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Sample records for cardioverter defibrillator placement

  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. 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 ...

  5. 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 ...

  6. [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

  7. 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

  8. 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...

  9. 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...

  10. 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

  11. 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.

  12. 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....

  13. 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

  14. 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...

  15. 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.

  16. 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.

  17. 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...

  18. 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...

  19. 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....

  20. 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....

  1. 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...

  2. 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.

  3. 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.

  4. 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.

  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. 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. [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

  8. 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...

  9. 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....

  10. 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...

  11. 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....

  12. 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...

  13. 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

  14. 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

  15. 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

  16. 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 ...

  17. 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...

  18. 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...

  19. 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 ...

  20. 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...

  1. 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...

  2. 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

  3. 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

  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. 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...

  8. 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.

  9. 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...

  10. 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...

  11. 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

  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. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. 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.

  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. 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

  4. 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...

  5. 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

  6. 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.

  7. 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...

  8. 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...

  9. 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.

  10. 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...

  11. 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...

  12. 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....

  13. 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.

  14. 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

  15. 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...

  16. 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...

  17. 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....

  18. 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....

  19. 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...

  20. 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.

  1. 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.

  2. 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...

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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.

  9. 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.

  10. 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...

  11. 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.

  12. 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.

  13. 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.

  14. 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...

  15. 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.

  16. 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

  17. 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

  18. 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...

  19. 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

  20. 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...

  1. 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...

  2. 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

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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....

  8. 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....

  9. 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.

  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. 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.

  12. 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 ...

  13. 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.

  14. 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.

  15. 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

  16. 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

  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. 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

  19. 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

  20. 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.

  1. 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.

  2. 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

  3. 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.

  4. 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)

  5. 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

  6. 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

  7. 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...

  8. 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.

  9. 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...

  10. 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.

  11. 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.

  12. 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

  13. 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

  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. 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.

  16. 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.)

  17. 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, ...

  18. 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.

  19. 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

  20. 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

  1. 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.

  2. 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.

  3. 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

  4. 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

  5. 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

  6. 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.

  7. 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

  8. 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

  9. 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....

  10. 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.

  11. 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...

  12. 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

  13. 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 ...

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. 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

  19. 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...

  20. 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.

  1. 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.

  2. 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.

  3. 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

  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. [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. 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

  7. 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。

  8. 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....

  9. 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...

  10. 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.

  11. 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.

  12. 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.

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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...

  18. 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 ...

  19. 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 ...

  20. 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.

  1. 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...

  2. 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...

  3. 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

  4. Use of Automated External Defibrillators

    Energy Technology Data Exchange (ETDEWEB)

    Gregory K Christensen

    2009-02-01

    " American Heart Association] Early intervention with both CPR and defibrillation can result in high long-term survival rates for SCA, as demonstrated by a study investigating the beneficial effects of AED devices at Chicago’s O’Hare and Midway airports. The American Medical Association (AMA) advocates the widespread placement of AEDs [AMA Res. 413, A-02; Res. 424, A-04]; supports increasing government and industry funding for the purchase of AED devices; and encourages the American public to become trained in CPR and the use of AEDs. Some states, including Maryland, have enacted legislation requiring AED devices and a certified responder be available at high school and school-sponsored athletic events due the risk of SCA to athletes (the most common cause of death in young athletes). Ensuring AED availability at Department of Energy (DOE) sites would serve as a means of preventative intervention for over 14,000 DOE employees and 193,000 contract workers. It is estimated 1 per 1,000 adults 35 years of age and older will experience SCA in a given year.

  5. 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.

  6. 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

  7. 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

  8. 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

  9. 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...

  10. 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

  11. 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

  12. 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...

  13. 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.

  14. 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.

  15. 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

  16. 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)

  17. 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...

  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. Implantation of dual chamber pacemaker defibrillator and placement of endocardial leads via the axillary vein%置入双腔起搏心脏复律除颤器及经腋静脉送入心内电极的初步临床体会

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    目的初步评价新型双腔起搏心脏复律除颤器抗室性心动过速/室颤(VT/VF)及心动过缓起搏的临床效果,了解经腋静脉送入心房及心室电极的安全性及有效性。 方法 7例室性心动过速及或室颤同时伴有心动过缓患者接受了双腔起搏心脏复律除颤器治疗,其中冠心病5例、扩张性心肌病2例。心房及心室电极均在X光线透视、静脉注入造影剂指导下,直接穿刺腋静脉,从该静脉送入。 结果脉冲发生器埋在左上胸皮下5例,胸大肌与胸小肌之间2例。仪器对所有VT/VF均能及时识别并成功治疗,同时提供有效的房室顺序起搏功能。所有心内电极均成功地经腋静脉送入,无并发症。 结论双腔起搏心脏复律除颤器不但能有效地治疗严重室性心律失常,而且能提供可靠的房室顺序性起搏功能,且经腋静脉送入电极安全,可靠。%Objectives To assess the preliminary clinical results of implantation of dual chamber pacemaker defibrillator and to evaluate the safety and effectiveness of placement of endocardial leads in the axillary vein. Methods Seven patients with ventricular tachycardia and/or ventricular fibrillation (VT/VF), associated with bradyarrhythmia received implantation of a dual chamber pacemaker defibrillator, including 5 patients with coronary artery disease and 2 patients with dilated cardiomyopathy.The atrial and ventricular leads were introduced via the axillary vein under venographic guidance. Results Dual chamber pacemaker defibrillators were successfully implanted in the left chest subcutaneous pocket in 5 patients and the left pectoral muscular pocket in 2 patients. All the VT/VF occurring either inducibly during the procedure or spontanuously during follow-up were detected promptly and treated successfully. Both the pacing and sensing functions were satisfactory. The endocardial leads required were successfully introduced via the axillary vein

  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.

  1. 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

  2. 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...

  3. 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...

  4. 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.

  5. 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 ...

  6. 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.

  7. 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....

  8. 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...

  9. 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 ...

  10. 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....

  11. 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....

  12. 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.

  13. 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- ...

  14. 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...

  15. Pathogenesis of sudden unexpected death in a clinical trial of patients with myocardial infarction and left ventricular dysfunction, heart failure, or both

    DEFF Research Database (Denmark)

    Pouleur, Anne-Catherine; Barkoudah, Ebrahim; Uno, Hajime;

    2010-01-01

    The frequency of sudden unexpected death is highest in the early post-myocardial infarction (MI) period; nevertheless, 2 recent trials showed no improvement in mortality with early placement of an implantable cardioverter-defibrillator after MI....

  16. 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

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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

  2. Product placement

    OpenAIRE

    Šafaříková, Kateřina

    2012-01-01

    This work focuses on the impact of product placement on children and comparison of attitudes towards its use in audiovisual works intended for children. The theoretical part describes the basic advertising and influencing what resources used, then it is defined by the influence of advertising on children. This issue is examined from the perspective of marketers and general ethical aspects. Product placement is a separate chapter in the theoretical part, starting with its definition, the d...

  3. 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

  4. 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...

  5. 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...

  6. 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....

  7. 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.

  8. 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...

  9. 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).

  10. 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...

  11. 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.)

  12. 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.

  13. 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.

  14. Effects of introducing a voluntary virtual patient module to a basic life support with an automated external defibrillator course: a randomised trial

    OpenAIRE

    Kononowicz Andrzej A; Krawczyk Paweł; Cebula Grzegorz; Dembkowska Marta; Drab Edyta; Frączek Bartosz; Stachoń Aleksandra J; Andres Janusz

    2012-01-01

    Abstract Background The concept of virtual patients (VPs) encompasses a great variety of predominantly case-based e-learning modules with different complexity and fidelity levels. Methods for effective placement of VPs in the process of medical education are sought. The aim of this study was to determine whether the introduction of a voluntary virtual patients module into a basic life support with an automated external defibrillator (BLS-AED) course improved the knowledge and skills of studen...

  15. 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.

  16. 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....

  17. 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.

  18. 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.

  19. [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.

  20. 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...

  1. Sediment Placement Areas 2012

    Data.gov (United States)

    California Department of Resources — Dredge material placement sites (DMPS), including active, inactive, proposed and historical placement sites. Dataset covers US Army Corps of Engineers San Francisco...

  2. 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...

  3. 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 ...

  4. 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.

  5. 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.

  6. 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.

  7. 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...

  8. 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

  9. 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...

  10. 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

  11. 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.

  12. 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...

  13. 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

  14. 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.

  15. 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...

  16. 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

  17. 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.

  18. 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.

  19. Math Sense: Placement Test.

    Science.gov (United States)

    2003

    Math Sense consists of five books that develop from basic to more advanced math skills. This document contains a placement test used with Math Sense to help students and their teachers decide into which Math Sense book to begin working. The placement test is divided into six parts, each consisting of 10 to 22 problems, and is based on exit skill…

  20. 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...

  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. Whither Advanced Placement?

    Directory of Open Access Journals (Sweden)

    William Lichten

    2000-06-01

    Full Text Available This is a review of the Advanced Placement (AP Program. In disagreement with claims of the College Board, there is firm evidence that the average test performance level has dropped. The College Board's scale and claims for AP qualification disagree seriously with college standards. A majority of tests taken do not qualify. It appears that "advanced placement" is coming closer to "placement." This article recommends that the College Board's policy of concentrating on numbers of participants should be changed to an emphasis on student performance and program quality.

  7. 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...

  8. 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,

  9. 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...

  10. 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...

  11. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available Coronary Angioplasty Stent Placement Shawnee Mission Heart & Vascular Center, Shawnee Mission, Kansas February 19, 2009 Welcome to this OR-Live westbound cast presentation, live from Shawnee Mission Medical Center ...

  12. Product placement in the czech film Revival

    OpenAIRE

    Lísková, Gabriela

    2013-01-01

    Marketing and commertial communication and position of product placement within it, legislature governing product placement and its aplication, history of product placement, forms of product placement, aplication of product placement in the czech film Revival

  13. 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.

  14. Product Placement in Cartoons

    Directory of Open Access Journals (Sweden)

    Irena Oroz Štancl

    2014-06-01

    Full Text Available Product placement is a marketing approach for integrating products or services into selected media content. Studies have shown that the impact of advertising on children and youth are large, and that it can affect their preferences and attitudes. The aim of this article is to determine the existing level of product placement in cartoons that are broadcast on Croatian television stations. Content analysis of cartoons in a period of one month gave the following results: in 30% of cartoons product placement was found; most product placement were visual ads, in 89%, however, auditory product placement and plot connection was also found. Most ads were related to toys and it is significant that even 65% of cartoons are accompanied by a large amount of products available on the Croatian market. This is the result of two sales strategies: brand licensing (selling popular cartoon characters to toys, food or clothing companies and cartoon production based on existing line of toys with the sole aim of making their sales more effective.

  15. Aerator Placement Strategies

    Science.gov (United States)

    The purpose of this study was to determine the effects on fish production, water quality and economics of concentrating paddlewheel aeration in large commercial ponds, compared to the current method of aerator placement. Ten 17-acre ponds (approximately 600 X 1300 ft) were brought into the study in ...

  16. Course Placement Study.

    Science.gov (United States)

    Fredericksen, Marlene; Slark, Julie

    Following the implementation of a matriculation plan at Rancho Santiago College (RSC), a study was conducted to examine the appropriateness of student course placement as assessed by faculty and students and to investigate faculty's perceptions of changes in students' skill level preparation over the past few years. Questionnaires were completed…

  17. Product placement werkt, ook onbewust

    NARCIS (Netherlands)

    Roelofs, G.H.M.; Ketelaar, P.E.; Gisbergen, M.S. van

    2008-01-01

    Product placement is een goed alternatief voor televisiecommercials. Consumenten waarderen product placement beter en ze vertonen nauwelijks reclamevermijdend gedrag. En: consumenten blijken geadverteerde merken goed te onthouden, zo blijkt uit onderzoek van de Radboud Universiteit Nijmegen in samen

  18. 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.

  19. 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.

  20. 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.

  1. 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...

  2. Advances in Pediatric Gastrostomy Placement.

    Science.gov (United States)

    McSweeney, Maireade E; Smithers, C Jason

    2016-01-01

    Placement of gastrostomy tubes in infants and children has become increasingly commonplace. A historical emphasis on use of open gastrostomy has been replaced by less invasive methods of placement, including percutaneous endoscopic gastrostomy and laparoscopically assisted gastrostomy procedures. Various complications, ranging from minor to the more severe, have been reported with all methods of placement. Many pediatric patients who undergo gastrostomy tube placement will require long-term enteral therapy. Given the prolonged time pediatric patients may remain enterally dependent, further quality improvement and education initiatives are needed to improve long-term care and outcomes of these patients.

  3. [Developmental Placement.] Collected Research References.

    Science.gov (United States)

    Bjorklund, Gail

    Drawing on information and references in the ERIC system, this literature review describes research related to a child's developmental placement. The issues examined include school entrance age; predictive validity, reliability, and features of Gesell School Readiness Assessment; retention; and the effectiveness of developmental placement. A…

  4. Product Placement and Brand Equity

    OpenAIRE

    Margherita Corniani

    2001-01-01

    Product placement is the planned insertion of a brand within a movie, a fiction, etc. It can be used with other communication tools (i.e. advertising, sales promotions, etc.) in order to disseminate brand awareness and characterize brand image, developing brand equity. In global markets, product placement is particularly useful for improving brand equity of brands with a well established brand awareness.

  5. 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.

  6. 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。

  7. 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

  8. Chest pain associated with moderator band pacing.

    Science.gov (United States)

    Goli, Anil K; Kaszala, Karoly; Osman, Mohammed N; Lucke, John; Carrillo, Roger

    2014-10-01

    A 65-year-old man was evaluated for chronic chest pain that had been present for 8 years after placement of a dual-chamber implantable cardioverter-defibrillator to treat inducible ventricular tachycardia. Previous coronary angiography had revealed nonobstructive coronary artery disease and a left ventricular ejection fraction of 0.45 to 0.50, consistent with mild idiopathic nonischemic cardiomyopathy. Evaluation with chest radiography and transthoracic echocardiography showed the implantable cardioverter-defibrillator lead to be embedded within the right ventricle at the moderator band, which had mild calcification. Treatment included extraction of the dual-coil lead and placement of a new single-coil right ventricular lead at the mid septum. The patient had complete relief of symptoms after the procedure. This case shows that chest pain can be associated with the placement of a right ventricular implantable cardioverter-defibrillator lead in the moderator band and that symptomatic relief can occur after percutaneous lead extraction and the implantation of a new right ventricular lead to the mid septal region.

  9. 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...

  10. 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.

  11. 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

  12. 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...

  13. 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...

  14. 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.

  15. Extension for prevention: margin placement.

    Science.gov (United States)

    Larson, Thomas D

    2012-01-01

    This article will review the concept of extension for prevention popularized by G.V. Black around the early 1900s. Concepts of extension and prevention have changed over the years with a more informed knowledge of the caries process, improved materials, cutting instruments, and techniques. The reasons for placement of the outline form relative to the tooth morphology, gingival tissue, relationship to adjacent teeth, and the choice of material will be described for all of the materials used in restorative dentistry. Research will be cited to support the scientific basis for outline form placement. PMID:22662468

  16. Optimal obstacle placement with disambiguations

    OpenAIRE

    Ceyhan, Elvan; Aksakalli, Vural

    2012-01-01

    arXiv:1201.5076v3 [stat.AP] 14 Jan 2013 The Annals of Applied Statistics 2012, Vol. 6, No. 4, 1730–1774 DOI: 10.1214/12-AOAS556 c Institute of Mathematical Statistics, 2012 OPTIMAL OBSTACLE PLACEMENT WITH DISAMBIGUATIONS By Vural Aksakalli and Elvan Ceyhan Istanbul S¸ehir University and Ko¸c University We introduce the optimal obstacle placement with disambigua-tions problem wherein the goal is to place true obstacles in an en-vironment cluttered with false obst...

  17. 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

  18. 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

  19. Familial placement of Wightia (Lamiales)

    DEFF Research Database (Denmark)

    Zhou, Qing-Mei; Jensen, Søren Rosendal; Liu, Guo-Li;

    2014-01-01

    The familial placement of Wightia has long been a problem. Here, we present a comprehensive phylogenetic inspection of Wightia based on noncoding chloroplast loci (the rps16 intron and the trnL–F region) and nuclear ribosomal internal transcribed spacer, and on chemical analysis. A total of 70...

  20. When Placement People Are Displaced.

    Science.gov (United States)

    Ehrlich, Marianne

    1991-01-01

    Describes the experiences and insights of five laid-off placement people who discover the trauma of job loss. Discusses grieving a job loss, the emotions involved, the challenge of finding a new job, guilt faced by survivors, and advice to colleagues. (NB)

  1. The Placement Professional as Marketeer.

    Science.gov (United States)

    Walz, Garry R.

    1988-01-01

    Discusses resistance of helping professions to marketing. Defines human services marketing. Describes forces that are placing human services in an increasingly competitive position. Makes recommendations to enhance the image of career planning and placement services and increase their usage. Concludes that by adopting a marketeer orientation,…

  2. PRODUCT PLACEMENT IN BRAND PROMOTION

    Directory of Open Access Journals (Sweden)

    Alicja Mikołajczyk

    2015-06-01

    Full Text Available Product placement can have a significant impact on brand awareness and customer purchasing decisions. The article discusses techniques applied in the mass media against the EU legal background and the opportunities it offers in reaching the target audience.

  3. 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...

  4. Advanced Placement: More than a Test.

    Science.gov (United States)

    Colwell, Richard

    1990-01-01

    Encourages music teachers to work with students interested in advanced placement (AP) music courses. Discusses the logistics and advantages of placing students in these courses. Describes the Advanced Placement Listening and Literature and the Advanced Placement Theory courses and examinations. Outlines the examination scoring method and looks at…

  5. Mathematics Placement at the University of Illinois

    Science.gov (United States)

    Ahlgren Reddy, Alison; Harper, Marc

    2013-01-01

    Data from the ALEKS-based placement program at the University of Illinois is presented visually in several ways. The placement exam (an ALEKS assessment) contains precise item-specific information and the data show many interesting properties of the student populations of the placement courses, which include Precalculus, Calculus, and Business…

  6. 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...

  7. 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...

  8. Product placement and its aplication in foreign film

    OpenAIRE

    Vaněk, Tomáš

    2010-01-01

    Marketing and commertial communication and position of product placement within it, legislature governing product placement and its aplication, history of product placement, forms of product placement, use of product placement within marketing campaign, aplication of product placement in movie Casino Royale.

  9. Termination Issues in Residential Placement

    OpenAIRE

    Mann-Feder, Varda

    2003-01-01

    The termination phase of residential child care placement has a powerful effect on postplacement adjustment. This article reviews relevant literature from a range of helping/caring professions and outlines implications for managing termination with children and youth in care. Major themes are: termination elicits ambivalence and can manifest as behavioural regression; intervention during the termination phase can have significant impact; and the capacity of child and youth care workers to ...

  10. 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

  11. 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...

  12. 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- ...

  13. 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)....

  14. 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 measure the QoL and the results were compared to healthy population. The expectative of freedom from ICD therapies were estimated by the Kaplan-Meier method. RESULTS: After 2.6±1.8 years follow-up, 8 (27.6% patients received 141 appropriate ICD shocks due to ventricular tachycardia (6 or ventricular fibrillation (2, and 11 (37.9% patients received 152 inappropriate ICD shocks due to supraventricular tachyarrhythmias (8 or oversensing (3. Expectative of freedom from appropriate shocks was 74.2±9.0% and 66.7±10.7% after one and three years, respectively. Compared to healthy population, QoL decreased in physical function (61.7±28.7, vitality (64.7±19.1, mental health (65.9±22.7 and role-emotional domains (66.7±38.5. All patients referred fear and concern related to ICD use. CONCLUSION: Despite the efficacy of ICD therapies, the high incidence of appropriate and inappropriate shocks interfered in patients’ QoL and adaptation to the device.

