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Estimating the Need for Implantable Cardioverter Defibrillators
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Abstracts Abstracts
ABSTRACTS
Estimating the Need for Implantable Cardioverter Defibrillators P.D. Larsen 1,2,∗ , L. Presant 1,2 , S.A. Harding 1,3 1 Wellington
Cardiovascular Research Group, New Zealand
2 Department of Surgery and Anaesthesia, University of Otago,
Wellington, New Zealand Department, Wellington Hospital, New Zealand
3 Cardiology
Background: Use of implanted cardioverter defibrillators (ICDs) in New Zealand has increased from 21/million in 2001 to 80/million in 2010. Despite this increase, it is not clear that we are meeting the current clinical need for ICDs. This study aimed to determine the required implant rate on the basis of the number of cardiology inpatients presenting to our institution who meet current national ICD guidelines. Methods: We identified all patients admitted to the cardiology ward at Wellington Hospital following ventricular fibrillation (VF), sustained ventricular tachycardia (VT), acute heart failure (HF) or acute myocardial infarction (AMI) over a four month time period in 2011, excluding patients transferred from other hospitals and those with pre-existing ICDs. Each patient’s admission and subsequent management was examined to identify those with ICD indications, and any co-morbid conditions likely to influence a decision to implant an ICD. Results: Over the study period 257 patients were admitted, 15 with VT/VF and 242 with AMI or HF. Eight of the 15 VT/VF patients had a clinical indication for an ICD with none of these having likely contraindications. Of the 242 AMI/HF patients 15 had a clinical indication for an ICD, although seven of these also had co-morbidities likely to be considered contraindications. Sixteen patients identified over four months equates to an implant rate of 162/million/year (95% confidence intervals 116–208/million/year) for our hospital. A further five patients had possible indications, but required further investigations. Conclusion: Our findings suggest that we are unlikely to be meeting the current clinical need for ICDs. http://dx.doi.org/10.1016/j.hlc.2012.03.048 ICD Therapy in Patients with Mustard and Senning Repair for D-Transposition of Great Arteries. The Greenlane/Auckland Hospital Experience M. Latif ∗ , B. Lowe Auckland City Hospital, New Zealand Background: Sudden cardiac death is the most common cause of late mortality in patients with Mustard and Senning repair for Transposition of great arteries with an incidence of 7%. There is limited knowledge about mechanisms of sudden death and ICDs in this group of patients. Hence we conducted a retrospective review of all the ICDs inserted in the Mustard and Senning repair patients at Greenlane/Auckland City hospital.
Heart, Lung and Circulation 2012;21:480–526
Methods: This was a single centre retrospective study of patients older than 15 years who had ICD implanted and had undergone Mustard or Senning repair at Greenlane/Auckland Hospital. We reviewed the clinical indications, procedure duration, difficulty in implantation and complications as well as looked at the rate of ICD discharges. Results: From 1964 to 1994, there were 195 cases of Mustard repair and 66 cases of Senning repair. A total of seven patients (five males and two females) had ICDs and almost all were inserted for primary prevention (6/7) and one for secondary prevention (1/7). Mean age at implantation was 30 years (range: 21–40 years). Mean follow up of 3.6 years (range: four months to seven years). There were no ICD discharges in this cohort. One patient had ATP for SVT. The procedure duration was acceptable (mean 76 min) and there were no procedure related complications. All patients are alive and living independently in community. The main indications for ICD implantation were episodes of presyncope/syncope and runs of NSVT on monitoring in the context of systemic RV impairment. Conclusion: Low risk of ICD related complications in our cohort of patients with prior Mustard/Senning repair for transposition of great arteries. http://dx.doi.org/10.1016/j.hlc.2012.03.049 Cardiac Function in COPD Exacerbations M. Lee 1,2,∗ , A. Hancox 2,3 1 Department 2 Department
Davies 2 , C.
Chang 2 , M.
Davis 1 , R.
