Internal Cardiac Defibrillator Implantation Research Articles

Perioperative management and outcomes in patients receiving low-dose rivaroxaban and/or aspirin: a subanalysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial

BackgroundNo study has investigated the perioperative management and clinical outcomes in patients who are receiving rivaroxaban 2.5 mg twice a day and acetylsalicylic acid (ASA) 81 to 100 mg daily. ObjectiveTo assess perioperative management and outcomes in patients who are receiving low-dose rivaroxaban, 2.5 mg twice-daily, and low-dose ASA, 81 to 100 mg daily. To assess perioperative management and outcomes in patients who are receiving low-dose rivaroxaban, 2.5 mg twice-daily, and low-dose ASA, 81 to 100 mg daily. MethodsSubanalysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial was performed to assess perioperative management and clinical outcomes in patients with stable coronary or peripheral artery disease who were randomized to receive rivaroxaban 2.5 mg twice a day plus ASA 100 mg daily, rivaroxaban 5 mg twice a day, or ASA 100 mg daily. Patients studied required a surgery/procedure during the trial. The study outcomes, which included myocardial infarction, angina, stroke, acute limb ischemia, bleeding, and death, were assessed according to treatment allocation. ResultsThere were 2632 patients studied (mean age, 68 years; 80% male) who had a surgery/procedure, comprising percutaneous coronary interventions (∼43%), carotid or other arterial angioplasty (∼15%), pacemaker or internal cardiac defibrillator implantation (∼9%), and coronary artery bypass graft surgery (∼7%). Perioperative study drug management varied, with about one-third of patients not interrupting study drug and the remainder interrupting it between 1 and ≥10 days preprocedure. The incidences of adverse outcomes across treatment groups were 12.7% to 15.3% for myocardial ischemia, 0.8% to 1.2% for stroke, 0.1% to 0.2% for venous thromboembolism, and 3.1% to 4.2% for any bleeding. There was no statistically significant difference in outcome rates across treatment groups. ConclusionIn patients in the COMPASS trial who required a surgery/procedure, there was no significant difference in perioperative adverse outcomes whether patients were receiving rivaroxaban 2.5 mg twice a day and ASA 100 mg daily, rivaroxaban 5 mg twice a day, or ASA alone.

Analysis of Three-Dimensional Scar Architecture and Conducting Channels by High-Resolution Contrast-Enhanced Cardiac Magnetic Resonance Imaging in Chagas Heart Disease.

We aimed to describe the morphology of the border zone of viable myocardium surrounded by scarring in patients with Chagas heart disease and study their association with clinical events. Adult patients with Chagas heart disease (n=22; 55% females; 65.5 years, SD 10.1) were included. Patients underwent high-resolution contrast-enhanced cardiac magnetic resonance using myocardial delayed enhancement with postprocessing analysis to identify the core scar area and border zone channels number, mass, and length. The association between border zone channel parameters and the combined end-point (cardiovascular mortality or internal cardiac defibrillator implantation) was tested by multivariable Cox proportional hazard regression analyses. The significance level was set at 0.05. Data are presented as the mean (standard deviation [SD]) or median (interquartile range). A total of 44 border zone channels (1[1-3] per patient) were identified. The border zone channel mass per patient was 1.25 (0.48-4.39) g, and the extension in layers of the border zone channels per patient was 2.4 (1.0-4.25). Most border zone channels were identified in the midwall location. Six patients presented the studied end-point during a mean follow-up of 4.9 years (SD 1.6). Border zone channel extension in layers was associated with the studied end-point independent from left ventricular ejection fraction or fibrosis mass (HR=2.03; 95% CI 1.15-3.60). High-resolution contrast-enhanced cardiac magnetic resonance can identify border zone channels in patients with Chagas heart disease. Moreover, border zone channel extension was independently associated with clinical events.

