- Email: [email protected]
Survival of dialysis patients after cardiac arrest in the United States: The impact of implantable cardioverter defibrillators
JACC
ABSTRACTS
March 19,2003
- Cardiac Arrhythmias
8:45 a.m.
4:45 p.m.
JoseDh J. DeRose, Swistel, Jonathan
Jr, Robert C. Ashton. Sackner-Bernstein.
Jr., Scott Belsley,
Jonathan
Hospital Center, New York, NY, Columbia Surgeons, New York, NY Background:
Approximately
Universrty
10% of patients
tion have a failure of coronary
Methods:
Seven patients
sinus (CS) cannulation.
with congestive
College
undergoing
pacing could be performed in these patients tricular (LV) epicardial approach.
Roxana
S. Steinberg,
Shaw. Daniel G.
St. Luke’s_ Roosevelt
JoshuaM. Cooter, Elizabeth
of Physicians
Laurence
M. Epstein,
Hospital,
Boston,
biventricular
and
pacemaker
We hypothesized
using a robotically
heart failure (NYHA
inser-
that biventricular
assisted,
direct left ven-
class 3.4 * 0.5) and a wid-
ened QRS (175 * 21 msec) underwent robotic LV lead placement following failed coronary sinus cannulation. Mean patient age was 69 * 11 years, LV ejection fraction (EF) was 13 * 7% and left ventricular prior cardiac surgery Results: Thirteen
end diastolic volume
and 5 patients
epicardial
of the LV in the 7 patients.
was 6.3 * 0.5 cm. Two patients had
had a prior device implanted.
leads were successfully lntraoperative
suriace
was 1.1 * 0.6 V at 0.5 ms. R-
prevention
of sudden
death.
fracture,
(5 of 7 patients),
ejection frac-
a srgnificant
drop in impedance
(310 + 54 ohms, p=O.O05) has been measured.
Conclusions: Robotic LV lead placement is an effective technique which can be used for ventricular resynchronization therapy in patients with no other minimally invasive options for biventricular
pacing.
ICD leads, over time, become
requires
disruption
of the adherent
demographics,
structural
heart disease tetralogy
or sensing
A. Herzoq,
Jennie Z. Ma, Allan J. Collins,
MN, Minneapolis
Medical
Research
Nephrology Foundation,
of dialysis
1,285,177 database
pts with
cardiac
pts in the 100% and identified
The survival
arrest.
We searched
(end-stage
15,531 dialysis
of pts discharged
compared to pts drscharged adjusted Cax model. Results
ESRD
Analytical
Services,
Minneapolis,
MN
is a newly-reported
finding.
in the 5 patients
the
records
(claims
sample
of the Medicare
alive without
for cardiac
survival strongly
shows suwival
and predictors
of dialysis pts with cardiac arrest is markedly suggest under-utilization of ICD in ESRD pts.
Survival
(%)
Predictors
of All-Cause
2Yr
ICD (n=167)
61.8
49.4
No ICD
40.4
26.2
3yr
Varrable
RR
data)
of
arrest was
and a comorbidity-
Conclusion:
with atnal switch
repair of transposition Young
data
Death
Philadelphia,
Age
1.6
6
75+
7
17.
Male
1.1
Methods:
9
(1.40,1.99)
<.OOO
0.8
dysfunction.
2 DM
1.2
0.5 3
implantable
cardioverter
defrbnllator
Results:
ICD events in 3 populations:
dilated cardiomyopathy ventricular tachycardia,
c.000
(1.10,1.32)
<.OOO
(0.43,0.66)
c.000
1
1
a.m.
(ICD)
(^p
Group
1 sustained
(DCM) and syncope, and Group 3 coronary disease and left ventncular
to group 1)
with DCM and syncope
were as likely to have VAs detected,
despite
shorter
follow-up;
(b) asymptomatic pts with coronary disease appeared less likely to have VAs detected, but this may be due to the much shorter median follow-up. (3) The time to the 1st susued ICD implantation
different
for both primary
in all 3 groups.
and secondary
These data support
prevention.
Group 1
Group
N=
53
46
51
Age, mean
63 +/- 13
60 +/- 15
70 +I- 9
LVEF, %
30 +/- 10%
25 +/- 9%*
29 +I- 9%
61%
379’Q’
92%”
838
436
393”
32%
33%
24%.
1110
59
27.
360
282
510
85%
93%
80%
28%
24%
10%
sustained
VAs, % pts days
% pts with sustacned VAs detected
by ICD
Total # VA detections
2
Group
mean
.0003
1
0 ICD
and altered
Conclusions: (1) The overall frequency of VAs is greatest in pts with clinically documented VA prior to ICD implantation. (2) Compared to pts with sustained VAs. (a) pts
Survival, (0.76.0.90)
drd
single rather than dual coil ICD leads in
1 (1.07.1.25)
6 Race(Black)
of the great arteries
CHD patrents with an ICD are at risk for
despite the issues of coil adherence
of appropriate
We examined
VAs. Group 2 nonischemic asymptomatic nonsustained
# days to 1 st detection, (n=3,380)
Twenty
PA
The frequency
Median follow-up,
(95% Cl)
(15
or failure. over time,
and fracture. The use of a laser sheath is safe and effective
in CHD patients,
The
by ICD. These
P 31.
was 17.9 + 5.7 years
was 42.0 * 18.9 months
events in patients (pts) presenting with sustained ventricular arrhythmias (VAs) is well established. However, the frequency and timing of ICD events in other populations is not
Inducible ‘Yr
had surgically-corrected
Andrea M. Russq Sanjay Dixit. Ralph J. Verdino, Hemal Nayak. Joseph Poku, Jamre Springman, Laurent Lewkowiez, Francis E. Marchlinski, University of Pennsylvanra
Background:
alive and received no
of death.
improved
patrents
of lead implantation
ICD. Of the 3547 pts, 48% were male, 56% 65+ yrs old, 61% white, 53% diabetic ESRD, and 77% prior CHF. Predictors of death included older age, race (white), diabetes (DM), CHF. and no ICD. The Table
Seven
extracted. There were three instances of blood loss no major complications or deaths. Use of a laser
tained VA event was not significantly
ICD was used rn 167 pts, and 3,380 pts were discharged
indica-
Frequency and Timing of Defibrillator Events in Patients Without Documented Arrhythmias: Who Is at Highest Risk?
Health System,
arrest in 1996.2000.
ICD withrn 30 days of cardiac
ICD, using lrfe table method
of Implantation.
A laser sheath was used for 20 of 21 lead extractions.
lead distortion
well described.
renal disease)
pts hospitalized
alive receiving
duration
of Fallot). The mean patient age at extraction
of 21 leads (95%) were completely requiring transfusion. There were
873-3
Sudden cardiac death is the single largest cause of mortality rn dtalysis pts. There are no published data on the impact of implantable cardioverter-defibrillators (ICD) on the survival
We retrospectively
9:oo
Survival of Dialysis Patients After Cardiac Arrest in the United States: The Impact of Implantable Cardioverter Defibrillators
Minneapolrs.
Methods:
of the great arteries with atrial switch repair, and
cardiac anatomy. It may be advisable to implant patients with the potential for future growth.
8:30 a.m.
Charles
to venc~us endothe-
to 75 months). Fourteen of 15 procedures were performed for lead fracture Binding of the proximal high voltage electrode, with coil stretching and fracture
growth-related
Wednesday, April 02, 2003, 8:30 a.m.-i 0:OO a.m. McCormick Place, Room S402
873-l
leads).
(5 transposition
(9 to 32 years), and the mean duration
for ICD lead extraction
New Perspectives in Implantable Cardioverter-Defibrillator Therapy
873
fibrous tiswe.
cardiac anatomy,
not result in baffle injury.Conclusions:
CONTRIBUTIONS
adherent
tions for removal, and extraction procedure details. Results: From April 1999 through January 2002, 14 patients underwent 15 lead extraction procedures to remove 21 leads
sheath
ORAL
P. Walsh,
MA, Boston Children’s
reviewed our experience with ICD lead complications and extraction in children and young adults with CHD. Multiple implantation and extraction parameters were analyzed
2 corrected
tolerance
I. Berul, Edward Boston,
lium and endocardium through the growth of scar tissue. This lead bindrng has unique implications in a growing patient. Lead removal, when necessary for lead infection or
patrent with an AICD.
in exercise
Charles Hospital,
MA
(17 ICD leads and 4 pacing
Improvements
&Women’s
Background: Implantable cardioverter-defibrillators (ICDs) are being implanted in children and young adults with congenital heart disease (CHD) for primary and secondary
wave was 15.8 f 6.5 mV, and impedance was 1074 * 301 ohms at 0.5V. Complications mcluded one post-operatwe pneumonia and one episode of ventricular tachycardia in a tion (19 f 10%) and QRS duration (152 i 16 msec) have been noted at 16.5 t 5.0 weeks follow-up. Lead thresholds have remained unchanged (1.8 * 1.1 Vat 0.5 ms, p=NS), and
A. Stephenson,
Brigham
in this cohort, including
placed on the posterolateral
lead threshold
Implantable Cardioverter Defibrillator Lead Complications and Laser Extraction in Children and Young Adults With Congenital Heart Disease
873-2
Robotically-Assisted Ventricular Resynchronization Therapy Following Failed Coronary Sinus Cannulation
862-4
137A
% pts
% pts wrth inappropriate
ICD detections
3
contin-
ABSTRACTS
March 19,2003
- Cardiac Arrhythmias
8:45 a.m.
