scholarly journals DECISION SUPPORT FOR PATIENTS FACING IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR GENERATOR REPLACEMENT: A FEASIBILITY TRIAL

2017 ◽  
Vol 33 (10) ◽  
pp. S223
Author(s):  
K.B. Lewis ◽  
D. Stacey ◽  
S.L. Carroll ◽  
L. Clark ◽  
C. Brousseau ◽  
...  
Keyword(s):  
Decision Support ◽  
Implantable Cardioverter Defibrillator ◽  
Feasibility Trial ◽  
Cardioverter Defibrillator ◽  
Generator Replacement

scholarly journals Defibrillation success after subcutaneous implantable cardioverter-defibrillator generator replacement is not affected by impedance increase

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
W Van Der Stuijt ◽  
S Pepplinkhuizen ◽  
ABE Quast ◽  
L Smeding ◽  
LRA Olde Nordkamp ◽  
...  
Keyword(s):  
Ventricular Arrhythmia ◽  
Success Rate ◽  
Implantable Cardioverter Defibrillator ◽  
Retrospective Analysis ◽  
Analysis Data ◽  
Cardioverter Defibrillator ◽  
Replacement Procedure ◽  
Shock Impedance ◽  
Tertiary Center ◽  
Generator Replacement

Abstract Funding Acknowledgements Type of funding sources: None. Background Routine defibrillation testing during implant and replacement of the subcutaneous implantable cardioverter-defibrillator (S-ICD) is recommended per current guidelines. Recently, concerns have been raised about an increase in shock impedance and consequent shock failure during defibrillation testing in S-ICD patients undergoing a generator replacement. Purpose We aim to describe the defibrillation success rate in relation to the shock impedance in patients undergoing S-ICD generator replacement in our large tertiary center. Methods In this retrospective analysis, data from replacement procedures were collected from all patients who underwent an S-ICD generator replacement in our center from June 2014 to December 2020. Defibrillation testing was performed with at least one shock of ≤65J, and a successful shock was defined as terminating the ventricular arrhythmia within 5 seconds after the shock. Results A total of 133 patients underwent an S-ICD generator replacement, 5.8 ± 0.9 years after initial implant. Reasons for replacement were: reaching of elective replacement indicator (n = 119), early battery depletion (n = 9), complaints of generator pocket (n = 3) and device malfunction (n = 2). Defibrillation testing was performed in 111 patients (86.5%) undergoing a replacement procedure. Shock impedance data from both the implant and replacement procedure were available in 101 patients. The median shock impedance of these patients during their replacement procedure was significantly higher than during their implant, 79Ω (IQR 66-94) and 66Ω (IQR 57.5-81) respectively (Z = -5.552, p < 0.001). Despite the higher shock impedance, first shock during defibrillation testing was successful in 105/111 patients (94.6%), with a success rate of 97.3% after two attempts. In the remaining three patients, the ventricular arrhythmia could only be terminated with a 80J shock. This was the case during both their initial implant and their replacement procedure. Shock impedance increase between implant and replacement was not significantly higher in patients with a successful first shock compared to patients with an unsuccessful first shock (Δ+11.1 ± 20.0Ω versus Δ+12.7 ± 27.6Ω, p = 0.86). Conclusion In this large retrospective analysis, we have shown a first shock success rate during S-ICD generator replacement of 94.6%, which is similar to the success rate of defibrillation testing after initial implant. After multiple attempts, defibrillation testing success rate was 100%. Even though the median shock impedance during replacement was significantly higher than during the initial implant, there was no difference in impedance increase in patients with a successful shock compared to patients with an unsuccessful shock. Abstract Figure. Defibrillation success

scholarly journals Implantable Cardioverter Defibrillator mHealth App for Physician Referrals and eHealth Education: ICD-TEACH Pilot Study (Preprint)

2018 ◽  
Author(s):  
Sumeet Gandhi ◽  
Carlos A Morillo ◽  
Jon-David Schwalm
Keyword(s):  
Decision Support ◽  
Pilot Study ◽  
Implantable Cardioverter Defibrillator ◽  
Smartphone App ◽  
Physician Survey ◽  
Cardioverter Defibrillator ◽  
Feasibility Assessment ◽  
Physician Decision Support ◽  
System Usability Scale ◽  
Direct Referral

