The subcutaneous implantable cardioverter defibrillators （SICD） is an altemative to the transvenous ICD for the prevention of sudden cardiac death （SCD）. Multiple studies have shown that the SICD is safe and effec...The subcutaneous implantable cardioverter defibrillators （SICD） is an altemative to the transvenous ICD for the prevention of sudden cardiac death （SCD）. Multiple studies have shown that the SICD is safe and effective in treating ventricular arrhythmias. While earlier stud- ies mainly enrolled younger patients with channelopathies, more recent reports included patients with ＂typical＂ indications for ICD therapy for the prevention of SCD. In this review we summarize the data available to date on the SICD while highlighting its pros and cons.展开更多
Background Clinical outcomes of cardiac resynchronization therapy （CRT） in patients over the age of 80 have not been well de-scribed.MethodsWe retrospectively identified 96 consecutive patients≥ 80 years old who un...Background Clinical outcomes of cardiac resynchronization therapy （CRT） in patients over the age of 80 have not been well de-scribed.MethodsWe retrospectively identified 96 consecutive patients≥ 80 years old who underwent an initial implant or an upgrade to CRT, with or without defibrillator （CRT-Dvs. CRT-P）, at our institution between January 2003 and July 2008. The control cohort consisted of 177 randomly selected patients 〈 80 years old undergoing CRT implant during the same time period. The primary efficacy endpoint was all-cause mortality at 36 months, assessed by Kaplan-Meier time to first event curves.Results In the octogenarian cohort, mean age at CRT implant was 83.1 ± 2.9 yearsvs. 60.1 ± 8.8 years among controls （P 〈 0.001）. Across both groups, 70% were male, mean left ventricular ejection fraction （LVEF） was 24.8% ± 14.1% and QRS duration was 154 ± 24.8 ms, without significant differences between groups. Octo-genarians were more likely to have ischemic cardiomyopathy （74%vs. 37%,P 〈 0.001） and more likely to undergo upgrade to CRT instead of an initial implant （42%vs. 19%,P 〈 0.001）. The rate of appropriate defibrillator shocks was lower among octogenarians （14%vs. 27%,P = 0.02） whereas the rate of inappropriate shocks was similar （3%vs. 6%,P = 0.55）. At 36 months, there was no significant difference in the rate of all-cause mortality between octogenarians （11%） and controls （8%,P = 0.381）.ConclusionAppropriately selected octogenarians who are candidates for CRT have similar intermediate-term mortality compared to younger patients receiving CRT.展开更多
The electrical storm （ES） is defined as a state of electrical instability with three or more sustained ventricular arrhythmias （VAs） occurring within twenty-four hours, which needs intravenous antiarrhythmic medic...The electrical storm （ES） is defined as a state of electrical instability with three or more sustained ventricular arrhythmias （VAs） occurring within twenty-four hours, which needs intravenous antiarrhythmic medications and frequent defibrillation. Recently, radiofrequency catheter ablation evolved as a sole therapy to terminate ES in patients with ICD, and the survival has been reported to be improved with successful ablation during follow-up. In this review, we briefly summarize substrate mapping and substrate ablation strategy in patients with ES, and discuss the reason of recurrence after ablation.展开更多
1 Introduction Over one million cardiac pacemakers are implanted every year worldwide,[11 of which approximately 200,000 are implanted in the United States alone.121 Combined with an aging population and increasing p...1 Introduction Over one million cardiac pacemakers are implanted every year worldwide,[11 of which approximately 200,000 are implanted in the United States alone.121 Combined with an aging population and increasing pacing indications, these numbers are expected to grow. Since the first pacemaker implantation in 1950s, cardiac pacemaker technology has rapidly advanced. Reduction in generator size, increased battery longevity, quality of pacemaker leads, algorithmic and rate responsive programming-all have revolutionized and transformed the implantation and management of transvenous cardiac pacemaker （TV-PPM）.展开更多
The subcutaneous implantable cardioverter-defi brillator(ICD)is a novel technology using a subcutaneous(extrathoracic)system for treatment of potential lethal ventricular arrhythmias.It avoids many of the risks of tra...The subcutaneous implantable cardioverter-defi brillator(ICD)is a novel technology using a subcutaneous(extrathoracic)system for treatment of potential lethal ventricular arrhythmias.It avoids many of the risks of transvenous ICD implantation.It may be considered in patients having an ICD indication who do not have a pacing and/or cardiac resynchronization therapy indication,and who are unlikely to benefi t from antitachycardia pacing therapy.We review patient selection,system components,the implantation technique,and screening considerations for subcutaneous ICD implantation.Its uses in specific patient populations,including children,patients with congenital heart disease,hypertrophic cardiomyopathy,or end-stage renal disease,and patients with preexisting pacemakers,are highlighted.Areas of future investigation are reviewed,including potential use with leadless pacing and magnetic resonance imaging.展开更多
文摘The subcutaneous implantable cardioverter defibrillators （SICD） is an altemative to the transvenous ICD for the prevention of sudden cardiac death （SCD）. Multiple studies have shown that the SICD is safe and effective in treating ventricular arrhythmias. While earlier stud- ies mainly enrolled younger patients with channelopathies, more recent reports included patients with ＂typical＂ indications for ICD therapy for the prevention of SCD. In this review we summarize the data available to date on the SICD while highlighting its pros and cons.