  15. 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...

  16. 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。

  17. 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...

  18. 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

  19. The Forms and Analysis of Product Placement

    OpenAIRE

    Hlaváček, Josef

    2014-01-01

    The aim of this thesis is to describe marketing communication and product placement in the theoretical part, consequently analyze examples of product placement from the practice and last but not least also analyze the perception and examples of product placement based on the survey research. Therefore the thesis is divided into three main parts. The first, theoretical part, describes the marketing mix, concept of communication, communication mix, new forms of communication, integrated marketi...

  20. 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。

  1. Service placement in ad hoc networks

    CERN Document Server

    Wittenburg, Georg

    2012-01-01

    Service provisioning in ad hoc networks is challenging given the difficulties of communicating over a wireless channel and the potential heterogeneity and mobility of the devices that form the network. Service placement is the process of selecting an optimal set of nodes to host the implementation of a service in light of a given service demand and network topology. The key advantage of active service placement in ad hoc networks is that it allows for the service configuration to be adapted continuously at run time. ""Service Placement in Ad Hoc Networks"" proposes the SPi service placement fr

  2. Product placement of computer games in cyberspace.

    Science.gov (United States)

    Yang, Heng-Li; Wang, Cheng-Shu

    2008-08-01

    Computer games are considered an emerging media and are even regarded as an advertising channel. By a three-phase experiment, this study investigated the advertising effectiveness of computer games for different product placement forms, product types, and their combinations. As the statistical results revealed, computer games are appropriate for placement advertising. Additionally, different product types and placement forms produced different advertising effectiveness. Optimum combinations of product types and placement forms existed. An advertisement design model is proposed for use in game design environments. Some suggestions are given for advertisers and game companies respectively. PMID:18721087

  3. Product placement of computer games in cyberspace.

    Science.gov (United States)

    Yang, Heng-Li; Wang, Cheng-Shu

    2008-08-01

    Computer games are considered an emerging media and are even regarded as an advertising channel. By a three-phase experiment, this study investigated the advertising effectiveness of computer games for different product placement forms, product types, and their combinations. As the statistical results revealed, computer games are appropriate for placement advertising. Additionally, different product types and placement forms produced different advertising effectiveness. Optimum combinations of product types and placement forms existed. An advertisement design model is proposed for use in game design environments. Some suggestions are given for advertisers and game companies respectively.

  4. 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

  5. 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...

  6. 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.

  7. 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

  8. 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.

  9. 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,

  10. Private Placement Debt Financing for Public Entities

    Science.gov (United States)

    Holman, Lance S.

    2010-01-01

    Private placement financing is a debt or capital lease obligation arranged between a municipality or a 501(c) (3) not-for-profit organization and a single sophisticated institutional investor. The investor can be a bank, insurance company, finance company, hedge fund, or high-net worth individual. Private placement financing is similar to…

  11. Internship guide : Work placements step by step

    NARCIS (Netherlands)

    Haag, Esther

    2013-01-01

    Internship Guide: Work Placements Step by Step has been written from the practical perspective of a placement coordinator. This book addresses the following questions : what problems do students encounter when they start thinking about the jobs their degree programme prepares them for? How do you fi

  12. 20 CFR 801.103 - Organizational placement.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Organizational placement. 801.103 Section 801... BOARD Establishment and Authority of the Board § 801.103 Organizational placement. As prescribed by the... Administration in the Department of Labor. It is accordingly found appropriate for organizational purposes...

  13. Effects of introducing a voluntary virtual patient module to a basic life support with an automated external defibrillator course: a randomised trial

    Directory of Open Access Journals (Sweden)

    Kononowicz Andrzej A

    2012-06-01

    Full Text Available Abstract Background The concept of virtual patients (VPs encompasses a great variety of predominantly case-based e-learning modules with different complexity and fidelity levels. Methods for effective placement of VPs in the process of medical education are sought. The aim of this study was to determine whether the introduction of a voluntary virtual patients module into a basic life support with an automated external defibrillator (BLS-AED course improved the knowledge and skills of students taking the course. Methods Half of the students were randomly assigned to an experimental group and given voluntary access to a virtual patient module consisting of six cases presenting BLS-AED knowledge and skills. Pre- and post-course knowledge tests and skills assessments were performed, as well as a survey of students' satisfaction with the VP usage. In addition, time spent using the virtual patient system, percentage of screen cards viewed and scores in the formative questions in the VP system throughout the course were traced and recorded. Results The study was conducted over a six week period and involved 226 first year medical students. The voluntary module was used by 61 (54% of the 114 entitled study participants. The group that used VPs demonstrated better results in knowledge acquisition and in some key BLS-AED action skills than the group without access, or those students from the experimental group deliberately not using virtual patients. Most of the students rated the combination of VPs and corresponding teaching events positively. Conclusions The overall positive reaction of students and encouraging results in knowledge and skills acquisition suggest that the usage of virtual patients in a BLS-AED course on a voluntary basis is feasible and should be further investigated.

  14. Genetic Algorithm Approaches for Actuator Placement

    Science.gov (United States)

    Crossley, William A.

    2000-01-01

    This research investigated genetic algorithm approaches for smart actuator placement to provide aircraft maneuverability without requiring hinged flaps or other control surfaces. The effort supported goals of the Multidisciplinary Design Optimization focus efforts in NASA's Aircraft au program. This work helped to properly identify various aspects of the genetic algorithm operators and parameters that allow for placement of discrete control actuators/effectors. An improved problem definition, including better definition of the objective function and constraints, resulted from this research effort. The work conducted for this research used a geometrically simple wing model; however, an increasing number of potential actuator placement locations were incorporated to illustrate the ability of the GA to determine promising actuator placement arrangements. This effort's major result is a useful genetic algorithm-based approach to assist in the discrete actuator/effector placement problem.

  15. A method to locate electrode placement.

    Science.gov (United States)

    Brodnick, D

    2000-01-01

    A new method uses redundancy in the 12-lead electrocardiogram (ECG) to determine the angles to all of the electrodes used to record the ECG. No other transducers or signals are needed. The method, a matrix manipulation of the standard 12-lead, would be applicable to all existing ECGs already stored on hospital systems. The invention of this method was originally motivated by the slight differences seen between ECGs acquired by the standard resting electrode placement versus those acquired in a monitoring or exercise placement. An ECG signal is acquired in multiple channels. A covariance matrix is formed. From the eigenvector solution of the matrix, the angles between the eigenvectors and the original signal vectors are determined. The angles calculated for any ECG test are compared to reference angles to determine whether the electrodes are placed in the standard ECG electrode placement, an alternative electrode placement, or an incorrect electrode placement.

  16. Artificial Intelligence based technique for BTS placement

    Science.gov (United States)

    Alenoghena, C. O.; Emagbetere, J. O.; Aibinu, A. M.

    2013-12-01

    The increase of the base transceiver station (BTS) in most urban areas can be traced to the drive by network providers to meet demand for coverage and capacity. In traditional network planning, the final decision of BTS placement is taken by a team of radio planners, this decision is not fool proof against regulatory requirements. In this paper, an intelligent based algorithm for optimal BTS site placement has been proposed. The proposed technique takes into consideration neighbour and regulation considerations objectively while determining cell site. The application will lead to a quantitatively unbiased evaluated decision making process in BTS placement. An experimental data of a 2km by 3km territory was simulated for testing the new algorithm, results obtained show a 100% performance of the neighbour constrained algorithm in BTS placement optimization. Results on the application of GA with neighbourhood constraint indicate that the choices of location can be unbiased and optimization of facility placement for network design can be carried out.

  17. Artificial Intelligence based technique for BTS placement

    International Nuclear Information System (INIS)

    The increase of the base transceiver station (BTS) in most urban areas can be traced to the drive by network providers to meet demand for coverage and capacity. In traditional network planning, the final decision of BTS placement is taken by a team of radio planners, this decision is not fool proof against regulatory requirements. In this paper, an intelligent based algorithm for optimal BTS site placement has been proposed. The proposed technique takes into consideration neighbour and regulation considerations objectively while determining cell site. The application will lead to a quantitatively unbiased evaluated decision making process in BTS placement. An experimental data of a 2km by 3km territory was simulated for testing the new algorithm, results obtained show a 100% performance of the neighbour constrained algorithm in BTS placement optimization. Results on the application of GA with neighbourhood constraint indicate that the choices of location can be unbiased and optimization of facility placement for network design can be carried out

  18. 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...

  19. 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.

  20. 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

  1. 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

  2. Automated external defibrillators inaccessible to more than half of nearby cardiac arrests in public locations during evening, nighttime, and weekends

    DEFF Research Database (Denmark)

    Hansen, Carolina Malta; Wissenberg, Mads; Weeke, Peter;

    2013-01-01

    BACKGROUND: Despite wide dissemination, use of automated external defibrillators (AEDs) in community settings is limited. We assessed how AED accessibility affected coverage of cardiac arrests in public locations. METHODS AND RESULTS: We identified cardiac arrests in public locations (1994-2011) ...

  3. Survival and health care costs until hospital discharge of patients treated with onsite, dispatched or without automated external defibrillator

    NARCIS (Netherlands)

    J. Berdowski; M.J. Kuiper; M.G.W. Dijkgraaf; J.G.P. Tijssen; R.W. Koster

    2010-01-01

    Background: This study aimed to determine whether automated external defibrillator (AED) use during resuscitation is associated with lower in-hospital health care costs. Methods: For this observational prospective study, we included all treated out-of-hospital cardiac arrests of suspected cardiac ca

  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. Best evidence: nasogastric tube placement verification.

    Science.gov (United States)

    Longo, M Anne

    2011-08-01

    Further research on cost-effective techniques to verify enteral tube placement is warranted using a variety of pediatric populations with differing conditions that may impact gastric pH. It is imperative that clinical facilities review current policies and procedures to ensure that evidence-based findings are guiding nursing practice. Many nurses continue to rely on auscultation to verify NGT placement. Education and competency validation can assist with current practices for NGT placement being consistently incorporated by all personnel in the health care setting. Continuing to search for evidence related to nursing care will guide the direct care RN in providing best practice.

  6. The effect of pinacidil on postshock activation and ventricular defibrillation threshold in canine hearts

    Institute of Scientific and Technical Information of China (English)

    Qi JIN; Ning ZHANG; Jian ZHOU; Chang-jian LIN; Yang PANG; Gang GU; Wei-feng SHEN; Li-qun WU

    2012-01-01

    Aim: To determine the postshock activation patterns with both successful and failed shocks in a canine model of ventricular fibrillation,and whether piniacidil,an early after-depolarization (EAD) inhibitor,altered the defibrillation threshold (DFT) and postshock activation patterns.Methods: In 6 beagles,a basket catheter with 64 unipolar electrodes was placed in the LV for global endocardial mapping,a monophasic action potential catheter was inserted into the LV apex,and a catheter with the negative electrode in the right ventricle and the positive electrode in the superior vena cava was inserted for defibrillation.The DFT,90% action potential duration (APD90) and activation recovery interval (ARI) were evaluated before and after pinacidil administration (loading dosage 0.5 mg/kg and maintenance dosage 0.5 mg·kg-1-h-1,iv).Electrical heterogeneities were defined with the dispersion of ARI.After successful and failed shocks with nearDFT strength,the earliest postshock activation patterns (focal or nonfocal endocardial activation),interval and location were detected.Results: Pinacidil significantly decreased APD90 (from 178±16 ms to 168±18 ms) and ARI from (152±10 ms to 143±10 ms) at pacing cycle length of 300 ms.The drug significantly increased VF activation rate (from 10.0±1.9 Hz to 10.8±2.0 Hz).The drug did not affect the dispersion of ARI,neither it changed DFT (baseline: 480±110 V; pinacidil: 425±55 V,P>O.05).The earliest postshock activation arose locally on the LV apical endocardium before and after the drug treatment.Pinacidil significantly prolonged the postshock cycle length of cycles 2 to 5 for the successful episodes but not for the failed episodes.Conclusion: Pinacidil increases the postshock cycle length suggesting that EAD may play a role in postshock activation,while it fails to alter DFT suggesting that EAD produced by shock does not determine a defibrillation success or failure.

  7. Chest Compressions Cause Recurrence of Ventricular Fibrillation After the First Successful Conversion by Defibrillation in Out-of-Hospital Cardiac Arrest

    NARCIS (Netherlands)

    J. Berdowski; J.G.P. Tijssen; R.W. Koster

    2010-01-01

    Background-Unlike Resuscitation Guidelines (GL) 2000, GL2005 advise resuming cardiopulmonary resuscitation (CPR) immediately after defibrillation. We hypothesized that immediate CPR resumption promotes earlier recurrence of ventricular fibrillation (VF). Methods and Results-This study used data of a

  8. Selective Placement Program Coordinator (SPPC) Directory

    Data.gov (United States)

    Office of Personnel Management — List of the Selective Placement Program Coordinators (SPPC) in Federal agencies, updated as needed. Users can filter the list by choosing a state and/or agency name.

  9. Educational Placement of Children with Spina Bifida.

    Science.gov (United States)

    Lauder, Calvin E.; And Others

    1979-01-01

    Procedures of school placement for 38 children (ages 5 to 18 years) with spina bifida in 23 school districts in western New York State were studied 5 years after a mandated process was enacted. (Author)

  10. Standard—Cell Placement from Functional Descriptions

    Institute of Scientific and Technical Information of China (English)

    KlausBuchenrieder

    1991-01-01

    This paper presents a functional language for the unambiguous description of digital circuits,a method and algorithms to obtain a standard-cell layout,and a comparative evaluation of the developed functional standard-cell placement technique.The presented placement scheme is different from traditional methods because the complete layout grometry is specified and constructed automatically from a functional description.The construction relies on a translation that combines the simplicity of standard-cells with the elegance of functional programming.An evaluation of the method introduced shows that the quality of the resulting placement is close to the results achieved with simulated annealing while the computation time is significantly less.Furthermore,the evaluation suggests to employ the functional placement method in conjunction with low-temperature simulated annealing for running-time reduction and improvedresults.

  11. Student life - Tips for placement success.

    Science.gov (United States)

    2016-03-01

    Placements are an inevitable part of a nursing degree which provide a platform for on-the-job learning and development, greatly enhancing a student nurse's understanding of their career choice. PMID:26932655

  12. Experiences of Supervision at Practice Placement Sites

    OpenAIRE

    Lesley Diack; Kathrine Gibson; Kim Munro; Alison Strath

    2014-01-01

    Background. Whilst placement supervision and clinical education programmes are of significant value in shaping the behaviours of undergraduate healthcare students, appropriate provisions which are efficacious to the learner are somewhat lacking, particularly for students studying on UK MPharm programmes. Objectives. To explore and explain the value of placement supervision to the personal development and employability of undergraduate pharmacy students. Methods. Students participated in a wee...

  13. Beacon Node Placement for Minimal Localization Error

    OpenAIRE

    Yuan, Zimu; Li, Wei; Xu, Zhiwei; Zhao, Wei

    2015-01-01

    Beacon node placement, node-to-node measurement, and target node positioning are the three key steps for a localization process. However, compared with the other two steps, beacon node placement still lacks a comprehensive, systematic study in research literatures. To fill this gap, we address the Beacon Node Placment (BNP) problem that deploys beacon nodes for minimal localization error in this paper. BNP is difficult in that the localization error is determined by a complicated combination ...

  14. Tow placement studies for liquid composite moulding

    OpenAIRE

    Turner, Matthew Richard

    1998-01-01

    This thesis describes the work undertaken developing techniques for the design and manufacture of continuous fibre preforms for liquid composite moulding. A prototype tow placement facility based on the roller placement of up to 5 tows onto a flat bed was developed. This was used to prepare preforms for 4 industrially based demonstrator components which were subsequently successfully moulded. In tests vibrational performance of parts so manufactured showed slight improvements in mechanical pe...

  15. Exploring continuous clinical placement for undergraduate students.

    Science.gov (United States)

    McKenna, Lisa G; Wray, Natalie; McCall, Louise

    2009-08-01

    Clinical placements are integral to health professional preparatory courses. These placements allow for the application of classroom-based learning into real patient care situations. In doing so, they provide opportunities for applying theoretical knowledge into practice contexts, skills development and socialisation into the chosen profession. However, despite its recognised importance across health professions, little has been written about optimal structures for supporting clinical learning. This paper presents one group of findings from a larger qualitative study aimed at exploring health professional student's clinical experiences and their impact on career intentions. Findings reported here present a group of undergraduate midwifery student's perspectives on a "home" hospital clinical placement model where continuous clinical placements were taken in the same agency (or hospital group) for 2 days per week over the final 2 years of their course. Two main themes emerged from the data analysis, these being, 'familiarity' and 'continuity'. It is concluded that continuous placements in the same clinical setting have the potential to offer greater opportunities for learning and early professional socialisation than traditional block (Monday to Friday) placements. They can offer a more integrated approach to classroom theory and its application into practice. PMID:18427942

  16. Optimal DG placement in deregulated electricity market

    Energy Technology Data Exchange (ETDEWEB)

    Gautam, Durga; Mithulananthan, Nadarajah [Electric Power System Management, Energy Field of Study, Asian Institute of Technology, P.O. Box 4, Klong Luang, Pathumthani 12120 (Thailand)

    2007-10-15

    This paper presents two new methodologies for optimal placement of distributed generation (DG) in an optimal power flow (OPF) based wholesale electricity market. DG is assumed to participate in real time wholesale electricity market. The problem of optimal placement, including size, is formulated for two different objectives, namely, social welfare maximization and profit maximization. The candidate locations for DG placement are identified on the basis of locational marginal price (LMP). Obtained as lagrangian multiplier associated with active power flow equation for each node, LMP gives the short run marginal cost (SRMC) of electricity. Consumer payment, evaluated as a product of LMP and load at each load bus, is proposed as another ranking to identify candidate nodes for DG placement. The proposed rankings bridges engineering aspects of system operation and economic aspects of market operation and act as good indicators for the placement of DG, especially in a market environment. In order to provide a scenario of variety of DGs available in the market, several cost characteristics are assumed. For each DG cost characteristic, an optimal placement and size is identified for each of the objectives. The proposed methodology is tested in a modified IEEE 14 bus test system. (author)

  17. Cardiac Resynchronization Therapy Defibrillator Treatment in a Child with Heart Failure and Ventricular Arrhythmia.

    Science.gov (United States)

    Kim, Hak Ju; Cho, Sungkyu; Kim, Woong-Han

    2016-08-01

    Cardiac resynchronization therapy (CRT) is a new treatment for refractory heart failure. However, most patients with heart failure treated with CRT are adults, middle-aged or older with idiopathic or ischemic dilated cardiomyopathy. We treated a 12-year-old boy, who was transferred after cardiac arrest, with dilated cardiomyopathy, left bundle-branch block, and ventricular tachycardia. We performed cardiac resynchronization therapy with a defibrillator (CRT-D). After CRT-D, left ventricular ejection fraction improved from 22% to 44% assessed by echocardiogram 1 year postoperatively. On electrocardiogram, QRS duration was shortened from 206 to 144 ms. The patient's clinical symptoms also improved. For pediatric patients with refractory heart failure and ventricular arrhythmia, CRT-D could be indicated as an effective therapeutic option. PMID:27525239

  18. Spontaneous defibrillation after cessation of resuscitation in out-of-hospital cardiac arrest: a case of Lazarus phenomenon.

