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https://www.readbyqxmd.com/read/28079553/end-of-life-decisions-in-heart-failure-to-turn-off-the-intracardiac-device-or-not
#1
Bilal Ayach, Amrit Malik, Colette Seifer, Shelley Zieroth
PURPOSE OF REVIEW: Heart failure is a significant public health concern around the world. Implantable cardioverter defibrillators with or without cardiac resynchronization therapy (CRT-D) have proven survival benefit. As patients progress to end-stage disease, management shifts to palliative care, and cardiologists are often confronted with how to best manage these devices. RECENT FINDINGS: Studies suggest that up to one-third of patients with an implantable cardioverter defibrillator receive painful shocks in the last 24 h of life...
January 11, 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/28065904/increasing-sex-differences-in-the-use-of-cardiac-resynchronization-therapy-with-or-without-implantable-cardioverter-defibrillator
#2
Neal A Chatterjee, Rasmus Borgquist, Yuchiao Chang, Jennifer Lewey, Vicki A Jackson, Jagmeet P Singh, Joshua P Metlay, Charlotta Lindvall
AIMS: Previous studies have identified sex disparities in the use of cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD), although the basis of underutilization in women remains poorly understood. The aim of this study was to assess sex differences in patterns of CRT use with our without ICD. METHODS AND RESULTS: In this cross-sectional study using the National Inpatient Sample database we identified 311 009 patients undergoing CRT implantation in the United States between 2006 and 2012...
January 8, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28031276/patients-upgraded-to-cardiac-resynchronization-therapy-due-to-pacing-induced-cardiomyopathy-are-at-low-risk-of-life-threatening-ventricular-arrhythmias-a-long-term-cause-of-death-analysis
#3
Sergio Barra, Rudolf Duehmke, Rui Providencia, Eloi Marijon, Serge Boveda, Munmohan Virdee, Patrick Heck, Simon Fynn, David Begley, Andrew Grace, Sharad Agarwal
AIMS: Upgrade to cardiac resynchronization therapy (CRT) should be offered to patients who have developed pacing-induced cardiomyopathy with conventional right ventricular pacing. The extent to which these patients would also benefit from defibrillator back-up at the time of CRT upgrade is, however, unknown. METHODS AND RESULTS: Retrospective observational cohort study of 199 patients with pacing-induced cardiomyopathy and no history of sustained ventricular arrhythmia, including 104 upgraded to CRT-Pacemaker (CRT-P) and 95 upgraded to CRT-Defibrillator (CRT-D)...
December 28, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28011796/cardiac-resynchronization-therapy-in-patients-with-end-stage-hypertrophic-cardiomyopathy
#4
Ammar M Killu, Jae-Yoon Park, Jaskanwal D Sara, David O Hodge, Bernard J Gersh, Rick A Nishimura, Samuel J Asirvatham, Christopher J McLeod
AIMS: A dilated/end-stage phase of hypertrophic cardiomyopathy (HCM) is rare but well-recognized. The role for cardiac resynchronization therapy (CRT) in this subset of patients remains unexplored. We aimed to clarify the impact of bi-ventricular pacing CRT in dilated/end-stage HCM. METHODS AND RESULTS: The Mayo Clinic HCM database was interrogated to identify patients with ejection fraction (EF) <50% and CRT. Control subjects were identified in 1:1 manner...
December 23, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28011795/cardiac-resynchronization-therapy-crt-device-replacement-considerations-upgrade-or-downgrade-a-complex-decision-in-the-current-clinical-setting
#5
REVIEW
Eleni S Nakou, Emmanuel N Simantirakis, Eleftherios M Kallergis, Konstantinos S Nakos, Panos E Vardas
There are limited data about the management of patients presenting for elective generator replacements in the setting of previously implanted cardiac resynchronization therapy (CRT) devices that are nearing end-of-life. The individual patient's clinical status and concomitant morbidities may evolve so that considerations may include not only replacement of the pulse generator, but also potentially changing the type of device [e.g. downgrading CRT-defibrillator (CRT-D) to CRT-pacemaker (CRT-P) or ICD or upgrading of CRT-P to CRT-D]...
