBJECTIVE The purpose of this study was to describe the dynamic nature of EC and the association...... with electrical abnormalities and lead extraction outcomes. METHODS A nationwide cohort established in 2012 of 295 patients with recalled Riata leads with dwell time 5.1 +/- 1.1 years, 34 ECs, and 19 electrical abnormalities were followed until death, lead discontinuation with fluoroscopy, or a new 2013 screening......-up in 27 patients with baseline EC showed an increase in EC length of 4 +/- 1 mm (P Electrical follow-up in 276 patients with normal baseline electrical function demonstrated 20 incident electrical abnormalities after 1.0 +/- 0.3 years, with an incidence rate of 7.1 per 100...

  13. Is there an Optimal Shape of the Defibrillation Shock: Constant Current vs. Pulsed Biphasic Waveforms

    Directory of Open Access Journals (Sweden)

    Ivan Dotsinsky

    2013-04-01

    Full Text Available Three waveforms for transthoracic defibrillation are assessed and compared: the Pulsed Biphasic Waveform (PBW, the Rectilinear Biphasic Waveform (RBW, and the "lossless" constant current (LLCC pulses. Two indices are introduced: 1 kf = W/W0 - the ratio between the delivered energy W and the energy W0 of a rectangular pulse with the same duration and electric charge; 2 ηC = W/WC0 - the level of utilizing the initially loaded capacitor energy WC0. The envisioned comparative study shows that ηC index is favorable for both PBW and LLCC, while kf of both RBW and LLCC demonstrates advantage over the PBW in the range of small inter-electrode thoracic impedances below 80 Ω. Some design considerations are also discussed. The attractive LLCC concept needs large and heavy inductive coil to support the constant current amplitude, besides it is capable to induce strong electromagnetic influences due to the complex current control. The RBW technology controls the delivery of current through a series of internal resistors which are, however, a source of high heat losses. The PBW implements controlled duty cycle of high-frequency chopped pulses to adapt the energy delivery in respect of the patient impedance measured at the beginning of the shock. PBW technology makes use of small capacitors which allows the construction of light weight and small-size portable devices for transthoracic defibrillation.

  14. Idiopathic Intractable Diarrhoea Leading to Torsade de Pointes.

    Science.gov (United States)

    Mouyis, Kyriacos; Okonko, Darlington; Missouris, Constantinos G

    2016-01-01

    An 81-year-old lady was admitted to our hospital with a 3-year history of noninfective diarrhoea and recurrent syncopal events over the last 3 months. Her initial electrocardiogram (ECG) revealed trigeminy and prolonged QTc interval. She had a structurally normal heart with no coronary artery disease. Investigations revealed low potassium at 3.0 mmol/L. Sigmoidoscopy and colonoscopy suggested a possible diagnosis of diverticulitis. Soon after admission she had an unresponsive episode with spontaneous recovery. Telemetry and Holter analysis confirmed multiple episodes of polymorphic ventricular tachycardia (Torsade de Pointes). Following electrolyte supplementation the episodes of polymorphic VT improved. Due to the protracted nature of the diarrhoea, the recurrent syncopal events, and recurrent hypokalaemia documented over recent years, an Implantable Cardioverter Defibrillator (ICD) was sanctioned by the multidisciplinary team (MDT). In summary, chronic diarrhoea may result in life threatening polymorphic VT due to hypokalaemia and QTc prolongation. In these patients an ICD may be considered. PMID:27313906

  15. Candida and cardiovascular implantable electronic devices: a case of lead and native aortic valve endocarditis and literature review.

    Science.gov (United States)

    Glavis-Bloom, Justin; Vasher, Scott; Marmor, Meghan; Fine, Antonella B; Chan, Philip A; Tashima, Karen T; Lonks, John R; Kojic, Erna M

    2015-11-01

    Use of cardiovascular implantable electronic devices (CIED), including permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD), has increased dramatically over the past two decades. Most CIED infections are caused by staphylococci. Fungal causes are rare and their prognosis is poor. To our knowledge, there has not been a previously reported case of multifocal Candida endocarditis involving both a native left-sided heart valve and a CIED lead. Here, we report the case of a 70-year-old patient who presented with nausea, vomiting, and generalised fatigue, and was found to have Candida glabrata endocarditis involving both a native aortic valve and right atrial ICD lead. We review the literature and summarise four additional cases of CIED-associated Candida endocarditis published from 2009 to 2014, updating a previously published review of cases prior to 2009. We additionally review treatment guidelines and discuss management of CIED-associated Candida endocarditis. PMID:26403965

