Prophylactic use of implantable cardioverter-defibrillators in the elderly population

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.

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

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).METHODS:Authors conducted a chart review of 20 patients with a cardiac pacemaker (CP) or implantable cardioverter defibrillator (ICD) who underwent continuous electrocardiographic monitoring during their SBCE from 2003-2008.authors searched for unexplained electrocardiogram (ECG) findings,changes in CP andICD set parameters,any abnormality in transmitted capsule data,and adverse clinical events.RESULTS:There were no adverse events or hemodynamically significant arrhythmias reported.CP and ICD set parameters were preserved.The majority of ECG abnormalities were also found in pre-or post-SBCE ECG tracings and the CP behavior during arrhythmias appeared appropriate.Two patients seemed to have episodes of undersensing by the CP.However,similar findings were documented in ECGs taken outside the time frame of the SBCE.One patient was observed to have a low signal encountered from the capsule resulting in lack of localization,but no images were lost.CONCLUSION:Capsule-induced EMI remains a possibility but is unlikely to be clinically important.CPinduced interference of SBCE is also possible,but is infrequent and does not result in loss of images transmitted by the capsule.

Remote monitoring of implantable defibrillators is associated with fewer inappropriate shocks and reduced time to medical assessment in a remote and rural area

BACKGROUND Implantable cardioverter defibrillators(ICDs)and cardiac resynchronisation therapy with defibrillators(CRT-D)reduce mortality in certain cardiac patient populations.However,inappropriate shocks pose a problem,having both adverse physical and psychological effects on the patient.The advances in device technology now allow remote monitoring(RM)of devices to replace clinic follow up appointments.This allows real time data to be analysed and actioned and this may improve patient care.AIM To determine if RM in patients with an ICD is associated with fewer inappropriate shocks and reduced time to medical assessment.METHODS This was a single centre,retrospective observational study,involving 156 patients implanted with an ICD or CRT-D,followed up for 2 years post implant.Both appropriate and inappropriate shocks were recorded along with cause for inappropriate shocks and time to medical assessment.RESULTS RM was associated with fewer inappropriate shocks(13.6%clinic vs 3.9%RM;P=0.030)and a reduced time to medical assessment(15.1±6.8 vs 1.0±0.0 d;P<0.001).CONCLUSION RM in patients with an ICD is associated with improved patient outcomes.

Remote monitoring of implantable cardioverters defibrillators:a comparison of acceptance between octogenarians and younger patients

Background Remote monitoring(RM)is increasingly employed for all types of cardiac implantable devices(CIED).However,there are only limited data on the acceptance of RM by the elderly.The aim of our study was to ascertain how octogenarians assess RM technologies compared to younger,presumably technically more literate patients,and what concerns or technical problems the system presents to both groups of patients.Methods The trial was designed as a descriptive,register-based single-center study.The study population consisted of all consecutive patients≥80 years of age(group A,n=94)and all consecutive patients aged≤40 years(group B,n=71),who had undergone implantation of an implantable cardioverter-defibrillator(ICD)between the years of 2009 and 2018 and were using a Home Monitoring?(HM,Biotronik,Berlin,Germany)system.All patients fulfilling entry criteria were approached with a request to participate in the survey.Results A total of 85(90.4%)and 65(91.5%)valid surveys were obtained for groups A and B,respectively.Ninety-two percent of patients in both groups(P=0.903)were satisfied with the limited number of planned ambulatory follow-ups(i.e.,once a year).All patients in both groups(100%)reported that they were satisfied with the HM system,and 97%and 94%of patients in Groups A and B,respectively,ranked it highly beneficial(P=0.68).A significant proportion of patients in both groups were completely unaware of any health-related benefits associated with the use of the HM system(42%in Group A vs.49%in Group B,P=0.4).Among the most frequently reported personal benefits of HM were a sense of safety and security and savings on travel expenses and time.5%and 9%of patients in Groups A and B,respectively,reported that usage of HM caused them some degree of psychological stress(P=0.27).Nearly all patients in both groups reported receiving information on HM from their doctor after ICD implantation.None of Group A reported receiving information from a nurse either before or after ICD implantation,while 14%of Group B patients reported receiving information from a nurse after,but not before ICD implantation.Seven and 51%(P<0.0001)of patients in Group A and B,respectively,sought additional information about HM post-discharge.Conclusions The HM system received good marks and was much appreciated,even in patients over 80 years of age.The level of acceptance and potential psychological stress resulting from RM technology appears to be about the same in older patients as in younger patients.The majority of octogenarians either did not fully understand the clinical benefits of the system or mistakenly thought that the HM system was a substitute for emergency 24-h surveillance.These results highlight the need for better patient education relative to RM technology,with one option being to delegate more of this educational process to specially trained nurses.

