Implantable Cardioverter Defibrillator Research Articles

Midterm outcomes of patients with native heart recovery after Impella 5+ for cardiogenic shock

AbstractAimsLeft ventricular unloading by percutaneous microaxial flow‐pump devices has been shown to improve survival in patients with cardiogenic shock (CS). The objective of the study is to examine whether Impella 5.0/5.5 (5+) support is effective in facilitating heart recovery, overall survival, and quality of life.Methods and resultsThis single‐centre retrospective study examined midterm (180 days) outcomes of patients with CS supported by Impella 5+ who achieved heart recovery. The primary endpoint was survival at 180 days and freedom from implantable cardioverter‐defibrillator (ICD), heart transplant/left ventricular assist device (LVAD), or readmission for heart failure. Functional status was assessed with New York Heart Association (NYHA) classification. Between June 2022 and April 2024, 20 patients with CS (64 ± 8.9 years, 80% male) received Impella 5+ and discharged with heart recovery. Before Impella placement, mean left ventricular ejection fraction (LVEF) was 19.2 ± 5.2%, 7 (35%) patients were SCAI stage C, 9 (45%) SCAI stage D, and 4 (20%) SCAI stage E, and the mean vasoactive‐inotropic score was 23.2 ± 38.0. The average duration of Impella support was 10.5 ± 8 days. At 180 days, 19 (95%) patients were alive, no patient received a heart transplant/LVAD, 40% were implanted with an ICD and there were two admissions for heart failure. The mean LVEF was 33.5 ± 10.7%, 5 (26.3%) patients were NYHA class I, 9 (47.4%) were NYHA class II, and 5 (26.3%) were NYHA class III. One patient died from a non‐cardiac cause.ConclusionImpella 5+ represents a promising treatment strategy for CS, providing high rates of sustained native heart recovery. A comprehensive platform of mechanical and pharmacological unloading is key.

Long-Term Results of Stereotactic Arrhythmia Radioablation for Refractory Ventricular Arrhythmias—A Taiwanese Population Study

BackgroundStereotactic arrhythmia radioablation (STAR) has proven to be effective in refractory ventricular tachyarrhythmia (VT). We report the long-term results in first Asian series of STAR for refractory VT in a group of Taiwanese. MethodsThis study prospectively enrolled patients with treatment-failure VT. 3D electroanatomic maps, delayed enhancement magnetic resonance imaging and dual energy computed tomography were used to identify scar substrates. The main target volume was treated with a single radiation dose of 25 Gy delivered by Varian/Edge TrueBeam System. Efficacy was assessed by VT events recorded by implantable cardioverter defibrillator. ResultsFrom February 2019 to Feburary 2023, 11 patients were enrolled and followed up for at least 1 year. Ten male and one female patient received the treatment. During the median follow-up of 53 months, VT episodes decreased by 88% in post-treatment first 6 months. Late VT recurrence was observed in most of patients. Five patients received repeated catheter ablation for recurrent VTs. One-year survival rate was 83%. Among surviving patients, 1 received heart transplant and 2 had HeartMate III implantation. ConclusionsIn patients with medication and catheter ablation refractory VT, STAR is associated with a marked acute reduction in the burden of VT. The acute response of VT burden reduction helps to bridge patients to the next treatment step of heart failure, including medical optimization or surgical management, and enhance clinical outcomes.

Cardiac MRI Pectoralis Muscle Thickness as a Measure of Sarcopenia: Prognostic Significance, Interreader Agreement, and Physiologic Correlation.

