The general public’s ability to operate automated external defi brillator: A controlled simulation study

BACKGROUND:Automated external defibrillators(AEDs)enable laypeople to provide early defi brillations to patients undergoing cardiac arrest,but scant information is available on the general public’s ability to use AEDs.This study assessed the ability of laypeople to operate AEDs,the effect of a 15-minute training,and whether skills differed by age.METHODS:From May 1 to December 31,2018,a prospective simulation study was conducted with 94 laypeople aged 18–65 years(32 aged 18–24 years,34 aged 25–54 years,and 28 aged 55–65 years)with no prior AED training.The participants’AED skills were assessed individually pretraining,post-training,and at a three-month follow-up using a simulated cardiac arrest scenario.The critical actions and time intervals were evaluated during the AED operating process.RESULTS:Only 14(14.9%)participants(eight aged 18–24 years,four aged 25–54 years,and two aged 55–65 years)successfully delivered defi brillations before training.AED operation errors were more likely to occur among the participants aged 55–65 years than among other age groups.After training,the proportion of successful defi brillations increased signifi cantly(18–24 years old:25.0%vs.71.9%,P<0.01;25–54 years old:11.8%vs.70.6%,P<0.01;55–65 years old:7.1%vs.67.9%,P<0.01).After three months,26.1%of the participants aged 55–65 years successfully delivered defi brillations,which was signifi cantly lower than that of participants aged 18–24 years(54.8%)and 25–54 years(64.3%)(P=0.02).There were no differences in time measures among three age groups in each test.CONCLUSIONS:The majority of untrained laypeople cannot effectively operate AEDs.More frequent training and refresher courses are crucial to improve AED skills.

The Subcutaneous Implantable Cardioverter-Defi brillator:A Practical Review and Real-World Use and Application

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.

Better Than You Think—Appropriate Use of Implantable Cardioverter-Defi brillators at a Single Academic Center:A Retrospective Review

Background:Implantable cardioverter-defi brillators(ICDs)can be life-saving devices,although they are expensive and may cause complications.In 2013,several professional societies published joint appropriate use criteria(AUC)assessing indications for ICD implantation.Data evaluating the clinical application of AUC are limited.Previous registry-based studies estimated that 22.5%of primary prevention ICD implantations were“non-evidence-based”implantations.On the basis of AUC,we aimed to determine the prevalence of“rarely appropriate”ICD implantation at our institution for comparison with previous estimates.Methods:We reviewed 286 patients who underwent ICD implantation between 2013 and 2016.Appropriateness of each ICD implantation was assessed by independent review and rated on the basis of AUC.Results:Of 286 ICD implantations,two independent reviewers found that 89.5%and 89.2%,respectively,were appropriate,5.6%and 7.3%may be appropriate,and 1.8%and 2.1%were rarely appropriate.No AUC indication was found for 3.5%and 3.4%of ICD implantations,respectively.Secondary prevention ICD implantations were more likely rarely appropriate(2.6%vs.1.2%and 3.6%vs.1.1%)or unrated(6.0%vs.1.2%and 2.7%vs.0.6%).The reviewers found 3.5%and 3.4%of ICD implantations,respectively,were non-evidence-based implantations.The difference in rates between reviewers was not statistically signifi cant.Conclusion:Compared with prior reports,our prevalence of rarely appropriate ICD implantation was very low.The high appropriate use rate could be explained by the fact that AUC are based on current clinical practice.The AUC could benefi t from additional secondary prevention indications.Most importantly,clinical judgement and individualized care should determine which patients receive ICDs irrespective of guidelines or criteria.

Characterization of available automated external def ibrillators in the market based on the product manuals in 2014

BACKGROUND: To popularize the wide-spread use of automated external defi brillator(AED) to save life in sudden cardiac arrest, we compared the strength and weakness of different types of AEDs to enable a sound selection based on regional requirement.METHODS: This was a retrospective descriptive study. Different types of AEDs were compared according to the information of AEDs from manuals and brochures provided by the manufacturers. Fifteen types of AEDs were divided into 3 groups, basic, intermediate and advanced.RESULTS: Lifeline? AUTO AED had the best performance in price, portability and user-friendly among AEDs of basic level. It required less time for shock charging. Samaritan PAD defi brillator was superior in price, portability, durability and characteristic among AEDs of intermediate level. It had the longest warranty and highest protection against water and dust. Lifeline? PRO AED had the best performance in most of the criteria among AEDs of advanced level and offered CPR video and manual mode for laypersons and clinicians respectively.CONCLUSION: Lifeline? AUTO AED, Samaritan PAD def ibrillator, Lifeline? PRO AED are superior in AEDs of basic, intermediate and advanced levels, respectively. A feasible AED may be chosen by users according to the regional requirement and the current information about the best available products.