    Science.gov (United States)

    Kämäräinen, Antti; Virkkunen, Ilkka; Holopainen, Leevi; Erkkilä, Elja-Pekka; Yli-Hankala, Arvi; Tenhunen, Jyrki

    2007-12-01

    This report describes a case of out-of-hospital cardiac arrest with spontaneous defibrillation and subsequent return of circulation after cessation of resuscitative efforts. A 47-year-old man was found in cardiac arrest and resuscitation was initiated. As no response was achieved, the efforts were withdrawn and final registered cardiac rhythm was ventricular fibrillation. Fifteen minutes later the patient was found to be normotensive and breathing spontaneously. The patient made a poor neurological recovery and died 3 months after the arrest. The authors are unable to give an explanation to the event, but suspect the effect of adrenaline combined with mild hypothermia to have contributed to the self-defibrillation of the myocardium. PMID:17629389

  19. 62. Gap in the application of implantable defibrillator and cardiac resynchronization therapy guidelines in heart failure patients

    OpenAIRE

    A. Hersi; A. Al Hammad; T. Al Doheyan; D. Al Munif; J. Alaskar; A. Haifa

    2016-01-01

    Literature review revealed no studies were done regarding the application of implantable defibrillator and cardiac resynchronization therapy guidelines in Saudi Arabia. Therefore, our aim was to identify the gap in the application of the guidelines for acute on chronic systolic heart failure patients in Saudi Arabia. Design and setting: We used data from the heart function assessment registry trial in Saudi Arabia (HEARTS) to explore the rate of device implantation. In consecutive cohort a...

  20. Using a Combined Platform of Swarm Intelligence Algorithms and GIS to Provide Land Suitability Maps for Locating Cardiac Rehabilitation Defibrillators

    OpenAIRE

    KAFFASH-CHARANDABI, Neda; SADEGHI-NIARAKI, Abolghasem; Park, Dong-Kyun

    2015-01-01

    Background: Cardiac arrest is a condition in which the heart is completely stopped and is not pumping any blood. Although most cardiac arrest cases are reported from homes or hospitals, about 20% occur in public areas. Therefore, these areas need to be investigated in terms of cardiac arrest incidence so that places of high incidence can be identi-fied and cardiac rehabilitation defibrillators installed there.Methods: In order to investigate a study area in Petersburg, Pennsylvania State, and...

  1. Assessment of the Efficacy of Pulsed Biphasic Defibrillation Shocks for Treatment of Out-of-hospital Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Jean-Philippe Didon

    2008-10-01

    Full Text Available This study evaluates the efficacy of a Pulsed Biphasic Waveform (PBW for treatment of out-of-hospital cardiac arrest (OHCA patients in ventricular fibrillation (VF. Large database (2001-2006, collected with automated external defibrillators (AED, (FRED®, Schiller Medical SAS, France, is processed.In Study1 we compared the defibrillation efficacy of two energy stacks (90-130-180 J vs. (130-130-180 J in 248 OHCA VF patients. The analysis of the first shock PBW efficacy proves that energies as low as 90 J are able to terminate VF in a large proportion of OHCA patients (77% at 5 s and 69% at 30 s. Although the results show a trend towards the benefit of higher energy PBW with 130 J (86% at 5 s, 73% at 30 s, the difference in shock efficacy does not reach statistical significance. Both PBW energy stacks (90-130-180 J and (130-130-180 J achieve equal success rates of defibrillation. Analysis of the post-shock rhythm after the first shock is also provided.For Study2 of 21 patients with PBW shocks (130-130-180 J, we assessed some attending OHCA circumstances: call-to-shock delay (median 16min, range 11-41 min, phone advices of CPR (67%. About 50% of the patients were admitted alive to hospital, and 19% were discharged from hospital. After the first shock, patients admitted to hospital are more often presenting organized rhythm (OR (27% to 55% than patients not admitted (0% to 10%, with significant difference at 15 s and 30 s. Post-shock VFs appear significantly rare until 15s for patients admitted to hospital (0% to 9% than for patients not admitted to hospital (40% to 50%. Return of OR (ROOR and efficacy to defibrillate VF at 5 s and 15 s with first shock are important markers to predict patient admission to hospital.

  2. Advanced tow placement of composite fuselage structure

    Science.gov (United States)

    Anderson, Robert L.; Grant, Carroll G.

    1992-01-01

    The Hercules NASA ACT program was established to demonstrate and validate the low cost potential of the automated tow placement process for fabrication of aircraft primary structures. The program is currently being conducted as a cooperative program in collaboration with the Boeing ATCAS Program. The Hercules advanced tow placement process has been in development since 1982 and was developed specifically for composite aircraft structures. The second generation machine, now in operation at Hercules, is a production-ready machine that uses a low cost prepreg tow material form to produce structures with laminate properties equivalent to prepreg tape layup. Current program activities are focused on demonstration of the automated tow placement process for fabrication of subsonic transport aircraft fuselage crown quadrants. We are working with Boeing Commercial Aircraft and Douglas Aircraft during this phase of the program. The Douglas demonstration panels has co-cured skin/stringers, and the Boeing demonstration panel is an intricately bonded part with co-cured skin/stringers and co-bonded frames. Other aircraft structures that were evaluated for the automated tow placement process include engine nacelle components, fuselage pressure bulkheads, and fuselage tail cones. Because of the cylindrical shape of these structures, multiple parts can be fabricated on one two placement tool, thus reducing the cost per pound of the finished part.

  3. Obese Patients Defibrillation Failure in 1 Cases%肥胖患者电除颤失败1例

    Institute of Scientific and Technical Information of China (English)

    赵莹; 吴浩

    2014-01-01

    利用除颤仪对某螳发生严重快速性异位性心律失常的心脏实施电击,借以消除这些心律失常。称作电除颤(也叫电复律)。在电除颤时。除颤仪释放强大的瞬时电脉冲,使全部心肌在同一时间完成除极,导致心律失常的异常兴奋灶及折返环被完全"消灭"。全部心肌在瞬问处于心电静止状态。这样窦房结就获得了重新主导心脏节律的机会。%Using the defibril ation apparatus of a serious rapidity of gladiator ectopic ar hythmias of cardiac shock, so as to eliminate these arrhythmia. Cal ed electric defibril ation (also cal ed cardioerter). When the electrical shock. Defibril ation apparatus release strong instantaneous electrical impulses, making al the myocardium in addition to the tasks at the same time, cause ar hythmia very excited and exhumation ring oven is completely"destroy". Al the myocardial instantaneous asked in ecg stationary state. The sinoatrial node have a new chance to dominate the heart rhythm.

  4. Decalogue of electric defibrillation Decálogo de la desfibrilación eléctrica

    Directory of Open Access Journals (Sweden)

    Elkín Ferdinand Cardona Duque

    2001-03-01

    Full Text Available Defibrillation is an emergency procedure and the only effective therapy for ventricular fibrillation. Electrical defibrillation delivers large amounts of current to the myocardium and thus depolarizes it, terminating ventricular fibrillation and other arrhythmias. A defibrillator is a device that administers a controlled electrical shock, allowing the operator to select a variable current at the precise moment, according to patient‘s condition. Understanding defibrillator‘s operation leads to more effective resuscitation rates and more therapeutic alternatives in patients with any cardiac electric disturbance. La desfibrilación es un procedimiento de emergencia y es la única terapia efectiva para el manejo de la fibrilación ventricular. La desfibrilación eléctrica libera corriente en gran cantidad al miocardio, despolarizándolo y terminando la fibrilación ventricular y otras arritmias. Un desfibrilador es un aparato que suministra un choque eléctrico en forma controlada, permitiendo al operador seleccionar una corriente variable en el momento oportuno, de acuerdo con la condición del paciente. El entendimiento del manejo del desfibrilador permite tasas de resucitación más efectivas y más alternativas terapéuticas en pacientes con trastornos del ritmo cardíaco.

  5. Pearls and perils of an implantable defibrillator trial using a common control: implications for the design of future studies

    Directory of Open Access Journals (Sweden)

    Hallstrom Alfred P

    2008-05-01

    Full Text Available Abstract Aims Implantable defibrillators are considered life-saving therapy in heart failure (CHF patients. Surprisingly, the recent Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT reached an opposing conclusion from that of numerous other trials about their survival benefit in patients with advanced CHF. A critical analysis of common control trial design may explain this paradoxical finding, with important implications for future studies. Methods and Results Common control trials compare several intervention groups to a single rather than separate control groups. Though potentially requiring fewer patients than trials using separate controls, variation in the common control group will influence all comparisons and creates correlations between findings. During subgroup analyses, this dependency of outcomes may increase belief in the presence of a real subgroup effect when, in fact, it should increase skepticism. For example, a high (r = 0.92, statistically unlikely (p = 0.052 correlation between comparisons was observed across the subgroups reported in SCD-HeFT. Such concordance between amiodarone and a defibrillator across subgroups was unexpected, given how much the effects of these treatments significantly differed from one another in the main study. This suggests the study's subgroup findings (specifically the absence of benefit from defibrillators in advanced CHF were not necessarily a consequence of treatment; more likely, they resulted from variation in what the treatments were compared against, the common control. Conclusion Common control trials can be more efficient than other designs, but induce dependence between treatment comparisons and require cautious interpretation.

  6. Where Should We Go With Advanced Placement?

    Science.gov (United States)

    Lichten, William

    2001-04-01

    This is a review of the Advanced Placement (AP)Program. In disagreement with claims of the College Board, there is firm evidence that the average test performance level has dropped. The College Board's scale and claims for AP qualification disagree seriously with college standards. A majority of tests taken do not qualify. It appears that "advanced placement" is coming closer to "placement." This paper recommends that the College Board's policy, which previously has concentrated on the numbers of participants, should include an emphasis on student performance and program quality. AP could accomplish its goal of reaching a wider range of students by changing along the lines followed in college introductory physics courses: multiple tracks.

  7. Analog Module Placement Design Using Genetic Algorithm

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    This paper presents a novel genetic algorithm for analog module placement based on ageneralization of the two-dimensional bin packing problem. The genetic encoding and operators assure that allproblem constraints are always satisfied. Thus the potential problems of adding penalty terms to the costfunction are eliminated so that the search configuration space is drastically decreased. The dedicated costfunction is based on the special requirements of analog integrated circuits. A fractional factorial experimentwas conducted using an orthogonal array to study the algorithm parameters. A meta GA was applied todetermine the optimal parameter values. The algorithm was tested with several local benchmark circuits. Theexperimental results show that the algorithm has better performance than the simulated annealing approachwith satisfactory results comparable to manual placement. This study demonstrates the effectiveness of thegenetic algorithm in the analog module placement problem. The algorithm has been successfully used in alayout synthesis tool.

  8. Slowing of electrical activity in ventricular fibrillation is not associated with increased defibrillation energies in the isolated rabbit heart

    Directory of Open Access Journals (Sweden)

    Jane eCaldwell

    2011-04-01

    Full Text Available Prolonged out-of-hospital ventricular fibrillation (VF arrests are associated with reduced ECG dominant frequency (DF and diminished defibrillation success. Partial reversal of ischaemia increases ECG DF and improves defibrillation outcome. We have investigated the metabolic components of ischaemia responsible for the decline in ECG DF and defibrillation success.Isolated Langendorff-perfused rabbit hearts were loaded with the voltage-sensitive dye RH237. Using a photodiode array, epicardial membrane potentials were recorded at 252 sites (15x15mm on the anterior surface of the left & right ventricles. Simultaneously, a global ECG was recorded. VF was induced by burst pacing, and after 60s, perfusion was either reduced to 6ml/min or the perfusate composition changed to impose hypoxia (95%N2/5%CO2, pH 6.7 (80%O2/20%CO2, or hyperkalaemia (8mM. Using Fast Fourier Transform, power spectra were created from the optical signals and the global ECG. The optical power spectra were summated to give a global power spectrum (pseudoECG. At 600s the minimum defibrillation voltage (MDV was determined by step-up protocol.During VF, the ECG and pseudoECG DF were reduced by low-flow ischaemia (9.0±1.0Hz, p<0.01, n=5 and raised [K+]o (12.2±1.3 Hz, p<0.05, n=7 compared to control (19.2±1.5 Hz, n=20, but were unaffected by acidic pHo (16.7±1.1 Hz, n=11 and hypoxia (14.0±1.2 Hz, n=10. In contrast, the MDV was raised by acidic pH (156.1±26.4V, p<0.001 and hypoxia (154.1±22.1V, p<0.01 compared to control (65.6±2.3V, but comparable changes were not observed in low-flow ischaemia (61.0±0.5V or raised [K+]o (56±3V. In summary, different metabolites are responsible for the reduction in DF and the increase in defibrillation energy during ischaemic VF.

  9. Development of standard defibrillation energy source%除颤能量标准源的研制

    Institute of Scientific and Technical Information of China (English)

    姚国红; 张亚冬; 李岩峰; 贾建革; 武文君; 邵海明

    2015-01-01

    To develop a standard defibrillation energy source which can output monophasic and biphasic de-fibrillation impulses and can display standard energy values. The storage capacitor was charged by single-end flyback transformator and discharged through the H bridge composed of insulated gate bipolar transistor (IGBT). Impulse voltage and current were collected by divider while discharging, and the energy value was calculated by STM32. The en-ergy value and waveform were displayed through the control module. The energy source could output both monophsic and biphasic waveforms, and the accuracy of displayed value was higher than ±2% or ±1 J. The standard defibrillation energy source can be used as standard device for defibrillator analyzer, and the metrological trace-ability system of defibrillation energy may come to be completed.%目的:研制一种除颤能量标准源,该标准源能释放单相波、双相波2种除颤脉冲,并且能显示释放能量标准值。方法:利用单端反激励充电方式给储能电容充电,通过脉冲宽度调制(pulse width modulation,PWM)驱动由绝缘栅双极型晶体管(insulated gate bipolar transistor,IGBT)组成的H桥控制电容放电,同时通过分压器、分流器分别采集脉冲电压和电流值,并通过STM32微处理器计算除颤脉冲能量值,最后通过显示模块显示释放的脉冲能量准确值。结果:所研制的除颤能量标准源可释放单相波和双相波2种波形除颤脉冲,并且显示的除颤脉冲能量值精度优于±2%或±1 J。结论:该除颤能量标准源可作为除颤器分析仪溯源校准的标准器具,可完善除颤器释放能量准确度的溯源体系。

  10. 基于DSP的体外自动除颤仪研究%Research on Automatic External Defibrillator Based on DSP

    Institute of Scientific and Technical Information of China (English)

    景军; 丁景艳; 张玮; 洪文学

    2012-01-01

    Electrical defibrillation is the most effective way to treat the ventricular tachycardia (VT) and ventricular fibrillation (VF). An automatic external defibrillator based on DSP is introduced in this paper. The whole design consists of the signal collection module, the microprocessor controlingl module, the display module, the defibrillation module and the automatic recognition algorithm for VF and non VF, etc. This automatic external defibrillator has a-chieved goals such as ECG signal real-time acquisition, ECG wave synchronous display, data deliivering to U disk and automatic defibrillate when shockable rhythm appears, etc.%电击除颤是治疗室速(VT)和室颤(VF)的最有效的方法.本文提出了一种基于DSP的体外自动除颤仪设计方案,整个设计包括了信号采集模块、微处理器控制模块、显示模块、除颤模块及R波检测和VF与非VF自动识别算法等.本文设计的自动除颤仪实现了心电(ECG)数据实时采集、ECG波形同步显示、数据U盘导出、出现可电击复律心率时自动进行除颤等功能.

  11. Suboccipital neuropathy after bone conduction device placement

    NARCIS (Netherlands)

    Faber, H.T.; Ru, J.A. de

    2013-01-01

    OBJECTIVE: To describe the clinical characteristics of a 70-year-old female with occipital neuropathy following bone conduction device surgery. DESCRIPTION: A 65-year-old woman underwent bone conduction device placement surgery on the left temporal bone. Postoperatively she progressively developed c

  12. Source placement for equalization in small enclosures

    DEFF Research Database (Denmark)

    Stefanakis, Nick; Sarris, J.; Cambourakis, G.

    2008-01-01

    ) but not with those that will deteriorate it (the "undesired" modes). Simulation results in rectangular rooms and in a car cavity show the benefits of source placement in terms of reduced overall error and increased spatial robustness in the equalization process. Additional benefits, which can be derived by proper...

  13. Photoelectron Spectroscopy in Advanced Placement Chemistry

    Science.gov (United States)

    Benigna, James

    2014-01-01

    Photoelectron spectroscopy (PES) is a new addition to the Advanced Placement (AP) Chemistry curriculum. This article explains the rationale for its inclusion, an overview of how the PES instrument records data, how the data can be analyzed, and how to include PES data in the course. Sample assessment items and analysis are included, as well as…

  14. Delayed bracket placement in orthodontic treatment

    Directory of Open Access Journals (Sweden)

    Chandra Wigati

    2008-12-01

    Full Text Available Background: Beside bracket position, the timing of bracket placement is one of the most essential in orthodontic treatment with fixed appliances. Even it seems simple the timing of bracket placement can be crucial and significantly influence the result of orthodontic treatment. However it is often found brackets are placed without complete understanding of its purpose and effects, which could be useless and even detrimental for the case. Purpose: The aim of this case report is to show that the timing of bracket placement could be different depending on the cases. Case: Five different cases are presented here with different timing of bracket placement. Case management: On these cases, brackets were placed on the upper arch first, on the lower arch first, or even only on some teeth first. Good and efficient orthodontic treatment results were achieved. Conclusion: For every orthodontic case, from the very beginning of treatment, bracket should be placed with the end result in mind. If brackets are correctly placed at a correct time, better treatment result could be achieved without unnecessary round tripping tooth movement.

  15. Situated learning in the practice placement.

    Science.gov (United States)

    Cope, P; Cuthbertson, P; Stoddart, B

    2000-04-01

    Nurses who had just completed their training in Scotland were interviewed with regard to their experiences on placements. The nurses had either completed a traditional training course or came from the first cohort of the Project 2000 diploma level course. The interviews focused on the way in which the student nurses had learned in their practice placements. The results suggest that the placement is a complex social and cognitive experience in which there are elements of situated learning. Acceptance into the community of practice is important but this can be separated, conceptually at least, into a social acceptance which might be extended to any student and a professional acceptance which relies on the display of appropriate competence. The nurses described the way in which their mentors had interacted with them in terms which suggested that cognitive apprenticeship strategies had been used to further their learning in practice. It is concluded that, in view of the central importance of the placement for training nurses, explicit use of mentoring techniques derived from situated learning and cognitive apprenticeship might be beneficial.

  16. 5 CFR 359.702 - Placement rights.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Placement rights. 359.702 Section 359.702 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS REMOVAL FROM THE SENIOR... rights. (a) An appointee covered by this subpart is entitled to be placed in a vacant civil...