Purpose To evaluate pectoralis muscle thickness at routine cardiac MRI as a marker of sarcopenia, including prognostic significance for major adverse cardiac events (MACE), interobserver agreement, and correlation with physiologic parameters. Materials and Methods This retrospective cohort study included adult patients undergoing cardiac MRI for assessment of suspected cardiomyopathy between October 2018 and February 2020. Measurements of maximum pectoralis major thickness were performed by two experienced radiologists using axial images at the level of the carina. A random subset of 50 patients were re-evaluated to assess intra- and interobserver agreement. The primary end point was MACE, defined as a composite of cardiac death, resuscitated sudden cardiac death, appropriate implantable cardioverter defibrillator discharge, or hospitalization for heart failure. Prognostic significance of pectoralis major thickness measurements for MACE was assessed using Cox proportional hazard models, and correlation between muscle thickness measurements and cardiopulmonary exercise testing (CPET), performed within 1 year of MRI, was assessed using Spearman correlation. Results The study included 1045 patients (mean age, 50 years ± 17 [SD]; 642 male, 403 female). After median follow-up of 3.3 years (IQR: 2.3-3.9 years), MACE occurred in 66 patients. In multivariable models adjusted for patient age, left ventricular ejection fraction, late gadolinium enhancement, and cardiomyopathy cause, pectoralis major muscle thickness was predictive of MACE in both male (hazard ratio [HR], 0.89 [95% CI: 0.85, 0.94]; P < .001) and female patients (HR, 0.85 [95% CI: 0.76, 0.96]; P = .008), with improved model fit in nested models. Pectoralis muscle thickness measurements had excellent intra- and interobserver agreement (intraclass correlation coefficient, 0.99 and 0.95, respectively) and correlated with absolute peak oxygen uptake (r = 0.65, P < .0001) and oxygen uptake efficiency slope (r = 0.61, P < .001) in the subset who underwent CPET within 1 year of MRI (n = 258). Conclusion Pectoralis major muscle thickness at routine cardiac MRI is a simple, reproducible measure of sarcopenia that was associated with MACE occurrence in male and female patients and correlated with CPET parameters. Keywords: Cardiac, Cardiomyopathies, MR Imaging Supplemental material is available for this article. © RSNA, 2024.

Declining Trend of Sudden Cardiac Death in Younger Individuals: A 20-Year Nationwide Study.

Declining cardiovascular mortality rates have been well-documented, yet temporal trends of sudden cardiac death (SCD) in young individuals remain unclear. We provide contemporary nationwide estimates of the temporal trends of SCD in young individuals (1-35 years of age) from 2000 through 2019 and correlate these trends to changes in out-of-hospital cardiac arrest (OHCA) patterns, rates of inherited cardiac diseases, and implantations of implantable cardioverter defibrillators (ICD). All individuals between 1 and 35 years of age living in Denmark from 2000 through 2019 were included, with annual re-evaluation of the at-risk population in regard to age. Adjudication of SCD cases relied on multiple sources, including death certificates, medical files, and autopsy reports. Information on OHCA, diagnostic rates, and ICD implantations were captured from nationwide administrative registries. Annual incidence rates of SCD were calculated, and temporal trends in SCD incidence were computed as percentage change annualized. Trends in OHCA survival and characteristics, diagnostic rates of inherited cardiac diseases, and ICD implantations were assessed. During the 20-year study period (47.5 million person-years), 1057 SCDs were identified (median age, 29 years; 69% male). The overall incidence of SCD was 2.2 per 100 000 person-years and declined by 3.31% (95% CI, 2.42-4.20) annually, corresponding to a 49% (95% CI, 38.7-57.6) reduction during the study. Rates of witnessed SCD declined markedly (percentage change annualized -7.03% [95% CI, -8.57 to -5.48]), but we observed no changes in the rate of unwitnessed SCD (percentage change annualized -0.09% [95% CI, -1.48 to 1.31]). Therefore, the proportion of unwitnessed SCD increased by 79% (P<0.001). Survival after OHCA in young individuals (1 to 35 years of age) increased from 3.9% to 28%, mainly because of increased bystander cardiopulmonary resuscitation and defibrillation rates. Diagnostic rates of inherited cardiac diseases increased 10-fold (incidence rate ratio, 10.4 [95% CI, 8.46-12.90]) and the ICD implantation rate increased 2-fold (incidence rate ratio, 1.97 [95% CI, 1.51-2.60]). SCD incidence rates in young individuals declined by 49% over the past 2 decades. The decline was paralleled by improved survival of OHCA, higher diagnostic rates of inherited cardiac diseases, and higher ICD implantation rates. However, rates of unwitnessed SCD were unchanged, which calls for new perspectives in preventive strategies.

Partnering RemoTe monitoring of Implanted Cardiac devices with Intelligent PATient Engagement – PARTICIPATE trial: a protocol for a randomised controlled trial

IntroductionCardiac implantable electronic devices (CIED) can transfer data to the healthcare team, remotely. National and international cardiac organisations recommend all patients use this technology, however patient engagement is suboptimal. Previously,...