December 23, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27979375/incidence-predictors-and-outcomes-of-hematoma-after-icd-implantation-an-analysis-of-a-nationwide-database-of-85-276-patients
#6
Arun Raghav Mahankali Sridhar, Vivek Yarlagadda, Arun Kanmanthareddy, Sravanthi Parasa, Ryan Maybrook, Buddhadeb Dawn, Yeruva Madhu Reddy, Dhanunjaya Lakkireddy
BACKGROUND: Pocket hematoma is one of the most common complications following cardiac device implantation. This study examined the impact of this complication on in-hospital outcomes following Implantable Cardioverter Defibrillator (ICD) implantation. METHODS: Data from Nationwide Inpatient Sample (NIS) 2010 was queried to identify all primary implantations of ICDs and Cardiac Resynchronization Therapy Defibrillators (CRT-D) during the year 2010 using ICD-9 codes...
September 2016: Indian Pacing and Electrophysiology Journal
https://www.readbyqxmd.com/read/27940933/management-of-functional-sprint-fidelis-leads-at-cardiac-resynchronization-therapy-defibrillator-generator-replacement-a-novel-option-for-preventing-inappropriate-shocks-from-lead-failure-in-fragile-patients-with-high-risk-of-sudden-death
#7
Dennis W X Zhu, Matthew M Chu, Chad M House
BACKGROUND: In patients with a functional Sprint Fidelis lead at generator replacement, the manufacturer recommended to either continue to use the existing lead or replace it with a new lead. For those patients who continue to use a functional Fidelis lead, the risk of inappropriate shocks remains present if the lead fails in the future. OBJECTIVE: We evaluated the feasibility of an alternative approach at the time of cardiac resynchronization therapy-defibrillator (CRT-D) generator replacement in patients with a functional bipolar left ventricular (LV) lead for prevention of inappropriate shocks from future Fidelis lead failure...
December 8, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27920834/trends-and-determinant-factors-in-the-use-of-cardiac-resynchronization-therapy-devices-in-japan-analysis-of-the-japan-cardiac-device-treatment-registry-database
#8
Hisashi Yokoshiki, Akihiko Shimizu, Takeshi Mitsuhashi, Hiroshi Furushima, Yukio Sekiguchi, Tetsuyuki Manaka, Nobuhiro Nishii, Takeshi Ueyama, Norishige Morita, Takashi Nitta, Ken Okumura
BACKGROUND: The choice of cardiac resynchronization therapy device, with (CRT-D) or without (CRT-P) a defibrillator, in patients with heart failure largely depends on the physician׳s discretion, because it has not been established which subjects benefit most from a defibrillator. METHODS: We examined the annual trend of CRT device implantations between 2006 and 2014, and evaluated the factors related to the device selection (CRT-D or CRT-P) for primary prevention of sudden cardiac death in patients with heart failure by analyzing the Japan Cardiac Device Treatment Registry (JCDTR) database from January 2011 and August 2015 (CRT-D, n=2714; CRT-P, n=555)...
December 2016: Journal of Arrhythmia
https://www.readbyqxmd.com/read/27915265/the-ethics-of-unilateral-implantable-cardioverter-defibrillators-and-cardiac-resynchronization-therapy-with-defibrillator-deactivation-patient-perspectives
#9
Margaret Daeschler, Ralph J Verdino, James N Kirkpatrick
AIMS: Decisions about deactivation of implantable cardioverter defibrillators (ICDs) are complicated. Unilateral do-not-resuscitate (DNR) orders (against patient/family wishes) have been ethically justified in cases of medical futility. Unilateral deactivation of ICDs may be seen as a logical extension of a unilateral DNR order. However, the ethical implications of unilateral ICD deactivation have not been explored. METHODS AND RESULTS: Sixty patients who had an ICD or cardiac resynchronization therapy with defibrillator (CRT-D) were interviewed at a quaternary medical centre outpatient electrophysiology practice...
December 2, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27909534/efficacy-and-safety-of-implantable-loop-recorder-experience-of-a-center
#10
Inês Silveira, Maria João Sousa, Nuno Antunes, Vânia Silva, Carla Roque, António Pinheiro-Vieira, Vítor Lagarto, António Hipólito-Reis, André Luz, Severo Torres
Introduction: Symptoms like syncope or palpitations frequently present a diagnostic challenge. An implantable loop recorder (ILR) is an important aid in the management of these patients. Methods: A retrospective study of patients that underwent ILR implantation from November 2007 to 2014. For each patient the indication for implantation, baseline characteristics, previous study, complications, recorded tracing and interventions were evaluated. Results: A total of 62 patients were included, 50% men, with a mean age of 62...