  17. Towards the Automated Analysis and Database Development of Defibrillator Data from Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Trygve Eftestøl

    2014-01-01

    Full Text Available Background. During resuscitation of cardiac arrest victims a variety of information in electronic format is recorded as part of the documentation of the patient care contact and in order to be provided for case review for quality improvement. Such review requires considerable effort and resources. There is also the problem of interobserver effects. Objective. We show that it is possible to efficiently analyze resuscitation episodes automatically using a minimal set of the available information. Methods and Results. A minimal set of variables is defined which describe therapeutic events (compression sequences and defibrillations and corresponding patient response events (annotated rhythm transitions. From this a state sequence representation of the resuscitation episode is constructed and an algorithm is developed for reasoning with this representation and extract review variables automatically. As a case study, the method is applied to the data abstraction process used in the King County EMS. The automatically generated variables are compared to the original ones with accuracies ≥90% for 18 variables and ≥85% for the remaining four variables. Conclusions. It is possible to use the information present in the CPR process data recorded by the AED along with rhythm and chest compression annotations to automate the episode review.

  18. Suppression of AC railway power-line interference in ECG signals recorded by public access defibrillators

    Directory of Open Access Journals (Sweden)

    Dotsinsky Ivan

    2005-11-01

    Full Text Available Abstract Background Public access defibrillators (PADs are now available for more efficient and rapid treatment of out-of-hospital sudden cardiac arrest. PADs are used normally by untrained people on the streets and in sports centers, airports, and other public areas. Therefore, automated detection of ventricular fibrillation, or its exclusion, is of high importance. A special case exists at railway stations, where electric power-line frequency interference is significant. Many countries, especially in Europe, use 16.7 Hz AC power, which introduces high level frequency-varying interference that may compromise fibrillation detection. Method Moving signal averaging is often used for 50/60 Hz interference suppression if its effect on the ECG spectrum has little importance (no morphological analysis is performed. This approach may be also applied to the railway situation, if the interference frequency is continuously detected so as to synchronize the analog-to-digital conversion (ADC for introducing variable inter-sample intervals. A better solution consists of rated ADC, software frequency measuring, internal irregular re-sampling according to the interference frequency, and a moving average over a constant sample number, followed by regular back re-sampling. Results The proposed method leads to a total railway interference cancellation, together with suppression of inherent noise, while the peak amplitudes of some sharp complexes are reduced. This reduction has negligible effect on accurate fibrillation detection. Conclusion The method is developed in the MATLAB environment and represents a useful tool for real time railway interference suppression.

  19. Lithium-manganese dioxide cells for implantable defibrillator devices-Discharge voltage models

    Science.gov (United States)

    Root, Michael J.

    The discharge potential behavior of lithium-manganese dioxide cells designed for implantable cardiac defibrillators was characterized as a function of extent of cell depletion for tests designed to discharge the cells for times between 1 and 7 years. The discharge potential curves may be separated into two segments from 0 ≤ x ≤ ∼0.51 and ∼0.51 ≤ x ≤ 1.00, where x is the dimensionless extent of discharge referenced to the rated cell capacity. The discharge potentials conform to Tafel kinetics in each segment. This behavior allows the discharge potential curves to be predicted for an arbitrary discharge load and long term discharge performance may be predicted from short term test results. The discharge potentials may subsequently be modeled by fitting the discharge curves to empirical functions like polynomials and Padé approximants. A function based on the Nernst equation that includes a term accounting for nonideal interactions between lithium ions and the cathode host material, such as the Redlich-Kister relationship, also may be used to predict discharge behavior.

  20. Lithium-manganese dioxide cells for implantable defibrillator devices - Discharge voltage models

    Energy Technology Data Exchange (ETDEWEB)

    Root, Michael J. [Cardiac Rhythm Management Research and Development, Boston Scientific Corp., 4100 Hamline Ave. N., St. Paul, MN 55112 (United States)

    2010-08-01

    The discharge potential behavior of lithium-manganese dioxide cells designed for implantable cardiac defibrillators was characterized as a function of extent of cell depletion for tests designed to discharge the cells for times between 1 and 7 years. The discharge potential curves may be separated into two segments from 0 {<=} x {<=} {proportional_to}0.51 and {proportional_to}0.51 {<=} x {<=} 1.00, where x is the dimensionless extent of discharge referenced to the rated cell capacity. The discharge potentials conform to Tafel kinetics in each segment. This behavior allows the discharge potential curves to be predicted for an arbitrary discharge load and long term discharge performance may be predicted from short term test results. The discharge potentials may subsequently be modeled by fitting the discharge curves to empirical functions like polynomials and Pade approximants. A function based on the Nernst equation that includes a term accounting for nonideal interactions between lithium ions and the cathode host material, such as the Redlich-Kister relationship, also may be used to predict discharge behavior. (author)

  1. Life-saving automated external defibrillation in a teenager: a case report

    Directory of Open Access Journals (Sweden)

    Rey Corsino

    2007-09-01

    Full Text Available Abstract Background Adolescent sudden death during sport participation is commonly due to cardiac causes. Survival is more likely when an automated external defibrillator (AED is used soon after collapse. Case presentation We describe a case of sudden death in a 14 year old boy with two remarkable points, successful resuscitation at school using an AED and diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC. Bystander cardiopulmonary resuscitation (CPR was immediately started by a witness and 5 minutes after the event the child was placed on an AED monitor that determined he was in a non shockable rhythm, therefore CPR was continued. Two minutes later, the AED monitor detected a shockable rhythm and recommended a shock, which was then administered. One minute after the shock, a palpable pulse was detected and the child began to breathe by himself. Four days after cardiac arrest, the boy was conversing and self-caring. Cardiac magnetic resonance imaging was suggestive of ARVC. Conclusion Ventricular fibrillation secondary to ARVC may be a devastating event and places young patients and athletes at high risk of sudden death. Immediate CPR and AED have been demonstrated to be lifesaving in such events. Therefore, we suggest that schools should have teachers skilled in CPR and accessible AEDs.

  2. Is an atrial defibrillator still an option in treating patients with atrial fibrillation?

    Directory of Open Access Journals (Sweden)

    Ziad El Khoury MD

    2013-02-01

    Full Text Available trial fibrillation (AF is a common disorder associated with significant morbidities and presents several challenges for the control of symptoms and prevention of long-term implications. Atrial defibrillators (ADs, used for rhythm control in patients with symptoms refractory to medical therapy, can detect recurrences of the arrhythmia, allow prompt patient-directed treatment, and have the potential to reduce hospitalizations and improve quality of life. The efficacy of this form of therapy is highest in patients with paroxysmal AF, and with the use of a coronary sinus shocking lead. While R-wave synchronized shocks are a prerequisite for a safe use, the procedure is well-tolerated and usually not associated with long-term psychological side effects. Limitations of ADs include acute and chronic complications related to a cardiac rhythm device implantation, the requirement in some cases for more than one shock to terminate AF, the discomfort from shocks, as well as the need for sedation to alleviate pain from the shocks. With the ever expanding role of catheter-based therapies for AF, it seems that the role of ADs in this regard is rather limited.

  3. Cardiac microstructure: implications for electrical propagation and defibrillation in the heart.

    Science.gov (United States)

    Hooks, Darren A; Tomlinson, Karl A; Marsden, Scott G; LeGrice, Ian J; Smaill, Bruce H; Pullan, Andrew J; Hunter, Peter J

    2002-08-23

    Our understanding of the electrophysiological properties of the heart is incomplete. We have investigated two issues that are fundamental to advancing that understanding. First, there has been widespread debate over the mechanisms by which an externally applied shock can influence a sufficient volume of heart tissue to terminate cardiac fibrillation. Second, it has been uncertain whether cardiac tissue should be viewed as an electrically orthotropic structure, or whether its electrical properties are, in fact, isotropic in the plane orthogonal to myofiber direction. In the present study, a computer model that incorporates a detailed three-dimensional representation of cardiac muscular architecture is used to investigate these issues. We describe a bidomain model of electrical propagation solved in a discontinuous domain that accurately represents the microstructure of a transmural block of rat left ventricle. From analysis of the model results, we conclude that (1) the laminar organization of myocytes determines unique electrical properties in three microstructurally defined directions at any point in the ventricular wall of the heart, and (2) interlaminar clefts between layers of cardiomyocytes provide a substrate for bulk activation of the ventricles during defibrillation.

  4. How media factors affect audience responses to brand placement

    NARCIS (Netherlands)

    E. van Reijmersdal; E. Smit; P. Neijens

    2010-01-01

    This study investigates the influence of media factors on brand placement effects in a real-life setting. Although many studies on brand placement have been conducted, insights into context effects on brand placement reactions are scarce. The impact of objective and subjective media context factors

  5. Brand placement prominence: good for memory! Bad for attitudes?

    NARCIS (Netherlands)

    E. van Reijmersdal

    2009-01-01

    This paper presents two laws about the effects of brand placement on audience reactions. This article presents two laws about the effects of brand placement on audience reactions. Brand placement is the compensated inclusion of brands or brand identifiers within media programming. The first law stat

  6. BRAND PLACEMENT AND CONSUMER CHOICE: AN IN-STORE EXPERIMENT

    OpenAIRE

    Sigurdsson, Valdimar; Saevarsson, Hugi; Foxall, Gordon

    2009-01-01

    An in-store experiment was performed to investigate the effects of shelf placement (high, middle, low) on consumers' purchases of potato chips. Placement of potato chips on the middle shelf was associated with the highest percentage of purchases. The results confirm the importance of item placement as a factor in consumers' buying behavior.

  7. Determining the brand awareness of product placement in video games

    OpenAIRE

    Král, Marek

    2015-01-01

    This bachelor thesis focusses on the determination of the brand awareness of product placement in video games. The theoretical part includes information about marketing, product placement and video games. The practical part consists of evaluation of the market research about product placements in video games. Conclusion suggests the most important factors influencing the level brand awareness.

  8. Dit programma bevat product placement: Effecten van sponsorvermeldingen in televisieprogramma's

    NARCIS (Netherlands)

    S.C. Boerman; E.A. van Reijmersdal; P.C. Neijens

    2015-01-01

    Europese richtlijnen vereisen dat brand placement in televisieprogramma’s wordt kenbaar gemaakt door een tekst zoals "Dit programma bevat product placement" of door een PP (product placement) logo. Deze sponsorvermeldingen hebben als doel de televisiekijker te informeren over merken of producten die

  9. Payment of Advanced Placement Exam Fees by Virginia Public School Divisions and Its Impact on Advanced Placement Enrollment and Scores

    Science.gov (United States)

    Cirillo, Mary Grupe

    2010-01-01

    The purpose of this study was to determine the impact of Virginia school divisions' policy of paying the fee for students to take Advanced Placement exams on Advanced Placement course enrollment, the number of Advanced Placement exams taken by students, the average scores earned and the percent of students earning qualifying scores of 3, 4, or 5…

  10. 心脏除颤器质量检定方法的分析研究%Analysis on cardiac defibrillators quality detection method

    Institute of Scientific and Technical Information of China (English)

    苏燕平; 姚念玲; 崔骊

    2014-01-01

    Objective:To use defibrillators calibration detection method, some problems could be find out and analyzed. Moreover, the quality safety of defibrillators calibration can be guaranteed. Methods:According to WSB 64-2003 verification regulation for cardiac defibrillators and cardiac defibrillator-Monitors, and the practical experience of effective detection methods, defibrillation analyzer verification can be used to detect the performance parameters of cardiac defibrillators. Results:In accordance with the effective test method, through regular check, not only can cardiac defibrillators risk be eliminated but also quality safety of clinical use and the life safety of patients will be safeguarded. Conclusion:The quality control can prevent medical accidents that caused by facility loses, at the same time, if we are pay attention to the daily maintenance, the defibrillator can be played a role in emergency time.%目的:按照国家计量检定规程,对临床使用中的除颤器进行质量检定,确保其在实际使用中的安全性。方法:依据国家卫生行业标准WSB64-2003“心脏除颤器和心脏除颤监护仪检定规程”,根据实际经验中有效的检定方法,使用除颤分析仪检定除颤器的各项性能参数。结果:按照有效的检定方法,通过定期检定,消除了除颤器的安全隐患,保障患者的生命安全。结论:对除颤器进行质量控制检定,可以预防因设备失准而引起的医疗事故,同时注意日常的维护和保养,确保除颤器在急救时的良好性能及临床使用的安全性。

  11. Using a Combined Platform of Swarm Intelligence Algorithms and GIS to Provide Land Suitability Maps for Locating Cardiac Rehabilitation Defibrillators

    Directory of Open Access Journals (Sweden)

    Neda KAFFASH-CHARANDABI

    2015-10-01

    Full Text Available Background: Cardiac arrest is a condition in which the heart is completely stopped and is not pumping any blood. Although most cardiac arrest cases are reported from homes or hospitals, about 20% occur in public areas. Therefore, these areas need to be investigated in terms of cardiac arrest incidence so that places of high incidence can be identi-fied and cardiac rehabilitation defibrillators installed there.Methods: In order to investigate a study area in Petersburg, Pennsylvania State, and to determine appropriate places for installing defibrillators with 5-year period data, swarm intelligence algorithms were used. Moreover, the location of the defibrillators was determined based on the following five evaluation criteria: land use, altitude of the area, econom-ic conditions, distance from hospitals and approximate areas of reported cases of cardiac arrest for public places that were created in geospatial information system (GIS.Results: The A-P HADEL algorithm results were more precise about 27.36%. The validation results indicated a wider coverage of real values and the verification results confirmed the faster and more exact optimization of the cost func-tion in the PSO method.Conclusion: The study findings emphasize the necessity of applying optimal optimization methods along with GIS and precise selection of criteria in the selection of optimal locations for installing medical facilities because the selected algorithm and criteria dramatically affect the final responses. Meanwhile, providing land suitability maps for installing facilities across hot and risky spots has the potential to save many lives.

  12. Optimal sensor placement using machine learning

    CERN Document Server

    Semaan, Richard

    2016-01-01

    A new method for optimal sensor placement based on variable importance of machine learned models is proposed. With its simplicity, adaptivity, and low computational cost, the method offers many advantages over existing approaches. The new method is implemented on an airfoil equipped with a Coanda actuator. The analysis is based on flow field data obtained from 2D unsteady Reynolds averaged Navier-Stokes (URANS) simulations with different actuation conditions. The optimal sensor locations is compared against the current de-facto standard of maximum POD modal amplitude location, and against a brute force approach that scans all possible sensor combinations. The results show that both the flow conditions and the type of sensor have an effect on the optimal sensor placement, whereas the choice of the response function appears to have limited influence.

  13. Stent graft placement for dysfunctional arteriovenous grafts

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Gyeong Sik [Dept. of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam (Korea, Republic of); Shin, Byung Seok; Ohm, Joon Young; Ahn, Moon Sang [Chungnam National University Hospital, Daejeon (Korea, Republic of)

    2015-07-15

    This study aimed to evaluate the usefulness and outcomes of stent graft use in dysfunctional arteriovenous grafts. Eleven patients who underwent stent graft placement for a dysfunctional hemodialysis graft were included in this retrospective study. Expanded polytetrafluoroethylene covered stent grafts were placed at the venous anastomosis site in case of pseudoaneurysm, venous laceration, elastic recoil or residual restenosis despite the repeated angioplasty. The patency of the arteriovenous graft was evaluated using Kaplan-Meier analysis. Primary and secondary mean patency was 363 days and 741 days. Primary patency at 3, 6, and 12 months was 82%, 73%, and 32%, respectively. Secondary patency at the 3, 6, 12, 24, and 36 months was improved to 91%, 82%, 82%, 50%, and 25%, respectively. Fractures of the stent graft were observed in 2 patients, but had no effect on the patency. Stent graft placement in dysfunctional arteriovenous graft is useful and effective in prolonging graft patency.

  14. Customized ATP towpreg. [Automated Tow Placement

    Science.gov (United States)

    Sandusky, Donald A.; Marchello, Joseph M.; Baucom, Robert M.; Johnston, Norman J.

    1992-01-01

    Automated tow placement (ATP) utilizes robotic technology to lay down adjacent polymer-matrix-impregnated carbon fiber tows on a tool surface. Consolidation and cure during ATP requires that void elimination and polymer matrix adhesion be accomplished in the short period of heating and pressure rolling that follows towpreg ribbon placement from the robot head to the tool. This study examined the key towpreg ribbon properties and dimensions which play a significant role in ATP. Analysis of the heat transfer process window indicates that adequate heating can be achieved at lay down rates as high as 1 m/sec. While heat transfer did not appear to be the limiting factor, resin flow and fiber movement into tow lap gaps could be. Accordingly, consideration was given to towpreg ribbon having uniform yet non-rectangular cross sections. Dimensional integrity of the towpreg ribbon combined with customized ribbon architecture offer great promise for processing advances in ATP of high performance composites.

  15. Endoscopic placement of enteral feeding tubes

    OpenAIRE

    2010-01-01

    Malnutrition is common in patients with acute and chronic illness. Nutritional management of these malnourished patients is an essential part of healthcare. Enteral feeding is one component of nutritional support. It is the preferred method of nutritional support in patients that are not receiving adequate oral nutrition and have a functioning gastrointestinal tract (GIT). This method of nutritional support has undergone progression over recent times. The method of placement of enteral feedin...

  16. Efficient iterative adaptive pole placement algorithm

    Institute of Scientific and Technical Information of China (English)

    李俊民; 李靖; 杨磊

    2004-01-01

    An iterative adaptive pole placement algorithm is presented. The stability and the convergence of the algorithm are respectively established. Since one-step iterative formulation in computing controller's parameters is used, the on-line computation cost is greatly reduced with respected to the traditional algorithm. The algorithm with the feed-forward can follow arbitrarily bounded output. The algorithm is also extended to multivariate case. Simulation examples show the efficiency and robustness of the algorithm.

  17. Product Placement: Systematisierung, Potenziale und Ausblick

    OpenAIRE

    Morlock, Felix; Schäffler, Robert; Schaffer, Philipp; Rennhak, Carsten

    2006-01-01

    Um zu gewährleisten, dass Zielgruppen weiterhin effektiv und effizient mit Werbung angesprochen werden können, muss ein Weg gefunden werden, der über die traditionellen Werbemethoden hinausgeht: die Werbeindustrie muss ihre Produkte in anderer Form unaufdringlich, aber dennoch effizient bewerben. Als neue Kommunikationsform wird deshalb neben dem Sponsoring verstärkt Product Placement eingesetzt. Die geringe Zahl an wissenschaftlichen Studien zur internationalen Verbreitung des Product Placem...

  18. Can donated media placements reach intended audiences?

    Science.gov (United States)

    Cooper, Crystale Purvis; Gelb, Cynthia A; Chu, Jennifer; Polonec, Lindsey

    2013-09-01

    Donated media placements for public service announcements (PSAs) can be difficult to secure, and may not always reach intended audiences. Strategies used by the Centers for Disease Control and Prevention's (CDC) Screen for Life: National Colorectal Cancer Action Campaign (SFL) to obtain donated media placements include producing a diverse mix of high-quality PSAs, co-branding with state and tribal health agencies, securing celebrity involvement, monitoring media trends to identify new distribution opportunities, and strategically timing the release of PSAs. To investigate open-ended recall of PSAs promoting colorectal cancer screening, CDC conducted 12 focus groups in three U.S. cities with men and women either nearing age 50 years, when screening is recommended to begin, or aged 50-75 years who were not in compliance with screening guidelines. In most focus groups, multiple participants recalled exposure to PSAs promoting colorectal cancer screening, and most of these individuals reported having seen SFL PSAs on television, in transit stations, or on the sides of public buses. Some participants reported exposure to SFL PSAs without prompting from the moderator, as they explained how they learned about the disease. Several participants reported learning key campaign messages from PSAs, including that colorectal cancer screening should begin at age 50 years and screening can find polyps so they can be removed before becoming cancerous. Donated media placements can reach and educate mass audiences, including millions of U.S. adults who have not been screened appropriately for colorectal cancer. PMID:23720533

  19. FPGA Congestion-Driven Placement Refinement

    Energy Technology Data Exchange (ETDEWEB)

    Vicente de, J.