BACKGROUND Mobile health (mHealth) decision tools for implantable cardioverter defibrillator may increase physician knowledge and overall patient care. OBJECTIVE The goals of the ICD-TEACH pilot study were to design a smartphone app or mHealth technology with a novel physician decision support algorithm, implement a direct referral mechanism for device implantation from the app, and assess its overall usability and feasibility with physicians involved in the care of patients with an implantable cardioverter defibrillator. METHODS The initial design and development of the mHealth or smartphone app included strategic collaboration from an information technology company and key stakeholders including arrhythmia specialists (electrophysiologists), general cardiologists, and key members of the hospital administrative team. A convenience sampling method was used to recruit general internists or cardiologists that refer to our local tertiary care center. Physicians were asked to incorporate the mHealth app in daily clinical practice and avail the decision support algorithm and direct referral feature to the arrhythmia clinic. Feasibility assessment, in the form of a physician survey, was conducted after initial mHealth app use (within 3 months) addressing the physicians’ overall satisfaction with the app, compliance, and reason for noncompliance; usability assessment of the mHealth app was addressed in the physician survey for technical or hardware problems encountered while using the app and suggestions on improvement. RESULTS A total of 17 physicians agreed to participate in the pilot study with 100% poststudy survey response rate. Physicians worked in an academic practice, which included both inpatient and ambulatory care. System Usability Scale was applied with an average score of 77 including the 17 participants (>68 points is above average). Regarding the novel physician decision support algorithm for implantable cardioverter defibrillator referral, 11% (1/9) strongly agreed and 78% (7/9) agreed that the algorithm for device eligibility was easy to use. Only 1 patient was referred through the direct referral system via the mHealth app during the pilot study of 3 months. Feasibility assessment showed that 46% (5/11) strongly agreed and 55% (6/11) agreed that the mHealth app would be utilized if integrated into an electronic medical record (EMR) where data are automatically sent to the referring arrhythmia clinic. CONCLUSIONS The ICD-TEACH pilot study revealed high usability features of a physician decision support algorithm; however, we received only 1 direct referral through our app despite supportive feedback. A specific reason from our physician survey included the lack of integration into an EMR. Future studies should continue to systematically evaluate smartphone apps in cardiology to assess usability, feasibility, and strategies to integrate into daily workflow.

scholarly journals Incidence of Ventricular Arrhythmias and 1‐Year Predictors of Mortality in Patients Treated With Implantable Cardioverter‐Defibrillator Undergoing Generator Replacement

2021 ◽  
Vol 10 (4) ◽  
Author(s):  
Andrea Demarchi ◽  
Stefano Cornara ◽  
Antonio Sanzo ◽  
Simone Savastano ◽  
Barbara Petracci ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Implantable Cardioverter Defibrillator ◽  
Ventricular Arrhythmias ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardioverter Defibrillator ◽  
Generator Replacement

Background When implantable cardioverter defibrillator (ICD) battery is depleted most patients undergo generator replacement (GR) even in the absence of persistent ICD indication. The aim of this study was to assess the incidence of ventricular arrhythmias and the overall prognosis of patients with and without persistent ICD indication undergoing GR. Predictors of 1‐year mortality were also analyzed. Methods and Results Patients with structural heart disease implanted with primary prevention ICD undergoing GR were included. Patients were stratified based on the presence/absence of persistent ICD indication (left ventricular ejection fraction ≤35% at the time of GR and/or history of appropriate ICD therapies during the first generator's life). The study included 371 patients (82% male, 40% with ischemic heart disease). One third of patients (n=121) no longer met ICD indication at the time of GR. During a median follow‐up of 34 months after GR patients without persistent ICD indication showed a significantly lower incidence of appropriate ICD shocks (1.9% versus 16.2%, P <0.001) and ICD therapies. 1‐year mortality was also significantly lower in patients without persistent ICD indication (1% versus 8.3%, P =0.009). At multivariable analysis permanent atrial fibrillation, chronic advanced renal impairment, age >80, and persistent ICD indication were found to be significant predictors of 1‐year mortality. Conclusions Patients without persistent ICD indication at the time of GR show a low incidence of appropriate ICD therapies after GR. Persistent ICD indication, atrial fibrillation, advanced chronic renal disease, and age >80 are significant predictors of 1‐year mortality. Our findings enlighten the need of performing a comprehensive clinical reevaluation of ICD patients at the time of GR.

Optimal Implantable Cardioverter Defibrillator (ICD) Generator Replacement

2014 ◽  
Vol 26 (3) ◽  
pp. 599-615 ◽  
Author(s):  
Anahita Khojandi ◽  
Lisa M. Maillart ◽  
Oleg A. Prokopyev ◽  
Mark S. Roberts ◽  
Timothy Brown ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Cardioverter Defibrillator ◽  
Generator Replacement

Estimating the Risks and Benefits of Implantable Cardioverter Defibrillator Generator Replacement: A Systematic Review

2016 ◽  
Vol 39 (7) ◽  
pp. 709-722 ◽  
Author(s):  
KRYSTINA B. LEWIS ◽  
DAWN STACEY ◽  
SANDRA L. CARROLL ◽  
LAURA BOLAND ◽  
LINDSEY SIKORA ◽  
...  
Keyword(s):  
Systematic Review ◽  
Implantable Cardioverter Defibrillator ◽  
Cardioverter Defibrillator ◽  
Risks And Benefits ◽  
Generator Replacement
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