A Review of ICD Anti-Tachycardia Therapy Programming with Generic Programming for Primary and Secondary Prevention

Intracardiac defibrillator plays a pivotal role in preventing sudden cardiac death; however, inappropriate shock delivery remains an important source of morbidity and mortality. Advancements in device technology along with various shock reduction strategies play a key role in reducing inappropriate and unnecessary shocks. Anti-tachycardia pacing (ATP) is the first-line therapy prior to shock delivery. Several trials have validated the efficacy of ATP for both slow and fast ventricular tachycardia without significant increase in occurrence of arrhythmia-related syncope. In addition, trials also support that therapy for non-sustained tachycardia can be prevented by higher programmed zones and prolonged intervals to detect without higher risk of syncope. With this perspective, authors employ a customized programming for both primary and secondary prevention to reduce inappropriate therapies or unnecessary therapies, in particular, progression to shock but allow for spontaneous termination at slower ventricular tachycardia rates. The programming was instituted at the time of device implantation or at follow up

Splenectomy induced portal and caval hypertension, aortic hypotension, venous thrombosis, peaked p waves, and tachycardia. therapy with pentadecapeptide BPC 157

We introduce BPC 157 therapy for a cluster of complications taking place after splenectomy in rats, including portal vein (PV), inferior vena cava (IVC), superior mesenteric vein (SMV) and lienal vein (LV) thrombosis, severe venous hypertension (PV, IVC), abdominal aorta (AA) hypotension, peaked P waves and tachycardia. Medication (/kg) (BPC 157 (10 μg)(treated group) or saline (5 ml)(control group)) was applied as an abdominal bath immediately after splenectomy. 10min, 3h, and 24h after splenectomy rats were assessed via electrocardiography, USB microcamera, intravascular cannulation, and thrombi extraction. Splenectomized rats exhibited PV and IVC hypertension, aortic hypotension (mmHg) (10min: 65±4 PV, 46±4 IVC, 71±3 AA; 3h: 42±4 PV, 61±4 IVC, 70±3 AA; 24h: 38±4 PV, 47±4 IVC, 68±3 AA) and thrombosis (thrombus weight, mg) (10min: 9.5±0.5 IVC, 6.6±0.9 PV, 4.8±0.9 SMV, 1.3±0.6 LV; 3h: 10.1±0.5 IVC, 5.3±0.8 PV, 19.2±0.9 SMV, 1.0±0.6 LV; 24h: 33.8±2.5 IVC, 27.5±2.9 PV, 8.8±0.9 SMV, 3.8±0.6 LV). BPC 157 normalised blood pressure (10min: 29±4 PV, 20±4 IVC, 87±3 AA; 3h: 20±4 PV, 17±4 IVC, 81±3 AA; 24h: 12±4 PV, 20±4 IVC, 82±3 AA) and reduced thrombosis (10min: 2.9±0.5 IVC, 2.6±0.9 PV, 3.2±0.3 SMV, 0.5±0.2 LV; 3h: 6.3±0.5 IVC, 2.3±0.5 PV, 5.9±0.9 SMV, 0.6±0.2 LV, 24h: 12.2±2.5 IVC, 1.9±0.5 PV, 4.8±0.9 SMV, 2.0±0.6 LV). Control group presented with peaked P waves, tachycardia and PV/SMV congestion, whereas the treated group showed none of the aforementioned phenomena. BPC 157 therapy counteracts hemodynamic disturbances, peaked P waves, and tachycardia as post-splenectomy complications

Splenectomy induced portal and caval hypertension, aortic hypotension, venous thrombosis, peaked p waves, and tachycardia. therapy with pentadecapeptide BPC 157