    2005-07-01

    The routing congestion usually limits the complete proficiency of the FPGA logic resources. A key question can be formulated regarding the benefits of estimating the congestion at placement stage. In the last years, it is gaining acceptance the idea of a detailed placement taking into account congestion. In this paper, we resort to the Thermodynamic Simulated Annealing (TSA) algorithm to perform a congestion-driven placement refinement on the top of the common Bounding-Box pre optimized solution. The adaptive properties of TSA allow the search to preserve the solution quality of the pre optimized solution while improving other fine-grain objectives. Regarding the cost function two approaches have been considered. In the first one Expected Occupation (EO), a detailed probabilistic model to account for channel congestion is evaluated. We show that in spite of the minute detail of EO, the inherent uncertainty of this probabilistic model impedes to relieve congestion beyond the sole application of the Bounding-Box cost function. In the second approach we resort to the fast Rectilinear Steiner Regions algorithm to perform not an estimation but a measurement of the global routing congestion. This second strategy allows us to successfully reduce the requested channel width for a set of benchmark circuits with respect to the widespread Versatile Place and Route (VPR) tool. (Author) 31 refs.

  20. Experiences of Supervision at Practice Placement Sites

    Directory of Open Access Journals (Sweden)

    Lesley Diack

    2014-01-01

    Full Text Available Background. Whilst placement supervision and clinical education programmes are of significant value in shaping the behaviours of undergraduate healthcare students, appropriate provisions which are efficacious to the learner are somewhat lacking, particularly for students studying on UK MPharm programmes. Objectives. To explore and explain the value of placement supervision to the personal development and employability of undergraduate pharmacy students. Methods. Students participated in a week long community pharmacy pilot programme, a result of a collaborative effort between the School of Pharmacy and Life Sciences and a small consortium of community pharmacies. Students and stakeholders were asked to evaluate their experiences via separate questionnaires which had been developed to elicit views and attitudes. Key Findings. Feedback from students and stakeholders towards the experience was overwhelmingly positive with multiple benefits being reported. Of particular prominence was the emphasis in student feedback on the value of placement supervision to their professional and personal development. Findings were indicative of a development in clinical practice proficiencies, core skills, and improvement in decision-making practice. Conclusions. The benefits of clinical supervision to the professional and personal development of MPharm students are well documented, although attracting professional pharmacy supervisors is proving a problematic task for educational providers in the UK.

  1. Machine Learning Techniques for the Detection of Shockable Rhythms in Automated External Defibrillators.

    Science.gov (United States)

    Figuera, Carlos; Irusta, Unai; Morgado, Eduardo; Aramendi, Elisabete; Ayala, Unai; Wik, Lars; Kramer-Johansen, Jo; Eftestøl, Trygve; Alonso-Atienza, Felipe

    2016-01-01

    Early recognition of ventricular fibrillation (VF) and electrical therapy are key for the survival of out-of-hospital cardiac arrest (OHCA) patients treated with automated external defibrillators (AED). AED algorithms for VF-detection are customarily assessed using Holter recordings from public electrocardiogram (ECG) databases, which may be different from the ECG seen during OHCA events. This study evaluates VF-detection using data from both OHCA patients and public Holter recordings. ECG-segments of 4-s and 8-s duration were analyzed. For each segment 30 features were computed and fed to state of the art machine learning (ML) algorithms. ML-algorithms with built-in feature selection capabilities were used to determine the optimal feature subsets for both databases. Patient-wise bootstrap techniques were used to evaluate algorithm performance in terms of sensitivity (Se), specificity (Sp) and balanced error rate (BER). Performance was significantly better for public data with a mean Se of 96.6%, Sp of 98.8% and BER 2.2% compared to a mean Se of 94.7%, Sp of 96.5% and BER 4.4% for OHCA data. OHCA data required two times more features than the data from public databases for an accurate detection (6 vs 3). No significant differences in performance were found for different segment lengths, the BER differences were below 0.5-points in all cases. Our results show that VF-detection is more challenging for OHCA data than for data from public databases, and that accurate VF-detection is possible with segments as short as 4-s. PMID:27441719

  2. Machine Learning Techniques for the Detection of Shockable Rhythms in Automated External Defibrillators.

    Directory of Open Access Journals (Sweden)

    Carlos Figuera

    Full Text Available Early recognition of ventricular fibrillation (VF and electrical therapy are key for the survival of out-of-hospital cardiac arrest (OHCA patients treated with automated external defibrillators (AED. AED algorithms for VF-detection are customarily assessed using Holter recordings from public electrocardiogram (ECG databases, which may be different from the ECG seen during OHCA events. This study evaluates VF-detection using data from both OHCA patients and public Holter recordings. ECG-segments of 4-s and 8-s duration were analyzed. For each segment 30 features were computed and fed to state of the art machine learning (ML algorithms. ML-algorithms with built-in feature selection capabilities were used to determine the optimal feature subsets for both databases. Patient-wise bootstrap techniques were used to evaluate algorithm performance in terms of sensitivity (Se, specificity (Sp and balanced error rate (BER. Performance was significantly better for public data with a mean Se of 96.6%, Sp of 98.8% and BER 2.2% compared to a mean Se of 94.7%, Sp of 96.5% and BER 4.4% for OHCA data. OHCA data required two times more features than the data from public databases for an accurate detection (6 vs 3. No significant differences in performance were found for different segment lengths, the BER differences were below 0.5-points in all cases. Our results show that VF-detection is more challenging for OHCA data than for data from public databases, and that accurate VF-detection is possible with segments as short as 4-s.

  3. Machine Learning Techniques for the Detection of Shockable Rhythms in Automated External Defibrillators

    Science.gov (United States)

    Irusta, Unai; Morgado, Eduardo; Aramendi, Elisabete; Ayala, Unai; Wik, Lars; Kramer-Johansen, Jo; Eftestøl, Trygve; Alonso-Atienza, Felipe

    2016-01-01

    Early recognition of ventricular fibrillation (VF) and electrical therapy are key for the survival of out-of-hospital cardiac arrest (OHCA) patients treated with automated external defibrillators (AED). AED algorithms for VF-detection are customarily assessed using Holter recordings from public electrocardiogram (ECG) databases, which may be different from the ECG seen during OHCA events. This study evaluates VF-detection using data from both OHCA patients and public Holter recordings. ECG-segments of 4-s and 8-s duration were analyzed. For each segment 30 features were computed and fed to state of the art machine learning (ML) algorithms. ML-algorithms with built-in feature selection capabilities were used to determine the optimal feature subsets for both databases. Patient-wise bootstrap techniques were used to evaluate algorithm performance in terms of sensitivity (Se), specificity (Sp) and balanced error rate (BER). Performance was significantly better for public data with a mean Se of 96.6%, Sp of 98.8% and BER 2.2% compared to a mean Se of 94.7%, Sp of 96.5% and BER 4.4% for OHCA data. OHCA data required two times more features than the data from public databases for an accurate detection (6 vs 3). No significant differences in performance were found for different segment lengths, the BER differences were below 0.5-points in all cases. Our results show that VF-detection is more challenging for OHCA data than for data from public databases, and that accurate VF-detection is possible with segments as short as 4-s. PMID:27441719

  4. P-700系列电极对猪室颤模型除颤效果的影响%The influence of defibrillation electrodes of P-700 series on the defibrillation effect at pig ventruicular fibrillation model

    Institute of Scientific and Technical Information of China (English)

    张真; 周正宇; 王禹斌; 周慧英; 王婧; 薛智谋

    2012-01-01

    Objective To evaluate the effect and safety of novel defibrillation electrode of P-700 series. Methods Cardiac catheter was used to induce and build ventricular fibrillation model on three different weight groups of Tai-hu pigs, according to the available energy in "The 2010 AHA Guidelines for CPR and ECC" , with P-500 series electrodes as control, Electrodes of P-700 and P-500 were utilized to do external defibrillate and resuscitation in vitro separately. The rate of successful defibrillation were recorded and Doppler ultrasound measurement were applied to evaluate the animals' myocardial function before and after defibrillation, Gross anatomy and pathological examination were performed after experiments. Results There was no obvious significance difference between the control groups and experimental groups on the rate of successful defibrillation(P >0. 05). Among the three groups, there was no obvious significance difference prior to and after experiment on left ventricular ejection fraction, fraction area change and left ventricular end-systolic thickness (all P > 0. 05 ). No obvious abnormal appearance was found in gross anatomy and pathological examination. Conclusion The efficacy and safety of P-700 series electrodes meet the standard.%目的 评价新型除颤电极片P-700系列除颤的有效性和安全性.方法 通过心导管对3组不同体质量的太湖猪诱导,制作太湖猪室颤模型,根据“2010美国心脏协会心肺复苏及心血管急救指南”中的除颤能量适用范围为依据,以P-500系列电极片作为对照,用P-700系列电极片和P-500系列电极片分别进行体外除颤与复苏,统计除颤成功率,进行多普勒超声检查评价除颤前后各组动物的心脏功能,实验结束后做大体解剖并作病理分析.结果 实验组和对照组的除颤成功率差异无统计学意义(P>0.05),3组动物除颤前后左室射血分数(EF)、左室舒缩面积变化率(FAC)、左心室收缩末期后壁厚

  5. FROM BRAND PLACEMENT TO TOURISM PRODUCT PLACEMENT. FICTION SERIES AS PROMOTIONAL SUPPORT OF SPANISH TOURISM DESTINATIONS

    Directory of Open Access Journals (Sweden)

    Noelia Araújo-Vila

    2011-12-01

    Full Text Available Every day more consumers spend much of their free time to the consumption of audiovisual series, which is reflected in the notable increase in downloads and audiences. Therefore, many sectors have decided to use audiovisual series as advertising (brand placement, being one of them the tourism sector (tourism product placement. There are many worldwide destinations that have decided to set in a fiction series, thus being viewed by thousands of spectators, which has resulted in increases in visitors. In the Spanish case is not so clear the use of this strategy, as it is analysed in this article.

  6. Temporal Trends in Coverage of Historical Cardiac Arrests Using a Volunteer-Based Network of Automated External Defibrillators Accessible to Laypersons and Emergency Dispatch Centers

    DEFF Research Database (Denmark)

    Malta Hansen, Carolina; Knudsen Lippert, Freddy; Wissenberg, Mads;

    2014-01-01

    BACKGROUND: -Although increased dissemination of Automated External Defibrillators (AEDs) has been associated with more frequent AED use, the trade-off between the number of deployed AEDs and coverage of cardiac arrests remains unclear. We investigated how volunteer-based AED dissemination affect...

  7. Design of a Defibrillator Analyzer System based on LabVIEW%基于LabVIEW的除颤监护检测仪的开发

    Institute of Scientific and Technical Information of China (English)

    赵晖

    2012-01-01

    Defibrillator is necessary apparatus for rescue and treatment. In order to assure the safety and effectiveness m clinical use of defibrillator, the defibrillator's performance must be test periodically. This paper present a defibrillator analyzer system based on Lab VIEW, to detect the parameters such as release energy and synchronization delay time, and it can output ECG signal and the sine (or square wave) signal.%除颤器是用于抢救和治疗心律失常病人的设备,为确保除颤器临床使用的安全有效,必须对其主要指标进行定期检测.本文设计了一款基于LabVIEW的除颤器检测仪,用于检测除颤器的释放能量、同步除颤延迟时间等指标,并可输出模拟心电信号和正弦波(或方波)信号.

  8. Suppurative otitis media after tympanostomy tube placement

    Directory of Open Access Journals (Sweden)

    Baljošević Ivan

    2003-01-01

    Full Text Available Suppurative otitis media after tympanostomy tube placement is the most frequent complication of this surgical intervention. Otorrhea that occurs in the first two weeks following tube placement is called early, late otorrhea occurs at least two weeks following placement. Early otorrhea is usually a result of either an infection that already existed when the tube was placed, or contamination of the external auditory canal during operation. Late otorrhea is mostly a result of upper respiratory tract infection. Material and methods Our investigation was performed at the ENT Department, Mother and Child Health Care Institute in Belgrade. The research included children treated for secretory or recurrent otitis media. Results and discussion We have examined 411 children implanted with 796 tympanostomy tubes in the last three years. We investigated changes within two weeks after operation. Suppuration was recorded with 81 children (19.7%. Staphylococcus aureus was established in 33 (40.7% Pseudomonas aeruginosa in 26 (32%, Haemophilus influenzae in 12 (15% and Streptococcus pneumoniae in 10 (12.3% cases. All children were treated with antibiotic ear drops according to the antibiogram for a period of 7 days. Full recovery was achieved after treatment with Ciprofloxacin drops in 67%, Neomycin in 18% and Gentamycin in 9% of cases. In other cases a combination of drops and oral antibiotics was used. Conclusion In cases of suppurative otitis media after implantation of tympanostomy tubes, the secret should be treated with suction and after that antibiotic drops should be applied during 5 to 7 days. If suppuration is persistent, drops should be used with oral antibiotics.

  9. Immediate placement of endosseous implants into the extraction sockets

    Directory of Open Access Journals (Sweden)

    Vijay Ebenezer

    2015-01-01

    Full Text Available Implant by definition "means any object or material, such as an alloplastic substance or other tissue, which is partial or completely inserted into the body for therapeutic, diagnostic, prosthetic, or experimental purpose." The placement of a dental implant in an extraction socket at the time of extraction or explantation is known as immediate implant placement whereas delayed placement of implant signifies the implant placement in edentulous areas where healing has completed with new bone formation after the loss of tooth/teeth. Recent idea goes by "why late when it can be done immediately." There are several advantages of immediate placement of implants, and lots of studies have been done. In this article, the advantages and disadvantages of immediate versus delayed placement of implants have been reviewed.

  10. Product placement as a form of advertainment

    Directory of Open Access Journals (Sweden)

    Chiţu, I. B.

    2010-12-01

    Full Text Available Nowadays, one of the big issues advertisers on television face is the consumer’s (viewer’s ability to “zap” advertisements, as the public is increasingly tired of commercials. Advertainment is a form of communication that combines the elements of advertising and entertainment and is designed to overcome the tendency, especially among television viewers, to change channels or mute the audio during standard advertising commercials. This paper tries to give a brief overview of a method that belongs to advertainment, product placement, and how it is used by companies.

  11. Modifying Orthogonal Drawings for Label Placement

    Directory of Open Access Journals (Sweden)

    Konstantinos G. Kakoulis

    2016-03-01

    Full Text Available In this paper, we investigate how one can modify an orthogonal graph drawing to accommodate the placement of overlap-free labels with the minimum cost (i.e., minimum increase of the area and preservation of the quality of the drawing. We investigate computational complexity issues of variations of that problem, and we present polynomial time algorithms that find the minimum increase of space in one direction, needed to resolve overlaps, while preserving the orthogonal representation of the orthogonal drawing when objects have a predefined partial order.

  12. Wind Farm Turbine Type and Placement Optimization

    Energy Technology Data Exchange (ETDEWEB)

    Graf, Peter; Dykes, Katherine; Scott, George; Fields, Jason; Lunacek, Monte; Quick, Julian; Rethore, Pierre-Elouan

    2016-10-03

    The layout of turbines in a wind farm is already a challenging nonlinear, nonconvex, nonlinearly constrained continuous global optimization problem. Here we begin to address the next generation of wind farm optimization problems by adding the complexity that there is more than one turbine type to choose from. The optimization becomes a nonlinear constrained mixed integer problem, which is a very difficult class of problems to solve. This document briefly summarizes the algorithm and code we have developed, the code validation steps we have performed, and the initial results for multi-turbine type and placement optimization (TTP_OPT) we have run.

  13. Post-placement temperature reduction techniques

    DEFF Research Database (Denmark)

    Liu, Wei; Nannarelli, Alberto

    2010-01-01

    With technology scaled to deep submicron era, temperature and temperature gradient have emerged as important design criteria. We propose two post-placement techniques to reduce peak temperature by intelligently allocating whitespace in the hotspots. Both methods are fully compliant with commercia...... technologies, and can be easily integrated with state-of-the-art thermal-aware design flow. Experiments in a set of tests on circuits implemented in STM 65nm technologies show that our methods achieve better peak temperature reduction than directly increasing circuit's area....

  14. Public Claims about Automatic External Defibrillators: An Online Consumer Opinions Study

    Directory of Open Access Journals (Sweden)

    Barnett Julie

    2011-05-01

    Full Text Available Abstract Background Patients are no longer passive recipients of health care, and increasingly engage in health communications outside of the traditional patient and health care professional relationship. As a result, patient opinions and health related judgements are now being informed by a wide range of social, media, and online information sources. Government initiatives recognise self-delivery of health care as a valuable means of responding to the anticipated increased global demand for health resources. Automated External Defibrillators (AEDs, designed for the treatment of Sudden Cardiac Arrest (SCA, have recently become available for 'over the counter' purchase with no need for a prescription. This paper explores the claims and argumentation of lay persons and health care practitioners and professionals relating to these, and how these may impact on the acceptance, adoption and use of these devices within the home context. Methods We carry out a thematic content analysis of a novel form of Internet-based data: online consumer opinions of AED devices posted on Amazon.com, the world's largest online retailer. A total of #83 online consumer reviews of home AEDs are analysed. The analysis is both inductive, identifying themes that emerged from the data, exploring the parameters of public debate relating to these devices, and also driven by theory, centring around the parameters that may impact upon the acceptance, adoption and use of these devices within the home as indicated by the Technology Acceptance Model (TAM. Results Five high-level themes around which arguments for and against the adoption of home AEDs are identified and considered in the context of TAM. These include opinions relating to device usability, usefulness, cost, emotional implications of device ownership, and individual patient risk status. Emotional implications associated with AED acceptance, adoption and use emerged as a notable factor that is not currently reflected

  15. Robust sensor placement for leak location: analysis and design

    OpenAIRE

    Blesa, Joaquim; Nejjari, Fatiha; Sarrate, Ramon

    2016-01-01

    In this paper, a nominal sensor placement methodology for leak location in water distribution networks is presented. To reduce the size and the complexity of the optimization problem a clustering technique is combined with the nominal sensor placement methodology. Some of the pressure sensor placement methods for leak detection and location in water distribution networks are based on the pressure sensitivity matrix analysis. This matrix depends on the network demands, which are nondeterminist...

  16. Placement suitability criteria of composite tape for mould surface in automated tape placement

    Directory of Open Access Journals (Sweden)

    Zhang Peng

    2015-10-01

    Full Text Available Automated tape placement is an important automated process used for fabrication of large composite structures in aeronautical industry. The carbon fiber composite parts realized with this process tend to replace the aluminum parts produced by high-speed machining. It is difficult to determine the appropriate width of the composite tape in automated tape placement. Wrinkling will appear in the tape if it does not suit for the mould surface. Thus, this paper deals with establishing placement suitability criteria of the composite tape for the mould surface. With the assumptions for ideal mapping and by applying some principles and theorems of differential geometry, the centerline trajectory of the composite tape is identified to follow the geodesic. The placement suitability of the composite tape is examined on three different types of non-developable mould surfaces and four criteria are derived. The developed criteria have been used to test the deposition process over several mould surfaces and the appropriate width for each mould surface is obtained by referring to these criteria.

