Aims Subcutaneous-implantable cardiac defibrillators (S-ICDs) are used increasingly to prevent sudden cardiac death in young patients. This study was set up to gain insight in the indications for S... Show moreAims Subcutaneous-implantable cardiac defibrillators (S-ICDs) are used increasingly to prevent sudden cardiac death in young patients. This study was set up to gain insight in the indications for S-ICD, possible complications, and their predictors and follow-up results. Methods and results A multicentre, observational, retrospective, non-randomized, standard-of-care registry on S-ICD outcome in young patients with congenital heart diseases (CHDs), inherited arrhythmias (IAs), idiopathic ventricular fibrillation (IVF), and cardiomyopathies (CMPs). Anthropometry was registered as well as implantation technique, mid-term device-related complications, and incidence of appropriate/inappropriate shocks (IASs). Data are reported as median (interquartile range) or mean +/- standard deviation. Eighty-one patients (47% CMPs, 20% CHD, 21% IVF, and 12% IA), aged 15 (14-17) years, with body mass index (BMI) 21.8 +/- 3.8 kg/m(2), underwent S-ICD implantation (primary prevention in 59%). This was performed with two-incision technique in 81% and with a subcutaneous pocket in 59%. Shock and conditional zones were programmed at 250 (200-250) and 210 (180-240) b.p.m., respectively. No intraoperative complications occurred. Follow up was 19 (6-35) months: no defibrillation failure occurred, 17% of patients received appropriate shocks, 13% of patients received IAS (supraventricular tachycardias 40%, T-wave oversensing 40%, and non-cardiac oversensing 20%). Reprogramming, proper drug therapy, and surgical revision avoided further IAS. Complications requiring surgical revision occurred in 9% of patients, with higher risks in patients with three-incision procedures [hazard ratio (HR) 4.3, 95% confidence interval (95% CI) 0.5-34, P = 0.038] and BMI < 20 (HR 5.1, 95% CI 1-24, P = 0.031). Conclusion This multicentre European paediatric registry showed good S-ICD efficacy and safety in young patients. Newer implantation techniques and BMI > 20 showed better outcome. Show less
Zeppenfeld, K.; Tfelt-Hansen, J.; Riva, M. de; Winkel, B.G.; Behr, E.R.; Blom, N.A.; ... ; ESC Scientific Document Group 2022
Het doel van dit proefschrift was om onderzoek te verrichten naar (het voorkomen van) plotse hartdood bij dialysepati_nten. Een groot deel van deze promotie is opgebouwd rondom de Implantable... Show moreHet doel van dit proefschrift was om onderzoek te verrichten naar (het voorkomen van) plotse hartdood bij dialysepati_nten. Een groot deel van deze promotie is opgebouwd rondom de Implantable Cardioverter Defibrillators in Dialysis patients (ICD2) studie. Dit studieprotocol werd opgezet om onderzoek te doen naar de mogelijke voordelen van profylactische implantatie van ICD__s bij dialysepati_nten. Verschillende aspecten van plotse dood bij deze pati_ntenpopulatie werden geanalyseerd. Verder werd onderzoek verricht naar de incidentie en behandeling van complicaties van deze therapie, met daarbij in het bijzonder aandacht voor pati_nten met nierfalen. Op basis van dit proefschrift kan gesteld worden dat er verscheidene onderzoeksmiddelen zijn, zoals bijvoorbeeld het electrocardiogram, waarmee pati_nten met een verhoogd risico op (plots) overlijden ge_dentificeerd kunnen worden. In de toekomst zal onderzocht kunnen worden of er behandelstrategie_n zijn die voor deze pati_nten een overlevingsvoordeel kunnen bieden. De rol van profylactische ICD implantatie bij dialysepati_nten, wordt momenteel nog onderzocht in de ICD2 studie. Hoewel ICD__s mogelijk in pati_nten met nierfalen een overlevingsvoordeel zouden kunnen bieden, moet wel in het achterhoofd gehouden worden dat er een belangrijke incidentie van complicaties is en dat mogelijk, met name, pati_nten met nierfalen potentieel levensbedreigende complicaties kunnen ervaren Show less
Maury, P.; Baratto, F.; Zeppenfeld, K.; Klein, G.; Delacretaz, E.; Sacher, F.; ... ; Chillou, C. de 2014
Implantable cardioverter defibrillators (ICDs) have become an important treatment op- tion for both patients who survived ventricular arrhythmia and patients with cardiac heart disease at risk for... Show moreImplantable cardioverter defibrillators (ICDs) have become an important treatment op- tion for both patients who survived ventricular arrhythmia and patients with cardiac heart disease at risk for ventricular arrhythmias. The aim of the current thesis is to study ICD patients outside the setting of a clinical trial and compare the findings with evi- dence of routine clinical trials. The thesis is divided in 3 parts: in Part I the long-term follow-up of ICD patients is studied, in Part II the safety of ICD treatment __ including implantation-related complications __ is assessed, and in Part III a patient tailored evalu- ation was conducted to assess which patient characteristics are associated with benefit from ICD treatment. Show less
Welsenes, G.H. van; Borleffs, C.J.W.; Rees, J.B. van; Atary, J.Z.; Thijssen, J.; Wall, E.E. van der; Schalij, M.J. 2012