Interference between pacemakers/implantable cardioverter defibrillators and video capsule endoscopy

Our Letter to the Editor, related to the article "Small bowel capsule endoscopy in patients with cardiac pacemakers and implantable cardioverter defibrillators: Outcome analysis using telemetry" by Cuschieri et al , comments on some small errors, that slipped into the authors discussions. The given informations concerning the pacemakerand implantable cardioverter defibrillators modes were inaccurate and differ between the text and the table. Moreover, as 8 of 20 patient's pacemakers were programmed to VOO or DOO ("interference mode") and one patient was not monitored by telemetry during capsule endoscopy, 9 of 20 patients (45%) lack the informations of possible interference between capsule endoscopy their implanted device. Another objection refers to the interpretation of an electrocardiogram (figure 1, trace B) presented: in contrast to the author's opinion the marked spike should be interpreted as an artefact and not as "undersensing of a fibrillatory wave". Finally, three comments to cited reviews were not complete respectively not quoted correctly.

Implantable cardiac defibrillators in octogenarians

OBJECTIVE Implantable cardiac defibrillators(ICD)implantation in the very elderly remains controversial.We aimed to describe the experience and outcome of patients over 80 years old implanted with an ICD in Belgium.METHODS Data were extracted from the national QERMID-ICD registry.All implantations performed in octogenarians between February 2010 and March 2019 were analysed.Data on baseline patient characteristics,type of prevention,device configuration and all-cause mortality were available.To determine predictors of mortality,multivariable Cox proportional hazard regression modelling was performed.RESULTS Nationwide,704 primo ICD implantations were performed in octogenarians(median age 82,IQR 81-83 years;83% male and 45% secondary prevention).During a mean follow-up of 3.1±2.3 years,249(35%)patients died,of which 76(11%)within the first year after implantation.In multivariable Cox regression analysis age(HR=1.15,P=0.004),oncological history(HR=2.43,P=0.027)and secondary prevention(HR=2.23,P=0.001)were independently associated with 1-year mortality.A better preserved left ventricular ejection fraction(LVEF)was associated with a better outcome(HR=0.97,P=0.002).Regarding overall mortality multivariable analysis withheld age,history of atrial fibrillation,centre volume and oncological history as significant predictors.Higher LVEF was again protective(HR=0.99,P=0.008).CONCLUSIONS Primary ICD implantation in octogenarians is not often performed in Belgium.Among this population,11%died within the first year after ICD implantation.Advanced age,oncological history,secondary prevention and a lower LVEF were associated with an increased one-year mortality.Age,low LVEF,atrial fibrillation,centre volume and oncological history were indicative of higher overall mortality.

Deep brain implantable microelectrode arrays for detection and functional localization of the subthalamic nucleus in rats with Parkinson’s disease

The subthalamic nucleus(STN)is considered the best target for deep brain stimulation treatments of Parkinson’s disease(PD).It is difficult to localize the STN due to its small size and deep location.Multichannel microelectrode arrays(MEAs)can rapidly and precisely locate the STN,which is important for precise stimulation.In this paper,16-channel MEAs modified with multiwalled carbon nanotube/poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate)(MWCNT/PEDOT:PSS)nanocomposites were designed and fabricated,and the accurate and rapid identification of the STN in PD rats was performed using detection sites distributed at different brain depths.These results showed that nuclei in 6-hydroxydopamine hydrobromide(6-OHDA)-lesioned brains discharged more intensely than those in unlesioned brains.In addition,the MEA simultaneously acquired neural signals from both the STN and the upper or lower boundary nuclei of the STN.Moreover,higher values of spike firing rate,spike amplitude,local field potential(LFP)power,and beta oscillations were detected in the STN of the 6-OHDA-lesioned brain,and may therefore be biomarkers of STN localization.Compared with the STNs of unlesioned brains,the power spectral density of spikes and LFPs synchronously decreased in the delta band and increased in the beta band of 6-OHDA-lesioned brains.This may be a cause of sleep and motor disorders associated with PD.Overall,this work describes a new cellular-level localization and detection method and provides a tool for future studies of deep brain nuclei.

