Implantable Defibrillation and Thromboembolic Events

Benedini, G; Marchini, A.; Curnis, Antonio; Bianchetti, F.; Gardini, Armando; Pinetti, P; Zanelli, Emanuela

doi:10.1111/j.1540-8159.1995.tb02504.x

Cited by 12 publications

(8 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11,15,16 This is particularly true in patients with refractory HF implanted with CRT-D, in whom both appropriate and inappropriate shocks may increase morbidity and mortality in different ways, including myocardial depression, 17,18 pro-arrhythmic effect of DC shock, 15,16 thromboembolic complications after DC shock, 19 and increased stress-related sympathetic tone which is pro-arrhythmogenic and pro-thrombotic. 20 …”

Section: Discussionmentioning

confidence: 99%

A simplified biventricular defibrillator with fixed long detection intervals reduces implantable cardioverter defibrillator (ICD) interventions and heart failure hospitalizations in patients with non-ischaemic cardiomyopathy implanted for primary prevention: the RELEVANT [Role of long dEtection window programming in patients with LEft VentriculAr dysfunction, Non-ischemic eTiology in primary prevention treated with a biventricular ICD] study

Gasparini¹,

Menozzi²,

Proclemer³

et al. 2009

European Heart Journal

149

View full text Add to dashboard Cite

AimsTo investigate the efficacy and safety of a cardiac resynchronization therapy with cardioverter–defibrillator (CRT-D) device with simplified ventricular tachycardia management in patients with non-ischaemic heart failure (HF) and primary prevention implantable cardioverter defibrillator (ICD) indication.Methods and resultsProspective, controlled, parallel, multicentre, non-randomized study enrolling 324 primary prevention non-ischaemic HF patients implanted with CRT-D devices from 2004 to 2007: Protect group, 164 patients implanted with a Medtronic Insync III Protect device and Control group, 160 patients utilizing other Medtronic CRT-D devices.Efficacy was assessed by computing appropriate and inappropriate detections and therapies during follow-up; safety compared hospitalizations and syncopal events between groups. Ninety per cent of both ventricular and supraventricular tachyarrhythmias terminated within the 13–29 beat detection interval with the Protect algorithm. The Protect group showed a significantly better event-free survival to first delivered therapy for total (P = 0.0001), appropriately treated (P = 0.002), and inappropriately treated episodes (P = 0.017). The total number of delivered shocks was significantly lower in the Protect group (22 vs. 59, P < 0.0001). In the Protect group, a significantly reduced HF hospitalization (hazard ratio 0.38, 95% CI 0.15–0.98, P = 0.044) was observed without any increase of syncope or death.ConclusionA simplified CRT-D device with fixed long detection reduced overall ICD therapy burden and HF hospitalizations without entailing any additional adverse events in primary prevention non-ischaemic HF patients.

show abstract

Section: Discussionmentioning

confidence: 99%

A simplified biventricular defibrillator with fixed long detection intervals reduces implantable cardioverter defibrillator (ICD) interventions and heart failure hospitalizations in patients with non-ischaemic cardiomyopathy implanted for primary prevention: the RELEVANT [Role of long dEtection window programming in patients with LEft VentriculAr dysfunction, Non-ischemic eTiology in primary prevention treated with a biventricular ICD] study

Gasparini¹,

Menozzi²,

Proclemer³

et al. 2009

European Heart Journal

149

View full text Add to dashboard Cite

show abstract

“…This suggests a role for transesophageal echocardiography and/or anticoagulation in high-risk ICD patients. 204 In contrast a retrospective study reported no thromboembolic complications in 21 patients who underwent elective or emergent cardioversion in the presence of left-ventricular thrombus. 205…”

Section: Thromboembolic Complicationsmentioning

confidence: 92%

“…Thromboembolism occurred despite the absence of a history of atrial fibrillation or documented intracardiac thrombus on preoperative transthoracic echocardiogram. This suggests a role for transesophageal echocardiography and/or anticoagulation in high‐risk ICD patients 204 . In contrast a retrospective study reported no thromboembolic complications in 21 patients who underwent elective or emergent cardioversion in the presence of left‐ventricular thrombus 205 …”

