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*  Clinical and Economic Implications of the Multicenter Automatic Defibrillator Implantation Trial-II | Annals of Internal...
William S Weintraub Emory University May 2, 2005 Cost Effectiveness of Therapy With Abnormal LV Function Post-MI Dr. Al-Khatib and colleagues are to be commended for their evaluation of the cost-effectiveness of implantable cardioverter defibrillators (ICD) based on the Multicenter Automatic Defibrillator Implantation Trial-II (MADIT-II).1 At 20 months, mortality was 14.2% in the ICD group and 19.8% in the controls, an absolute difference of 5.6%.2 Cost in the ICD group was estimated at $131,490 and in the medical therapy group $40,661, a difference of $90,829, and a gain in life years of 1.8 years.(1) The authors find ICDs to be marginally cost-effective, with a base-case estimate of the incremental cost-effectiveness ratio (ICER) of $50,500 per life-year gained. Sensitivity analysis suggested that the ICER could vary greatly, from a somewhat lower to a great deal higher value, depending on the assumptions made. The ICER was especially ...
  http://annals.org/aim/fullarticle/718329/clinical-economic-implications-multicenter-automatic-defibrillator-implantation-trial-ii
*  Cardioverter-defibrillator implantation after myocardial infarction: Costs for treatment #175169 in Germany | BookingHealth
Cardioverter-defibrillator implantation after myocardial infarction (costs for program #175169) ✔ Max Grundig Clinic ✔ Department of Cardiology and Cardiovascular Diseases ✔ BookingHealth.com
  https://bookinghealth.com/max-grundig-klinik/treatment-programs/175169-cardioverter-defibrillator-implantation-after-myocardial-infarction.html
*  Pacemakers and Implantable Cardioverter Defibrillators (ICDs) - Health Encyclopedia - University of Rochester Medical Center
Living with a pacemaker or ICD requires special instructions and care. Listed in the directory below you will find information related to pacemakers, for which we have provided a brief overview. Overview of Pacemakers and Implantable Cardioverter Defibrillators (ICDs) Living With a Pacemaker or Implantable Cardioverter Defibrillator (ICD). Frequently Asked Questions About Pacemakers and Implantable Cardioverter Defibrillators (ICDs) ...
  https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P00233
*  ST Monitoring to Detect Acute Coronary Syndrome Events in Implantable Cardioverter Defibrillator Patients - Mayo Clinic
During the early phases (phases 1 and 2), researchers assess safety, side effects, optimal dosages and risks/benefits. In the later phase (phase 3), researchers study whether the treatment works better than the current standard therapy. They also compare the safety of the new treatment with that of current treatments. Phase 3 trials include large numbers of people to make sure that the result is valid. There are also less common very early (phase 0) and later (phase 4) phases. Phase 0 trials are small trials that help researchers decide if a new agent should be tested in a phase 1 trial. Phase 4 trials look at long-term safety and effectiveness, after a new treatment has been approved and is on the market. ...
  http://www.mayo.edu/research/clinical-trials/cls-20154099
*  2001 - The implantable cardioverter defibrillator was not as cost-effective as amiodarone for prolonging survival |...
CIDS is the fourth reported randomized controlled trial that compared ICDs with antiarrhythmic drugs in recent years. The other 3 studies were the AVID (Antiarrhythmics versus Implantable Defibrillators) trial (1), the MADIT (Multicenter Automatic Defibrillator Implantation Trial) (2), and the CASH (Cardiac Arrest Study Hamburg) trial (3). CIDS allocated 600 patients to either ICD or amiodarone therapy. The current economic analysis limited itself to the first 430 patients. CIDS showed a small, statistically nonsignificant mortality advantage for patients in the ICD group, but the cost-benefit analysis showed a very high cost per year-of-life saved by ICDs. The authors concluded that ICD implantation was not cost-effective in these patients. Several points should be made about this study relative to its predecessors. First, the patient populations in these trials have been different. For example, the CIDS patients had resuscitated VF, VT, or unmonitored ...
  http://acpjc.org/Content/135/3/issue/ACPJC-2001-135-3-113.htm
*  Abstract 16912: The Incidence of the First Appropriate ICD Shock Remains Stable in Heart Failure Patients Over 6 Years |...