Clinical prediction of insufficient vaults after implantable collamer lens implantation

AIM:To determine the factors related to preoperative ocular characters that are predictive of insufficient vault(<250μm)after implantable collamer lens(ICL V4c;STAAR Surgical)implantation.METHODS:The participants underwent ICL surgery and were divided into the low(<250μm)and normal(250-1000μm)vault groups based on the postoperative vault at 3mo.The preoperative biometric parameters and clinical outcomes were compared between the two groups.The relationship between the 3-month vault values and preoperative ocular parameters were evaluated by Generalized estimating equations.RESULTS:Sixteen(23 eyes)and 36 patients(63 eyes)were in the low and normal vault groups,respectively.All implantation procedures were uneventful with no cataract formation in the early postoperative period.The sulcusto-sulcus lens rise(STSL)and iris ciliary angle(ICA)were correlated with vault at 3mo after surgery.Every 0.1 mm increase in STSL was associated with 38.9μm decrease in the postoperative 3-month vault.A rise of 1 degree in ICA is associated with a reduction of 4μm in vault.CONCLUSION:Eyes with a narrow ciliary sulcus are associated with a higher rate of low vault after ICL implantation,suggesting a need for adjustments to the ICL size in these patients.Evaluating the characteristics of the ciliary sulcus contributes valuable information to predict low vault after surgery.

Rhegmatogenous retinal detachment in highly myopic eyes with implantable collamer lens

AIM:To investigate the clinical characteristics,treatment methods and outcomes of rhegmatogenous retinal detachment(RRD)in highly myopic eyes with implantable collamer lens(ICL).METHODS:High myopia patients who received treatment for nontraumatic RRD after ICL implantation surgery at the Retinal Department of Zhongshan Ophthalmic Center from Jan 2018 to Dec 2022 were reviewed.Comprehensive ophthalmologic examinations including visual acuity measurement and digital fundus photography were performed in each patient.RESULTS:A total of nine RRD eyes from nine patients who received V4c-ICL implantation were included.The mean time from ICL implantation surgery to the diagnosis of RRD was 32.44±22.56mo(range,1-60mo).At the initial visit for RRD,giant retinal tear(GRT),horseshoe tear,simple round hole,and horseshoe tear combined with round hole were detected in 3,3,2,and 1 eye(s),respectively,with maculaoff in eyes.Eight patients received surgical treatment,and one patient was treated by retinal laser photocoagulation alone.The ICL was preserved in 7 eyes.At the last followup,the mean best corrected visual acuity(BCVA)improved significantly from 1.76±1.06 logMAR at presentation to 0.81±1.01 logMAR(P=0.035),and no case of recurrent retinal detachment was found.CONCLUSION:The morphological presentation of retinal breaks is diverse in this study.The ICL can be preserved in most cases during the course of retinal detachment repair surgery in our data,companied with acceptable visual and anatomical outcomes.

Early clinical outcome with lens position adjustment following implantable collamer lens surgery

AIM:To observe early clinical outcome with lens position adjustment following the implantable collamer lens(ICL)surgery.METHODS:Sixty patients were selected for this retrospective study.One eye from each patient received Toric ICL for astigmatism correction,and the other received non-astigmatic ICL surgery using horizontal position.Patients with higher postoperative arch height were selected,and their non-astigmatic eye clinical outcome were observed after ICL surgery at 1wk,1,and 3mo.The clinical measurements included uncorrected visual acuity(UCVA),intraocular pressure(IOP),refractive state,corneal endothelium cell count,and arch height.Three months later,the ICL in each patient’s non-astigmatic eye was adjusted to the vertical from the horizontal position.The results were compared before and 1wk,1,and 3mo after adjustment.RESULTS:UCVA and IOP were significantly reduced 1wk after position adjustment compared to 1wk after ICL implantation(P<0.05).The patients demonstrated significantly reduced arch height and corneal endothelium cell count 1wk,1,and 3mo after adjusting position compared to 1wk,1,and 3mo after ICL implantation(P<0.05).However,there was no significant difference in refraction between 1wk,1,and 3mo after ICL implantation and position adjustment(P>0.05).CONCLUSION:Early positioning adjustment postphakic ICL implantation can benefit patients with adjusted arch height or higher IOP.Despite the good clinical effects,the doctors should pay attention to the potential for adverse effects on UCVA and corneal endothelium cells following early position adjustment after posterior chamber phakic ICL implantation.