  17. Placement suitability criteria of composite tape for mould surface in automated tape placement

    Institute of Scientific and Technical Information of China (English)

    Zhang Peng; Sun Ronglei; Zhao Xueying; Hu Lingjin

    2015-01-01

    Automated tape placement is an important automated process used for fabrication of large composite structures in aeronautical industry. The carbon fiber composite parts realized with this process tend to replace the aluminum parts produced by high-speed machining. It is difficult to determine the appropriate width of the composite tape in automated tape placement. Wrinkling will appear in the tape if it does not suit for the mould surface. Thus, this paper deals with establishing placement suitability criteria of the composite tape for the mould surface. With the assumptions for ideal mapping and by applying some principles and theorems of differential geometry, the centerline trajectory of the composite tape is identified to follow the geodesic. The placement suitability of the composite tape is examined on three different types of non-developable mould surfaces and four criteria are derived. The developed criteria have been used to test the deposition process over several mould surfaces and the appropriate width for each mould surface is obtained by referring to these criteria.

  18. Identity and Placement Learning: Student Accounts of the Transition Back to University Following a Placement Year

    Science.gov (United States)

    Auburn, Timothy

    2007-01-01

    There has been an increasing emphasis on employability within the higher education curriculum. Supervised work experience, particularly in the form of a placement year, has been an established means of providing experiences which are intended to enhance employability. This study examines a relatively neglected but important aspect of supervised…

  19. The Re-Placement Test: Using TOEFL for Purposes of Placement

    Science.gov (United States)

    Moglen, Daniel

    2015-01-01

    This article will consider using TOEFL scores for purposes of placement and advising for international graduate students at a northern California research university. As the number of international students is on the rise and the funds for the graduate ESL program are diminishing, the way in which the university is handling the influx of…

  20. Retained Urethral Catheter Secondary to Placement in Proximal Ureter

    Directory of Open Access Journals (Sweden)

    Thomas B. McGregor

    2016-01-01

    Full Text Available We present an unusual complication secondary to indwelling urethral catheter placement. Routine catheter placement by the obstetrics team in a postpartum female leads to retention of the catheter and inability of its removal by both the obstetrics and urology teams. Although a retained urinary catheter is relatively common, inability to remove a catheter secondary to placement inadvertently into a ureter is extremely rare. In this paper we will discuss the options in removing a retained catheter and present our case of a retained catheter secondary to placement within the right proximal ureter.

  1. Retained Urethral Catheter Secondary to Placement in Proximal Ureter.

    Science.gov (United States)

    McGregor, Thomas B; Sharda, Rajan

    2016-01-01

    We present an unusual complication secondary to indwelling urethral catheter placement. Routine catheter placement by the obstetrics team in a postpartum female leads to retention of the catheter and inability of its removal by both the obstetrics and urology teams. Although a retained urinary catheter is relatively common, inability to remove a catheter secondary to placement inadvertently into a ureter is extremely rare. In this paper we will discuss the options in removing a retained catheter and present our case of a retained catheter secondary to placement within the right proximal ureter.

  2. Systematic downloading and analysis of data from automated external defibrillators used in out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Hansen, Marco Bo; Lippert, Freddy Knudsen; Rasmussen, Lars Simon;

    2014-01-01

    BACKGROUND: Valuable information can be retrieved from automated external defibrillators (AEDs) used in victims of out-of-hospital cardiac arrest (OHCA). We describe our experience with systematic downloading of data from deployed AEDs. The primary aim was to compare the proportion of shockable...... rhythm from AEDs used by laypersons with the corresponding proportion recorded by the Emergency Medical Services (EMS) on arrival. METHODS: In a 20-month study, we collected data on OHCAs in the Capital Region of Denmark where an AED was deployed prior to arrival of EMS. The AEDs were brought to the...... emergency medical dispatch centre for data downloading and rhythm analysis. Patient data were retrieved from the medical records from the admitting hospital, whereas data on EMS rhythm analyses were obtained from the Danish Cardiac Arrest Register between 2001 and 2010. RESULTS: A total of 121 AEDs were...

  3. AEDs at your fingertips: automated external defibrillators on college campuses and a novel approach for increasing accessibility.

    Science.gov (United States)

    Berger, Ryan J; O'Shea, Jesse G

    2014-01-01

    The use of automated external defibrillators (AEDs) increases survival in cardiac arrest events. Due to the success of previous efforts and free, readily available mobile mapping software, the discussion is to emphasize the importance of the use of AEDs to prevent sudden cardiac arrest-related deaths on college campuses and abroad, while suggesting a novel approach to aiding in access and awareness issues. A user-friendly mobile application (a low-cost iOS map) was developed at Florida State University to decrease AED retrieval distance and time. The development of mobile AED maps is feasible for a variety of universities and other entities, with the potential to save lives. Just having AEDs installed is not enough--they need to be easily locatable. Society increasingly relies on phones to provide information, and there are opportunities to use mobile technology to locate and share information about relevant emergency devices; these should be incorporated into the chain of survival. PMID:25116796

  4. Assessing and predicting successful tube placement outcomes in ALS patients.

    Science.gov (United States)

    Beggs, Kathleen; Choi, Marcia; Travlos, Andrew

    2010-01-01

    This study reviews feeding tube placement outcomes in 69 ALS outpatients seen at an outpatient interdisciplinary ALS clinic in British Columbia, Canada. The objective was to determine at which point the risks outweigh the benefits of tube placement by reviewing outcomes against parameters of respiratory function, nutritional status and speech and swallowing deterioration. The study was a retrospective review of tube placements between January 2000 and 2005, analysing data on respiratory function (forced vital capacity and respiratory status), weight change from usual body weight (UBW) and speech/swallowing deterioration using ALS Severity Score ratings (Hillel et al., 1989) at time of tube placement. Results show a statistically significant association between nutritional status and successful tube placement outcomes (p=0.003), and none between respiratory status, speech/swallowing variables, or number of deteriorated variables in each patient. Study findings were impacted by lack of available respiratory data. The only study variable that predicted successful tube placement outcome was a body weight greater than or equal to 74% UBW at time of tube placement. In the absence of access to respiratory testing, the relatively simple assessment of weight may assist patients and caregivers in appropriate decisions around tube placement.

  5. 34 CFR 104.35 - Evaluation and placement.

    Science.gov (United States)

    2010-07-01

    ... ASSISTANCE Preschool, Elementary, and Secondary Education § 104.35 Evaluation and placement. (a) Preplacement... 34 Education 1 2010-07-01 2010-07-01 false Evaluation and placement. 104.35 Section 104.35 Education Regulations of the Offices of the Department of Education OFFICE FOR CIVIL RIGHTS, DEPARTMENT...

  6. Advancing Prediction of Foster Placement Disruption Using Brief Behavioral Screening

    Science.gov (United States)

    Hurlburt, Michael S.; Chamberlain, Patricia; DeGarmo, David; Zhang, Jinjin; Price, Joe M.

    2010-01-01

    Objective: Behavioral difficulties increase the risk that children will experience negative placement disruptions while in foster care. Chamberlain et al. (2006) found that the Parent Daily Report (PDR), a brief measure of parent-reported child behaviors, was a strong predictor of negative placement changes over 1 year among children receiving…

  7. Is a Writing Sample Necessary for "Accurate Placement"?

    Science.gov (United States)

    Sullivan, Patrick; Nielsen, David

    2009-01-01

    The scholarship about assessment for placement is extensive and notoriously ambiguous. Foremost among the questions that continue to be unresolved in this scholarship is this one: Is a writing sample necessary for "accurate placement"? Using a robust data sample of student assessment essays and ACCUPLACER test scores, we put this question to the…

  8. Memoirs of a Trip into the Placement Culture of Japan.

    Science.gov (United States)

    Weatherall, Robert K.

    1991-01-01

    Presents observations of a U.S. college placement officer who participated in a careers conference in Japan. Describes changing desires of Japanese college students; hospitable treatment U.S. students received; their sightseeing experiences; the placement office at Waseda University; and the conference experience. (ABL)

  9. Small Bowel Obstruction Due to Suprapubic Catheter Placement

    OpenAIRE

    Bonasso, Patrick C.; Brandon Lucke-Wold; Uzer Khan

    2016-01-01

    Suprapubic catheter placement has associated complications such as bowel injury, bladder injury, or bleeding. This case describes the management of an elderly patient who had suprapubic catheter placement complicated by small bowel obstruction. The catheter had continued production of urine. Further patient treatment required abdominal exploration and bowel resection.

  10. Small Bowel Obstruction Due to Suprapubic Catheter Placement

    Directory of Open Access Journals (Sweden)

    Patrick C. Bonasso

    2016-07-01

    Full Text Available Suprapubic catheter placement has associated complications such as bowel injury, bladder injury, or bleeding. This case describes the management of an elderly patient who had suprapubic catheter placement complicated by small bowel obstruction. The catheter had continued production of urine. Further patient treatment required abdominal exploration and bowel resection.

  11. Small Bowel Obstruction Due to Suprapubic Catheter Placement.

    Science.gov (United States)

    Bonasso, Patrick C; Lucke-Wold, Brandon; Khan, Uzer

    2016-07-01

    Suprapubic catheter placement has associated complications such as bowel injury, bladder injury, or bleeding. This case describes the management of an elderly patient who had suprapubic catheter placement complicated by small bowel obstruction. The catheter had continued production of urine. Further patient treatment required abdominal exploration and bowel resection. PMID:27335801

  12. Infant Placement in Canadian Child Maltreatment-Related Investigations

    Science.gov (United States)

    Tonmyr, Lil; Williams, Gabriela; Jack, Susan M.; MacMillan, Harriet L.

    2011-01-01

    This study examined factors associated with decisions in favour of out-of-home placement following investigations involving infants at risk of maltreatment. We used data from a sample of children less than 1 year of age (n = 763) investigated by child welfare services across Canada in 2003. We tested unadjusted relationships with placement using…

  13. 41 CFR 60-2.16 - Placement goals.

    Science.gov (United States)

    2010-07-01

    ... publicly announced preference for American Indians as is authorized in 41 CFR 60-1.5(a)(6) may reflect in... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Placement goals. 60-2.16...-AFFIRMATIVE ACTION PROGRAMS Purpose and Contents of Affirmative Action Programs § 60-2.16 Placement goals....

  14. Placements: An Underused Vehicle for Quality Enhancement in Higher Education?

    Science.gov (United States)

    Kettis, Asa; Ring, Lena; Gustavsson, Maria; Wallman, Andy

    2013-01-01

    Placements have the potential to contribute more effectively to the quality of higher education. The aim of this article is to discuss how placements can be made more worthwhile for individual students, while also contributing to the overall quality of teaching and learning at HEIs as well as to the development of workplace cultures that are…

  15. Consumers with Major Depressive Disorder: Factors Influencing Job Placement

    Science.gov (United States)

    Hergenrather, Kenneth C.; Haase, Eileen; Zeglin, Robert J.; Rhodes, Scott D.

    2013-01-01

    The theory of planned behavior (TPB) was applied to study the factors that influence the intention of public rehabilitation placement professionals to place consumers with major depressive disorder (MDD) in jobs. A sample of 108 public rehabilitation placement professionals in the Mid-Atlantic region of the United States completed the MDD…

  16. Machine learning techniques for fault isolation and sensor placement

    Science.gov (United States)

    Carnes, James R.; Fisher, Douglas H.

    1993-01-01

    Fault isolation and sensor placement are vital for monitoring and diagnosis. A sensor conveys information about a system's state that guides troubleshooting if problems arise. We are using machine learning methods to uncover behavioral patterns over snapshots of system simulations that will aid fault isolation and sensor placement, with an eye towards minimality, fault coverage, and noise tolerance.

  17. The Placement Survey: Final Report, 1990-1991.

    Science.gov (United States)

    Von Wald, Stephen C.

    The Arrowhead Community College Region (ACCR), in Minnesota, conducted a follow-up study of its 1991 graduates designed to collect information on whether the graduates had found employment, were continuing their education, or had another placement status. Each college in the ACCR contacted its graduates to determine placement status, resulting in…

  18. Academic Freedom and Grading: The Role of Placement Providers

    Science.gov (United States)

    Martin, Ian

    2011-01-01

    Placement providers can be successfully involved in assessing students. This is demonstrated in the Monash University Faculty of Information Technology Cooperative Education Program. Students are thoroughly prepared for their placements and industry supervisors receive written assessment guidelines. Not one student has been awarded a pass grade by…

  19. Distinguishing implicit from explicit brand attitudes in brand placement research

    NARCIS (Netherlands)

    A.M. Wennekers; L. Vandeberg; K. Zoon; E.A. van Reijmersdal

    2016-01-01

    Brand placement is a popular topic, both in business and academia. Brands are placed in a wide-ranging array of media, including television programs, movies, radio shows, magazines, games, music videos, and websites. Expenditures on brand placement are still growing (PQ Media, 2013), as well as the

  20. 46 CFR 130.460 - Placement of machinery alarms.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Placement of machinery alarms. 130.460 Section 130.460..., AND MISCELLANEOUS EQUIPMENT AND SYSTEMS Automation of Unattended Machinery Spaces § 130.460 Placement of machinery alarms. (a) Visible and audible alarms must be installed at the pilothouse to...

  1. Effect of Cardiac Resynchronization Therapy in Patients With Insulin-Treated Diabetes Mellitus

    DEFF Research Database (Denmark)

    Szepietowska, Barbara; Kutyifa, Valentina; Ruwald, Martin H;

    2015-01-01

    branch block in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy trial. Treatment with CRT-D versus implantable cardioverter defibrillator was associated with 76% risk reduction in all-cause mortality (hazard ratio 0.24; 95% confidence interval 0.08 to 0...... by the presence of insulin treatment. We determined whether cardiac resynchronization therapy with defibrillator (CRT-D) versus implantable cardioverter defibrillator improves clinical outcomes in these 3 subgroups. Cox proportional hazards regression models were used to analyze 1,278 patients with left bundle...

  2. 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.

  3. Optimal Placement Algorithms for Virtual Machines

    CERN Document Server

    Bellur, Umesh; SD, Madhu Kumar

    2010-01-01

    Cloud computing provides a computing platform for the users to meet their demands in an efficient, cost-effective way. Virtualization technologies are used in the clouds to aid the efficient usage of hardware. Virtual machines (VMs) are utilized to satisfy the user needs and are placed on physical machines (PMs) of the cloud for effective usage of hardware resources and electricity in the cloud. Optimizing the number of PMs used helps in cutting down the power consumption by a substantial amount. In this paper, we present an optimal technique to map virtual machines to physical machines (nodes) such that the number of required nodes is minimized. We provide two approaches based on linear programming and quadratic programming techniques that significantly improve over the existing theoretical bounds and efficiently solve the problem of virtual machine (VM) placement in data centers.

  4. Camera placement in integer lattices (extended abstract)

    Science.gov (United States)

    Pocchiola, Michel; Kranakis, Evangelos

    1990-09-01

    Techniques for studying an art gallery problem (the camera placement problem) in the infinite lattice (L sup d) of d tuples of integers are considered. A lattice point A is visible from a camera C positioned at a vertex of (L sup d) if A does not equal C and if the line segment joining A and C crosses no other lattice vertex. By using a combination of probabilistic, combinatorial optimization and algorithmic techniques the position they must occupy in the lattice (L sup d) in the order to maximize their visibility can be determined in polynomial time, for any given number s less than or equal to (5 sup d) of cameras. This improves previous results for s less than or equal to (3 sup d).

  5. Energy Efficient Military Mobile Base Station Placement

    Directory of Open Access Journals (Sweden)

    Saikat Ray

    2010-11-01

    Full Text Available This research deals with an energy efficient network for military mobile base station placement. Theproposed method is based on minimizing the energy loss of military communication networks where thebase station is moving along a preset path and the users are constantly moving in an independent speedand direction. It takes into account the free space loss and the knife edge effect for the energy loss toestablish a path weight for the shortest path model. Then, it evaluates the neighboring points to the basestation for the energy loss of the network in order to find the position at which the minimum energy lossoccurs. The results show a clear energy saving advantage when compared to Lloyd-Max’s method

  6. Sensor Placement for Modal Parameter Subset Estimation

    DEFF Research Database (Denmark)

    Ulriksen, Martin Dalgaard; Bernal, Dionisio; Damkilde, Lars

    2016-01-01

    The present paper proposes an approach for deciding on sensor placements in the context of modal parameter estimation from vibration measurements. The approach is based on placing sensors, of which the amount is determined a priori, such that the minimum Fisher information that the frequency...... responses carry on the selected modal parameter subset is, in some sense, maximized. The approach is validated in the context of a simple 10-DOF mass-spring-damper system by computing the variance of a set of identified modal parameters in a Monte Carlo setting for a set of sensor configurations, whose......). It is shown that the widely used Effective Independence (EI) method, which uses the modal amplitudes as surrogates for the parameters of interest, provides sensor configurations yielding theoretical lower bound variances whose maxima are up to 30 % larger than those obtained by use of the max-min approach....

  7. Brocade: Optimal flow placement in SDN networks

    CERN Document Server

    CERN. Geneva

    2015-01-01

    Today' network poses several challanges to network providers. These challanges fall in to a variety of areas ranging from determining efficient utilization of network bandwidth to finding out which user applications consume majority of network resources. Also, how to protect a given network from volumetric and botnet attacks. Optimal placement of flows deal with identifying network issues and addressing them in a real-time. The overall solution helps in building new services where a network is more secure and more efficient. Benefits derived as a result are increased network efficiency due to better capacity and resource planning, better security with real-time threat mitigation, and improved user experience as a result of increased service velocity.

  8. The effects of pulse duration on efficacy of ventricular defibrillation%脉冲宽度对除颤效果的影响

    Institute of Scientific and Technical Information of China (English)

    谷云飞; 金军; 薛书峰; 陈剑锋; 贺慧娟; 段卡丹; 张守彦

    2013-01-01

    目的:通过动物实验,探讨不同脉冲宽度对室颤(VF)除颤效果的影响.方法:交流电刺激诱发猪VF,随机采用4ms+1 ms +4 ms和5ms+1ms+5ms两组不同脉冲宽度的双相波除颤,记录除颤成功次数,评价除颤阈值,统计比较两组除颤效果.结果:诱发VF80次,除颤成功25次.两组总的放电电压、能量、电量及除颤成功率无统计学差异;除颤阈值4ms+1ms+4ms组低于5 ms+1 ms+5 ms组.结论:脉冲宽度对除颤效果有影响,适当缩短脉冲宽度,可以减小除颤阈值并有提高除颤成功率的趋势.%Objective The aim of this study was to evaluate the effect of pulse duration on efficacy of ventricular defibrillation using automated external defibrillator (AED). Methods The pig's ventricular fibrillation (VF) was induced through alternating current (AC) ,then the pigs randomly received defibrillation with biphasic waveforms which pulse duration was 4 ms + 1 ms + 4 ms or 5 ms + 1 ms + 5 ms.Defibrillation thresholds (DFTs) and success rates were determined and analyzed by statistics. Results There are induced VF 80 episode and 25 achieve success.The two groups have no significant difference on total shock voltage , energy and electric quantity. But the defibrillation threshold of voltage , energy and electric quantity of 4 ms + 1 ms + 4 ms group were lower compare with 5 ms + 1 ms + 5 ms group(254.337 ± 93.191V Vs 310.818 ± 86.534V, P = 0.023; 9.811 ± 5.167J Vs 11.340 ± 8.086 J, P=0.047; 0.031 ± 0.011C Vs 0.037 ± 0.010C, P= 0.022). Conclusion The pulse duration is an important influence factor for defibrillation efficacy and we may decrease DFTs by shorten the pulse duration.