Introduction: Implantable cardioverter defibrillators (ICDs) are indicated for primary and secondary sudden cardiac death (SCD) prevention in patients with systolic heart failure (HF). Most ICDs are never used; it is not known whether subjects who have never had an appropriate ICD shock after several years are at decreased SCD risk.. Method: Data was collected on 384 subjects enrolled between March 2002 and November 2004 from one site of the Genetic Risk Assessment of Defibrillator Events (GRADE) study, a prospective observational study of subjects with severe systolic dysfunction (EF , 30%) and ICDs. The incidence of the first appropriate ICD shock for VT or VF and of death/transplant/VAD (DTV) was calculated for years 1 to 6.. Results: The cohort was 62±12 yrs old, 78% male, 95% white, 76% ischemic, EF 20±6 %, NYHA class 2.3±0.6, median f/u 43 months. 110 (29%) subjects reached the primary endpoint of appropriate ICD shock, and 186 (48%) ...
  http://circ.ahajournals.org/content/124/Suppl_21/A16912
*  Primary Prevention Implantable Cardioverter Defibrillators in Patients With Nonischemic Cardiomyopathy | Circulation
Article, see p 1772. Early randomized clinical trials of primary prevention implantable cardioverter defibrillators (ICDs) in patients with nonischemic cardiomyopathy failed to establish survival benefit from this therapy; however, those trials were too small to provide definitive results.1,2 When the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial) was published in 2005, it was practice changing. SCD-HeFT showed that primary prevention ICDs significantly improve the survival of patients with a left ventricular ejection fraction ≤35% attributable to ischemic or nonischemic cardiomyopathy and New York Heart Association class II or III heart failure symptoms despite optimal medical therapy.3 Patients with nonischemic cardiomyopathy constituted about half of the 2521 total enrolled patients in SCD-HeFT.3 The results of SCD-HeFT formed the basis of a class I guideline recommendation for primary prevention ICDs in patients with New York ...
  http://circ.ahajournals.org/content/136/19/1781
*  High Incidence of Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients With Syncope of Unknown Etiology and...
Previous follow-up data for the patients with syncope, a nondiagnostic, noninvasive workup and inducible ventricular arrhythmias at electrophysiologic testing are limited. The largest series of these patients to date was reported by Click et al. ([15]) in 1987. In that group of 112 patients presenting with syncope and bundle branch block, 46 had inducible ventricular arrhythmias with triple extrastimuli during ventricular pacing (SMVT in 25, NSVT in 19, VF in 2). All patients in the inducible ventricular tachyarrhythmia cohort were treated with antiarrhythmic agents or ablative operation. With a mean 30-month follow-up period, sudden cardiac deaths in the inducible ventricular arrhythmia group occurred frequently (11 patients). Seventeen additional patients had recurrent syncope, and four had recurrent SMVT. Bass et al. ([16]), in 1987, also reported high sudden cardiac death rates (14 of 35) in patients with ventricular arrhythmias found at electrophysiologic testing performed for syncope of ...
  http://www.onlinejacc.org/content/29/2/370
*  Primary Prevention Implantable Cardioverter Defibrillator Placement in the Elderly - American College of Cardiology
It's not the years in your life that count. It's the life in your years." Abraham Lincoln. Implantable cardioverter defibrillators (ICDs) have one fundamental function the prevention of sudden unexpected arrhythmic cardiac death.. As Americans age and more baby boomers become "eligible" for a primary prevention ICD, it is important to ensure that treatments are appropriately and effectively applied to this growing segment of the population. Yet, enrollment of patients older than age 65 years in major primary prevention ICD trials is limited. A surprising 28% of Americans suitable for an ICD by conventional criteria are over age 79 years.1 Over 40% of primary prevention ICDs in the United States are placed in patients ≥70 years old. A review of over 115,000 Medicare patients in the National Cardiovascular Database ICD Registry revealed a mean age of 75 years at the time of ICD implantation, a trend that did not change between 2006 and ...
