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P2-1
S138 POSTER SESSION 2 Thursday, May 18, 2006 Session Time: 9:00 a.m.–12:00 p.m. Presenter Available: 9:30 a.m.–10:30 a.m. Location: Exhibit Hall P2-1 SINGLE CENTER EXPERIENCE OF DEEP SEDATION WITH NONANESTHESIA TRAINED EP LAB PERSONNEL Arthur T. Mize, Marcos Daccarett, MD and Christian Machado, MD. Providence Hospital, Southfield, MI. Background: The EP Lab has been using Deep Sedation with diprovan without the use of Anesthesia Personnel for over eight years. There has been a low occurrence of Reportable Sedation incidences. The Electrophysiologist is trained in Deep Sedation with credentialing through the hospital. The staff has advanced intra-departmental training in medication usage and airway management. There is a high degree of physician/staff interaction for training and education. Methods: A retrospective study from January 2004 till November 2005 was performed comparing the risk of adverse events between the EP Lab using Conscious Sedation and Deep Sedation and two departments using Conscious Sedation. An adverse incident was defined by the intra-facility’s Sedation Committee. An occurrence rate per 1000 cases was calculated. A X value was used for comparison. Results: A rate of incidents was determined cumulatively for the Cardiac Cath Lab and the Endoscopy Department at 1.61 per 1000 cases for Conscious Sedation. A rate of incidents for Deep Sedation and Conscious Sedation in the EP Lab was 1.09 per 1000 cases. A rate of incidents for Deep Sedation Only in the EP Lab was 1.28 per 1000 cases. A p value was indeterminate due to the low number of incidents. When comparing Conscious Sedation incidents from the other departments to Conscious Sedation and Deep Sedation incidents of the EP Lab, a Pearson Uncorrected X value of 0.146 was obtained. When comparing Conscious Sedation incidents from the other departments to Deep Sedation Only in the EP Lab, a Pearson Uncorrected X value of 0.05 was obtained. Conclusions: Due to the higher level of training and physician/staff interaction required during Deep Sedation procedures, an overall decrease in reportable incidents was identified and proven to be significant for all procedures, both Conscious Sedation and Deep Sedation, within the EP Lab. Though there is an increase in the risk to patients in general when using Deep Sedation as compared to Conscious Sedation, this risk in the EP Lab is still below that of patients undergoing Conscious Sedation in other areas of the hospital. P2-2 OUTCOMES OF SIX MONTHLY STIMULATION THRESHOLD ASSESSMENTS IN PATIENTS WITH PACING SYSTEMS: A TWENTIETH YEAR FOLLOW-UP Marleen E. Irwin, RCP, RRT, Kim Kyllo, RN and Sajad S. Gulamhusein, MD, FRCP. Grey Nuns Hospital, Edmonton, Alberta, Canada. The purpose of this review was to evaluate the yield of atrial & ventricular stimulation threshold (ST) assessments at each routine six month pacemaker clinic (PC) visit. Since n 1983, and as reported in 1995, six monthly ST have been performed in all 886 actively followed pts: 73.34 ⫾ 0.27 (range 16-102 yrs) with programmable output pacing systems (PS) to establish reduced output levels for safe capture margins while maintaining pulse generator longevity. All records of pts with PS implanted for greater than 24 months were retrospectively reviewed for ST stability. After PS implantation and the initial three month visit all pts were routinely followed in the PC with full programming including the assessment of ST using the programmer options for voltage and duration attenuation. Mean follow-up was 16.5 yrs (range 1 to 22 yrs). Results: Eight hundred and fifty-one of 886 (96%) pts maintained stable ST throughout long-term follow-up and were safely programmed to ⱕ chronaxie time. Of the 35 pts with unstable ST; 27 of 35 (77%) increased