Advances in Cardiac Imaging and Genetic Testing for Diagnosis and Risk Stratification in Cardiomyopathies: 2024 Update

Cardiomyopathies represent a diverse group of heart muscle diseases marked by structural and functional abnormalities that are not primarily caused by coronary artery disease. Recent advances in non-invasive imaging techniques, such as echocardiography, cardiac magnetic resonance, and computed tomography, have transformed diagnostic accuracy and risk stratification, reemphasizing the role of cardiac imaging in diagnosis, phenotyping, and management of these conditions. Genetic testing complements imaging by clarifying inheritance patterns, assessing sudden cardiac death risk, and informing therapeutic choices. Integrating imaging data, such as left ventricular wall thickness, fibrosis, and apical aneurysms, with genetic findings enhances decision-making for implantable cardioverter-defibrillators in high-risk patients. Emerging technologies like artificial intelligence, strain imaging, and molecular imaging, alongside genetic testing, hold the promise of further refining diagnosis and personalized treatment approaches. This article summarizes the current state and future perspectives of cardiac imaging and genetic testing for diagnosis and risk stratification in cardiomyopathies, offering practical insights for patients’ management.

Resting heart rate assessed within clinical practice demonstrates no prognostic relevance for defibrillator recipients in the German DEVICE registry

Resting heart rate (RHR) has prognostic implications in heart failure with reduced ejection fraction, where ≤ 70 bpm is targeted. Whether a RHR > 70 bpm assessed within clinical practice goes along with elevated cardiovascular risk in implantable cardioverter-defibrillator (ICD) / cardiac resynchronization therapy-defibrillator (CRT-D) recipients remains incompletely understood. A total of 1589 patients (ICD n = 1172 / CRT-D n = 417, median age 65 years, 22.6% female) undergoing ICD/CRT-D implantation or revision in the prospective German DEVICE multicenter registry were analyzed. RHR was assessed via a 12-channel electrocardiogram at enrollment. 1-year outcomes (all-cause mortality, major cardio- and cerebrovascular events (MACCE), all-cause hospital admission) were compared between patients with a RHR ≤ 70 bpm and > 70 bpm. 733 patients (46.1%) showed a RHR > 70 bpm. Median RHR was 63 (interquartile range 59; 68) bpm (≤ 70 bpm group) and 80 (75; 89) bpm (> 70 bpm group). Heart failure with reduced ejection fraction was present in 76.3%, a prior myocardial infarction in 32.4% and non-ischemic heart disease in 44.9%. One-year all-cause mortality was similar between RHR groups (≤ 70 bpm 5.4% vs. > 70 bpm 5.4%, p = 0.96), and subgroup analysis regarding patient characteristics and comorbidities revealed only a significantly higher rate of patients with dual chamber ICD in the > 70 bpm group (0.8% vs. 9.2%, p = 0.003). MACCE (5.9% vs. 6.1%, p = 0.87) and defibrillator shock rates (9.9% vs. 9.8%, p = 1.0) were similar. Higher all-cause hospital admission rates were observed in patients with > 70 bpm RHR (23.1% vs. 29.0%, p = 0.027) driven by non-cardiovascular events (6.0% vs. 11.7%, p = 0.001). In conclusion, in ICD and CRT-D recipients a RHR at admission > 70 bpm may indicate patients at increased risk of all-cause hospital admission but not of other adverse cardiovascular events or death at 1-year follow-up.

Risk of Recurrent Ventricular Tachyarrhythmia Following the Occurrence of a First Ventricular Arrhythmic Event in Patients with a Primary Prevention Implantable Cardioverter-Defibrillator

