In this trial, two new programs for delivering implantable cardioverter–defibrillator therapy resulted in fewer inappropriate interventions (shocks or antitachycardia pacing) and an unexpected ...reduction in mortality. Improved programming could benefit patients with ICDs.
The implantable cardioverter–defibrillator (ICD), either alone or in conjunction with cardiac-resynchronization therapy (CRT), is highly effective in reducing the rate of death due to ventricular tachyarrhythmia among high-risk cardiac patients.
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However, inappropriate ICD activations, which are typically caused by supraventricular tachyarrhythmias, are frequent, despite sophisticated device-related detection algorithms that are designed to differentiate supraventricular from ventricular tachyarrhythmias; such activations have potentially life-threatening side effects.
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Inappropriate device-delivered therapy, defined as therapy delivered for nonventricular tachyarrhythmias, affects 8 to 40% of patients with ICDs.
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The best method for programming ICD devices to reduce inappropriate therapy is unknown.
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We conducted a . . .
In a multicenter study, 526 patients underwent implantation of a new leadless cardiac pacemaker. Among the first 300 patients who were followed for 6 months, the pacemaker met prespecified sensing ...and pacing requirements in 90%, and serious adverse events were observed in 6.7%.
Each year, nearly 1 million persons worldwide receive conventional transvenous cardiac pacemakers with active-fixation leads to treat bradycardia and heart block.
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Despite considerable technological advancements since the clinical introduction of these pacemakers six decades ago, pacemaker-related adverse events occur in 1 in 10 patients.
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These events are typically related to the transvenous lead, surgical pocket, or pulse generator.
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The leads are susceptible to dislodgement, fracture, or insulation failure and can also cause infection, cardiac perforation, venous occlusion, and tricuspid regurgitation. Pulse generators have been associated with infection, pocket hematoma, and skin erosion.
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A recently developed . . .
Atrial Fibrillation (AF) is the most common arrhythmia in adults, and the rapid increase in AF prevalence has been classified by experts as an epidemic. The mechanisms of AF are complex and ...incompletely understood. While many aspects of management are now based on high quality evidence, other clinical decisions are based on experience and judgment. This article provides an up to date review relating to lifestyle modification and its effect on AF to inform clinical treatment. This comprehensive review used PubMed and Google Scholar to perform keyword searches of articles published between 1998 and the present, with the exception of the 1978 “Holiday Heart” article. Robust data has emerged identifying multiple risk factors for development of AF, including age, sex, hypertension, diabetes mellitus, obesity, alcohol consumption, exercise, and obstructive sleep apnea. Recent evidence indicates that lifestyle modification has a significant role in mitigating the risk and burden of AF. In conclusion, based on the available evidence, an interdisciplinary approach to lifestyle modification will likely reduce risk and/or symptom burden of AF.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
It has been proposed that competitive sport increases the risk of ventricular tachyarrhythmias (VTA) and death in patients with arrhythmogenic right-ventricular cardiomyopathy (ARVC). However, it is ...unknown whether this only applies to competitive sport or if recreational sports activity also increases the risk of VTA/death.
Probands diagnosed with ARVC according to the 2010 task force criteria for ARVC (n = 108) were included in the current analysis. At the time of enrolment, study participants were questioned about exercise level prior to and after ARVC diagnosis, within three categories of sports participation: competitive (n = 41), recreational (n = 48), and inactive (n = 19). Competitive sport was associated with a significantly higher risk of VTA/death when compared with both recreational sport HR = 1.99 (1.21-3.28), P = 0.007 and inactive patients HR = 2.05 (1.07-3.91), P = 0.030. No increased risk of VTA/death was associated with recreational sport when compared with patients who were inactive HR = 1.03 (0.54-1.97), P = 0.930. Symptoms developed at an earlier age in patients who participated in competitive sport (30 ± 12 years), when compared with patients who participated in recreational sport (38 ± 17 years) (P = 0.015) and inactive patients (41 ± 11 years) (P = 0.002). No difference in age at first symptom was seen between patients who participated in recreational sport and inactive patients (P = 0.651).
