Karin Kraaier

Gender differences in psychological distress and quality of life in patients with an ICD 1-year postimplant

Gender differences in patient‐reported outcomes in patients with an implantable cardioverter defibrillator (ICD) have been researched, but findings are inconclusive and mostly based on cross‐sectional study designs. To gain a better insight into potential determinants of psychological distress and health‐related quality of life (HQOL), we examined the relationship between gender and patient‐reported outcomes in patients with an ICD in the first year after ICD implantation.

Early mortality in prophylactic implantable cardioverter-defibrillator recipients: development and validation of a clinical risk score

AIMS To reduce sudden cardiac death, implantable cardioverter-defibrillators (ICDs) are indicated in patients with ischaemic and non-ischaemic dilated cardiomyopathy and a left ventricular ejection fraction (LVEF) ≤35%. Current guidelines do not recommend device therapy in patients with a life expectancy <1 year since benefit in these patients is low. In this study, we evaluated the incidence and predictors of early mortality (<1 year after implantation) in a consecutive primary prevention population. METHODS AND RESULTS Analysis was performed on a prediction and validation cohort. The primary endpoint was all-cause mortality at 1 year. The prediction cohort comprised 861 prophylactic ICD recipients with ischaemic cardiomyopathy or dilated cardiomyopathy from the Academic Medical Center (Amsterdam) and Thorax Center Twente (Enschede). Detailed clinical data were collected. After multivariate analysis, a risk score was developed based on age ≥75 years, LVEF ≤ 20%, history of atrial fibrillation, and estimated glomerular filtration rate (eGFR) ≤30 mL/min/1.73 m(2). Using these predictors, a low (≤1 factor), intermediate (2 factors), and high (≥3 factors) risk group could be identified with 1-year mortality of, respectively, 3.4, 10.9, and 38.9% (P< 0.01). Afterwards, the risk score was validated in 706 primary prevention patients from the Erasmus Medical Center (Rotterdam). One-year mortality was, respectively, 2.5, 13.2, and 46.3% (all P< 0.01). CONCLUSION A simple risk score based on age, LVEF, eGFR, and atrial fibrillation can identify patients at low, intermediate, and high risk for early mortality after ICD implantation. This may be helpful in the risk assessment of ICD candidates.

Psychological Indices as Predictors for Phantom Shocks in Implantable Cardioverter Defibrillator Recipients

A phantom shock—the sensation of an implantable cardioverter defibrillator (ICD) discharge in the absence of an actual discharge—is a phenomenon that can occur in ICD patients. Little is known about the influence of psychological factors on the incidence of phantom shocks. We evaluated psychological correlates of phantom shocks 2 years post‐ICD implant in a cohort of Dutch ICD recipients.

Towards a better risk stratification for sudden cardiac death in patients with structural heart disease.

With the introduction of the implantable cardioverter defibrillator (ICD), patients can be protected against sudden cardiac death (SCD) due to ventricular arrhythmia (VA). Guidelines have been drawn up for selecting patients for primary and secondary prophylaxis. However, most ICD recipients today who receive an ICD for primary prevention will not experience a life-threatening VA requiring antitachypacing or shock therapy. Better risk stratification is desirable with efficacy, costs and complication rate in mind. An overview is presented of widely accepted and potentially valuable risk markers and the role they may play in better identifying candidates for ICD therapy. (Neth Heart J 2009;17:101–6.)

Performance of an external transtelephonic loop recorder for automated detection of paroxysmal atrial fibrillation

Although atrial fibrillation (AF) is the most commonly encountered arrhythmia, some of the properties make its detection challenging. In daily practice, underdiagnosis can lead to less effective treatment in prevention of stroke. Based on data from studies on treatment of AF, more intensive follow‐up strategies, including 7‐day Holter recording, 30‐day event recording, and even implantable cardiac monitoring devices, are suggested. The study purpose is to evaluate the performance of a continuous single‐channel loop recorder with automatic AF detection and transtelephonic electrocardiogram (ECG) transmission capabilities.

Successful bystander cardiopulmonary resuscitation complicated by liver rupture.

A 40-year-old man, who had collapsed while running and was resuscitated successfully by bystanders, was referred. An automated external defibrillator had shown ventricular fibrillation before a single shock restored sinus rhythm. On arrival, the patient was alert and haemo-dynamically stable. He reported that he had recently suffered from chest pain during exercise but had not visited his general practitioner; before collapsing he had no complaints. Physical examination showed a moderately tender abdomen with normal peristalsis.

Intermittent spastic coronary occlusion at site of non-significant atherosclerotic lesion requiring stent implantation.

