CSH is associated with a significantly increased risk of infection requiring hospitalization within 1 year following cardiac implantable electronic device surgery. Strategies aimed at reducing hematomas may decrease the long-term risk of infection. (Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial [BRUISE CONTROL]; NCT00800137).

The FOI method is feasible, further reduces QRS duration, and improves acute hemodynamic response compared to nominal programming of CRT.

Implantable cardioverter-defibrillators (ICDs) improve survival when used as primary or secondary prevention therapy in patients with a broad spectrum of disorders associated with a high risk of sudden death. As indications continue to be refined, attention has increasingly turned to ICD-related complications and their impact on quality of life. Foremost among these complications are inappropriate shocks. This issue remains a major challenge, despite technological advances with sophisticated recording capabilities and detection algorithms. While pharmacological and catheter-based interventions represent important adjunctive tools for the reduction of inappropriate shocks, this contemporary review focuses on customizing and optimizing ICD programming. Studies addressing ICD programming beyond "out the box" settings are reviewed for each device manufacturer and special circumstances are considered. We discuss the benefits and pitfalls of strategies such as high cutoff rates, longer detections times, antitachycardia pacing, and discriminators in reducing the incidence of inappropriate shocks and offer practical programming tips.

No abstract

Implantable cardioverter-defibrillators (ICD) are widely regarded as the treatment of choice for primary and secondary prevention against sudden cardiac death across a broad spectrum of underlying pathologies. Over the past 20 years, ICDs have evolved into complex multifunctional units capable of recording, chronicling, self-testing, and delivering interventional therapies. Technological advances permitted the creation of ICD monitoring zones that are now considered valuable in diagnosing slower, presumably more stable ventricular arrhythmias. They may be helpful especially in patients with unexplained symptoms such as palpitations and/or syncope, particularly in the setting of antiarrhythmic pharmacological therapy that may slow ventricular tachyarrhythmias. Caregivers largely view ICD monitoring zones as passive features that do not interfere or interact with appropriate functioning of active treatment zones. As will be discussed in this clinical review, this is not always the case. Herein, we unravel the intricacies regarding monitoring zone functions and algorithms, highlight potential pitfalls, and offer practical programming tips relevant to each device manufacturer.

Background: Handover of anaesthesia patient care during surgery is common; however, its association with patient outcome is unclear. This systematic review aimed to assess the impact of anaesthesia handover during surgery on patient outcome. Methods: All prospective and retrospective clinical studies specifically investigating the association of intraoperative transfer of anaesthesia care between anaesthesia providers in the operating room with patient morbidity and mortality were included. Searches were conducted from inception to April 24, 2019 in Medline, Medline in Process, CINAHL, and Embase. Reference lists of included studies were searched. Studies were assessed for eligibility and data were extracted by independent reviewers in duplicate with disagreements resolved by consensus or a third reviewer. Risk of bias was assessed in duplicate using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were summarised narratively given substantial heterogeneity. An exploratory metaanalysis was conducted using a random-effects model for a subset of comparable studies. Results: Eight studies met the inclusion criteria. Six studies focused on patients as the unit of analysis (n patients ¼605 678) and two focused on anaesthesia providers as the unit of analysis (n providers ¼307). Seven studies identified a relationship between anaesthesia handovers and adverse patient outcomes, whereas one suggested that handover may be beneficial to error detection or rectification. Included studies were of fair or good quality. Meta-analysis of four studies found a 40% increased risk of patients experiencing an adverse event when an anaesthesia handover occurs during the procedure (pooled risk ratio¼1.40; 95% confidence interval, 1.19 to 1.65; P<0.001; I 2 ¼98%). Conclusions: Intraoperative anaesthesia handovers generally increase morbidity and mortality for surgical patients but could have the potential to improve safety in certain contexts. Future research should determine the specific handover characteristics that impact safety.

No abstract

No abstract