There are limited data on clinical and arrhythmic outcomes following a first ventricular tachyarrhythmia (VTA) in heart failure (HF) patients who receive a primary prevention implantable cardioverter-defibrillator (ICD). To quantify the burden and identify risk factors for recurrent VTA in this population, and to evaluate the risk of all-cause mortality associated with recurrent VTA. The study comprised 789 patients who experienced VTA following primary prevention ICD implantation in 5 ICD trials (MADIT-II, MADIT-RISK, MADIT-CRT, MADIT-RIT, RAID). Landmark analysis was used to quantify the burden and identify predictors of recurrent VTA. Time-dependent analysis was used to evaluate the association of VTA recurrence with subsequent mortality. Among the study patients, mean age was 63 years and 17% were women. The cumulative probability of experiencing at least one recurrent VTA episode at 3 years following a first VTA episode was 60%; the recurrent VTA burden after a first event over 3 years was 2.8 episodes per patient. The risk of recurrent VTA remained ≥56% at 3 years regardless of baseline clinical and echocardiographic risk factors. VTA recurrence was associated with a significant two-fold increased risk of subsequent all-cause mortality. Patients with a primary prevention ICD who experience an episode of VTA are at very high risk of recurrent VTA, regardless of baseline risk factors. Recurrent VTA is associated with a pronounced increase in the risk of death. These findings suggest a need for early intervention following a first VTA in patients who receive a primary prevention ICD.

Diagnosis and Prognosis of Isolated Cardiac Sarcoidosis: Multidisciplinary Diagnosis vs Japanese Circulation Society Criteria.

The prognosis of isolated cardiac sarcoidosis (ICS) has not been fully elucidated. The only diagnostic criteria available for ICS, the Japanese Circulation Society (JCS) criteria, have not been validated. Our objective was to study the prognosis of ICS, according to 2 different diagnostic strategies. We prospectively included patients with high suspicion for cardiac sarcoidosis (CS) by a multidisciplinary sarcoidosis team from November 2016 to June 2021. We included only incident cases. We applied the JCS ICS criteria and our multidisciplinary diagnosis (MDD) ICS criteria. We included 198 incident patients who had a final diagnosis of cardiac sarcoidosis. Median follow up time was 2.4 years (p25-p75 1.2-3.7). The prevalence of ICS was 7% (14/198) per the JCS criteria, and 29% (57/198) per our MDD criteria. Compared to non-isolated CS, patients with ICS per either criteria had similar rates of major cardiovascular outcomes (progression of atrioventricular block, worsening EF ≥ 10%, appropriate implantable cardioverter defibrillator [ICD] therapies, heart transplant, and death). Kaplan-Meier analyses showed similar prognosis for ICS and non-isolated CS in all outcomes, except for an association between ICS by MDD criteria and a shorter time to cardiac hospitalization. Multivariable Cox regression analyses showed that ICS was not an independent predictor of death, heart transplant, or clinical worsening. In conclusion, our MDD ICS criteria were more inclusive than the JCS ICS criteria. The prognosis was similar between ICS and non-isolated CS patients, regardless of which criteria were used.

To prevent sudden death in m.3243A>G carriers, comprehensive neurologic, cardiac, and pulmological examinations are required.

The interesting study has limitations that put the results and their interpretation into perspective. m.3243A>G carriers should undergo prospective testing for multisystem disease to avoid missing subclinical multisystem involvement. m.3243A>G carriers with hypertrophic cardiomyopathy require long-term electrocardiogram recordings to determine whether implantable cardioverter defibrillator implantation is necessary or not. To assess the outcome of m.3243A>G carriers, knowledge of heteroplasmy rates and mtDNA copy numbers is required. It is tempting to assign pathogenicity when any pathogenic variant is seen with genotype-phenotype correlation. However, double hits are possible and if genetic information is to be used to screen or risk-stratify other family members, the standard of care would be to ensure that post-mortem genetic autopsy is performed for a panel of causative genes, and that an autopsy is done to exclude other causes of death, if possible.

Non-Pharmacological Therapy in Heart Failure and Management of Heart Failure in Special Populations-A Review.

Non-pharmacological therapies play an essential role in the management of heart failure, complementing pharmacological treatments to mitigate disease progression and improve patient outcomes. This review provides an updated perspective on non-pharmacological interventions with a focus on lifestyle modifications, device therapies, and the management of heart failure in special populations, such as the elderly, women, and patients with comorbid conditions like renal dysfunction and diabetes. Key lifestyle interventions, including sodium and fluid restriction, dietary changes, and physical activity, are explored for their impact on symptom reduction, hospital readmissions, and quality of life. Device therapies like cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD) are also evaluated for their effectiveness in reducing mortality in patients with advanced HF. Special attention is given to vulnerable populations, emphasizing the need for individualized approaches tailored to specific pathophysiological mechanisms and socioeconomic factors. By integrating these strategies, healthcare providers can optimize care and enhance patient adherence, reducing the overall burden of heart failure.