4:45 p.m.
JoseDh J. DeRose, Swistel, Jonathan
Jr, Robert C. Ashton. Sackner-Bernstein.
Jr., Scott Belsley,
Jonathan
Hospital Center, New York, NY, Columbia Surgeons, New York, NY Background:
Approximately
Universrty
10% of patients
tion have a failure of coronary
Methods:
Seven patients
sinus (CS) cannulation.
with congestive
College
undergoing
pacing could be performed in these patients tricular (LV) epicardial approach.
Roxana
S. Steinberg,
Shaw. Daniel G.
St. Luke’s_ Roosevelt
JoshuaM. Cooter, Elizabeth
of Physicians
Laurence
M. Epstein,
Hospital,
Boston,
biventricular
and
pacemaker
We hypothesized
using a robotically
heart failure (NYHA
inser-
that biventricular
assisted,
direct left ven-
class 3.4 * 0.5) and a wid-
ened QRS (175 * 21 msec) underwent robotic LV lead placement following failed coronary sinus cannulation. Mean patient age was 69 * 11 years, LV ejection fraction (EF) was 13 * 7% and left ventricular prior cardiac surgery Results: Thirteen
end diastolic volume
and 5 patients
epicardial
of the LV in the 7 patients.
was 6.3 * 0.5 cm. Two patients had
had a prior device implanted.
leads were successfully lntraoperative
suriace
was 1.1 * 0.6 V at 0.5 ms. R-
prevention
of sudden
death.
fracture,
(5 of 7 patients),
ejection frac-
a srgnificant
drop in impedance
(310 + 54 ohms, p=O.O05) has been measured.
Conclusions: Robotic LV lead placement is an effective technique which can be used for ventricular resynchronization therapy in patients with no other minimally invasive options for biventricular
pacing.
ICD leads, over time, become
requires
disruption
of the adherent
demographics,
structural
heart disease tetralogy
or sensing
A. Herzoq,
Jennie Z. Ma, Allan J. Collins,
MN, Minneapolis
Medical
Research
Nephrology Foundation,
of dialysis
1,285,177 database
pts with
cardiac
pts in the 100% and identified
The survival
arrest.
We searched
(end-stage
15,531 dialysis
of pts discharged
compared to pts drscharged adjusted Cax model. Results
ESRD
Analytical
Services,
Minneapolis,
MN
is a newly-reported
finding.
in the 5 patients
the
records
(claims
sample
of the Medicare
alive without
for cardiac
survival strongly
shows suwival
and predictors
of dialysis pts with cardiac arrest is markedly suggest under-utilization of ICD in ESRD pts.
Survival
(%)
Predictors
of All-Cause
2Yr
ICD (n=167)
61.8
49.4
No ICD
40.4
26.2
3yr
Varrable
RR
data)
of
arrest was
and a comorbidity-
Conclusion:
with atnal switch
repair of transposition Young
data
Death
Philadelphia,
Age
1.6
6
75+
7
17.
Male
1.1
Methods:
9
(1.40,1.99)
<.OOO
0.8
dysfunction.
2 DM
1.2
0.5 3
implantable
cardioverter
defrbnllator
Results:
ICD events in 3 populations:
dilated cardiomyopathy ventricular tachycardia,
c.000
(1.10,1.32)
<.OOO
(0.43,0.66)
c.000
1
1
a.m.
(ICD)
(^p
Group
1 sustained
(DCM) and syncope, and Group 3 coronary disease and left ventncular
to group 1)
with DCM and syncope
were as likely to have VAs detected,
despite
shorter
follow-up;
(b) asymptomatic pts with coronary disease appeared less likely to have VAs detected, but this may be due to the much shorter median follow-up. (3) The time to the 1st susued ICD implantation
different
for both primary
in all 3 groups.
and secondary
These data support
prevention.
Group 1
Group
N=
53
46
51
Age, mean
63 +/- 13
60 +/- 15
70 +I- 9
LVEF, %
30 +/- 10%
25 +/- 9%*
29 +I- 9%
61%
379’Q’
92%”
838
436
393”
32%
33%
24%.
1110
59
27.