Decompressive laparotomy for abdominal compartment syndrome in patient on extracorporeal life support: A first survival case among adults with literature review

Here, we report a case of successful treatment for a patient with abdominal compartment syndrome who was on venoarterial extracorporeal life support. A 33-year-old man visited the emergency room with cardiac arrest. Extracorporeal cardiopulmonary resuscitation was performed, and massive volume infusion was needed to maintain adequate perfusion pressure. After 6 h, his abdomen was distended, and venous drain was decreased. His bladder pressure was more than 25 mm Hg. Abdominal compartment syndrome was suspected, and prompt decompressive laparotomy was performed to restore venous drain, resulting in stabilization hemodynamically. The patient made a full recovery. He was discharged after implantation of internal cardiac defibrillator.

Ventricular Arrhythmias in Adult Congenital Heart Disease: Mechanisms, Diagnosis, and Clinical Aspects.

The risk of ventricular arrhythmias in the adult congenital heart disease population increases with age. The mechanism, type, and frequency vary depending on the complexity of the defect, whether it has been repaired, and the type and timing of repair. Risk stratification for sudden death in patients with congenital heart disease is often challenging. Current recommendations provide a useful guide for management of these patients and risk stratification continues to evolve. Internal cardiac defibrillator implantation is often challenging due to limited transvenous access, often resulting in the need for epicardial or subcutaneous devices.

757 Ambulatory blood pressure monitoring and 2D-echo in predicting non arrhythmic cardiac events after ICD implantation for MADIT II criteria. A new prognostic index

Aim:We compared ambulatory blood pressure monitoring (ABPM) and 2D echo to predict cardiac death and heart failure (combined end-point) after implantation of internal cardiac defibrillator (ICD) in 135 consecutive patients, all fulfilling MADIT II criteria; 115 men and 20 females, mean age 66±7, 86 with dual chamber ICD, 20 with cardiac resinchronization therapy (CRT), 29 patients received single chamber ICD. Methods: ABPM was performed 2 weeks after ICD implantation on outpatients basis with Spacelabs 90207. Mostpatients were on medical therapy with betablockers (75%), ace-inhibitors (90%) and diuretics (90%) at the time of ABPM evaluation. ABPM variables considered were: mean 24hour Systolic Blood Pressure (m24hSBP), mean 24hour Diastolic Blood Pressure (m24hDBP), mean 24h Heart Rate (m24hHR), Pulse pressure (PP). 2D-echo was performed before ICD implantation. LVEF was calculated by Simpson rule. Age, Blood Creatinine (BC) and CRT were also considered in statistical analysis. Results: At 1 year follow-up there were 25 cardiac events (18%), 4 cardiac deaths (cardiogenic shock) and 21 hospitalizations for pulmonary oedema or congestive heart failure. Age (p= 0.007), m24hDBP (p=0.02) and BC (p=0.02) were significantly associated with events, but not LVEF (p = 0.6), m24hSBP (p=0.09), m24hHR (p=0.08), PP (p= 0.27) and CRT (p=0.96). Only age (Odds ratio 3.8, p=0.01) and m24hDBP (Odds Ratio 2.3 p=0.04) remained significantly associated with clinical events in multivariate analysis. A prognostic index (PI) was built from these variables (m24hDBP and age) according to the formula: 120− age + m24hDBP. PI was significantly lower in patients with clinical events (107± 9 vs 121± 14, p 108 remained event-free in contrast with 55% of patients with PI ≤108 (p <0.001 by Log-rank test). Multivariate Cox regression analysis (including as covariates PI, age, LVEF, m24hDBP) confirmed that only PI was significantly associated with events (Hazard Ratio 11.4 with 95% confidence interval 2.4-55 with p =0.003). Conclusion:The PI built bym24hDBP and age could be a simple method to stratify the hemodynamic risk in patients with uniformally depressed LVEF (≤ 30% by MADIT II criteria) and ICD. .

Management issues for patients with coronary artery disease and heart failure.

Despite recent favorable trends in survival, heart failure remains a highly fatal disease. Improvements in the prevention of early death from coronary artery disease, along with an aging population, have resulted in an increased prevalence for heart failure in the United States. In the management of patients with heart failure secondary to coronary artery disease, the relative efficacy of invasive therapies such as coronary revascularization, surgical left ventricle remodeling, internal cardiac defibrillator implantation, cardioverter resynchronization therapy, mechanical ventricular assist, and cardiac transplantation need to be considered. Clinical studies examining these important treatment options are reviewed in order to better define the optimal management strategy for this challenging population of patients.