Comparison of optical quality after implantable collamer lens implantation and wavefront-guided laser in situ keratomileusis

AIM： To compare the optical quality after implantation of implantable collamer lens（ICL） and wavefront-guided laser in situ keratomileusis（WG-LASIK）.METHODS： The study included 40 eyes of 22 patients with myopia who accepted ICL implantation and 40 eyes of 20 patients with myopia who received WG-LASIK. Before surgery and three months after surgery, the objective scattering index（OSI）, the values of modulation transfer function（MTF） cutoff frequency, Strehl ratio, and the Optical Quality Analysis System（OQAS） values（OVs） were accessed. The higher order aberrations（HOAs） data including coma, trefoil, spherical, 2^（nd） astigmatism and tetrafoil were also obtained. For patients with pupil size 〈6 mm, HOAs data were analyzed for 4 mm-pupil diameter. For patients with pupil size ≥6 mm, HOAs data were calculated for 6 mm-pupil diameter. Visual acuity, refraction, pupil size and intraocular pressures were also recorded.RESULTS： In both ICL and WG-LASIK group, significant improvements in visual acuities were found postoperatively, with a significant reduction in spherical equivalent（P〈 0.001）. After the ICL implantation, the OSI decreasedslightly from 2.34±1.92 to 2.24±1.18 with no statistical significance（P=0.62）. While in WG-LASIK group, the OSI significantly increased from 0.68±0.43 preoperatively to 0.91±0.53 postoperatively（Wilcoxon signed ranks test, P=0.000）. None of the mean MTF cutoff frequency, Strehl ratio, OVs showed statistically significant changes in both ICL and WG-LASIK groups. In the ICL group, there were no statistical differences in the total HOAs for either 4 mmpupil or 6 mm-pupil. In the WG-LASIK group, the HOA parameters increased significantly at 4 mm-pupil. The total ocular HOAs, coma, spherical and 2^（nd） astigmatism were 0.12±0.06, 0.06±0.03, 0.00±0.03, 0.02±0.01, respectively. After the operation, these values were increased into 0.16±0.07, 0.08±0.05,-0.04±0.04, 0.03±0.01 respectively（Wilcoxon signed ranks test, all P〈0.05）. At 6 mm-pupil, the induction of total HOAs was not statistically significant in the WG-LASIK group. CONCLUSION： ICL implantation has a less disturbance to optical quality than WG-LASIK. The OQAS is a valuable complementary measurement to the wavefront aberrometers in evaluating the optical quality.

A case of hypermature cataract formation following implantation of an implantable collamer lens with an Aquaport

To improve humor circulation the latest V4c Visian implantable collamer lens （ICL） was designed with a0.36-ram Aquapon. This design also eliminates the need to perform peripheral iridectomy before ICL implantation. Several authors reported rates of secondary surgical intervention related to insufficient vault in the presence or absence of cataract formation and excessive vault in the presence or absence of elevated intraocular pressure （IOP） after ICL insertion. Here, we report a case of rapid progression of a cataract to a hypermature state after implantation of an ICL with an Aquaport.

The gender difference of utilization of cardiac implantable electronic device in China： data from Arrhythmia Interventional Therapy Data Registry

Background Cardiac implantable electronic devices （CIEDs） greatly improve survival and life quality of patients. However, there are gender differences regarding both the utilization and benefit of these devices. In this prospective CIED registry, we aim to appraise the gender differences in CIED utilization in China. Methods Twenty centers from 14 provinces in China were included in our registry study. All patients who underwent a CIED implantation in these twenty centers between Jan 2015 and Dec 2016 were included. Results A total of 8570 patients were enrolled in the baseline cohort, including 7203 pacemaker, 664 implantable cardiac defibrillators （ICD） implants and 703 cardiac resynchronization therapy device （CRT/D）. Totally, 4117 （48.0%） CIED patients were female, and more than 59% pacemaker patients were female, but women account only one third of ICD or CRT/D implantation in this registry. There were significant differences between genders at pacemaker and ICD indications. Female was more likely received a pacemaker due to sick sinus syndrome （SSS） （63.9% vs. 51.0%, P 〈 0.001）. Female patients receiving an ICD were more likely due to cardiac ion channel disease （29.2% vs. 4.2%, P 〈 0.001）. The percentage of utilization of dual-chamber pacemaker in female patients was significantly higher than male （85.3% vs. 81.1%, P 〈 0.001）. But male patients were more likely received a cardiac resynchronization therapy devices with defibrillator than female （56.5% vs. 41.9%, P = 0.001）. In pacemaker patient, male was more likely to have structure heart disease （31.3% vs. 28.0%, P = 0.002）. In ICD patient, male patients were more likely to have ischemic heart disease （48.2% vs. 29.2%, P 〈 0.001）. The mean age of women at the time of CRT/D implantation was older than men （P = 0.014）. Nonischemic cardiomyopathy （70.9%） was the most common etiology in the patients who underwent the treat？ment of CRT/D, no matter male or female. Conclusions In real-world setting, female do have different epidemiology, pathophysiology and clinical presentation of many cardiac rhythm disorders when compared with male, and all these factors may affect the utilization of CIED implantation. But it also possibility that cultural and socioeconomic features may play a role in this apparent discrimination.