We introduce BPC 157 therapy for a cluster of complications taking place after splenectomy in rats, including portal vein (PV), inferior vena cava (IVC), superior mesenteric vein (SMV) and lienal vein (LV) thrombosis, severe venous hypertension (PV, IVC), abdominal aorta (AA) hypotension, peaked P waves and tachycardia. Medication (/kg) (BPC 157 (10 μg)(treated group) or saline (5 ml)(control group)) was applied as an abdominal bath immediately after splenectomy. 10min, 3h, and 24h after splenectomy rats were assessed via electrocardiography, USB microcamera, intravascular cannulation, and thrombi extraction. Splenectomized rats exhibited PV and IVC hypertension, aortic hypotension (mmHg) (10min: 65±4 PV, 46±4 IVC, 71±3 AA; 3h: 42±4 PV, 61±4 IVC, 70±3 AA; 24h: 38±4 PV, 47±4 IVC, 68±3 AA) and thrombosis (thrombus weight, mg) (10min: 9.5±0.5 IVC, 6.6±0.9 PV, 4.8±0.9 SMV, 1.3±0.6 LV; 3h: 10.1±0.5 IVC, 5.3±0.8 PV, 19.2±0.9 SMV, 1.0±0.6 LV; 24h: 33.8±2.5 IVC, 27.5±2.9 PV, 8.8±0.9 SMV, 3.8±0.6 LV). BPC 157 normalised blood pressure (10min: 29±4 PV, 20±4 IVC, 87±3 AA; 3h: 20±4 PV, 17±4 IVC, 81±3 AA; 24h: 12±4 PV, 20±4 IVC, 82±3 AA) and reduced thrombosis (10min: 2.9±0.5 IVC, 2.6±0.9 PV, 3.2±0.3 SMV, 0.5±0.2 LV; 3h: 6.3±0.5 IVC, 2.3±0.5 PV, 5.9±0.9 SMV, 0.6±0.2 LV, 24h: 12.2±2.5 IVC, 1.9±0.5 PV, 4.8±0.9 SMV, 2.0±0.6 LV). Control group presented with peaked P waves, tachycardia and PV/SMV congestion, whereas the treated group showed none of the aforementioned phenomena. BPC 157 therapy counteracts hemodynamic disturbances, peaked P waves, and tachycardia as post-splenectomy complications

Monitoring the effect of Radiation Therapy on cardiac implantable electronic devices to assess patient risk

Given the overlap in risk factors between cardiac disease and cancer, it is likely that the number of patients presenting to radiation therapy departments with cardiac implantable electronic devices (CIEDs) will continue to increase. CIED malfunction during radiation therapy is poorly understood, and there is a need for further investigation into the efficacy of current departmental protocols. This research aimed to assess the risks associated with radiation therapy when treating CIED patients, and whether these may be managed by the use of a treatment protocol. The research concluded that severe soft errors may be associated with up to a 22.2% failure rate of implantable cardioverter defibrillators (ICDs) treated at 18MV when not exposed to the direct beam; when exposed to the direct radiation beam the risk is increased with the severity of errors increased at 18MV when compared to 6MV in both ICDs and Pacemakers (PM). Removal of the CIED from the treatment field decreased, but did not eliminate, the risk associated with both low and high photon energy treatment. ICDs continued to prove more sensitive to radiation than PMs, with failure not considered a dose driven effect. Maximum heart doses during radiation therapy greater than 20Gy were associated with changes in PMs that may indicate early failure. Previous treatment, treatment technique and treatment intent did not affect the risk of failure. The implementation of management protocols during radiation therapy proved to be effective in managing these patients. CIED patients may be safely treated using radiation therapy when there is a departmental protocol followed with adequate cardiac monitoring during and after treatment. This research suggests limiting the treatment energy used in CIED irradiation to less than 10MV, and reducing the maximum accumulated heart dose to 40Gy. A number of radiation therapy treatment recommendations are included as a vital update to current protocols

Temporary device malfunction of an MR conditional cardiac resynchronization defibrillator when undergoing MRI without appropriate re-programming: a case report

Background Magnetic resonance (MR) imaging (MRI) for patients with implantable cardiac devices is becoming more routine, with the development of MR conditional devices allowing more patients access to the imaging they need. However, for this to be performed safely, strict protocols must be followed necessitating close collaboration between cardiology and radiology departments. We present a case where mandatory device re-programming of a cardiac resynchronization therapy defibrillator device into MRI mode was not performed pre-scan leading to temporary device dysfunction with no clinical consequences. Case summary A 72-year-old man presented to a device clinic for a routine device interrogation. An atrial tachycardia response episode was recorded at the same time as the patient reported having undergone an MRI scan at a local centre. The electrogram demonstrated temporary right ventricular loss of capture with standard output programming, and a short episode of oversensing on the atrial and ventricular channel which was not sustained for long enough to meet tachycardia detection. Discussion We demonstrate two potential electrophysiological effects of MRI on pacemakers, where the device had not been appropriately re-programmed pre-procedure. This illustrates that whilst MRI in patients with implantable cardiac devices is safe, strict protocols must be followed requiring robust multidisciplinary communication

Incidence and Clinical Significance of Inducible Atrial Tachycardia in Patients with Atrioventricular Nodal Reentrant Tachycardia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72373/1/j.1540-8167.2001.00507.x.pd

Implantable Cardioverter Defibrillator Outcomes in Pediatric and Congenital Heart Disease: Time to System Revision

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/122425/1/pace12878.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/122425/2/pace12878_am.pd

Effects of hearing aid programming equipment and assistive listening devices on implantable cardiac devices

This study examines the potential for electromagnetic interference from the use of neck-worn hearing aid programming equipment and assistive listening devices to affect cardiac pacemakers and defibrillators