文摘Background Clinical outcomes of cardiac resynchronization therapy （CRT） in patients over the age of 80 have not been well de-scribed.MethodsWe retrospectively identified 96 consecutive patients≥ 80 years old who underwent an initial implant or an upgrade to CRT, with or without defibrillator （CRT-Dvs. CRT-P）, at our institution between January 2003 and July 2008. The control cohort consisted of 177 randomly selected patients 〈 80 years old undergoing CRT implant during the same time period. The primary efficacy endpoint was all-cause mortality at 36 months, assessed by Kaplan-Meier time to first event curves.Results In the octogenarian cohort, mean age at CRT implant was 83.1 ± 2.9 yearsvs. 60.1 ± 8.8 years among controls （P 〈 0.001）. Across both groups, 70% were male, mean left ventricular ejection fraction （LVEF） was 24.8% ± 14.1% and QRS duration was 154 ± 24.8 ms, without significant differences between groups. Octo-genarians were more likely to have ischemic cardiomyopathy （74%vs. 37%,P 〈 0.001） and more likely to undergo upgrade to CRT instead of an initial implant （42%vs. 19%,P 〈 0.001）. The rate of appropriate defibrillator shocks was lower among octogenarians （14%vs. 27%,P = 0.02） whereas the rate of inappropriate shocks was similar （3%vs. 6%,P = 0.55）. At 36 months, there was no significant difference in the rate of all-cause mortality between octogenarians （11%） and controls （8%,P = 0.381）.ConclusionAppropriately selected octogenarians who are candidates for CRT have similar intermediate-term mortality compared to younger patients receiving CRT.
文摘The electrical storm （ES） is defined as a state of electrical instability with three or more sustained ventricular arrhythmias （VAs） occurring within twenty-four hours, which needs intravenous antiarrhythmic medications and frequent defibrillation. Recently, radiofrequency catheter ablation evolved as a sole therapy to terminate ES in patients with ICD, and the survival has been reported to be improved with successful ablation during follow-up. In this review, we briefly summarize substrate mapping and substrate ablation strategy in patients with ES, and discuss the reason of recurrence after ablation.
文摘1 Introduction Over one million cardiac pacemakers are implanted every year worldwide,[11 of which approximately 200,000 are implanted in the United States alone.121 Combined with an aging population and increasing pacing indications, these numbers are expected to grow. Since the first pacemaker implantation in 1950s, cardiac pacemaker technology has rapidly advanced. Reduction in generator size, increased battery longevity, quality of pacemaker leads, algorithmic and rate responsive programming-all have revolutionized and transformed the implantation and management of transvenous cardiac pacemaker （TV-PPM）.
文摘The subcutaneous implantable cardioverter-defi brillator(ICD)is a novel technology using a subcutaneous(extrathoracic)system for treatment of potential lethal ventricular arrhythmias.It avoids many of the risks of transvenous ICD implantation.It may be considered in patients having an ICD indication who do not have a pacing and/or cardiac resynchronization therapy indication,and who are unlikely to benefi t from antitachycardia pacing therapy.We review patient selection,system components,the implantation technique,and screening considerations for subcutaneous ICD implantation.Its uses in specific patient populations,including children,patients with congenital heart disease,hypertrophic cardiomyopathy,or end-stage renal disease,and patients with preexisting pacemakers,are highlighted.Areas of future investigation are reviewed,including potential use with leadless pacing and magnetic resonance imaging.