Competitive sport was associated with a two-fold increased risk of VTA/death, and earlier presentation of symptoms, when compared with inactive patients, and to patients who participated in recreational sport. When compared with inactive patients, recreational sport was not associated with earlier onset of symptoms or increased risk of VTA/death. ClinicalTrials.gov Identifier: NCT00024505.
BACKGROUND—Atrial fibrillation (AF), the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), is capable of producing symptoms that impact quality of life and is associated with ...risk for embolic stroke. However, the influence of AF on clinical course and outcome in HCM remains incompletely resolved.
METHODS—Records were accessed of 1558 consecutive patients followed at the Tufts Medical Center Hypertrophic Cardiomyopathy Institute for 4.8 ± 3.4 years, from 2004 to 2014.
RESULTS—Of the 1558 HCM patients, 304 (20%) had episodes of AF, of which 226 (74%) were confined to symptomatic paroxysmal AF (PAF; average 5 ± 5; range 1 to > 20), while 78 (26%) developed permanent AF, preceded by 7 ± 6 PAF episodes. At last evaluation, 277 patients (91%) are alive at 62 ± 13 years of age, including 89% in NYHA class I or II. There was no difference in outcome measures for AF patients and age and gender matched HCM patients without AF. Four percent of AF patients died of HCM-related causes (n=11) with annual mortality 0.7 %; mortality directly attributable to AF (thromboembolism without prophylactic anticoagulation) was 0.1 %/year (n=2 patients). Patients were treated with antiarrhythmic drugs (most commonly amiodarone n=103 or sotalol n=78), and with AF catheter ablation (n=49) or Maze procedure at surgical myectomy (n=72). Freedom from AF recurrence at 1 year was 44% for ablation patients and 75% with Maze (p<0.001). Embolic events were less common with anticoagulation prophylaxis (4/233; 2%) than without (9/66; 14%) (p<0.001).
CONCLUSIONS—Transient symptomatic episodes of AF, although relatively uncommon in HCM, are unpredictable in frequency and timing, amenable to effective contemporary treatments, and infrequently progress to permanent AF. AF is not a major contributor to heart failure morbidity, nor a cause of arrhythmic sudden death, and when treated is associated with low-disease-related mortality, no different than for patients without AF. AF is an uncommon primary cause of death in HCM virtually limited to embolic stroke, supporting a low threshold for initiating anticoagulation therapy.
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with sudden cardiac death. However, the selection of patients for implanted cardioverter-defibrillators (ICDs), as well as ...programming of the ICD, is unclear.
The objective of this study was to identify predictors, characteristics, and treatment of ventricular arrhythmias in patients with ARVC.
The Multidisciplinary Study of Right Ventricular Cardiomyopathy established the North American ARVC Registry and enrolled patients with a diagnosis of ARVC. Patients were followed prospectively.
Of 137 patients enrolled, 108 received ICDs. Forty-eight patients had 502 sustained episodes of ventricular arrhythmias, including 489 that were monomorphic and 13 that were polymorphic. In the patients with ICDs, independent predictors of ventricular arrhythmias in follow-up included spontaneous sustained ventricular arrhythmias before ICD implantation and T-wave inversions inferiorly. The only independent predictor for life-threatening arrhythmias, defined as sustained ventricular tachycardia (VT) ≥240 beats/min or ventricular fibrillation, was a younger age at enrollment. Anti-tachycardia pacing (ATP), independent of the cycle length of the VT, was successful in terminating 92% of VT episodes.
In the North American ARVC Registry, the majority of ventricular arrhythmias in follow-up are monomorphic. Risk factors for ventricular arrhythmias were spontaneous ventricular arrhythmias before enrollment and a younger age at ICD implantation. ATP is highly successful in terminating VT, and all ICDs should be programmed for ATP, even for rapid VT.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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