Impact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline-directed medical therapy: a propensity score-matched study

BackgroundIn the contemporary management of heart failure with reduced ejection fraction (HFrEF), the recommended quadruple guideline-directed medical therapy (GDMT) consists of angiotensin receptor-neprilysin inhibitor (ARNI), evidence-based beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i). This study explored the impact of adding implantable cardioverter-defibrillator (ICD) therapy to this comprehensive regimen in HFrEF patients.MethodsUtilizing deidentified data from the National Electronic Database of the Turkish Ministry of Health, we conducted a nationwide retrospective cohort study on 5450 HFrEF patients receiving quadruple GDMT, including ARNI. Among them, 709 patients underwent additional ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation. Propensity score matching ensured balanced baseline characteristics between groups. Primary endpoint was determined as all-cause mortality.ResultsIn the matched cohort, all-cause mortality occurred in 108 out of 619 patients (17.4%) in the GDMT group and 101 out of 619 patients (16.3%) in the ICD group, with a hazard ratio (HR) of 0.74 and a 95% confidence interval (CI) ranging from 0.57 to 0.98. The median follow-up time was 1365 days in the matched cohort, 1283 days in the GDMT group. Subgroup analyses consistently demonstrated benefits, particularly among individuals aged 61 years and older (HR: 0.60, 95% CI: 0.42–0.87, p = 0.006), those with sinus rhythm (HR: 0.55, 95% CI: 0.34–0.89, p = 0.013), individuals not using amiodarone (HR: 0.61, 95% CI: 0.42–0.89, p = 0.011), and those with an estimated glomerular filtration rate lower than 61.9 (HR: 0.66, 95% CI: 0.48–0.91, p = 0.011).ConclusionsThis study may offer a glimmer of hope that even after achieving the best current optimal medical therapy, the addition of device therapy could still yield positive outcomes in the management of patients with HFrEF.Graphical

Electrocardiographic Characteristics of Brugada Syndrome Type I During Exercise Stress Test.

Brugada syndrome (BS) is a genetic channelopathy characterized by an increased risk of sudden cardiac death (SCD) in the absence of structural heart disease. Prognostic stratification is necessary to determine which patients are candidates for implantable cardioverter defibrillator (ICD). The present study aims to evaluate EKG changes during exercise stress tests in patients with BS and to identify any poor prognosis variables. This was an observational, case-control study. Three comparison groups were created: patients with Type 1 BS with or without prior arrhythmic events (BE and BNoE subgroups) and age- and sex-matched healthy individuals. Patients underwent EST and electrocardiographic variables were analyzed. The study recruited 36 patients with type 1 BS, 12 with prior Event (BE) and 24 without (BNoE). Patients in the BE group, in all postexercise recordings, had lower heart rates, notably in the first minute. A significant difference was also observed in the HR drop in the recovery phase, with a greater drop in relation to maximum HR in the first minute in the group of patients who had events. BS patients with prior events had a lower capacity to increase heart rate at peak effort and a greater proportional drop in the recovery phase. No relationship was observed between the occurrence of arrhythmic events and ST-segment elevation during the exercise test.

Determining the Relationship Between Sleep Problems, Shock Pain, and Shock Anxiety in Patients With ICD.

This study aimed to determine the relationship between sleep problems, shock pain, and shock anxiety in patients with implantable cardioverter defibrillator (ICD) and the affecting factors. The population of this descriptive cross-sectional study consisted of all patients who underwent ICD implantation in university hospital (N = 200), and the sample consisted of patients who met the inclusion criteria of the study (n = 132). Data were obtained using a "General Information Form", the "Florida Shock Anxiety Scale (FSAS)", the "Epworth Sleepiness Scale (ESS)", the "Pittsburgh Sleep Quality Index (PSQI)", and the "Visual Pain Scale (VPS)". The mean age of the patients was 66.13 years. The VPS was 6.40±3.36; the mean FSAS score was 29.98±8.46; the mean PSQI score was 8.02±3.81; the mean ESS score was 7.59±4.10. PSQI had a statistically significant correlation with the total FSAS score (p<0.001) and a statistically insignificant correlation with ESS (p>0.001). Age, sex, marital status, smoking status, cohabitants, previous ICD shocks, the status of lying on ICD, and fear of dislocation of ICD affected the total FSAS score; sex, employment status, history of heart attack, defined sleep disorder, awakening from sleep due to nightmares, and cessation of breathing during sleep affected the total PSQI score; history of previously defined sleep disorder, history of heart attack, use of medication for a sleep disorder, the pain felt when lying on ICD, and pain experienced during ICD shocks affected the total ESS score. The mean shock VPS scores differed between patients who received an ICD shock during sleep and those who were awakened by nightmares. It was found that the shock anxiety and shock pain scores of ICD patients were above average, that they had poor sleep quality, and that their sleepiness was at the level of "normal but increased daytime sleepiness".

Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia.

Patients with ventricular tachycardia and ischemic cardiomyopathy are at high risk for adverse outcomes. Catheter ablation is commonly used when antiarrhythmic drugs do not suppress ventricular tachycardia. Whether catheter ablation is more effective than antiarrhythmic drugs as a first-line therapy in patients with ventricular tachycardia is uncertain. In an international trial, we randomly assigned in a 1:1 ratio patients with previous myocardial infarction and clinically significant ventricular tachycardia (defined as ventricular tachycardia storm, receipt of appropriate implantable cardioverter-defibrillator [ICD] shock or antitachycardia pacing, or sustained ventricular tachycardia terminated by emergency treatment) to receive antiarrhythmic drug therapy or to undergo catheter ablation. All the patients had an ICD. Catheter ablation was performed within 14 days after randomization; sotalol or amiodarone was administered as antiarrhythmic drug therapy according to prespecified criteria. The primary end point was a composite of death from any cause during follow-up or, more than 14 days after randomization, ventricular tachycardia storm, appropriate ICD shock, or sustained ventricular tachycardia treated by medical intervention. A total of 416 patients were followed for a median of 4.3 years. A primary end-point event occurred in 103 of 203 patients (50.7%) assigned to catheter ablation and in 129 of 213 (60.6%) assigned to drug therapy (hazard ratio, 0.75; 95% confidence interval, 0.58 to 0.97; P = 0.03). Among patients in the catheter ablation group, adverse events within 30 days after the procedure included death in 2 patients (1.0%) and nonfatal adverse events in 23 patients (11.3%). Among the patients assigned to drug therapy, adverse events that were attributed to antiarrhythmic drug treatment included death from pulmonary toxic effects in 1 patient (0.5%) and nonfatal adverse events in 46 patients (21.6%). Among patients with ischemic cardiomyopathy and ventricular tachycardia, an initial strategy of catheter ablation led to a lower risk of a composite primary end-point event than antiarrhythmic drug therapy. (Funded by the Canadian Institutes of Health Research and others; VANISH2 ClinicalTrials.gov number, NCT02830360.).

Implantable cardioverter defibrillators in people dying with cancer: A SEER-Medicare analysis of ICD prevalence and association with aggressive end-of-life care.

The shared risk profiles for cancer and heart disease suggest many individuals with cancer may have an implantable cardioverter defibrillator (ICD). ICDs can have dramatic cancer end-of-life care implications including painful and distressing shocks. ICD prevalence and association with aggressive end-of-life care among individuals with breast, colorectal, and pancreatic cancer was evaluated using the Surveillance, Epidemiology, and End Results-Medicare dataset. A total of 37,306 Medicare beneficiaries aged ≥66 years with stage 3 or 4 cancer who died between 2005 and 2016 were identified. ICD prevalence, ICD-related care utilization that might present opportunities to discuss end-of-life implications and association with aggressive end-of-life care (>1 emergency department visit, intensive care unit admission, >1 hospitalization, terminal hospitalization, chemotherapy, and invasive or life-extending procedures) in the last month of life was assessed using multivariable logistic regression. Among cancer decedents, 6% had an ICD. More individuals with an ICD (31%) died in the hospital than individuals without an ICD (25%; p<.001). Half (46%) of individuals with an ICD had device programming or interrogation visits that could be an opportunity for device discussion. In adjusted models, ICD presence was associated with higher odds of every indicator of aggressive end-of-life care other than chemotherapy. Many older cancer decedents in the United States had an ICD, and those with ICDs received more aggressive care at the end of life. Results suggest there are opportunities to discuss ICD and goals of care, raise awareness and encourage shared decision-making for this population to ensure goal-concordant care, and improve end-of-life care quality.

