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Article: Effect of coexisting cardiovascular disease on the long-term efficacy and safety of the implantable atrial defibrillator

TitleEffect of coexisting cardiovascular disease on the long-term efficacy and safety of the implantable atrial defibrillator
Authors
Issue Date2002
PublisherWiley-Blackwell Publishing, Inc. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=0147-8389&site=1
Citation
Pace - Pacing And Clinical Electrophysiology, 2002, v. 25 n. 5, p. 809-815 How to Cite?
AbstractThe long-term efficacy and safety of implantable atrial defibrillator (IAD) therapy in patients with AF and cardiovascular disease is unclear. The aim of this study was to evaluate the efficacy and safety of lAD therapy in patients with and without coexisting cardiovascular disease. In 115 patients implanted with an IAD, 85 patients had cardiovascular disease: 41 (48%) patients had 1 cardiovascular abnormality, 29 (35%) patients had 2, 13 (15%) patients had 3, and 2 (2%) patients had 4 different cardiovascular abnormalities. The device was programmed into a rhythm monitoring mode for the first 3-month postimplant period. All defibrillation therapy was performed under physician supervision to monitor safety and efficacy. After this initial monitoring period, patients were allowed to activate their device away from the hospital or clinic. A total of 357 spontaneous AF episodes occurred in 83 (72%) patients during observed operation and the mean shock efficacy was 93.5 ± 20.3% (lower 95% confidence interval [CI] 89.8%). As of the last follow-up, 58 (55%) patients had transition to receive nonphysician observed therapy. Forty-two (72%) patients had experienced 332 episodes of AF for which they had received device therapy away from the hospital/ clinic (mean shock efficacy 90.5 ± 39.7%). The presence of hypertension, valvular heart disease, and ischemic heart disease did not affect the shock efficacy of the IAD during physician observed and nonobserved therapy (P > 0.05). However, the presence of congestive heart failure was associated with a lower clinical efficacy during observed and nonobserved therapy (P < 0.05). Overall, 5,262 shocks have been delivered with the IAD without any episode of proarrhythmia. The observed proarrhythmic risk was 0%, with an estimated maximum proarrhythmic risk of 0.06% per shock (95% upper CI). A stand-alone IAD appears to be safe in the presence of cardiovascular disease. The lower clinical efficacy for AF associated with congestive heart failure might be related to a higher rate of early reinitiation of AF after defibrillation.
Persistent Identifierhttp://hdl.handle.net/10722/162575
ISSN
2015 Impact Factor: 1.156
2015 SCImago Journal Rankings: 0.662
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorTse, HFen_US
dc.contributor.authorLau, CPen_US
dc.contributor.authorRodriguez, LMen_US
dc.contributor.authorTimmermans, Cen_US
dc.contributor.authorDaoud, EGen_US
dc.contributor.authorAyers, GMen_US
dc.contributor.authorWellens, HJJen_US
dc.date.accessioned2012-09-05T05:21:20Z-
dc.date.available2012-09-05T05:21:20Z-
dc.date.issued2002en_US
dc.identifier.citationPace - Pacing And Clinical Electrophysiology, 2002, v. 25 n. 5, p. 809-815en_US
dc.identifier.issn0147-8389en_US
dc.identifier.urihttp://hdl.handle.net/10722/162575-
dc.description.abstractThe long-term efficacy and safety of implantable atrial defibrillator (IAD) therapy in patients with AF and cardiovascular disease is unclear. The aim of this study was to evaluate the efficacy and safety of lAD therapy in patients with and without coexisting cardiovascular disease. In 115 patients implanted with an IAD, 85 patients had cardiovascular disease: 41 (48%) patients had 1 cardiovascular abnormality, 29 (35%) patients had 2, 13 (15%) patients had 3, and 2 (2%) patients had 4 different cardiovascular abnormalities. The device was programmed into a rhythm monitoring mode for the first 3-month postimplant period. All defibrillation therapy was performed under physician supervision to monitor safety and efficacy. After this initial monitoring period, patients were allowed to activate their device away from the hospital or clinic. A total of 357 spontaneous AF episodes occurred in 83 (72%) patients during observed operation and the mean shock efficacy was 93.5 ± 20.3% (lower 95% confidence interval [CI] 89.8%). As of the last follow-up, 58 (55%) patients had transition to receive nonphysician observed therapy. Forty-two (72%) patients had experienced 332 episodes of AF for which they had received device therapy away from the hospital/ clinic (mean shock efficacy 90.5 ± 39.7%). The presence of hypertension, valvular heart disease, and ischemic heart disease did not affect the shock efficacy of the IAD during physician observed and nonobserved therapy (P > 0.05). However, the presence of congestive heart failure was associated with a lower clinical efficacy during observed and nonobserved therapy (P < 0.05). Overall, 5,262 shocks have been delivered with the IAD without any episode of proarrhythmia. The observed proarrhythmic risk was 0%, with an estimated maximum proarrhythmic risk of 0.06% per shock (95% upper CI). A stand-alone IAD appears to be safe in the presence of cardiovascular disease. The lower clinical efficacy for AF associated with congestive heart failure might be related to a higher rate of early reinitiation of AF after defibrillation.en_US
dc.languageengen_US
dc.publisherWiley-Blackwell Publishing, Inc. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=0147-8389&site=1en_US
dc.relation.ispartofPACE - Pacing and Clinical Electrophysiologyen_US
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshAtrial Fibrillation - Complications - Therapyen_US
dc.subject.meshDefibrillators, Implantableen_US
dc.subject.meshEquipment Safetyen_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshHeart Diseases - Complicationsen_US
dc.subject.meshHumansen_US
dc.subject.meshHypertension - Complicationsen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.titleEffect of coexisting cardiovascular disease on the long-term efficacy and safety of the implantable atrial defibrillatoren_US
dc.typeArticleen_US
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_US
dc.identifier.authorityTse, HF=rp00428en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.pmid12049373-
dc.identifier.scopuseid_2-s2.0-0036090496en_US
dc.identifier.hkuros74792-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0036090496&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume25en_US
dc.identifier.issue5en_US
dc.identifier.spage809en_US
dc.identifier.epage815en_US
dc.identifier.isiWOS:000175689700010-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridTse, HF=7006070805en_US
dc.identifier.scopusauthoridLau, CP=7401968501en_US
dc.identifier.scopusauthoridRodriguez, LM=7402239863en_US
dc.identifier.scopusauthoridTimmermans, C=7006153844en_US
dc.identifier.scopusauthoridDaoud, EG=7005636549en_US
dc.identifier.scopusauthoridAyers, GM=7102015157en_US
dc.identifier.scopusauthoridWellens, HJJ=35395866600en_US

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