  9. Cumulative Risks of Foster Care Placement for Danish Children

    DEFF Research Database (Denmark)

    Fallesen, Peter; Emanuel, Natalia; Wildeman, Christopher

    2014-01-01

    Although recent research suggests that the cumulative risk of foster care placement is far higher for American children than originally suspected, little is known about the cumulative risk of foster care placement in other countries, which makes it difficult to gauge the degree to which factor...... foster care placement is salient in other contexts. In this article, we provide companion estimates to those provided in recent work on the US by using Danish registry data and synthetic cohort life tables to show how high and unequally distributed the cumulative risk of foster care placement...... is for Danish children. Results suggest that at the beginning of the study period (in 1998) the cumulative risk of foster care placement for Danish children was roughly in line with the risk for American children. Yet, by the end of the study period (2010), the risk had declined to half the risk for American...

  10. Strategies for Controlled Placement of Nanoscale Building Blocks

    Directory of Open Access Journals (Sweden)

    Koh SeongJin

    2007-01-01

    Full Text Available AbstractThe capability of placing individual nanoscale building blocks on exact substrate locations in a controlled manner is one of the key requirements to realize future electronic, optical, and magnetic devices and sensors that are composed of such blocks. This article reviews some important advances in the strategies for controlled placement of nanoscale building blocks. In particular, we will overview template assisted placement that utilizes physical, molecular, or electrostatic templates, DNA-programmed assembly, placement using dielectrophoresis, approaches for non-close-packed assembly of spherical particles, and recent development of focused placement schemes including electrostatic funneling, focused placement via molecular gradient patterns, electrodynamic focusing of charged aerosols, and others.

  11. 9. Incidence of tricuspid valve regurgitation following pacemaker/defibrillator lead extraction

    Directory of Open Access Journals (Sweden)

    A. AlFagih

    2016-07-01

    .5% had pacing leads across the valve.Our study being a simple descriptive study could not find overwhelming evidence to support the claim that there is an elevated risk of new onset TR or deterioration of a regurgitant valve following pacemaker/defibrillator lead extraction. However, our study being a simple observational study with a considerably small sample size may influence the findings. Lack of appropriate control group in this study is a limitation in appraising the hypothesis. As there is scarcity of data in this important area of cardiac research, our findings should prompt motivation for larger and well controlled cohort studies.

  12. Placement History of Foster Children: A Study of Placement History and Outcomes in Long-Term Family Foster Care

    Science.gov (United States)

    Strijker, Johan; Knorth, Erik J.; Knot-Dickscheit, Jana

    2008-01-01

    The files of 419 children in family foster care and kinship foster care were used in a retrospective longitudinal design study that examined their placement histories in child welfare. Significant associations were found between the number of placements on one hand, and the prevalence of attachment disorders, severity of behavioral problems, and…

  13. 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

  14. Emotions and health

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Stoier, Louise; Moons, Philip;

    2015-01-01

    Serious illness will inevitably lead to a fundamental emotional reaction. Traditionally, in interventional treatment or rehabilitation trials, the psychological status of patients with implantable cardioverter defibrillators has been evaluated with anxiety and depression as outcome measures...

  15. 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.

  16. 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....

  17. 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)....

  18. From the risk-stratification of patients with dilated cardiomyopathy to the optimal treatment strategy

    Directory of Open Access Journals (Sweden)

    Frolov A.V.

    2016-03-01

    Conclusions. Application of the original model of risk stratification will allow to optimize the general management in DCM and the strategy of timely selection of potential candidates for implantation of cardioverter- defibrillator for the primary prevention of SCD.

  19. 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.

  20. 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...

  1. Combining Amplitude Spectrum Area with Previous Shock Information Using Neural Networks Improves Prediction Performance of Defibrillation Outcome for Subsequent Shocks in Out-Of-Hospital Cardiac Arrest Patients.

    Directory of Open Access Journals (Sweden)

    Mi He

    Full Text Available Quantitative ventricular fibrillation (VF waveform analysis is a potentially powerful tool to optimize defibrillation. However, whether combining VF features with additional attributes that related to the previous shock could enhance the prediction performance for subsequent shocks is still uncertain.A total of 528 defibrillation shocks from 199 patients experienced out-of-hospital cardiac arrest were analyzed in this study. VF waveform was quantified using amplitude spectrum area (AMSA from defibrillator's ECG recordings prior to each shock. Combinations of AMSA with previous shock index (PSI or/and change of AMSA (ΔAMSA between successive shocks were exercised through a training dataset including 255shocks from 99patientswith neural networks. Performance of the combination methods were compared with AMSA based single feature prediction by area under receiver operating characteristic curve(AUC, sensitivity, positive predictive value (PPV, negative predictive value (NPV and prediction accuracy (PA through a validation dataset that was consisted of 273 shocks from 100patients.A total of61 (61.0% patients required subsequent shocks (N = 173 in the validation dataset. Combining AMSA with PSI and ΔAMSA obtained highest AUC (0.904 vs. 0.819, p<0.001 among different combination approaches for subsequent shocks. Sensitivity (76.5% vs. 35.3%, p<0.001, NPV (90.2% vs. 76.9%, p = 0.007 and PA (86.1% vs. 74.0%, p = 0.005were greatly improved compared with AMSA based single feature prediction with a threshold of 90% specificity.In this retrospective study, combining AMSA with previous shock information using neural networks greatly improves prediction performance of defibrillation outcome for subsequent shocks.

  2. Cost-Utility Analysis of the EVOLVO Study on Remote Monitoring for Heart Failure Patients With Implantable Defibrillators: Randomized Controlled Trial

    OpenAIRE

    Zanaboni, Paolo; Landolina, Maurizio; Marzegalli, Maurizio; Lunati, Maurizio; Perego, Giovanni B; Guenzati, Giuseppe; CURNIS, ANTONIO; Valsecchi, Sergio; Borghetti, Francesca; Borghi, Gabriella; Masella, Cristina

    2013-01-01

    Background Heart failure patients with implantable defibrillators place a significant burden on health care systems. Remote monitoring allows assessment of device function and heart failure parameters, and may represent a safe, effective, and cost-saving method compared to conventional in-office follow-up. Objective We hypothesized that remote device monitoring represents a cost-effective approach. This paper summarizes the economic evaluation of the Evolution of Management Strategies of Hear...

  3. 除颤仪使用质量监控及效果观察%Quality Monitoring and Effect Observation of Defibrillator

    Institute of Scientific and Technical Information of China (English)

    张宇平; 王正云; 周淑珍

    2014-01-01

    Objective To improve nurses' operational skills and salvaging success rate. Method With quarterly defibrillator operational assessment on nurses by quality control team, 575 problems were found. Based on these problems, quality control team members analyzed the causes, made countermeasures and reassessed relevant staffs after implementing these countermeasures. Results Under the monitoring of operational skill quality control team, defibrillator operation of nurses was regularized, which improved the proper operation of defibrillators and the salvaging ability of the nurses. Conclusion Quality control is an effective nursing management method, which is conductive to the improvement of nurses' operational skills of defibrillators.%目的提升全院护士除颤仪的操作技能,提高抢救成功率。方法通过质控小组每季度对护士进行除颤仪操作考核,发现问题575项,针对护士存在问题,质控小组成员分析讨论发生的原因并制订相应的对策组织实施,实施后对相关人员再进行考核评价。结果通过技能操作质控小组的监控,规范了护士对除颤仪的操作使用,提高了除颤仪操作的正确性,进一步提升了护士的抢救能力。结论通过质控对提高护士操作除颤仪的技能有很大的成效,是一种非常有效的护理管理方法。

  4. A New Method for Optimal Harmonic Meter Placement

    Directory of Open Access Journals (Sweden)

    A. Ketabi

    2008-01-01

    Full Text Available In this research, a new method based on Singular Value Decomposition (SVD is proposed to solve the problem of optimal placement of meters for static estimation of harmonic sources in a power system. Also, the Binary Genetic Algorithm (BGA is used to solve the problem of optimization. IEEE 14-bus test system is provided to validate the measurement placement algorithm. It has been observed that the quality of estimation is improved and the Number of Observable Variable (NOV is increased. Moreover, the BGA-based meter placement strategy yields the same solution as obtained from the complete enumeration technique but in shorter time.

  5. Research on Quality Control in Defibrillation ECG Monitor%除颤心电监护仪质量控制研究

    Institute of Scientific and Technical Information of China (English)

    钱正瑛

    2012-01-01

    目的 介绍无锡地区某三甲医院18台除颤心电监护仪进行的质控检测.方法 参考浙江省计量标准,采用FLUKE电气安全分析仪和除颤器分析仪进行检测,检测内容包括电气安全、能量输出和心电监测.结果 除同步模式下的延迟时间以外,其他合格率均为100%.结论 希望通过质控检测,降低除颤仪的使用风险,提高医疗质量,并进一步关注除颤仪电池检测和同步模式延迟时间的风险控制.%Objective To introduce the quality control (QC) testing of 18 defibrillation ECG monitors in a Level 3 hospital in Wuxi. Methods Based on measurement standards of Zhejiang province, we tested the electrical safety, energy output and electrocardiogram monitor using FLUKE electric analyzer and defibrillator analyzer. Results Qualified rates are 100% except delay time under synchronous mode. Conclusion By QC testing, we hope to reduce the use nsk of defibritlators, improve medical quality, and further focus on the detection of defibrillator battery and risk control of delay time under synchronous mode.

  6. Complications after placement of peritoneal catheter

    Directory of Open Access Journals (Sweden)

    Đurđević-Mirković Tatjana

    2011-01-01

    Full Text Available Introduction. Peritoneal dialysis is one of the modalities used for treatment of end-stage chronic kidney failure. Nowadays, this method is complementary to haemodialysis and renal transplantation. Owing to the rich vascularization of the peritoneum, it is used in the processes of osmosis and diffusion, enabling the removal of uremic material from the body. The procedure includes introduction of peritoneal fluid via the peritoneal catheter. Complications. The catheter is placed through the anterior abdominal wall with its tip positioned in the small pelvis. There are several techniques for catheter placement considered minimally invasive, which, however, may be associated with various complications. These complications can be divided into mechanical (catheter dysfunction, cuff protrusion, hernia, dialysate leaks, visceral perforation and infectious (early peritonitis, exit site or tunnel infection, surgical wounds. In most cases, such complications are rare and can be successfully managed using conservative therapy; however, in some situations severe complications can endanger the life of the patient. On-time recognition of complications, particularly in patients at risk, is of paramount importance for an effective treatment. The development of complications can increase the morbidity and the chance of treatment failure, and therefore transfer to haemodialysis. Conclusion. The preoperative evaluation and determination of the risk factors as well as the early recognition and adequate management of complications are essential in their prevention.

  7. Nasogastric Tube Placement in Newborns Before Discharge.

    Science.gov (United States)

    Alnemri, Abdulrahman M; Saeed, Anjum; Assiri, Asaad M

    2016-04-01

    The aim of this study was to assess the knowledge of medical staff (physicians) at different levels about insertion or placement of nasogastric tube (NGT) in a normal newborn before discharge. It was a survey-based, observational study conducted at King Khalid University Hospital. Atotal of 103 doctors were sent text message; among those 81 (78.6%) responded. Among the respondents, 27, 16, 11 and 27 were neonatologists, general physicians, obstetricians/ ENT/pediatric surgeons, and senior registrars neonatology (SRN), respectively. Majority of physicians, 57 (70.3%) rejected the idea of insertion of NGTin a normal newborn but in 24 (29.6%), answer was to insert NGTin all the newborns before discharge to check the patency of nasal cavities. Regarding the position, region of doctors and their response, majority from Center said ‘No’(not in favour of insertion) but from South, 17/18 (94.4%) said ‘Yes’(in favour of insertion). Regarding other specialties, majority of them showed rejection of this idea. In conclusion, most of the healthcare professionals, directly involved with neonatal care, rejected the idea of routine insertion of NGTin normal newborn examination before discharge; rather, some non-invasive technique could be opted.

  8. 除颤能量的合理选择%The logical choice for defibrillation energy

    Institute of Scientific and Technical Information of China (English)

    石宗华; 高传玉

    2012-01-01

    Objective Searching the right defibrillation (DF) energy so that lessening DF injury for patients in the base of no reducing success rate of DF, and benefiting better therapy for patients of CPR success. Methods The type of DF instrument is biphasic truncated exponential waveform (BTE). We Routinely note DF waveform of 93 cases needing emergent DF because of fast deadly arrhythmia in Critical - care medicine( CCM) of our hospital before each DF from Jan 2007 to Jan 2012, and choose 5 s waveform before DF as studying object. Then we systematically review and analyze DF energy, waveform of fast deadly arrhythmia, success rate of DF, and search for the relations of them. Results ①For no VF - fast deadly arrhythmia, we should choose 150 J for DF. The success rate of DF is very high, almost 100%. ②Frequency and amplitude of vibration of VF waveform take obviously on a relation of positive correlation. With time prolonging of VF, they fast synchronously become small. When frequency of VF isnt more than 200 bpm, or amplitude of vibration of VF not more than 0. 2 mV, the success rate of DF for 150 J and 200 J all is very low, and it hasn't statistics difference between two groups. And in frequency 400 ~ 500 bpm and > 500 bpm two groups or amplitude of vibration 0. 6 ~ 1. 0 mV and > 1. 0 mV two groups, the success rates of DF for 150 J and 200 J all are very high, and they have not statistics difference between two groups. Only when frequency of VF is among 200 ~ 400 bpm or amplitude of vibration of VF is among 0.2 ~ 0. 6 mV. The success rate of DF for 150 J and 200 J has statistics difference(P 400 bpm or amplitude of vibration of VF >0.6 mV, we should first choose 150 J for immediate DF. As frequency of VF among 200 ~400 bpm or amplitude of vibration of VF among 0. 2 ~0. 6 mV, we should first choose 200J for immediate DF.%目的 探求合适的除颤(DF)能量,以期在不降低DF成功率的前提下,尽量减少DF对患者的损伤,利于心肺复苏(CPR)成功后

  9. Advanced in In Situ Inspection of Automated Fiber Placement Systems

    Science.gov (United States)

    Juarez, Peter D.; Cramer, K. Elliott; Seebo, Jeffrey P.

    2016-01-01

    Automated Fiber Placement (AFP) systems have been developed to help take advantage of the tailorability of composite structures in aerospace applications. AFP systems allow the repeatable placement of uncured, spool fed, preimpregnated carbon fiber tape (tows) onto substrates in desired thicknesses and orientations. This automated process can incur defects, such as overlapping tow lines, which can severely undermine the structural integrity of the part. Current defect detection and abatement methods are very labor intensive, and still mostly rely on human manual inspection. Proposed is a thermographic in situ inspection technique which monitors tow placement with an on board thermal camera using the preheated substrate as a through transmission heat source. An investigation of the concept is conducted, and preliminary laboratory results are presented. Also included will be a brief overview of other emerging technologies that tackle the same issue. Keywords: Automated Fiber Placement, Manufacturing defects, Thermography

  10. Are we preparing student nurses for final practice placement?

    Science.gov (United States)

    Morrell, Nicola; Ridgway, Victoria

    The aims of this research were to illuminate student nurses' perceptions of preparedness for final practice placement, and to ascertain factors that supported and hindered preparation for final placement practice. This phenomenological qualitative research was carried out in a UK higher education institution (HEI) with eight adult branch student nurses maintaining written diaries for the first 4 weeks of their final 10-week practice placement. Data were then analysed by means of an interpretive phenomenological approach (IPA). Results showed that students felt ill-prepared for placement. Eight clear themes emerged, including: being used as 'an extra pair of hands'; mentors appearing to treat student practice documentation as unimportant; and high staff expectations. Other themes were: mentor importance; students feeling that they lacked knowledge; and students feeling unsupported and stressed. In conclusion, although students felt that they lacked knowledge and were used as an extra pair of hands, they did show clinical competence. PMID:24851915

  11. A Closer Look at an Advanced Placement Calculus Problem.

    Science.gov (United States)

    Rudd, David

    1985-01-01

    Answers and justifications for an interesting problem on the Advanced Placement Calculus AB Examination are discussed. The problem provides diverse ways in which students can gain appreciation and understanding for the subject. (MNS)

  12. Lumbar pedicle screw placement: Using only AP plane imaging

    Directory of Open Access Journals (Sweden)

    Anil Sethi

    2012-01-01

    Conclusion: Placement of pedicle screws under fluoroscopic guidance using AP plane imaging alone with tactile guidance is safe, fast, and reliable. However, a good understanding of the radiographic landmarks is a prerequisite.

  13. Complications of nasogastric tube placement--don't blow it.

    LENUS (Irish Health Repository)

    Leonard, S

    2012-04-01

    Preventable complications maybe associated with the placement of nasogastric tubes. Our report raises awareness of the potentially fatal complications that can occur. We also recommend an approach for clinicians which maybe used to avoid significant patient morbidity.

  14. Critical Path-Based Thread Placement for NUMA Systems

    Energy Technology Data Exchange (ETDEWEB)

    Su, C Y; Li, D; Nikolopoulos, D S; Grove, M; Cameron, K; de Supinski, B R

    2011-11-01

    Multicore multiprocessors use a Non Uniform Memory Architecture (NUMA) to improve their scalability. However, NUMA introduces performance penalties due to remote memory accesses. Without efficiently managing data layout and thread mapping to cores, scientific applications, even if they are optimized for NUMA, may suffer performance loss. In this paper, we present algorithms and a runtime system that optimize the execution of OpenMP applications on NUMA architectures. By collecting information from hardware counters, the runtime system directs thread placement and reduces performance penalties by minimizing the critical path of OpenMP parallel regions. The runtime system uses a scalable algorithm that derives placement decisions with negligible overhead. We evaluate our algorithms and runtime system with four NPB applications implemented in OpenMP. On average the algorithms achieve between 8.13% and 25.68% performance improvement compared to the default Linux thread placement scheme. The algorithms miss the optimal thread placement in only 8.9% of the cases.

  15. Community placements need to be spread more evenly across country.

    Science.gov (United States)

    2014-07-01

    Greater investment is needed to provide a more consistent spread of student practice placements in community children's nursing across the UK, children's nursing lecturers and nurses have warned. PMID:25004028

  16. Heterocyst placement strategies to maximize growth of cyanobacterial filaments

    CERN Document Server

    Brown, Aidan I

    2012-01-01

    Under conditions of limited fixed-nitrogen, some filamentous cyanobacteria develop a regular pattern of heterocyst cells that fix nitrogen for the remaining vegetative cells. We examine three different heterocyst placement strategies by quantitatively modelling filament growth while varying both external fixed-nitrogen and leakage from the filament. We find that there is an optimum heterocyst frequency which maximizes the growth rate of the filament; the optimum frequency decreases as the external fixed-nitrogen concentration increases but increases as the leakage increases. In the presence of leakage, filaments implementing a local heterocyst placement strategy grow significantly faster than filaments implementing random heterocyst placement strategies. With no extracellular fixed-nitrogen, consistent with recent experimental studies of Anabaena sp. PCC 7120, the modelled heterocyst spacing distribution using our local heterocyst placement strategy is qualitatively similar to experimentally observed patterns...

