Journal articles: 'Defibrillatori'

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Calò, Leonardo, Antonio Chirico, and Gabriele Palozzi. "Cost accounting del follow-up annuo per il controllo remoto dei defibrillatori impiantabili." MECOSAN, no. 90 (October 2014): 71–98. http://dx.doi.org/10.3280/mesa2014-090005.

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McLeod, Karen A., Eileen Fern, Fiona Clements, and Ruth McGowan. "Prescribing an automated external defibrillator for children at increased risk of sudden arrhythmic death." Cardiology in the Young 27, no. 7 (June 13, 2017): 1271–79. http://dx.doi.org/10.1017/s1047951117000026.

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AbstractBackgroundAutomated external defibrillators can be life-saving in out-of-hospital cardiac arrest.ObjectiveOur aim was to review our experience of prescribing automated external defibrillators for children at increased risk of sudden arrhythmic death.MethodsWe reviewed all automated external defibrillators issued by the Scottish Paediatric Cardiac Electrophysiology Service from 2005 to 2015. All parents were given resuscitation training according to the Paediatric Resuscitation Guidelines, including the use of the automated external defibrillator.ResultsA total of 36 automated external defibrillators were issued to 36 families for 44 children (27 male). The mean age at issue was 8.8 years. Diagnoses at issue included long QT syndrome (50%), broad complex tachycardia (14%), hypertrophic cardiomyopathy (11%), and catecholaminergic polymorphic ventricular tachycardia (9%). During the study period, the automated external defibrillator was used in four (9%) children, and in all four the automated external defibrillator correctly discriminated between a shockable rhythm – polymorphic ventricular tachycardia/ventricular fibrillation in three patients with one or more shocks delivered – and non-shockable rhythm – sinus rhythm in one patient. Of the three children, two of them who received one or more shocks for ventricular fibrillation/polymorphic ventricular tachycardia survived, but one died as a result of recurrent torsades de pointes. There were no other deaths.ConclusionParents can be taught to recognise cardiac arrest, apply resuscitation skills, and use an automated external defibrillator. Prescribing an automated external defibrillator should be considered for children at increased risk of sudden arrhythmic death, especially where the risk/benefit ratio of an implantable defibrillator is unclear or delay to defibrillator implantation is deemed necessary.

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Uyei, Jennifer, and R. Scott Braithwaite. "EFFECTIVENESS OF WEARABLE DEFIBRILLATORS: SYSTEMATIC REVIEW AND QUALITY OF EVIDENCE." International Journal of Technology Assessment in Health Care 30, no. 2 (April 2014): 194–202. http://dx.doi.org/10.1017/s026646231400004x.

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Objectives: The objectives of this systematic literature review were to identify all published literature on wearable defibrillators, assess the wearable defibrillator's efficacy and effectiveness in general and among specific patient groups, including post-myocardial infarction, post coronary artery bypass grafting or percutaneous coronary intervention, non-ischemic cardiomyopathy, and ischemic cardiomyopathy, and to evaluate the quality of evidence.Methods: The search and synthesis was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation and the Newcastle Ottawa Scale.Results: A total of thirty-six articles and conference abstracts from thirty-three studies were included in the review. It appears that wearable defibrillator use compared with no defibrillator use reduces the chance of ventricular tachycardia and ventricular fibrillation (VT/VF) associated deaths by an absolute risk reduction of approximately 1 percent, achieved by averting approximately 4/5th of all VT/VF associated deaths. The quality of evidence was low to very low quality, such that our confidence in the reported estimates is weak.Conclusions: To validate beneficial results, further investigation using robust study designs conducted by independent researchers is warranted.

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Garner, Daniel, Matthew Blackburn, David J. Wright, and Archana Rao. "Improving guideline-mandated care of patients with implantable cardiac defibrillators." British Journal of Hospital Medicine 81, no. 8 (August 2, 2020): 1–10. http://dx.doi.org/10.12968/hmed.2020.0259.

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Background/Aims Implantable cardiac defibrillators reduce the risk of sudden cardiac death in selected patients. The value of an implantable cardiac defibrillator declines as the patient's disease progresses. