The Mechanisms Responsible for Lack of Reproducible Induction of Atrioventricular Nodal Reentrant Tachycardia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75434/1/j.1540-8167.1996.tb00556.x.pd

Radiofrequency Ablation of Idiopathic Left Anterior Fascicular Tachycardia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71580/1/j.1540-8167.1995.tb00389.x.pd

A Quantitative Fluoroscopic Comparison of the Coronary Sinus Ostium in Patients With and Without AV Nodal Reentrant Tachycardia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75367/1/j.1540-8167.1995.tb00444.x.pd

“Quiet at Night”: Reduced overnight vital sign monitoring linked to both safety and improvements in patients’ perception of hospital sleep quality

Obtaining middle of the night vital signs is disruptive to sleep and not founded on evidence-based medicine. We sought to investigate the perception of quality of sleep and overall satisfaction during a hospital stay between an intervention group where overnight night vital signs were not obtained and a standard of care group where overnight vital signs were obtained every four hours. We also monitored for adverse events in the intervention and standard group. Low-risk observational stay patients with a planned cardiac procedure were eligible for this study. After consent, patients were randomized to the intervention or standard group. Participants were provided a questionnaire on the day following their overnight stay to assess their perception of quality of sleep and satisfaction with their hospital stay. Charts were reviewed to assess for any adverse outcomes. During the study period, 39 patients were enrolled in the standard group and 41 in the intervention group. All patients were discharged the following day as planned and no adverse events occurred overnight. More patients in the standard group rated good/excellent sleep at home, and more patients in the intervention group rated good/excellent sleep in the hospital. There was a trend toward less disruptive sleep between home and hospital for the intervention group (p = 0.096). There was no difference found in the overall satisfaction of hospital stay response between the intervention and standard groups (p = 0.999). Fewer patients in the intervention group had worse sleep in the hospital as compared to home, significant at p \u3c 0.10. We also found there was no escalation of care despite not obtaining vitals throughout the night in our intervention group. With this proof of concept now safely implemented, it is our intention to implement further studies to broaden our inclusion criteria and population to encourage a restful and healing environment through the entire healthcare stay

927-37 Is Coronary Revascularization Complete Therapy for Secondary Prevention of Ischemic Cardiac Arrest?

Coronary revascularization has been suggested assole therapy for secondary prevention of sudden cardiac arrest associated with ischemia. Among 412 consecutive patients receiving an implantable defibrillator (ICD), 23 (6%) were identified as: sudden cardiac arrest survivors, noninducible with programmed stimulation, unstable angina or ischemia on a functional study, and underwent successful coronary revascularization. In follow-up, 10 (43%) of the 23 patients received ICD shocks (8±8 per patient, range: 1–22) shocks) and 9/10 had syncope/presyncope associated with at least one ICD discharge.Clinical Characteristics:ICD firings (n=10)*No ICD firings (n=13)*Follow-up (months)39±1331±21Age (years)63±763±12Male gender89Mean left ventricular ejection fraction (%)36±1040±14Previous history of a myocardial infarction1010Presence of a left ventricular aneurysm41Q-wave infarction pattern on electrocardiogram75Sudden cardiac arrest presenting with exertion, angina, or CPK elevation88Mean number of vessels with coronary disease2.2±0.823±0.9Mean severity of coronary stenosis (%)87±1888±16Coronary revascularization considered complete710β-blocker therapy55Antiarrhythmic therapy812*p value>0.05No clinical characteristic was statistically different between patients with and without ICD shocks. In conclusion, coronary revascularization alone may be inadequate therapy for survivors of sudden cardiac arrest associated with ischemia who are noninducible with programmed stimulation, and clinical variables cannot predict which patients are likely to experience recurrent malignant ventricular arrhythmias. Therefore, ICD therapy should be considered in these patients

The Economic Impact of Transvenous Defibrillation Lead Systems

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72437/1/j.1540-8159.1994.tb02379.x.pd

927-37 Is Coronary Revascularization Complete Therapy for Secondary Prevention of Ischemic Cardiac Arrest?

Coronary revascularization has been suggested assole therapy for secondary prevention of sudden cardiac arrest associated with ischemia. Among 412 consecutive patients receiving an implantable defibrillator (ICD), 23 (6%) were identified as: sudden cardiac arrest survivors, noninducible with programmed stimulation, unstable angina or ischemia on a functional study, and underwent successful coronary revascularization. In follow-up, 10 (43%) of the 23 patients received ICD shocks (8±8 per patient, range: 1–22) shocks) and 9/10 had syncope/presyncope associated with at least one ICD discharge.Clinical Characteristics:ICD firings (n=10)*No ICD firings (n=13)*Follow-up (months)39±1331±21Age (years)63±763±12Male gender89Mean left ventricular ejection fraction (%)36±1040±14Previous history of a myocardial infarction1010Presence of a left ventricular aneurysm41Q-wave infarction pattern on electrocardiogram75Sudden cardiac arrest presenting with exertion, angina, or CPK elevation88Mean number of vessels with coronary disease2.2±0.823±0.9Mean severity of coronary stenosis (%)87±1888±16Coronary revascularization considered complete710β-blocker therapy55Antiarrhythmic therapy812*p value>0.05No clinical characteristic was statistically different between patients with and without ICD shocks. In conclusion, coronary revascularization alone may be inadequate therapy for survivors of sudden cardiac arrest associated with ischemia who are noninducible with programmed stimulation, and clinical variables cannot predict which patients are likely to experience recurrent malignant ventricular arrhythmias. Therefore, ICD therapy should be considered in these patients

Patients with an ICD Can Safely Resume Work in Industrial Facilities Following Simple Screening for Electromagnetic Interference

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74026/1/j.1460-9592.2003.t01-1-00251.x.pd

A Prospective Evaluation of Two Defibrillation Safety Margin Techniques in Patients with Low Defibrillation Energy Requirements

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75077/1/j.1540-8167.1998.tb00865.x.pd

Incidence, presentation, diagnosis, and management of malfunctioning implantable cardioverter-defibrillator rate-sensing leads

Recognition of tachyarrhythmia by an implantable cardioverter-defibrillator (ICD) requires an intact rate-sensing lead. We retrospectively examined 266 consecutive patients requiring an ICD to characterize the incidence, clinical presentation, diagnosis, and management of a defective rate-sensing lead. To identify clinical parameters that may contribute to lead complications, we also assessed the effects of age, gender, type of rate-sensing lead, manufacturer of the lead, and surgeon. Over a follow-up period of 30 +/- 22 months (mean +/- standard deviation), a defective lead was found in 9 (3.4%) patients, in 9 (1.7%) of 514 leads over a period of 2 to 39 (mean 17 +/- 15) months after implantation. Except for 1 patient, in whom a lead fracture was incidently found during ICD generator replacement, these patients had multiple inappropriate shocks of recent onset. Clinical parameters were not helpful in identifying patients at risk for lead complication. An abnormal beeping signal obtained while the patients performed various maneuvers was helpful in confirming a defect. All of the defective leads were epicardial. These cases were managed by placement of a transvenous endocardial lead.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31233/1/0000136.pd