Objectives
This study sought to determine how often patients with primary prevention implantable cardioverter-defibrillators (ICDs) meet guideline-derived indications at the time of generator replacement.
Background
Professional societies have developed guideline criteria for the appropriate implantation of an ICD for the primary prevention of sudden cardiac death. It is unknown whether patients continue to meet criteria when their devices need replacement for battery depletion.
Methods
We performed a retrospective chart review of patients undergoing replacement of primary prevention ICDs at 2 tertiary Veterans Affairs Medical Centers. Indications for continued ICD therapy at the time of generator replacement included a left ventricular ejection fraction (LVEF) ≤35% or receipt of appropriate device therapy.
Results
In our cohort of 231 patients, 59 (26%) no longer met guideline-driven indications for an ICD at the time of generator replacement. An additional 79 patients (34%) had not received any appropriate ICD therapies and had not undergone reassessment of their LVEF. Patients with an initial LVEF of 30% to 35% were less likely to meet indications for ICD therapy at the time of replacement (odds ratio: 0.52; 95% confidence interval: 0.30 to 0.88; p = 0.01). Patients without ICD indications subsequently received appropriate ICD therapies at a significantly lower rate than patients with indications (2.8% vs. 10.7% annually, p < 0.001). If ICD generator explantations were performed instead of replacements in the patients without ICD indications, the cost savings would be $1.6 million.
Conclusions
Approximately 25% of patients who receive primary prevention ICDs may no longer meet guideline indications for ICD use at the time of generator replacement, and these patients receive subsequent ICD therapies at a significantly lower rate.
a b s t r a c tPremature ventricular contractions (PVCs) and slow coronary flow phenomenon (SCFP) are primarily separate entities. Each one of them has different characteristics and a diverse spectrum of presentation. However, and despite many suggested theories, a comprehensive understanding of the etiology of both of them is still a matter of debate. PVCs, which can be triggered by consuming cannabis (marijuana), and through decreasing the diastolic time (DT), can affect the slow blood flow found in SCFP even more and worsen the clinical picture in patients who have PVCs and SCFP. In this paper, we present a patient who uses marijuana and has PVCs and SCFP, try to address different aspects of PVCs and SCFP, pinpoint any suspected interaction between both of them and the role of marijuana in this context.
discovered with advanced imaging modalities such as computed tomography (CT) of the chest. Conclusion: Calcified apical aneurysms can develop in patients with ICMP and advanced CHF and should always be looked for before LVAD implantation. Advanced imaging techniques, such as CT of the chest, can help to identify such calcified aneurysms preoperatively and safely tailor surgical plans in these patients.
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