Tag Archives: implantable cardioverter defibrillator

Introduction Atrioventricular (AV) block is an uncommon complication of myocarditis, which is most often observed in combination with underlying conditions such as that caused by cardiac sarcoidosis (CS), giant cell myocarditis (GCM) and acute lymphocytic myocarditis. Myocarditis is a broad term that describes inflammation of the myocardium, which can range from mild and self-limiting to fulminant variants that require cardiac transplantation. Patients with proven GCM and CS may benefit from immunosuppression, and it is important to investigate for underlying infiltrative disease in cases of myocarditis and AV block as specific treatments ma

Introduction Cardiac implant electronic devices (CIED) are undertaken under local anaesthetic by cardiologists. Patient experience is a key metric by which the delivery of healthcare is assessed, and, for CIED implantation, optimal peri-procedural pain management is central to patient experience. A recent study has highlighted that significant procedural pain in CIED implantation is underestimated and poorly predicted.1 According to the James Lind Alliance, a collaboration of British patients, carers and clinicians that set research priorities in anaesthesia and peri-operative medicine, several research themes relating to improving patient ex

Introduction During the COVID-19 pandemic, difficult decisions have had to be made about access to a wide range of therapies and procedures. On 17 March 2020, National Health Service (NHS) bodies were instructed to create capacity to manage an expected surge of COVID-19 cases, and this included stopping all elective procedures by 15 April.1 Guidelines for triage of patients left those awaiting a primary prevention implantable cardioverter-defibrillator (ICD) in a grey area: a case-by-case decision should be made, but that these procedures could be reasonably delayed.2 It has recently been highlighted that patients awaiting a primary preventio

Introduction Primary percutaneous coronary intervention (pPCI) and stenting are considered first-line management of ST-elevation myocardial infarction (STEMI).1 There is a well-recognised inflammatory component to ischaemic heart disease (IHD), and, thus, C-reactive protein (CRP) has been implicated as a poor prognostic indicator for stent re-stenosis, cardiovascular mortality and all-cause mortality post-myocardial infarction (MI).1,2 Case An 87-year-old man presented to Accident and Emergency (A&E) for “a one day history of severe neck/parietal headache on background of recent discharge from hospital with an MI”. Past medical histor

A CT scan of his diseased knee was sent to Boston USA, where they created two 3D models, one of his diseased knee and another of a computer generated perfect knee. The former was used to plan the minimally invasive cutting of his actual knee to reduce blood loss and damage, the latter was used to mold his knee replacement. I know what I will want when my knees reach their sell-by-date. So, it was fascinating to read John Pepper’s account of their ‘bespoke’ Personalised External Aortic Root Support ExoVasc mesh, not least because the second author Tal Golesworthy invented it and was the first recipient. Still on the patient involvement t

Introduction In many centres, patients stay overnight after their pacing procedure. Most would prefer to get home quicker, and reduced length of stay would result in healthcare savings. Various centres have reported high rates of patient satisfaction,1 and significant cost-savings with day-case pacing,2,3 although this practice is not widespread. A recent survey,4 revealed variation in practice across Europe with many centres routinely mandating a one or two night hospital stay. The safety of day-case pacing was described more than 25 years ago.5,6 Since then, the implant rates of both bradycardia (simple) and more complex devices (cardiac re

Introduction The implantable cardioverter defibrillator (ICD) implant rate within the UK remains significantly lower than that across Europe; furthermore, there is marked inequity in access to ICD implant between regions within the UK.1 The need for an ICD is self-evident in secondary prevention patients successfully resuscitated from ventricular tachycardia (VT) or ventricular fibrillation (VF). Intuitively, therefore, it would seem most likely that underperformance and inequity of access in the UK resides chiefly within the primary prevention patient group. A number of international randomised-controlled trials have identified patient subgr

We retrospectively evaluated our ICD database between September 2006 and October 2007 to determine baseline patient/procedure characteristics and details of defibrillation threshold assessment during implant. All patients underwent at least two defibrillation safety margin (DSM) tests (≥10 J below the maximum output of the device). Logistic regression analysis was performed to identify factors predicting two successful consecutive DSM tests (with ≥10 J safety margin). A total of 264 procedures were performed (mean age ± standard error: 65.6 ± 0.8 years); 258 (97.7%) patients had successful first DSM test (with ≥10 J safety margin),

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