360
282
510
85%
93%
80%
28%
24%
10%
sustained
VAs, % pts days
% pts with sustacned VAs detected
by ICD
Total # VA detections
2
Group
mean
.0003
1
0 ICD
and altered
Conclusions: (1) The overall frequency of VAs is greatest in pts with clinically documented VA prior to ICD implantation. (2) Compared to pts with sustained VAs. (a) pts
Survival, (0.76.0.90)
drd
single rather than dual coil ICD leads in
1 (1.07.1.25)
6 Race(Black)
of the great arteries
CHD patrents with an ICD are at risk for
despite the issues of coil adherence
of appropriate
We examined
VAs. Group 2 nonischemic asymptomatic nonsustained
# days to 1 st detection, (n=3,380)
Twenty
PA
The frequency
Median follow-up,
(95% Cl)
(15
or failure. over time,
and fracture. The use of a laser sheath is safe and effective
in CHD patients,
The
by ICD. These
P 31.
was 17.9 + 5.7 years
was 42.0 * 18.9 months
events in patients (pts) presenting with sustained ventricular arrhythmias (VAs) is well established. However, the frequency and timing of ICD events in other populations is not
Inducible ‘Yr
had surgically-corrected
Andrea M. Russq Sanjay Dixit. Ralph J. Verdino, Hemal Nayak. Joseph Poku, Jamre Springman, Laurent Lewkowiez, Francis E. Marchlinski, University of Pennsylvanra
Background:
alive and received no
of death.
improved
patrents
of lead implantation
ICD. Of the 3547 pts, 48% were male, 56% 65+ yrs old, 61% white, 53% diabetic ESRD, and 77% prior CHF. Predictors of death included older age, race (white), diabetes (DM), CHF. and no ICD. The Table
Seven
extracted. There were three instances of blood loss no major complications or deaths. Use of a laser
tained VA event was not significantly
ICD was used rn 167 pts, and 3,380 pts were discharged
indica-
Frequency and Timing of Defibrillator Events in Patients Without Documented Arrhythmias: Who Is at Highest Risk?
Health System,
arrest in 1996.2000.
ICD withrn 30 days of cardiac
ICD, using lrfe table method
of Implantation.
A laser sheath was used for 20 of 21 lead extractions.
lead distortion
well described.
renal disease)
pts hospitalized
alive receiving
duration
of Fallot). The mean patient age at extraction
of 21 leads (95%) were completely requiring transfusion. There were
873-3
Sudden cardiac death is the single largest cause of mortality rn dtalysis pts. There are no published data on the impact of implantable cardioverter-defibrillators (ICD) on the survival
We retrospectively
9:oo
Survival of Dialysis Patients After Cardiac Arrest in the United States: The Impact of Implantable Cardioverter Defibrillators
Minneapolrs.
Methods:
of the great arteries with atrial switch repair, and
cardiac anatomy. It may be advisable to implant patients with the potential for future growth.
8:30 a.m.
Charles
to venc~us endothe-
to 75 months). Fourteen of 15 procedures were performed for lead fracture Binding of the proximal high voltage electrode, with coil stretching and fracture
growth-related
Wednesday, April 02, 2003, 8:30 a.m.-i 0:OO a.m. McCormick Place, Room S402
873-l
leads).
(5 transposition
(9 to 32 years), and the mean duration
for ICD lead extraction
New Perspectives in Implantable Cardioverter-Defibrillator Therapy
873
fibrous tiswe.
cardiac anatomy,
not result in baffle injury.Conclusions:
CONTRIBUTIONS
adherent
tions for removal, and extraction procedure details. Results: From April 1999 through January 2002, 14 patients underwent 15 lead extraction procedures to remove 21 leads
sheath
ORAL
P. Walsh,
MA, Boston Children’s
reviewed our experience with ICD lead complications and extraction in children and young adults with CHD. Multiple implantation and extraction parameters were analyzed
2 corrected
tolerance
I. Berul, Edward Boston,
lium and endocardium through the growth of scar tissue. This lead bindrng has unique implications in a growing patient. Lead removal, when necessary for lead infection or
patrent with an AICD.
in exercise
Charles Hospital,
MA
(17 ICD leads and 4 pacing
Improvements
&Women’s
Background: Implantable cardioverter-defibrillators (ICDs) are being implanted in children and young adults with congenital heart disease (CHD) for primary and secondary
wave was 15.8 f 6.5 mV, and impedance was 1074 * 301 ohms at 0.5V. Complications mcluded one post-operatwe pneumonia and one episode of ventricular tachycardia in a tion (19 f 10%) and QRS duration (152 i 16 msec) have been noted at 16.5 t 5.0 weeks follow-up. Lead thresholds have remained unchanged (1.8 * 1.1 Vat 0.5 ms, p=NS), and
A. Stephenson,
Brigham
in this cohort, including
placed on the posterolateral
lead threshold
Implantable Cardioverter Defibrillator Lead Complications and Laser Extraction in Children and Young Adults With Congenital Heart Disease
873-2
Robotically-Assisted Ventricular Resynchronization Therapy Following Failed Coronary Sinus Cannulation
862-4
137A
% pts
% pts wrth inappropriate
ICD detections
3
contin-