of Cardiology, Waikato Hospital, New Zealand of Respiratory Medicine, Waikato Hospital, New
Zealand 3 Department
of Social and Preventative Medicine, University of Otago, Dunedin, New Zealand
Background: Chronic Obstructive Pulmonary Disease (COPD) is an important cause of mortality and morbidity in New Zealand. We have recently shown that elevated levels of cardiac biomarkers (troponins and B-type natriuretic peptides) are strong predictors of early mortality in patients with COPD exacerbations. The pathophysiological basis for this is unknown. Methods: An exploratory study of 18 patients admitted with exacerbations of COPD. Patients with overt heart failure were excluded. Eight patients had elevated levels of NT-proBNP (>220 pmol/L) and 10 had low or intermediate levels. Echocardiography was performed within 48 h of admission to assess ventricular function. Results: Levels of NT-proBNP were positively correlated with left ventricular diastolic diameter with a trend towards statistical significance (rho = 0.40, p = 0.097) and negatively correlated with measures of biventricular function (tricuspid annular plane systolic excursion: rho = −0.51, p = 0.044; left ventricular ejection fraction: rho = −0.76, p = <0.001). Conclusion: In patients with exacerbations of COPD, elevated levels of cardiac biomarkers are associated with
Abstracts Abstracts
ABSTRACTS
Estimating the Need for Implantable Cardioverter Defibrillators P.D. Larsen 1,2,∗ , L. Presant 1,2 , S.A. Harding 1,3 1 Wellington
Cardiovascular Research Group, New Zealand
2 Department of Surgery and Anaesthesia, University of Otago,
Wellington, New Zealand Department, Wellington Hospital, New Zealand
3 Cardiology
Background: Use of implanted cardioverter defibrillators (ICDs) in New Zealand has increased from 21/million in 2001 to 80/million in 2010. Despite this increase, it is not clear that we are meeting the current clinical need for ICDs. This study aimed to determine the required implant rate on the basis of the number of cardiology inpatients presenting to our institution who meet current national ICD guidelines. Methods: We identified all patients admitted to the cardiology ward at Wellington Hospital following ventricular fibrillation (VF), sustained ventricular tachycardia (VT), acute heart failure (HF) or acute myocardial infarction (AMI) over a four month time period in 2011, excluding patients transferred from other hospitals and those with pre-existing ICDs. Each patient’s admission and subsequent management was examined to identify those with ICD indications, and any co-morbid conditions likely to influence a decision to implant an ICD. Results: Over the study period 257 patients were admitted, 15 with VT/VF and 242 with AMI or HF. Eight of the 15 VT/VF patients had a clinical indication for an ICD with none of these having likely contraindications. Of the 242 AMI/HF patients 15 had a clinical indication for an ICD, although seven of these also had co-morbidities likely to be considered contraindications. Sixteen patients identified over four months equates to an implant rate of 162/million/year (95% confidence intervals 116–208/million/year) for our hospital. A further five patients had possible indications, but required further investigations. Conclusion: Our findings suggest that we are unlikely to be meeting the current clinical need for ICDs. http://dx.doi.org/10.1016/j.hlc.2012.03.048 ICD Therapy in Patients with Mustard and Senning Repair for D-Transposition of Great Arteries. The Greenlane/Auckland Hospital Experience M. Latif ∗ , B. Lowe Auckland City Hospital, New Zealand Background: Sudden cardiac death is the most common cause of late mortality in patients with Mustard and Senning repair for Transposition of great arteries with an incidence of 7%. There is limited knowledge about mechanisms of sudden death and ICDs in this group of patients. Hence we conducted a retrospective review of all the ICDs inserted in the Mustard and Senning repair patients at Greenlane/Auckland City hospital.
Heart, Lung and Circulation 2012;21:480–526
Methods: This was a single centre retrospective study of patients older than 15 years who had ICD implanted and had undergone Mustard or Senning repair at Greenlane/Auckland Hospital. We reviewed the clinical indications, procedure duration, difficulty in implantation and complications as well as looked at the rate of ICD discharges. Results: From 1964 to 1994, there were 195 cases of Mustard repair and 66 cases of Senning repair. A total of seven patients (five males and two females) had ICDs and almost all were inserted for primary prevention (6/7) and one for secondary prevention (1/7). Mean age at implantation was 30 years (range: 21–40 years). Mean follow up of 3.6 years (range: four months to seven years). There were no ICD discharges in this cohort. One patient had ATP for SVT. The procedure duration was acceptable (mean 76 min) and there were no procedure related complications. All patients are alive and living independently in community. The main indications for ICD implantation were episodes of presyncope/syncope and runs of NSVT on monitoring in the context of systemic RV impairment. Conclusion: Low risk of ICD related complications in our cohort of patients with prior Mustard/Senning repair for transposition of great arteries. http://dx.doi.org/10.1016/j.hlc.2012.03.049 Cardiac Function in COPD Exacerbations M. Lee 1,2,∗ , A. Hancox 2,3 1 Department 2 Department
Davies 2 , C.
Chang 2 , M.
Davis 1 , R.
of Cardiology, Waikato Hospital, New Zealand of Respiratory Medicine, Waikato Hospital, New
Zealand 3 Department
of Social and Preventative Medicine, University of Otago, Dunedin, New Zealand
Background: Chronic Obstructive Pulmonary Disease (COPD) is an important cause of mortality and morbidity in New Zealand. We have recently shown that elevated levels of cardiac biomarkers (troponins and B-type natriuretic peptides) are strong predictors of early mortality in patients with COPD exacerbations. The pathophysiological basis for this is unknown. Methods: An exploratory study of 18 patients admitted with exacerbations of COPD. Patients with overt heart failure were excluded. Eight patients had elevated levels of NT-proBNP (>220 pmol/L) and 10 had low or intermediate levels. Echocardiography was performed within 48 h of admission to assess ventricular function. Results: Levels of NT-proBNP were positively correlated with left ventricular diastolic diameter with a trend towards statistical significance (rho = 0.40, p = 0.097) and negatively correlated with measures of biventricular function (tricuspid annular plane systolic excursion: rho = −0.51, p = 0.044; left ventricular ejection fraction: rho = −0.76, p = <0.001). Conclusion: In patients with exacerbations of COPD, elevated levels of cardiac biomarkers are associated with