  http://www.acc.org/latest-in-cardiology/articles/2016/05/24/07/53/primary-prevention-implantable-cardioverter-defibrillator-placement-in-the-elderly
*  Abstract 17060: Implantable Cardioverter Defibrillator Events and Mortality in Unexplained Cardiac Arrest Subjects in the...
Background: Implantable cardioverter defibrillators (ICDs) have been shown to reduce mortality in survivors of life-threatening arrhythmias. It is important to understand the rate of ICD events and mortality among subjects with unexplained cardiac arrest.. Methods: Patients with unexplained cardiac arrest and normal cardiac function enrolled in the Cardiac Arrest Survivors with Preserved Ejection Fraction Registry (CASPER) were evaluated for ICD events and mortality. A systematic evaluation including coronary angiogram, signal averaged ECG, cardiac magnetic resonance imaging, exercise testing, adrenaline and procainamide challenge, electrophysiological study and phenotype-directed genetic testing were performed in attempt to establish diagnosis.. Results: Two hundred and fourteen patients from 12 Canadian sites were studied (age 47 ± 16 years, 128 males). Two hundred and four patients (95%) received an implantable ...
  http://circ.ahajournals.org/content/128/Suppl_22/A17060
*  Image Quality of CMR Imaging in Patients With an Implantable Cardioverter Defibrillator System - Society for Cardiovascular...
2016; 9: e004025 Link: http://circimaging.ahajournals.org/content/9/5/e004025.abstract. Background-Recently, magnetic resonance (MR)-conditional implantable cardioverter defibrillator (ICD) systems have become available. However, associated cardiac MR image (MRI) quality is unknown. The goal was to evaluate the image quality performance of various cardiac MR sequences in a multicenter trial of patients implanted with an MR-conditional ICD system. Methods and Results-The Evera-MRI trial enrolled 275 patients in 42 centers worldwide. There were 263 patients implanted with an Evera-MRI single- or dual-chamber ICD and randomized to controls (n=88) and MRI (n=175), 156 of whom underwent a protocol-required MRI (9-12 weeks post implant). Steady-state-free-precession (SSFP) and fast-gradient-echo (FGE) sequences were acquired in short-axis and horizontal long-axis orientations. Qualitative and quantitative assessment of image quality was performed by using a 7-point scale (grades ...
  http://scmr.org/news/292536/SCMR-News-Image-Quality-of-CMR-Imaging-in-Patients-With-an-Implantable.htm
*  Implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure | Guidance and...
Evidence-based recommendations on implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) for arrhythmias and heart failure
  https://www.nice.org.uk/guidance/ta314
*  Implantable cardioverter-defibrillators in the elderly and potentially terminally ill patients - For Medical Professionals -...
Two seminal trials established the ICD as an effective therapy that reduces mortality. In the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II), patients with an ejection fraction , 30 percent due to prior myocardial infarctions were randomized to best medical therapy or best medical therapy with an ICD. After two-year follow-up, patients randomized to receive an ICD had a 20 percent reduction in risk of death.. Using a slightly different patient population, the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) randomized patients with an ejection fraction , 35 percent due to either ischemic or nonischemic cardiomyopathy, and NYHA Class II or Class III heart failure, to receive an ICD, amiodarone or placebo. After 46-month follow-up, patients who received an ICD had a 23 percent reduction in mortality compared with the placebo and amiodarone groups.. When applying the results of clinical trials to management of individual patients, it is important to clearly understand ...