  16. Primary cardiac lymphoma: diagnostic tools and treatment challenges.

    LENUS (Irish Health Repository)

    Bambury, R

    2011-03-01

    Primary cardiac lymphoma (PCL) is a rare malignancy and the optimal treatment strategy remains uncertain. It appears to respond much better to systemic chemotherapy than to surgery and it should be considered in the differential diagnosis of all cardiac tumours before definitive management is undertaken. We report a case of this rare disorder treated successfully with a combination of rituximab and cyclophosphamide, adriamycin, vincristine and prednisolone. The patient developed recurrent unstable ventricular tachycardia (VT) post-chemotherapy secondary to extensive scarring at the tumour site. The tumour as well as the post-treatment scarring is well illustrated by cardiac magnetic resonance imaging highlighting its usefulness in this setting. An implantable cardioverter defibrillator (ICD) was placed. This is only the second case in the literature of PCL to have an ICD placed for recurrent VT. A brief literature review is included.

  17. High-dose daptomycin and fosfomycin treatment of a patient with endocarditis caused by daptomycin-nonsusceptible Staphylococcus aureus: Case report

    Directory of Open Access Journals (Sweden)

    Hsiao Chen-Yuan

    2011-05-01

    Full Text Available Abstract Background Emergence of daptomycin-nonsusceptible (DNS Staphylococcus aureus is a dreadful problem in the treatment of endocarditis. Few current therapeutic agents are effective for treating infections caused by DNS S. aureus. Case presentation We describe the emergence of DNS S. aureus. in a patient with implantable cardioverter-defibrillator (ICD device -related endocarditis who was priorily treated with daptomycin. Metastatic dissemination as osteomyelitis further complicated the management of endocarditis. The dilemma was successfully managed by surgical removal of the ICD device and combination antimicrobial therapy with high-dose daptomycin and fosfomycin. Conclusions Surgical removal of intracardiac devices remains an important adjunctive measure in the treatment of endocarditis. Our case suggests that combination therapy is more favorable than single-agent therapy for infections caused by DNS S. aureus.

  18. Candida and cardiovascular implantable electronic devices: a case of lead and native aortic valve endocarditis and literature review.

    Science.gov (United States)

    Glavis-Bloom, Justin; Vasher, Scott; Marmor, Meghan; Fine, Antonella B; Chan, Philip A; Tashima, Karen T; Lonks, John R; Kojic, Erna M

    2015-11-01

    Use of cardiovascular implantable electronic devices (CIED), including permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD), has increased dramatically over the past two decades. Most CIED infections are caused by staphylococci. Fungal causes are rare and their prognosis is poor. To our knowledge, there has not been a previously reported case of multifocal Candida endocarditis involving both a native left-sided heart valve and a CIED lead. Here, we report the case of a 70-year-old patient who presented with nausea, vomiting, and generalised fatigue, and was found to have Candida glabrata endocarditis involving both a native aortic valve and right atrial ICD lead. We review the literature and summarise four additional cases of CIED-associated Candida endocarditis published from 2009 to 2014, updating a previously published review of cases prior to 2009. We additionally review treatment guidelines and discuss management of CIED-associated Candida endocarditis.

  19. The prognosis of implantable defibrillator patients treated with cardiac resynchronization therapy: Comorbidity burden as predictor of mortality

    NARCIS (Netherlands)

    D.A.M.J. Theuns (Dominic); B. Schaer (Beat); O.I.I. Soliman (Osama Ibrahim Ibrahim); D. Altmann (David); C. Sticherling (Christian); M.L. Geleijnse (Marcel); S. Osswald (Stefan); L.J.L.M. Jordaens (Luc)

    2011-01-01

    textabstractAimsComorbidity, such as myocardial infarction, diabetes, and renal failure, plays a pivotal role in the prognosis of a patient with arrhythmias. However, data on the prognostic impact of comorbiditiy in heart failure patients with cardiac resynchronization therapy and defibrillation (CR

  20. Subclavian Vein Stenosis/Occlusion Following Transvenous Cardiac Pacemaker and Defibrillator Implantation: Incidence, Pathophysiology and Current Management

    Directory of Open Access Journals (Sweden)

    Brian O'Leary

    2015-08-01

    Full Text Available Subclavian vein stenosis is a common, but usually asymptomatic, complication following cardiac device placement. In addition to reviewing the literature on incidence, pathogenesis and management options for this important clinical problem, we describe two cases of symptomatic subclavian vein occlusion following pacemaker/defibrillator placement and successful treatment with venoplasty and stenting.