Chinese expert consensus and practice guideline of totally implantable access port for digestive tract carcinomas

Totally implantable access port is a fully implantable drug delivery system that is implanted subcutaneously and can be retained for a long time.Advantages of ports include a simple nursing process,low risk of infection and embolism,and high patient comfort.In order to promote the standardized application of ports in the treatment of digestive tract tumors and reduce port-related complications,the Chinese Research Hospital Association Digestive Tumor Committee,the Chinese Association of Upper Gastrointestinal Surgeons,the Chinese Gastric Cancer Association,and the Gastrointestinal Surgical Group of Chinese Surgical Society Affiliated to Chinese Medical Association have organized multidisciplinary expert discussions at the General Hospital of the People’s Liberation Army and nationwide expert letter reviews and on-site seminars,and formulated an expert consensus of the operation guidelines.

Full-vision maintenance in extra-high myopia from implantable collamer lens to trifocal intraocular lens implantation

Dear Editor,I am Dr.Ye Shen from the Department of Ophthalmology,the First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou,China.I write to share my experience of full-vision maintenance in patient with extrahigh myopia from implantable collamer lens （ICL） to trifocal intraocular lens （IOL） implantation.

Expert consensus on the clinical application of totally implantable venous access devices in the upper arm(2022 Edition)

With the widespread adoption of ultrasound guidance,Seldinger puncture techniques,and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years,an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices(TIVADs)in the upper arm.This approach has the advantage of completely avoiding the risks of hemothorax,pneumothorax,and neck and chest scarring.Medical specialties presently engaged in this study in China include internal medicine,surgery,anesthesiology,and interventional departments.However,command over implantation techniques,treatment of complications,and proper use and maintenance of TIVAD remain uneven among different medical units.Moreover,currently,there are no established quality control standards for implantation techniques or specifications for handling complications.Thus,this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach,reduce complication rates,and ensure patient safety.This consensus elaborates on the technical indications and contraindications,procedures and technical points,treatment of complications,and the use and maintenance of upper-arm TIVAD,thus providing a practical reference for medical staff.

Induced atrial fibrillation during defibrillation test on implantation of subcutaneous implantable cardioverter defibrillator

The subcutaneous implantable cardioverter defibrillator(S-ICD)has become an alternative to the transvenous ICD in indicated patients.However,inappropriate shock or failed ventricular tachycardia/fibrillation conversion is the most alarming complication of S-ICD.Therefore,defibrillation test(DFT)is recommended for the S-ICD implantation.

Risk profiles and outcomes of patients receiving antibacterial cardiovascular implantable electronic device envelopes:A retrospective analysis