Spinal cord stimulation in a patient with an implantable cardioverter defibrillator for managing chronic chest pain: a case report and literature review.

The simultaneous use of spinal cord stimulation (SCS) and an implantable cardioverter-defibrillator (ICD) is safe and effective in selected patients with refractory chest pain. Our case highlights successful pain management with SCS without compromising ICD function. Careful patient selection, low device settings, and ongoing monitoring are crucial for achieving optimal outcomes.

Cardiac Implantable Electronic Devices in Cardiac Transplant Patients: A Comprehensive Review

A fraction of patients (approximately 10%) undergoing heart transplantation require permanent pacemaker (PPM) implantation due to sinus node dysfunction or atrioventricular block, occurring either shortly after surgery or later. The incidence of PPM implantation has declined to less than 5% with the introduction of bicaval anastomosis transplantation surgery. Pacing dependency during follow-up varies among recipients. A smaller subset (1.5–3.4%) receives implantable cardioverter-defibrillators (ICDs), but data on their use in transplant recipients are limited, primarily from cohort studies and case series. Sudden cardiac death affects around 10% of transplant recipients, attributed to various nonarrhythmic factors such as acute rejection, late graft failure, and cardiac allograft vasculopathy-induced ischemia. This review offers a comprehensive analysis of the existing data concerning the role of PPMs and ICDs in this population, encompassing leadless PPMs, subcutaneous ICDs, unique considerations, and future directions.

A case of pioneering subcutaneous implantable cardioverter defibrillator intervention in Timothy syndrome

This case report presents a notable instance of subcutaneous implantable cardioverter defibrillator (S-ICD) implantation in a 9-year-old patient diagnosed with Timothy syndrome (TS), which is a rare condition characterized by mutations in the CACNA1c gene. Conventional therapies often have limited efficacy in managing TS. This case is significant, as it represents the youngest age for S-ICD implantation recorded in mainland China. While the absence of ventricular arrhythmias during hospitalization and follow-up is encouraging, it is not sufficient to conclusively establish the safety and feasibility of this intervention in young TS patients. Further research is needed to evaluate the long-term outcomes and to consider S-ICD as a potential standard treatment option for TS. Additionally, there is a need for a more detailed exploration of the molecular mechanisms underlying gene therapy and personalized interventions.

Abstract 4121624: Ambulatory Inotropic Support in Patients with Stage D Heart Failure Does Not Increase ICD Therapies

Background: Ambulatory inotropic infusions can be used as a palliative therapy (PT) or bridge to advanced therapies in end-stage heart failure (ESHF) patients, many of whom have implantable cardioverter defibrillators (ICDs). Research Questions: How often do patients receive ICD therapies after initiation of outpatient inotropic support and how often is defibrillation inactivated? Methods: We conducted a retrospective review of all patients discharged from an academic tertiary medical center with a new prescription for inotropic therapy between November 2017 and March 2023. Clinical data, Palliative Care consultation, and ICD interrogations before and after inotrope initiation were extracted from the electronic health record. Results: The cohort comprised 45 patients discharged on new inotropic support, including 22 (49%) with intent of PT and 23 (51%) as a bridge to advanced therapies (Figure). Among PT patients, 15 (68%) had an ICD in place with only 4 having ICD therapies deactivated at discharge. Only 2 additional PT patients had a documented discussion regarding ongoing ICD therapies. By 1 year, 4 (18%) PT patients were transitioned to hospice and 13 (59%) had died, with only 1 additional patient having ICD deactivation. Of 28 patients discharged on inotropic infusions with ICD therapies on (both PT and bridge patients), only 4 patients had ICD therapies turned off later and no ICD shocks were reported for the year following initiation of inotropic support. Conclusion: In a series of 45 patients initiated on inotropic support for PT or bridge to advanced therapies, the majority (77%) had an active ICD, but therapies were rarely delivered. Notably, there were very few documented discussions regarding ICD therapies in PT patients even with specialty Palliative Care consultation. In patients with ESHF initiated on inotropic support as PT, most patients chose to leave ICD therapies in place. For those patients, there was a low rate of ICD therapies delivered.