Section: Risks Of Assessing Defibrillation Efficacy At Implantmentioning

confidence: 99%

The Dilemma of ICD Implant Testing

Swerdlow

Russo

DeGroot

2007

Pacing Clinical Electrophis

130

112

View full text Add to dashboard Cite

Ventricular fibrillation (VF) has been induced at implantable cardioverter defibrillator (ICD) implant to ensure reliable sensing, detection, and defibrillation. Despite its risks, the value was self-evident for early ICDs: failure of defibrillation was common, recipients had a high risk of ventricular tachycardia (VT) or VF, and the only therapy for rapid VT or VF was a shock. Today, failure of defibrillation is rare, the risk of VT/VF is lower in some recipients, antitachycardia pacing is applied for fast VT, and vulnerability testing permits assessment of defibrillation efficacy without inducing VF in most patients. This review reappraises ICD implant testing. At implant, defibrillation success is influenced by both predictable and unpredictable factors, including those related to the patient, ICD system, drugs, and complications. For left pectoral implants of high-output ICDs, the probability of passing a 10 J safety margin is approximately 95%, the probability that a maximum output shock will defibrillate is approximately 99%, and the incidence of system revision based on testing is < or = 5%. Bayes' Theorem predicts that implant testing identifies < or = 50% of patients at high risk for unsuccessful defibrillation. Most patients who fail implant criteria have false negative tests and may undergo unnecessary revision of their ICD systems. The first-shock success rate for spontaneous VT/VF ranges from 83% to 93%, lower than that for induced VF. Thus, shocks for spontaneous VT/VF fail for reasons that are not evaluated at implant. Whether system revision based on implant testing improves this success rate is unknown. The risks of implant testing include those related to VF and those related to shocks alone. The former may be due to circulatory arrest alone or the combination of circulatory arrest and shocks. Vulnerability testing reduces risks related to VF, but not those related to shocks. Mortality from implant testing probably is 0.1-0.2%. Overall, VF should be induced to assess sensing in approximately 5% of ICD recipients. Defibrillation or vulnerability testing is indicated in 20-40% of recipients who can be identified as having a higher-than-usual probability of an inadequate defibrillation safety margin based on patient-specific factors. However, implant testing is too risky in approximately 5% of recipients and may not be worth the risks in 10-30%. In 25-50% of ICD recipients, testing cannot be identified as either critical or contraindicated.

show abstract

“…Numerous studies have shown that implantable cardioverter defibrillators (ICD) have a significant benefit in patients with life-threatening ventricular arrhythmias. [1][2][3][4] Implantation of ICD devices, however, carries an increased thromboembolic risk with a 3-7% incidence of clinical thromboembolism, 5,6 and autopsy evidence of venous thrombi in < 20% and pulmonary emboli in <8% of patients. 7 The factors that predispose to thromboembolic risk in patients with ICD devices have not been fully resolved.…”

Section: Introductionmentioning

confidence: 99%

“…7 The factors that predispose to thromboembolic risk in patients with ICD devices have not been fully resolved. However, as a temporal relationship may exist between the onset of symptoms of systemic thromboembolism and discharge of an ICD, 6 as circulatory stasis occurring in settings like percutaneous balloon mitral valvuloplasty 8 or cardiac arrest 9 may activate the coagulation cascade, and as ICD discharge may result in myocar-dial injury, [10][11][12] it is possible that isolated or cumulative brief periods of circulatory arrest or the ensuing ICD discharge in such patients may contribute to the activation of blood coagulation processes.…”

Section: Introductionmentioning

confidence: 99%

Chronic Threshold Testing of Implantable Cardioverter Defibrillators Does Not Increase Coagulation Activity or Platelet Activation

Smolich

Yates

Malan

et al. 2002

Pacing Clinical Electrophis

View full text Add to dashboard Cite

It is unknown if the brief periods of circulatory statis occurring with induction of VF during DFT testing in patients with an ICD activate blood coagulation processes. To address this question, coagulation activity and platelet activation were measured in peripheral venous blood samples obtained from 12 patients undergoing DFT testing under general anesthesia, 3 (n = 11) or 6 months (n = 1) after ICD implantation for recurrent ventricular arrhythmias. Five patients were anticoagulated with warfarin and two to six episodes of VF (median five) were induced per patient. Blood samples were drawn at baseline, after each DFT test and on the following morning. Coagulation activity was assessed by measuring prothrombin fragment 1 + 2 (F1 + 2) (a marker of thrombin generation), soluble fibrin (a marker of fibrin production), and D-dimer (a breakdown product of cross-linked fibrin). Platelet activation was evaluated by measuring the expression P-selectin on the platelet surface using flow cytometry. No significant changes in F1 + 2, soluble fibrin, D-dimer, or P-selectin expression occurred during DFT testing, or between baseline and morning after samples. Moreover, results were unaffected by warfarin. These findings suggest that chronic threshold testing of implantable cardioverter defibrillators is not associated with activation of blood coagulation processes.

show abstract

Implantable Defibrillation and Thromboembolic Events

Cited by 12 publications

References 15 publications

The Dilemma of ICD Implant Testing

Chronic Threshold Testing of Implantable Cardioverter Defibrillators Does Not Increase Coagulation Activity or Platelet Activation

Contact Info

Product

Resources

About