Heart Rhythm, Vol 3, No 5, May Supplement 2006 but remained stable and within programmable voltage range; of which only 5% were implanted for greater than 60 months. The remaining 8 of 35 (23%) had minor fluctuations of 0.5 to 1.0volt. In the unstable ST group, capture was below 3.0 volts and 0.3 ms in 70%. Only 2 patients presented with minor symptoms due to loss of capture. Conclusions: In this patient population: 1) routine 6 monthly stimulation threshold assessments may not be required due to consistently stable ST, however should be used to guide setting output levels for maximum PS longevity thus achieving decreased cost per pt treatment year, 2) stimulation thresholds fluctuate in a small number of patients and can be managed successfully with minor output changes, 3) stimulation threshold assessments reduced from six monthly to annually, while minimizing health care costs, would still leave a safe window of time between assessments, 4) the advent of auto capture trending will further enhance device output management. P2-3 SEX DISCRIMINATION IN THE PROVISION OF PRIMARY PREVENTION ICDS - EVIDENCE FROM A SINGLE UK CENTRE Helen S. Lindsay, BSc, Richard L. Snowdon, MRCP, David J. Wright, MD, MBBS, Johan E. P. Waktare, MD and Derick M. Todd, MD. The Cardiothoracic Centre NHS Trust, Liverpool, United Kingdom. Objective: Women have been under represented in recent major cardiovascular studies. They represented only 8% of patients in MADIT 1 and 16% of patients in MADIT 2, but were better represented with 32% of patients in COMPANION and 23% of patients in SCD HeFT. There has been recent focus on cardiovascular death in women, which is now the leading cause of death. We sought to determine whether women were receiving equitable care in terms of provision of primary prevention ICDs in our region. Methods: We reviewed all primary prevention ICD implants over a 1 year period from October 2003 to October 2004. Case notes were reviewed to determine indication for implantation, and 1 year follow up data. We also reviewed 300 new patient referrals to consultants responsible for ICD implantation in the preceding 6 month period. Results: A total of 66 patients had a primary prevention ICD implanted during the 1 year period. Of these only 7 (11%) were female (F). A small number of implants were performed for long QT syndrome (2 F), hypertrophic cardiomyopathy (1 male (M), 1 F), and arrhythmogenic right ventricular cardiomyopathy (2 M). Of the remaining 60 patients receiving ICDs on the basis of the MADIT 1 and 2, COMPANION and SCD HeFT studies only 4 (6.7%) were female. The indications in the 4 women were MADIT 2 (n ⫽ 3, 1 broad QRS) and SCD HeFT (n ⫽ 1). Overall patients had implantation on the basis of MADIT 1 (n ⫽ 4), MADIT 2 (n ⫽ 44, broad QRS n ⫽ 31), COMPANION (n ⫽ 7), and SCD HeFT (n ⫽ 5) studies. The mean age for men was 65 ⫾ 12 years and for women was 74 ⫾ 2 years. Left ventricular function and medications were well matched between males and females. During follow-up anti-tachycardia pacing or shock therapy rates were similar in both groups (1 of 4 (25%) women and 15 of 56 (26%) men). Analysis of the new patient referrals showed that during this period no female patients were declined ICD. Conclusions: Women are vastly under represented in the clinical practice of primary prevention ICDs in our region. The data obtained from the new patient referrals suggests the cause of the discrepancy is due to referral bias. We hope by highlighting this issue to improve awareness and subsequently referral of women for primary prevention ICD. P2-4 CATHETER REPROCESSING: A PROSPECTIVE STUDY Kenneth M. Costin, BA, Bryan O. Burke, AAS, Scott Seagrave, RN, Ramakota K. Reddy, MD and James H. McClelland, MD. Peacehealth, Eugene, OR. Oregon Heart and Vascular Institute, Eugene, OR. Introduction: It is claimed that “Reprocessed devices provide the same functionality, cleanliness, and sterility as new devices. The only difference