Implantation of an S-ICD in a Patient with a DDD Pacemaker and Congenitally Corrected Transposition of the Great Arteries

Subcutaneous implantable cardioverter-defi brillator(S-ICD)therapy has become a viable alternative to conventional transvenous ICD implantation.Patients with congenitally corrected transposition of the great arteries(ccTGA)have a high risk of sudden cardiac death due to malignant arrhythmia.The interaction between the S-ICD system and the transvenous pacemaker system is not fully understood.We report a case of S-ICD implantation in a patient with ccTGA and a DDD pacemaker.The patient was a 30-year-old man with a previously placed pacemaker with diagnoses of congenital heart disease,ccTGA(SLL),left atrioventricular valve insuffi ciency,and third-degree atrioventricular block.He presented with an out-of-hospital cardiac arrest,and an S-ICD was implanted to prevent sudden cardiac death.Defi brillation checks were performed successfully.We tested the compatibility of the DDD pacemaker with the S-ICD and found that there was no interference between them.In conclusion,an S-ICD system is a reasonable and safe option in patients with ccTGA.

Case of morphine-induced ventricular fi brillation

Morphine is considered as a traditional and safemedication to relieve pain and dyspnea in the setting of acutecoronary syndrome and cardiogenic pulmonary edema.[1,2]It is also attributed to dispose an antiarrhythmic effect.[3] Wereport a case of morphine-induced ventricular fi brillation inthe prehospital emergency treatment. The patient presentedacute myocardial infarction with ST segment elevationscomplicated with uncontrolled hypertension and cardiogenicpulmonary edema.

Atrial Fibrillation Ablation:Indications,New Advances,and Complications

Atrial fibrillation(AF)is the most common cardiac arrhythmia affecting millions of people worldwide with increasing incidence and prevalence.Radiofrequency catheter ablation has evolved as the treatment of choice for both paroxysmal and persistent AF.Several studies have been reported on catheter ablation as the first-line treatment for paroxysmal AF and different strategies for persistent AF.New technologies such as contact-force sensing catheters and cryoballoon have been recently used and the procedure carries the risk of complications like hematoma,arteriovenous fistula,cardiac tamponade,pulmonary vein stenosis,atrio-esophageal fistula and death.

Frailty and Anticoagulant Therapy in Patients Aged 65 Years or Older with Atrial Fibrillation

Background:Elderly adults with atrial fi brillation(AF)are at increased risk of frailty and thromboembolic complications.However,studies on the prevalence of frailty in AF patients and data on the relationship between frailty and the use of anticoagulants are limited.Methods:We conducted a cross-sectional study involving 500 participants.Patients aged 65 years or older were consecutively selected from the Chinese Atrial Fibrillation Registry study.The patient’s frailty status was assessed with use of the Canadian Study of Health and Aging Clinical Frailty Scale.We assessed the prevalence of and factors associated with frailty,and how frailty affects anticoagulant therapy.Results:In 500 elderly adults with AF(age 75.2±6.7 years;51.6%female),201 patients(40.2%)were frail.The prevalence of frailty was higher in females(P=0.002)and increased with age and CHA 2 DS 2-VASc score(P for trend less than 0.001 for both).The factors associated with frailty were a history of heart failure(odds ratio[OR]2.40,95%confi dence interval[CI]1.39–4.14),female sex(OR 2.09,95%CI 1.27–3.43),and advanced age(OR 1.13,95%CI 1.09–1.17).Frail patients were signifi cantly less likely to have ever been prescribed anticoagulants compared with nonfrail patients(81.7 vs.54.9%,P<0.001).Conclusions:Frailty is prevalent in elderly adults with AF,especially in females,those of advanced age,and those with heart failure.Frailty status has a signifi cant impact on prescription of anticoagulants for high-risk AF patients.

Concentration-Dependent Inuence of Silver Nanoparticles on Amyloid Fibrillation Kinetics of Hen Egg-White Lysozyme

Understanding the inuence of nanoparticles on the formation of protein amyloid brillation is cru-cial to extend their application in related biological diagnosis and nanomedicines.In this work,Ra-man spectroscopy was used to probe the amyloid brillation of hen egg-white lysozyme in the pres-ence of silver nanoparticles(Ag-NPs)at di erent concentrations,combined with atomic force mi-croscopy and thioavin T(ThT)uorescence assays.Four representative Raman indicators were utilized to monitor transformation of the protein tertiary and secondary structures at the molecular level:the Trp doublet bands at 1340 and 1360 cm^(-1),the disul de stretching vibrational peak at 507 cm^(-1),the N-Cα-C stretching vibration at 933 cm^(-1),and the amide I band.All experimental results con rmed the concentration-dependent inuence of AgNPs on the hen egg-white lysozyme amyloid brillation kinetics.In the presence of AgNPs at low concentration(17μg/mL),electrostatic interaction of the nanoparticles stabilizes disul de bonds,and protects the Trp residues from exposure to hydrophilic environment,thus leading to formation of amorphous aggregates rather than brils.However,with the action of AgNPs at high concentration(1700μg/mL),the native disul de bonds of hen egg-white lysozyme are broken to form Ag-S bonds owing to the competition of electrostatic interaction from a great deal of nanoparticles.As for providing functional surfaces for protein to interact with,AgNPs play a bridge role in direct transformation from-helices to organized-sheets.The present investigation sheds light on the controversial e ects of AgNPs on the kinetics of hen egg-white lysozyme amyloid brillation.