A 65-year-old woman was admitted with severe but mainly atypical chest pain at rest for some weeks. Two years ago, primary percutaneous coronary intervention with stenting of the mid left anterior descending artery (LAD) had been performed in the setting of an anterior myocardial infarction. Physical examination, electrocardiogram, serum levels of troponin I, and echocardiography were normal. During maximal treadmill test, a significant depression of the ST segment was found in leads V4 to V6 while the patient remained asymptomatic. Coronary angiography demonstrated normal right (figure 1A) and circumflex (figure 1B) coronary arteries while the LAD was totally occluded just proximal to the previously implanted stent (figure 1B). However, a few minutes later, ventriculography showed – besides normal left ventricular function – anterograde filling of the LAD (figure 1C, arrows).

Challenging pacemaker implantation: Persistent left superior vena cava with absent right superior vena cava

ZusammenfassungDas Vorliegen einer persistierenden linken oberen Hohlvene in Abwesenheit einer rechten oberen Hohlvene stellt eine seltene congenitale kardiovaskuläre Anomalie dar, die meist zufällig im Rahmen einer Schrittmacherimplantation entdeckt wird. In diesem Fallbericht beschreiben wir eine Schrittmacherimplantation mit Zugang über die rechte Vena cephalica, durch die persistierende linke obere Hohlvene und den Koronarsinus mit Sondenfixierung im rechten Vorhof und in einem posterolateralen Ast des Koronarsinus.AbstractA persistent left superior vena cava (PLSVC) in combination with an absent right superior vena cava (RSVC) is a rare congenital cardiovascular abnormality which is usually found by chance during pacemaker (PM) implantation. In this case we describe a PM implantation using right cephalic approach through PLSVC and coronary sinus (CS), with lead fixation in right atrium and a posterolateral branch of the CS.

Schwierige Schrittmacherimplantation bei persistierender linker oberer Hohlvene und Fehlen einer rechten oberen Hohlvene

ZusammenfassungDas Vorliegen einer persistierenden linken oberen Hohlvene in Abwesenheit einer rechten oberen Hohlvene stellt eine seltene congenitale kardiovaskuläre Anomalie dar, die meist zufällig im Rahmen einer Schrittmacherimplantation entdeckt wird. In diesem Fallbericht beschreiben wir eine Schrittmacherimplantation mit Zugang über die rechte Vena cephalica, durch die persistierende linke obere Hohlvene und den Koronarsinus mit Sondenfixierung im rechten Vorhof und in einem posterolateralen Ast des Koronarsinus.AbstractA persistent left superior vena cava (PLSVC) in combination with an absent right superior vena cava (RSVC) is a rare congenital cardiovascular abnormality which is usually found by chance during pacemaker (PM) implantation. In this case we describe a PM implantation using right cephalic approach through PLSVC and coronary sinus (CS), with lead fixation in right atrium and a posterolateral branch of the CS.

Impact of atrial fibrillation in an implantable cardioverter defibrillator cohort

Purpose: Atrial fibrillation (AF) is the most common supraventricular arrhythmia in patients with an implantable cardioverter defibrillator (ICD). We evaluated the prognostic significance of AF in ICD patients with ischemic or dilated heart disease. Methods: 647 consecutive patients with ischemic or dilated heart disease (81% male, mean age 64±10 years, 70% primary prevention) receiving an ICD in the Thoraxcenter Twente were included. Demographic data, including existence and type of AF (permanent or non-permanent) was collected. Primary endpoints were all cause mortality and ICD discharge (appropriate or inappropriate). Results: At implantation, 183 (28%) had a history of AF (13% non-permanent and 15% permanent. During 41±15 months follow up, 135 (21%) patient died, 142 (22%) patients experienced an ICD shock, of which 104 (16%) appropriate and 58 (9%) inappropriate. After multivariate analysis permanent AF was significantly related to mortality (HR 1.63 (95% CI: 1.08-2.47)) and shock therapy (HR 2.10 (95% CI 1.39-3.15), both appropriate (HR 1.67 (95% CI 1.03-2.71) and inappropriate (HR 3.62 (95% CI 1.92-6.84)). Non-permanent AF was only related to inappropriate shock therapy (HR 2.43 (95% CI 1.21-4.87)). During follow up, 29 patients (6.3%) with sinusrhythm developed AF, this was related to inappropriate shock therapy (HR 2.83 (95% CI 1.08-7.41). Conclusion: In real-world ICD recipients, almost a third have a history of permanent or non-permanent AF, which leads to higher rates of mortality and ICD discharge. Especially permanent AF is associated with higher rates of mortality and ICD discharge (both appropriate and inappropriate). Non-permanent AF and new onset AF are associated with inappropriate ICD discharge.