August 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27903393/-a-multi-center-study-on-the-long-term-mortality-and-related-risk-factors-in-patients-with-chronic-heart-failure-receiving-resynchronization-therapy
#11
S Y Qi, D M Wang, H B Yu, C Ding, F L Tian, L S Ru, J Li, B Zhang, Y L Han
Objective: To analyze long-term mortality and patients characteristics of cardiac resynchronization therapy (CRT) for patients with chronic heart failure. Methods: In-patients with chronic heart failure who received CRT in the three medical centers(Bethune International Peace Hospital, General Hospital of Shenyang Military Command of Chinese People's Liberation Army, and 251 Hospital of People's Liberation Army)from March 2001 to June 2013 were included.Mortality and related causes, echocardiographic parameters were analyzed...
November 24, 2016: Zhonghua Xin Xue Guan Bing za Zhi
https://www.readbyqxmd.com/read/27886920/why-we-have-to-use-cardiac-resynchronization-therapy-pacemaker-more
#12
REVIEW
Jean-Claude Daubert, Raphaël Martins, Christophe Leclercq
Both cardiac resynchronization therapy with a pacemaker (CRT-P) and with a biventricular implantable cardioverter-defibrillator (CRT-D) are electrical treatment modalities validated for the management of chronic heart failure. There is no strong scientific evidence that a CRT-D must be offered to all candidates. Common sense should limit the prescription of these costly and complicated devices. The choice of CRT-P is currently acceptable. A direction to explore could be to downgrade from CRT-D to CRT-P at the time of battery depletion in patients with large reverse remodeling and no ventricular tachycardia and ventricular fibrillation detected...
January 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/27885751/effect-of-pr-interval-on-outcomes-following-cardiac-resynchronization-therapy-a-secondary-analysis-of-the-companion-trial
#13
Jeffrey Lin, Kevin A Buhr, Ryan Kipp
BACKGROUND: Prolonged PR intervals may impair atrioventricular mechanical coupling and adversely affect cardiac performance. We hypothesize that patients with advanced systolic heart failure, wide QRS complexes, and prolonged PR intervals will have improved survival from CRT-D regardless of whether LBBB or non-LBBB is present. METHODS AND RESULTS: A total of 308 patients enrolled in the OPT and and 595 patients in the CRT-D arms of the COMPANION trial were stratified according to normal (≤230 ms) or prolonged PR interval (>230 ms)...
November 25, 2016: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/27856539/left-ventricular-dimensions-predict-risk-of-appropriate-shocks-but-not-mortality-in-cardiac-resynchronization-therapy-defibrillator-recipients-with-left-bundle-branch-block-and-non-ischemic-cardiomyopathy
#14
Evan C Adelstein, David Schwartzman, Sandeep Jain, Raveen Bazaz, Norman C Wang, Samir Saba
AIMS: Patients with non-ischaemic cardiomyopathy (NICM) and left bundle-branch block (LBBB) often benefit markedly from cardiac resynchronization therapy (CRT). Cardiac resynchronization therapy responders have a lower risk of appropriate device shocks from CRT-defibrillators (CRT-D) than do non-responders. Larger baseline left ventricular (LV) dimensions may be associated with less CRT response and thus greater risk of appropriate shocks. METHODS AND RESULTS: We analysed all (n = 249; 55% female) primary prevention CRT-D recipients at our institution with LBBB, NICM, and measured LV dimensions prior to device implant for the outcomes of (i) appropriate shocks, (ii) any appropriate tachyarrhythmia therapies, and (iii) risk of death, transplant, or left ventricular assist device (LVAD)...
November 17, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27826203/economic-impact-of-longer-battery-life-of-cardiac-resynchronization-therapy-defibrillators-in-sweden
#15
Fredrik Gadler, Yao Ding, Nathalie Verin, Martin Bergius, Jeffrey D Miller, Gregory M Lenhart, Mason W Russell
OBJECTIVE: The objective of this study was to quantify the impact that longer battery life of cardiac resynchronization therapy defibrillator (CRT-D) devices has on reducing the number of device replacements and associated costs of these replacements from a Swedish health care system perspective. METHODS: An economic model based on real-world published data was developed to estimate cost savings and avoided device replacements for CRT-Ds with longer battery life compared with devices with industry-standard battery life expectancy...