  17. 基于能量检测的心电除颤模拟教学系统%Cardiac defibrillation simulation teaching system based on energy detection

    Institute of Scientific and Technical Information of China (English)

    杨延雷; 张子明; 卢旺; 梁书立

    2012-01-01

    采S3C2440作为主控制芯片,使用Linux2.6.240S,在嵌入式Qt2.7平台下开发设计了一款医学心电除颤模拟教学系统。系统进行高压降压后通过AD采集计算除颤仪释放的能量。心电波形的拟合是采用M丌_Bm心电数据库,通过分析截取一个周期的数据,经变换得到适合嵌入式下的波形数据。该系统可作为独立的除颤模拟系统使用也可与智能综合模型人相连配合使用,能够真实地模拟心电除颤的整个过程。该系统的成功研制为医学心电除颤教学与学习提供了优越的教学平台。%Using S3C2440 as the main control chip, Linux2.6.24 as OS and use embedded Qt2.7 as developed platform to design a simulation teaching system of medical heart defibrillator. The system calculates energy of defibrillator released after step-dowan and MD collection. Electrocardiogram waveform fitting is the use of MIT-BIH ECG database, and interception of a cycle by analyzing the data obtained by the transformation under very suitable for embedded waveform data. The system can be used as stand-alone defibrillation simulation system and can be integrated with smart people connected with the use of the model. Which is able to simulate the whole process of heart defibrillator. This system successfully developed cardiac defibrillation for medical teaching and learning provides excellent teaching platform.

  18. 影响电击除颤效果的因素分析%Influential Factors of Defibrillation in Patients with Ventricular Fibrillation

    Institute of Scientific and Technical Information of China (English)

    马承君; 马哲; 马永才; 白岩松; 韩图亚

    2011-01-01

    目的 分析影响心室颤动(VF)电击除颤效果的因素,提高VF的救治质量.方法 对本院2001年1月至2010年1月收治的VF患者206例进行分析,比较电击除颤成功组与失败组年龄、VF持续时间、VF振幅、VF频率、除颤次数、胺碘酮用量、肾上腺素用量.结果 VF电击除颤成功组与失败组在年龄、除颤次数上比较差异无统计学意义(P>0.05).在VF振幅、VF 频率、VF持续时间、胺碘酮、肾上腺素用量方面比较差异有统计学意义(P<0.05).结论 VF振幅、频率及持续时间决定电击除颤时机,正确把握才能保证电击除颤效果.合理应用胺碘酮、肾上腺素可以提高电击除颤成功率.%Objective To analyze several factors of defibrillation in the patients with ventricular fibrillation ( VF ). Methods 206 VF cases on our hospital from Janaury 2001 to Janaury 2010 were analyzed. VF duration, VF amplitude, VF frequency, the number of defibrillation, dosage of amiodarone and adrenaline was compared between success and failure group of VF. Results There was no significant difference in age and number of previous defibrillation between the two groups ( P > 0.05 ). There was significant difference in VF amplitude, VF frequency, VF duration, dosage of amiodarone and adrenaline ( P < 0.05 ). Conclusions The achievement of defibrillation was related to amplitude ,frequency and duration of VF. The using of amiodarone and epinephrine properly can improve the success rate of defibrillation.

  19. Product placement jako marketingový nástroj

    OpenAIRE

    Kincl, Albert

    2015-01-01

    The aim of this thesis is to describe thoroughly the execution of a product placement process in TV broadcasting with focus on the Czech Republic. So as to analyse product placement as a marketing tool and to introduce its possible forms and current trends. Moreover, to explain the development of this marketing communication and last but not least, discuss the strengths and weaknesses of this specific form of advertisement. Furthermore, questionnaire analysis is used to research the reception...

  20. Endoscopic Stent Placement in the Palliation of Malignant Biliary Obstruction

    OpenAIRE

    Kim, Jin Hong

    2011-01-01

    Biliary drainage with biliary stent placement is the treatment of choice for palliation in patients with malignant biliary obstruction caused by unresectable neoplasms. In such patients, the endoscopic approach can be initially used with percutaneous radiological intervention. In patients with unresectable malignant distal bile duct obstructions, endoscopic biliary drainage with biliary stent placement has now become the main and least invasive palliative modality, which has been proven to be...

  1. Effects of Advertising and Product Placement on Television Audiences

    OpenAIRE

    Wilbur, Kenneth C; Michelle S. Goeree; Ridder, Geert

    2009-01-01

    Digital video recorder proliferation and new commercial audience metrics are making television networks’ revenues more sensitive to audience losses from advertising. There is currently limited understanding of how traditional advertising and product placement affectntelevision audiences. We estimate a random coefficients logit model of viewing demand for television programs, wherein time given to advertising and product placement plays a role akinnto the “price” of consuming a program. Our da...

  2. Isotropic Optical Mouse Placement for Mobile Robot Velocity Estimation

    OpenAIRE

    Sungbok Kim

    2014-01-01

    This paper presents the isotropic placement of multiple optical mice for the velocity estimation of a mobile robot. It is assumed that there can be positional restriction on the installation of optical mice at the bottom of a mobile robot. First, the velocity kinematics of a mobile robot with an array of optical mice is obtained and the resulting Jacobian matrix is analysed symbolically. Second, the isotropic, anisotropic and singular optical mouse placements are identified, along with the co...

  3. Speeding Up FPGA Placement via Partitioning and Multithreading

    Directory of Open Access Journals (Sweden)

    Cristinel Ababei

    2009-01-01

    placement subproblems are created by partitioning and then processed concurrently by multiple worker threads that are run on multiple cores of the same processor. Our main goal is to investigate the speedup that can be achieved with this simple approach compared to previous approaches that were based on distributed computing. The new hybrid parallel placement algorithm achieves an average speedup of 2.5× using four worker threads, while the total wire length and circuit delay after routing are minimally degraded.

  4. Common ECG Lead Placement Errors. Part II: Precordial Misplacements

    OpenAIRE

    Allison V. Rosen; Sahil Koppikar; Catherine Shaw; Adrian Baranchuk

    2014-01-01

    Background: Electrocardiography is a very useful diagnostic tool. However, errors in placement of ECG leads can create artifacts, mimic pathologies, and hinder proper ECG interpretation. This is the second of a two-part series discussing how to recognize and avoid these errors. Methods: 12-lead ECGs were recorded in a single male healthy subject in his mid 20s. Various precordial lead misplacements were compared to ECG recordings from correct lead placement. Results: Precordial mispla...

  5. Factors influencing radiation therapy student clinical placement satisfaction

    OpenAIRE

    Bridge, Pete; Carmichael, Mary-Ann

    2014-01-01

    Introduction: Radiation therapy students at Queensland University of Technology (QUT) attend clinical placements at five different clinical departments with varying resources and support strategies. This study aimed to determine the relative availability and perceived importance of different factors affecting student support while on clinical placement. The purpose of the research was to inform development of future support mechanisms to enhance radiation therapy students’ experience on clini...

  6. 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

  7. Factors influencing radiation therapy student clinical placement satisfaction

    International Nuclear Information System (INIS)

    Introduction: Radiation therapy students at Queensland University of Technology (QUT) attend clinical placements at five different clinical departments with varying resources and support strategies. This study aimed to determine the relative availability and perceived importance of different factors affecting student support while on clinical placement. The purpose of the research was to inform development of future support mechanisms to enhance radiation therapy students’ experience on clinical placement. Methods: This study used anonymous Likert-style surveys to gather data from years 1 and 2 radiation therapy students from QUT and clinical educators from Queensland relating to availability and importance of support mechanisms during clinical placements in a semester. Results: The study findings demonstrated student satisfaction with clinical support and suggested that level of support on placement influenced student employment choices. Staff support was perceived as more important than physical resources; particularly access to a named mentor, a clinical educator and weekly formative feedback. Both students and educators highlighted the impact of time pressures. Conclusions: The support offered to radiation therapy students by clinical staff is more highly valued than physical resources or models of placement support. Protected time and acknowledgement of the importance of clinical education roles are both invaluable. Joint investment in mentor support by both universities and clinical departments is crucial for facilitation of effective clinical learning

  8. Hybrid IR-Gas Heater for Automated Tow Placement

    Science.gov (United States)

    Grenoble, Ray W.; Johnston, Norman J.; Tiwari, S. N.; Marchello, Joseph M.

    1998-01-01

    A hybrid infrared-hot gas heat source has been developed and tested for the NASA Langley Tow Placement Facility. The IR heat source provides supplemental heat to the nip region. The additional heat is intended to reduce the need for conduction heating by the compaction roller, which causes (he roller to stick to the panel surface. Initial bench scale testing was performed to identify the most effective means of focusing IR energy into the nip region. A compact lamp and reflector that placed the lamp as close to the nip point as possible was found to deliver the highest heat flux in the nip region. A prototype heater was installed on the NASA Langley tow placement robot. Panels placed with a 400 C (sticking) compaction roller gave DCB initiation toughness numbers comparable to those reported for autoclave processed panels but were found to have unexpectedly high void contents. Placement with compaction roller temperatures that prevented roller sticking resulted in mode I fracture toughness approximately 70% that reported for autoclave processed panels. The variability in strength among specimens placed with reduced roller temperature was found to be greatly reduced, which implies that use of supplemental nip point heat may improve the robustness of the tow placement process. Use of the IR heat source permitted placement with a compaction roller temperature that would have resulted in negligible interfacial strength with the hot gas torch alone. The roller temperature reductions eliminated the need for the robot operator to attend placement operations.

  9. A Sea-of-Gates Style FPGA Placement Algorithm

    Directory of Open Access Journals (Sweden)

    Kalapi Roy

    1996-01-01

    Full Text Available Field Programmable Gate Arrays (FPGAs have a pre-defined chip boundary with fixed cell locations and routing resources. Placement objectives for flexible architectures (e.g., the standard cell design style such as minimization of chip area do not reflect the primary placement goals for FPGAs. For FPGAs, the layout tools must seek 100% routability within the architectural constraints. Routability and congestion estimates must be made directly based on the demand and availability of routing resources for detailed routing of the particular FPGA. We. present a hierarchical placement approach consisting of two phases: a global placement phase followed by a detailed placement phase. The global placement phase minimizes congestion estimates of the global routing regions and satisfies all constraints at a coarser level. The detailed placer seeks to maximize the routability of the FPGA by considering factors which cause congestion at the detailed routing level and to precisely satisfy all of the constraints. Despite having limited knowledge about the gate level architectural details, we have achieved a 90%reduction in the number of unrouted nets in comparison to an industrial tool (the only other tool developed specifically for this architecture.

  10. Mixing advertising and editorial content in radio programmes: appreciation and recall of brand placements versus commercials

    NARCIS (Netherlands)

    E.A. van Reijmersdal

    2011-01-01

    Although the literature on brand placement is rapidly evolving, no studies thus far have focused on radio brand placement or on the effects of the combination of brand placement and commercials. Therefore, the present experiment (N = 153) focused on the effects of radio brand placement on liking, cr

  11. The Placement Handbook. A Guide for the Competitive Employment of the Handicapped.

    Science.gov (United States)

    Horn, Adelaide; Drury, Stephen

    This handbook stresses those components that are considered peripheral to the placement process but that must precede the actual placement. The philosophy of placement upon which this guide is based appears first. Discussions follow of the basic components of the process of training and placement of handicapped individuals, including a varied…

  12. PERFORMANCE EVALUATION OF AODV AND DSR IN FEASIBLE AND RANDOM PLACEMENT MODELS

    OpenAIRE

    K. Narasimha Raju; Dr. S.P.Setty

    2014-01-01

    Routing is a challenging issue in Mobile Ad hoc Network to pass the data packets through intermediate hops in an efficient manner. In this paper, Reactive routing protocols namely AODV and DSR are evaluated under the feasible placement and random placement models. Simulation results shows that AODV and DSR are performing better in feasible placement approach comparative to the existing random placement approach.

  13. An Experimental Study on Myocardial Injury From Low Energy Defibrillation.%低能量心脏除颤心肌损伤的实验研究

    Institute of Scientific and Technical Information of China (English)

    高蕴雅; 龚镇楠; 朱伯良; 张觉先; 孙友法; 方祖祥; 石镭; 戚文航; 王志刚

    2001-01-01

    在13只犬的低能量心脏除颤实验中,应用病理检查、除颤心电图记录以及除颤前后肌酸磷酸激酶及其同工酶(CPK和CPK-MB)测定三种方法探测心肌损伤。肉眼观察和显微镜检查见到5只犬(除颤7~21次,能量10~40 J)电极处心脏轻度充血,2只犬(除颤9~20次,能量20~50 J)心肌苍白、心内膜附有血栓,6只犬(除颤7~29次,能量10~60 J)心内膜水肿、血栓形成、局部心肌断裂和退行性变、心肌间质出血等病理变化。记录到4只犬(除颤8~24次,能量20~50 J)除颤放电后ST段压低或ST段抬高心电图波形。测得2只犬(除颤10~19次,能量5~40J)除颤后CPK和CPK-MB有轻度升高(1只CPK由104升至110 IU,另1只CPK-MB由47.1升至60.9 IU)。本实验提示:低能量心脏除颤可导致心肌损伤;损伤可能由热和电等因素造成;损伤程度与除颤能量和除颤脉冲间隔时间等因素有关;损伤范围为局灶性且可能愈合。%During low energy defibrillation experiments in 13 dogs,three methods for the detection of myocardial injury were used:pathologic examination,defibrillation electrocardiogram recording,and creatine phosphokinase (CPK) and CPK-MB determination before and after defibrillation.In visual observation and microscopic examination,5 dogs (7~21 shocks,10~40 J) showed slight hyperemia in the area around electrodes,2 dogs (9~20 shocks,20~50 J) showed pale myocardium,and endocardium with thrombi.Also,pathologic changes including endocardial edema,thrombosis,localized fragmentation of myocardium and retrograde changes,and myocardial interstitial hemorrhage were found in 6 dogs (7~29 shocks,10~60 J).ST-T segment changes in electrocardiographic patterns were recorded after defibrillation charges in 4 dogs(8~24 shocks,20~50 J).CPK and CPK-MB showed slight elevation in 2 dogs (10~19 shocks ,5~40 J) after receiving defibrillation shocks,with CPK elevated from

  14. Placement of students to high schools in Turkey: Factors affecting student achievement in placement tests

    Directory of Open Access Journals (Sweden)

    Hasan Basri Gündüz

    2010-04-01

    Full Text Available The objective of the research is to identify factors that affect the degree the most successful and the most unsuccessful ten students get at their class levels and in their dwelling units in "Level Determination Examination" which is a form of placement test held at provincial levels in allocation of students from elementary to secondary education.   The research was conducted in Sakarya Province.  The sample of the research comprised of 420 6th, 7th and 8th grade students in total who ranked among the first and the last 10 groups in dwelling units in the examination held at provincial level.  It was ascertained that 82% (Nagelkerke R2 = 0.82 of student's ranking among the first most successful or the last most unsuccessful group of ten people in their own dwelling unit and at their own class level in the Placement Test could be predicted by TE, PA, BÇG, BY, SİD and Ç factors according to Stepwise logistic regression analysis.  AKD, AİFK and AO are the variables which were not found to be meaningful in the last regression equation. 

  15. Effects of a Foster Parent Training Intervention on Placement Changes of Children in Foster Care

    OpenAIRE

    Price, Joseph M.; Chamberlain, Patricia; LANDSVERK, JOHN; Reid, John; Leve, Leslie; Laurent, Heidemarie

    2008-01-01

    Placement disruptions undermine efforts of child welfare agencies to promote safety, permanency, and child well-being. Child behavior problems significantly contribute to placement changes. The aims of this investigation were to examine the impact of a foster parent training and support intervention (KEEP) on placement changes and to determine whether the intervention mitigates placement disruption risks associated with children's placement histories. The sample consisted of 700 families with...

  16. The Effect of the Duration of Basic Life Support Training on the Learners’ Cardiopulmonary and Automated External Defibrillator Skills

    Directory of Open Access Journals (Sweden)

    Jin Hyuck Lee

    2016-01-01

    Full Text Available Background. Basic life support (BLS training with hands-on practice can improve performance during simulated cardiac arrest, although the optimal duration for BLS training is unknown. This study aimed to assess the effectiveness of various BLS training durations for acquiring cardiopulmonary resuscitation (CPR and automated external defibrillator (AED skills. Methods. We randomised 485 South Korean nonmedical college students into four levels of BLS training: level 1 (40 min, level 2 (80 min, level 3 (120 min, and level 4 (180 min. Before and after each level, the participants completed questionnaires regarding their willingness to perform CPR and use AEDs, and their psychomotor skills for CPR and AED use were assessed using a manikin with Skill-Reporter™ software. Results. There were no significant differences between levels 1 and 2, although levels 3 and 4 exhibited significant differences in the proportion of overall adequate chest compressions (p<0.001 and average chest compression depth (p=0.003. All levels exhibited a greater posttest willingness to perform CPR and use AEDs (all, p<0.001. Conclusions. Brief BLS training provided a moderate level of skill for performing CPR and using AEDs. However, high-quality skills for CPR required longer and hands-on training, particularly hands-on training with AEDs.

  17. 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.

  18. The Effect of the Duration of Basic Life Support Training on the Learners' Cardiopulmonary and Automated External Defibrillator Skills

    Science.gov (United States)

    Kang, Ku Hyun; Song, Keun Jeong; Lee, Chang Hee

    2016-01-01

    Background. Basic life support (BLS) training with hands-on practice can improve performance during simulated cardiac arrest, although the optimal duration for BLS training is unknown. This study aimed to assess the effectiveness of various BLS training durations for acquiring cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skills. Methods. We randomised 485 South Korean nonmedical college students into four levels of BLS training: level 1 (40 min), level 2 (80 min), level 3 (120 min), and level 4 (180 min). Before and after each level, the participants completed questionnaires regarding their willingness to perform CPR and use AEDs, and their psychomotor skills for CPR and AED use were assessed using a manikin with Skill-Reporter™ software. Results. There were no significant differences between levels 1 and 2, although levels 3 and 4 exhibited significant differences in the proportion of overall adequate chest compressions (p < 0.001) and average chest compression depth (p = 0.003). All levels exhibited a greater posttest willingness to perform CPR and use AEDs (all, p < 0.001). Conclusions. Brief BLS training provided a moderate level of skill for performing CPR and using AEDs. However, high-quality skills for CPR required longer and hands-on training, particularly hands-on training with AEDs. PMID:27529066

  19. 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.

  20. The Effect of the Duration of Basic Life Support Training on the Learners' Cardiopulmonary and Automated External Defibrillator Skills.

    Science.gov (United States)

    Lee, Jin Hyuck; Cho, Youngsuk; Kang, Ku Hyun; Cho, Gyu Chong; Song, Keun Jeong; Lee, Chang Hee

    2016-01-01

    Background. Basic life support (BLS) training with hands-on practice can improve performance during simulated cardiac arrest, although the optimal duration for BLS training is unknown. This study aimed to assess the effectiveness of various BLS training durations for acquiring cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skills. Methods. We randomised 485 South Korean nonmedical college students into four levels of BLS training: level 1 (40 min), level 2 (80 min), level 3 (120 min), and level 4 (180 min). Before and after each level, the participants completed questionnaires regarding their willingness to perform CPR and use AEDs, and their psychomotor skills for CPR and AED use were assessed using a manikin with Skill-Reporter™ software. Results. There were no significant differences between levels 1 and 2, although levels 3 and 4 exhibited significant differences in the proportion of overall adequate chest compressions (p < 0.001) and average chest compression depth (p = 0.003). All levels exhibited a greater posttest willingness to perform CPR and use AEDs (all, p < 0.001). Conclusions. Brief BLS training provided a moderate level of skill for performing CPR and using AEDs. However, high-quality skills for CPR required longer and hands-on training, particularly hands-on training with AEDs. PMID:27529066