  https://www.mayoclinic.org/medical-professionals/clinical-updates/cardiovascular/implantable-cardioverter-defibrillators-elderly-potentially-terminally-ill-patients
*  Patent US7363083 - Flexible subcutaneous implantable cardioverter-defibrillator - Google Patents
One embodiment of the present invention provides an implantable cardioverter-defibrillator for subcutaneous positioning over a patient's ribcage, the implantable cardioverter-defibrillator including a housing, wherein the housing conforms to the patient's ribcage when subcutaneously positioned; an electrode disposed upon a portion of the housing; and an electrical circuit located within the housing, wherein the electrical circuit is electrically coupled to the electrode.
  http://www.google.co.uk/patents/US7363083
*  Efficacy of a tiered therapy defibrillator system used to treat recurrent ventricular arrhythmias refractory to drugs. | Heart
OBJECTIVE--To evaluate an implantable tiered therapy defibrillator system that delivered antitachycardia pacing treatment for slower well tolerated ventricular tachycardias and cardioversion or defibrillation for fast tachycardias or ventricular fibrillation. METHODS--A tiered treatment device (Ventritex Cadence V-100) was implanted in 30 patients with ventricular tachycardia that was refractory to drugs. Efficacy was evaluated by the responses of induced or spontaneous arrhythmias to the treatments delivered. RESULTS--Antitachycardia pacing successfully terminated 80% of episodes of ventricular tachycardia induced by non-invasive programmed stimulation, but acceleration was brought about by pacing in six patients in 10% of episodes. During a follow up of two to 17 (mean seven) months, 18 patients (60%) had recurrence of ventricular arrhythmias. Antitachycardia pacing terminated ventricular tachycardia in 17 of 18 patients in 87% of episodes. Twelve patients received shocks for ventricular ...
  http://heart.bmj.com/content/70/1/61
*  Pacemaker and Defibrillator Lead Extraction | Circulation
Surgically implanted cardiac devices play an important role in the treatment of heart disease. In the 50 years since the first pacemaker was implanted, technology has improved dramatically, and these devices have saved or improved the quality of countless lives. Pacemakers treat slow heart rhythms by increasing the heart rate or by coordinating the heart's contraction for some heart failure patients.1 Implantable cardioverter defibrillators stop dangerous rapid heart rhythms by delivering an electric shock.2 As the range of applications widens, the number of patients with cardiac devices continues to increase. Approximately 400 000 devices are implanted each year in the United States, and there ,3 million patients with implanted cardiac devices currently.. Occasionally, pacemaker and implantable cardioverter defibrillator systems must be removed. The removal of such systems is potentially a high-risk ...
  http://circ.ahajournals.org/content/123/11/e378.full
*  The automatic implantable cardioverter/defibrillator for a life threatening arrhythmia in a case of post-partum cardiomyopathy....
We report the development of severe life threatening polymorphic ventricular tachycardia in a young woman shortly following her first pregnancy, who ultimately required the insertion of an automatic implantable cardioverter/defibrillator because of the failure of conventional antiarrhythmic therapy. Although only about 7 patients have received units in the UK to date, the experience in the USA, where up to 300 per month may be implanted, suggests that they will become a more common method of treatment in cases of life threatening arrhythmias.. ...
  http://pmj.bmj.com/content/65/770/932
*  Syncope in High-Risk Cardiomyopathy Patients With Implantable Defibrillators: Frequency, Risk Factors, Mechanisms, and...