Heart Rhythm, Vol 3, No 5, May Supplement 2006 but remained stable and within programmable voltage range; of which only 5% were implanted for greater than 60 months. The remaining 8 of 35 (23%) had minor fluctuations of 0.5 to 1.0volt. In the unstable ST group, capture was below 3.0 volts and 0.3 ms in 70%. Only 2 patients presented with minor symptoms due to loss of capture. Conclusions: In this patient population: 1) routine 6 monthly stimulation threshold assessments may not be required due to consistently stable ST, however should be used to guide setting output levels for maximum PS longevity thus achieving decreased cost per pt treatment year, 2) stimulation thresholds fluctuate in a small number of patients and can be managed successfully with minor output changes, 3) stimulation threshold assessments reduced from six monthly to annually, while minimizing health care costs, would still leave a safe window of time between assessments, 4) the advent of auto capture trending will further enhance device output management. P2-3 SEX DISCRIMINATION IN THE PROVISION OF PRIMARY PREVENTION ICDS - EVIDENCE FROM A SINGLE UK CENTRE Helen S. Lindsay, BSc, Richard L. Snowdon, MRCP, David J. Wright, MD, MBBS, Johan E. P. Waktare, MD and Derick M. Todd, MD. The Cardiothoracic Centre NHS Trust, Liverpool, United Kingdom. Objective: Women have been under represented in recent major cardiovascular studies. They represented only 8% of patients in MADIT 1 and 16% of patients in MADIT 2, but were better represented with 32% of patients in COMPANION and 23% of patients in SCD HeFT. There has been recent focus on cardiovascular death in women, which is now the leading cause of death. We sought to determine whether women were receiving equitable care in terms of provision of primary prevention ICDs in our region. Methods: We reviewed all primary prevention ICD implants over a 1 year period from October 2003 to October 2004. Case notes were reviewed to determine indication for implantation, and 1 year follow up data. We also reviewed 300 new patient referrals to consultants responsible for ICD implantation in the preceding 6 month period. Results: A total of 66 patients had a primary prevention ICD implanted during the 1 year period. Of these only 7 (11%) were female (F). A small number of implants were performed for long QT syndrome (2 F), hypertrophic cardiomyopathy (1 male (M), 1 F), and arrhythmogenic right ventricular cardiomyopathy (2 M). Of the remaining 60 patients receiving ICDs on the basis of the MADIT 1 and 2, COMPANION and SCD HeFT studies only 4 (6.7%) were female. The indications in the 4 women were MADIT 2 (n ⫽ 3, 1 broad QRS) and SCD HeFT (n ⫽ 1). Overall patients had implantation on the basis of MADIT 1 (n ⫽ 4), MADIT 2 (n ⫽ 44, broad QRS n ⫽ 31), COMPANION (n ⫽ 7), and SCD HeFT (n ⫽ 5) studies. The mean age for men was 65 ⫾ 12 years and for women was 74 ⫾ 2 years. Left ventricular function and medications were well matched between males and females. During follow-up anti-tachycardia pacing or shock therapy rates were similar in both groups (1 of 4 (25%) women and 15 of 56 (26%) men). Analysis of the new patient referrals showed that during this period no female patients were declined ICD. Conclusions: Women are vastly under represented in the clinical practice of primary prevention ICDs in our region. The data obtained from the new patient referrals suggests the cause of the discrepancy is due to referral bias. We hope by highlighting this issue to improve awareness and subsequently referral of women for primary prevention ICD. P2-4 CATHETER REPROCESSING: A PROSPECTIVE STUDY Kenneth M. Costin, BA, Bryan O. Burke, AAS, Scott Seagrave, RN, Ramakota K. Reddy, MD and James H. McClelland, MD. Peacehealth, Eugene, OR. Oregon Heart and Vascular Institute, Eugene, OR. Introduction: It is claimed that “Reprocessed devices provide the same functionality, cleanliness, and sterility as new devices. The only difference