BACKGROUND Cardiovascular implantable electronic devices(CIEDs)are implanted in an increasing number of patients each year,which has led to an increase in the risk of CIED infection.Antibacterial CIED envelopes locally deliver antibiotics to the implant site over a short-term period and have been shown to reduce the risk of implant site infection.These envelopes are derived from either biologic or nonbiologic materials.There is a paucity of data examining patient risk profiles and outcomes from using these envelope materials in the clinical setting and comparing these results to patients receiving no envelope with their CIED implantation.AIM To evaluate risk profiles and outcomes of patients who underwent CIED procedures with an antibacterial envelope or no envelope.METHODS After obtaining Internal Review Board approval,the records of consecutive patients who underwent a CIED implantation procedure by a single physician between March 2017 and December 2019 were retrospectively collected from our hospital.A total of 248 patients within this period were identified and reviewed through 12 mo of follow up.The CIED procedures used either no envelope(n=57),a biologic envelope(CanGaroo®,Aziyo Biologics)that was pre-hydrated by the physician with vancomycin and gentamicin(n=89),or a non-biologic envelope(Tyrx^(TM),Medtronic)that was coated with a resorbable polymer containing the drug substances rifampin and minocycline by the manufacturer(n=102).Patient selection for receiving either no envelope or an envelope(and which envelope to use)was determined by the treating physician.Statistical analyses were performed between the 3 groups(CanGaroo,Tyrx,and no envelope),and also between the No Envelope and Any Envelope groups by an independent,experienced biostatistician.RESULTS On average,patients who received any envelope(biologic or non-biologic)were younger(70.7±14.0 vs 74.9±10.6,P=0.017),had a greater number of infection risk factors(81.2%vs 49.1%,P<0.001),received more high-powered devices(37.2%vs 5.8%,P=0.004),and were undergoing more reoperative procedures(47.1%vs 0.0%,P<0.001)than patients who received no envelope.Between the two envelopes,biologic envelopes tended to be used more often in higher risk patients(84.3%vs 78.4%)and reoperative procedures(62.9%vs 33.3%)than non-biologic envelopes.The rate of CIED implant site pocket infection was low(any envelope 0.5%vs no envelope 0.0%)and was statistically equivalent between the two envelope groups.Other reported adverse events(lead dislodgement,lead or pocket revision,device migration or erosion,twiddler’s syndrome,and erythema/fever)were low and statistically equivalent between groups(biologic 2.2%,non-biologic 3.9%,no envelope 1.8%).CONCLUSION CIED infection rates for biologic and non-biologic antibacterial envelopes are similar.Antibacterial envelopes may benefit patients who are higher risk for infection,however additional studies are warranted to confirm this.

Gastrointestinal stromal tumor metastasis at the site of a totally implantable venous access port insertion:A rare case report

BACKGROUND The totally implantable venous access port(TIVAP)is an important device in patients for injecting blood products,parenteral nutrition or antineoplastic chemotherapy.Metastatic spread at the site of the insertion of a TIVAP is extremely rare.CASE SUMMARY We report the case of 33-year-old male with advanced gastrointestinal stromal tumor(GIST)who underwent radical tumor resection after neoadjuvant imatinib therapy.However,a solitary GIST metastasis at the site of a TIVAP insertion developed during adjuvant imatinib treatment.Mutational analysis showed secondary mutation in KIT exon 13(V564 A),which is resistant to imatinib treatment.To our knowledge,this is the first case report of a patient with advanced GIST developing GIST metastasis at the site of a TIVAP insertion.CONCLUSION This case highlights that when a patient with advanced,high metastatic GIST requires TIVAP insertion,we should realize that there is a risk of developing tumor metastasis at the site of a TIVAP insertion.

Prospective evaluation of health status, quality of life and clinical outcomes following implantable defibrillator generator exchange

BACKGROUND Little is known about health status and quality of life(QoL)after implantable cardioverter-defibrillator(ICD)generator exchange(GE).METHODS We prospectively followed patients undergoing first-time ICD GE.Serial assessments of health status were performed by administering the 36-Item Short Form Survey(SF-36).RESULTS Mean age was 67.5±14.3 years,left ventricle ejection fraction(LVEF)was 36.5%±15.0%and over 40%of the cohort had improved LVEF to>35%at the time of GE.SF-36 scores were significantly worse in physical/general health domains compared to domains of emotional/social well-being(P<0.001 for each comparison).Physical health scores were significantly worse among those with medical comorbidities including diabetes,chronic obstructive pulmonary disease and atrial fibrillation.Mean follow-up was 1.6±0.5 years after GE.Overall SF-36 scores remained stable across all domains during follow-up.Survival at 3 years post-GE was estimated at 80%.Five patients died during follow-up and most deaths were adjudicated as non-arrhythmic in origin.Four patients experienced appropriate ICD shocks after GE,three of whom had LVEF which remains impaired LVEF(i.e.,<35%)at the time of GE.CONCLUSION Patients undergoing ICD GE have significantly worse physical health compared to emotional/social well-being,which is associated with the presence of medical comorbidities.In terms of clinical outcomes,the incidence of appropriate shocks after GE among those with improvement in LVEF is very low,and most deaths post-procedure appear to be non-arrhythmic in origin.These data represent an attempt to more fully characterize the spectrum of QoL and clinical outcomes after GE.