Although the beneficial effect of ICD treatment has been proven in selected patients, the population assessed in large clinical trials does not reflect the population with ICDs in the real world.... Show moreAlthough the beneficial effect of ICD treatment has been proven in selected patients, the population assessed in large clinical trials does not reflect the population with ICDs in the real world. The aim of the current thesis is to give better insight in these patients at risk for lifethreatening arrhythmias by studying a large population of patients treated with an ICD, outside the setting of a clinical trial. In part I, the actual need for defibrillator backup during long-term follow-up is evaluated. Chapter 2 describes differences in mortality and the occurrence of ventricular arrhythmia between patients receiving an ICD as primary vs. secondary prevention of SCD. The actual need for device replacement after an event-free first battery service-life is studied in Chapter 3. In part II, an attempt is made to improve risk stratification by evaluating currently available parameters and the additive value of novel parameters. In Chapter 4 all classic baseline variables are combined to construct a clinically applicable mortality risk score in primary prevention ICD recipients with ischemic heart disease. Chapter 5 demonstrates the importance of atrial fibrillation in patients with ICD or CRT-D. Chapter 6 shows that usage of a risk model can predict the risk of non-benefit (death, prior to first ventricular arrhythmia) which might have important clinical consequences. In Chapter 7 the spatial QRS-T angle is evaluated in the prediction of ventricular arrhythmia. Chapter 8 demonstrates the risk of lead failure in smalldiameter defibrillation leads compared with a benchmark cohort. Show less
Cardiovascular disease remains the leading cause of mortality in the western World, but significant improvements have been made in its treatment and prevention. This thesis shows that consistent... Show moreCardiovascular disease remains the leading cause of mortality in the western World, but significant improvements have been made in its treatment and prevention. This thesis shows that consistent implementation of a structured regional treatment and prevention program for acute myocardial infarction patients is feasible when health professionals of various disciplines collaborate.The aim of the main part of this thesis was to evaluate the implementation of the MISSION! AMI protocol in clinical practice at various stages of the program (from pre-hospital care to secondary prevention), to evaluate efficacy and safety of sirolimus-eluting stents at 3-year follow-up, and to study differences in stent edge characteristics in a subgroup of patients by the use of virtual histology-intravascular ultrasound imaging. Show less
On one hand, clinicians have expressed concern that the number-needed-to-treat for primary prevention implantable cardioverter defibrillator (ICD) might be too high and that the population eligible... Show moreOn one hand, clinicians have expressed concern that the number-needed-to-treat for primary prevention implantable cardioverter defibrillator (ICD) might be too high and that the population eligible for primary prevention ICD treatment is of such magnitude that ICD therapy will strain financial resources and the pool of trained personnel. On the other hand, the currently implanted population has a relatively low incidence of ventricular arrhythmia. Therefore, additional clinically applicable tools are necessary to aid in the optimal allocation of ICD treatment. The current thesis explores possibilities for risk stratification for mortality and ventricular arrhythmia using easily available clinical parameters and evaluates the usefulness of novel, not routinely acquired parameters. The results of these studies should assist clinicians in the identification of patients who, although currently indicated, should not receive ICD treatments because of ery low risk of ventricular arrhythmia or very high risk of non arrhythmic death. Finally, this thesis clearly maps the drawbacks, accompanying ICD treatment. Show less
Ventricular tachyarrhythmias, the major cause of sudden unexpected cardiac arrest, occur specifically in patients with structural heart disease. In general, all types of structural heart disease... Show moreVentricular tachyarrhythmias, the major cause of sudden unexpected cardiac arrest, occur specifically in patients with structural heart disease. In general, all types of structural heart disease may lead to chronic heart failure, a severe condition with an additional high risk of atrial- and ventricular tachyarrhythmias. The thesis starts with a general overview (chapter 1) of the epidemiology, pathofysiology, prognosis and therapeutical options of heart failure. In this overview all subjects of study of the following chapters are introduced and explained. Next, attention is focused on clinical ventricular tachyarrhythmias. Chapter 2-5 of this thesis aim at evaluating the diagnostic approach, the therapeutical option of radiofrequency catheter ablation and the risk of recurrences in patients who had presented with a (malignant) ventricular tachyarrhythmia. The second part of this thesis (chapter 6-9) evaluates the effect of cardiac resynchronization therapy -a novel treatment option in patients suffering from heart failure- on the occurrence of atrial- and ventricular tachyarrhythmias. In addition the effect of cardiac resynchroniation therapy on patients with diabetes mellitus is evaluated. Show less