2016: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/27823599/relation-of-body-mass-index-to-long-term-survival-after-cardiac-resynchronization-therapy
#16
E Wilson Grandin, Alison Wand, Payman Zamani, J Eduardo Rame, Ralph J Verdino
Obesity confers a paradoxical survival benefit in patients with heart failure, but this obesity paradox has not been well established in those who have undergone cardiac resynchronization therapy with a defibrillator (CRT-D). We sought to determine the impact of body mass index (BMI) on long-term survival in patients with heart failure after CRT-D. We identified 113 patients implanted with CRT-D at our institution from May 2002 to November 2003. Patients were divided into 3 categories by pre-implant BMI (kg/m(2)): normal weight (BMI <25), overweight (BMI 25-29), and obese (BMI ≥30)...
September 15, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27808410/effect-of-significant-weight-change-on-inappropriate-implantable-cardioverter-defibrillator-therapy
#17
Usama A Daimee, Yitschak Biton, Mehmet K Aktas, Faiez Zannad, Helmut Klein, Barbara Szepietowska, Scott McNitt, Bronislava Polonsky, Paul J Wang, Wojciech Zareba, Arthur J Moss, Valentina Kutyifa
BACKGROUND: Weight loss has been associated with adverse outcomes among heart failure (HF) patients, including those receiving cardiac resynchronization therapy with defibrillator (CRT-D). The effect of significant weight change on inappropriate implantable cardioverter-defibrillator (ICD) therapy among CRT-D patients is not well understood. METHODS: We evaluated the impact of significant weight change at 1 year on subsequent inappropriate ICD therapy during follow-up among 993 CRT-D patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy...
November 3, 2016: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/27798759/soluble-st2-and-risk-of-arrhythmias-heart-failure-or-death-in-patients-with-mildly-symptomatic-heart-failure-results-from-madit-crt
#18
Hicham Skali, Robert Gerwien, Timothy E Meyer, James V Snider, Scott D Solomon, Craig M Stolen
Soluble ST2 is an established biomarker of heart failure (HF) progression. Data about its prognostic implications in patients with mildly symptomatic HF eligible to receive cardiac resynchronization therapy defibrillators (CRT-D) are limited. In a cohort of 684 patients enrolled in Multicenter Automated Defibrillator Implantation Trial (MADIT)-CRT, levels of soluble ST2 (sST2) were serially assessed at baseline and 1 year (n = 410). In multivariable-adjusted models, elevated baseline sST2 was associated with an increased risk of death, death or HF, and death or ventricular arrhythmia (VA) even when adjusting for baseline brain natriuretic protein (BNP) levels...
December 2016: Journal of Cardiovascular Translational Research
https://www.readbyqxmd.com/read/27760795/association-between-a-prolonged-pr-interval-and-outcomes-of-cardiac-resynchronization-therapy-a-report-from-the-national-cardiovascular-data-registry
#19
Daniel J Friedman, Haikun Bao, Erica S Spatz, Jeptha P Curtis, James P Daubert, Sana M Al-Khatib
BACKGROUND: A prolonged PR interval is common among cardiac resynchronization therapy (CRT) candidates; however, the association between PR interval and outcomes is unclear, and the data are conflicting. METHODS: We conducted inverse probability weighted analyses of 26 451 CRT-eligible (ejection fraction ≤35, QRS ≥120 ms) patients from the National Cardiovascular Data Registry ICD Registry to assess the association between a prolonged PR interval (≥230 ms), receipt of CRT with defibrillator (CRT-D) versus implantable cardioverter defibrillator (ICD), and outcomes...
November 22, 2016: Circulation
https://www.readbyqxmd.com/read/27756040/predictors-of-response-to-cardiac-resynchronization-therapy-a-systematic-review
#20
John Rickard, Henry Michtalik, Ritu Sharma, Zackary Berger, Emmanuel Iyoha, Ariel R Green, Nowreen Haq, Karen A Robinson
BACKGROUND: Multiple studies have sought to determine variables associated with improved "response" to cardiac resynchronization therapy(CRT). Such variables, however, are often derived from inadequately controlled, single center cohort studies calling external validity into question. We sought to determine predictors of response to CRT-D and CRT-P utilizing the methods of systematic review. METHODS: We searched MEDLINE, Embase®, and the Cochrane Central Register of Controlled Trials (CENTRAL) from January 1, 1995, as this is the date of first article reporting use of CRT through October 20, 2014...
September 25, 2016: International Journal of Cardiology
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