The use of implantable cardioverter defibrillators in Iceland: a retrospective population based study

BACKGROUND: Indications for implantable cardioverter defibrillator (ICD) implantation have expanded considerably in recent years, resulting in steadily growing numbers of ICD recipients worldwide. The aim of this study was to review the overall experience with ICDs in Iceland. METHODS: This was a retrospective single centre study set at the University Hospital in Iceland. Data on all ICD implantations in Iceland from the first implantation in 1992 till the end of 2002 was reviewed. RESULTS: Sixty-two patients (71% male) received an ICD during this period. There was an increase in the number of implants by year and the number of new implants in 2001 and 2002 amounted to 56 and 38 per million, respectively. The mean age at implantation was 58 (+/-14) years. Forty patients (65%) had coronary artery disease. The most common indications for ICD implantation were cardiac arrest, 32 (52%) and another 26 (42%) had experienced ventricular tachycardia without cardiac arrest. The most common adverse event was inappropriate shocks. Twenty-eight patients (45%) received therapy from their ICDs, with the majority receiving appropriate therapy. Of the thirteen patients deceased before or during the study period, no case of sudden arrhythmic death was observed. CONCLUSION: This study shows that the experience with ICDs in Iceland is in most respects similar to other Western countries

Impact of preprocedural upper gastrointestinal endoscopy for pulmonary vein isolation - single-center experience of 400 patients

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Mucosal esophageal lesions (ELs) are reported in 10-40% after pulmonary vein isolation (PVI) and may be precursors of (almost always lethal) atrio-esophageal fistula (AEF). Although mechanisms of lesion progression are not completely understood, inflammation (e.g. by acidic reflux) is thought to be a major contributor. However, ELs may also be preexisting or due to mechanical instrumentation rather than ablation-induced, and these lesions are not prone to progression. On the other hand, preexisting reflux-induced esophagitis might facilitate lesion generation during ablation. Therefore, esophagogastroscopy (EGD) before PVI might reveal important information regarding preexisting vulnerability that needs to be considered/is relevant for ablation procedure planning. Purpose (1) To study the incidence of preexisting esophageal and upper gastrointestinal pathology detected by EGD in patients undergoing PVI. (2) To assess the impact of preprocedural EGD on procedure planning. Methods All consecutive patients undergoing PVI (radiofrequency energy PVI or cryoablation) had routine pre- and post-procedural EGD. The preexisting EGD-findings were analyzed with regard to their impact on PVI planning, postprocedural ELs, and additional endoscopic workup. Results From 08/2018 to 08/2021, 396 patients (66 ± 9 years, 58% male) were included. During preprocedural EGD, 207 patients (52%) had esophageal and extraesophageal abnormalities. In 57 patients, the findings influenced the procedure strategy (e.g. in the presence of inflammation of the lower third of the esophagus, maximum power at the posterior left atrial wall was reduced from 25 to 20 Watts). 9/29 patients with new ELs in postprocedural EGD had preexisting esophagitis. Ablation was postponed for five patients, thereof two with candida esophagitis, two with gastral and one with duodenal ulcer, respectively). 16 patients received further endoscopic workup with identification of a gastric carcinoma in one. Endoscopic ultrasound identified a patient with a pancreatic head neoplasia. There were no procedure-related complications of EGDs. Discussion and Conclusion In an unselected cohort, preprocedural EGD showed incidental findings in a half of the patients, and one-fourth of these were considered to be relevant for procedural aspects of PVI. Of particular interest is the absence of inflammation of the esophageal wall. Ulcer do not affect the safety of the PVI directly, but have impact on anticoagulation issues. EGD before PVI merits consideration. Abstract Figure. EGD-findings before PVI </jats:sec

Mechanisms of action behind the protective effects of proactive esophageal cooling during radiofrequency catheter ablation in the left atrium

Proactive esophageal cooling for the purpose of reducing the likelihood of ablation-related esophageal injury resulting from radiofrequency (RF) cardiac ablation procedures is increasingly being used and has been Food and Drug Administration cleared as a protective strategy during left atrial RF ablation for the treatment of atrial fibrillation. In this review, we examine the evidence supporting the use of proactive esophageal cooling and the potential mechanisms of action that reduce the likelihood of atrioesophageal fistula (AEF) formation. Although the pathophysiology behind AEF formation after thermal injury from RF ablation is not well studied, a robust literature on fistula formation in other conditions (eg, Crohn disease, cancer, and trauma) exists and the relationship to AEF formation is investigated in this review. Likewise, we examine the abundant data in the surgical literature on burn and thermal injury progression as well as the acute and chronic mitigating effects of cooling. We discuss the relationship of these data and maladaptive healing mechanisms to the well-recognized postablation pathophysiological effects after RF ablation. Finally, we review additional important considerations such as patient selection, clinical workflow, and implementation strategies for proactive esophageal cooling