Methods and Results-The Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) randomized 1500 patients to 3 different implantable cardioverter-defibrillator programming arms: (1) Conventional programming with therapy for ventricular tachycardia ≥170 bpm; (2) high-rate cutoff with therapy for ventricular tachycardia ≥200 bpm and a monitoring zone at 170 to 199 bpm, and (3) prolonged 60-second delay with a monitoring zone before therapy. Syncope was a prespecified safety end point that was adjudicated independently. Multivariable Cox models were used to identify risk factors associated with syncope and to analyze subsequent risk of mortality. During follow-up, 64 of 1500 patients (4.3%) had syncope. The incidence of syncope was similar across the 3 treatment arms. Prognostic factors for all-cause syncope included the presence of ischemic cardiomyopathy (hazard ratio [HR], 2.48; 95% confidence interval [CI], 1.42-4.34; P=0.002), ...
  http://circ.ahajournals.org/content/129/5/545.short?rss=1
*  Abstract 2140: Infrequent Need for Pacing Following Implantable Cardioverter-Defibrillator Shocks: Analysis of the Sudden...
Background: Implantable cardioverter-defibrillators (ICD) are routinely programmed to pace after a shock to prevent possible asystole. In those with no prior history of bradycardia, there is little data regarding the prevalence and characteristics of those who use post-shock pacing (PSP).. Methods: We analyzed the occurrence of pacing within the first nine beats after the first successful ICD shock for ventricular tachycardia (VT) or ventricular fibrillation (VF) in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). All ICDs were single lead with the first PSP delivered at 1400msec and all subsequent stimuli delivered at 1200msec. We excluded patients with pacing during pre-shock rhythms and those who had pacing rates different than the protocol default rate of 50bpm (1200 msec).. Results: There were 2521 patients enrolled in SCD-HeFT, of which 811 received an ICD. A total of 153 shock events were examined; 36 (23.5%) had at least ...
  http://circ.ahajournals.org/content/118/Suppl_18/S_674.1
*  An exploration of body image and self-esteem in adolescents with implantable cardioverter defibrillators (ICDs): a qualitative...
Introduction. Adolescents with Implantable Cardioverter Defibrillators (ICDs) have to negotiate the tasks of growing up while coping with their ICD device. Current research on the psychosocial effect of ICDs in this population is limited. Issues of body image may be particularly salient for adolescents with visible health conditions, as they experience typical physical and emotional development in addition to the burden of their health condition. This study aims to explore the effect of having an ICD device on adolescent's body image and self-esteem, and other challenges they encounter. Method. This study utilised a qualitative research design comprised of in-depth individual interviews lasting between thirty minutes to one hour. Participants were recruited from the Royal Hospital for Sick Children, Glasgow. The data were analysed using Interpretative Phenomenological Analysis (IPA). Results. The sample comprised four males aged between ...
  http://theses.gla.ac.uk/6700/
*  Overview of Pacemakers and Implantable Cardioverter Defibrillators (ICDs) in Children | Health Information | MedCentral Health...
Overview of Pacemakers and Implantable Cardioverter Defibrillators (ICDs) in Children What is an implanted pacemaker? An implanted pacemaker is a small device that is implanted under the skin and sends electrical signals to start or regulate a slow heartbeat. An implanted pacemaker may be used to stimulate the heartbeat if the heart's natural pacemaker (the sinoatrial, or SA, node) is not functioning properly, has developed an abnormally slow heart rate or rhythm, or if the electrical pathways are block...
  http://www.medcentral.org/Main/StayWellProducts.aspx?iid=90_P01810
*  Tachycardia and Implantable Cardioverter Defibrillators (ICD)
Read about implantable cardioverter defibrillators (ICDs) and how they can provide protection by restoring the heart's rhythm when a tachyarrhythmia occurs.
  http://www.medtronic.com/au-en/your-health/treatments-therapies/fast-heartbeat/therapy.html
*  Eligibility for biventricular pacing in patients with an implantable cardioverter defibrillator.
Implantable cardioverter defibrillator (ICD)-therapy prevents sudden death in patients at high risk, but incidence of death due to heart failure remains unaltered. Recent data suggest that biventricular (BV) pacing is useful in patients with heart fa
  http://www.biomedsearch.com/nih/Eligibility-biventricular-pacing-in-patients/12798829.html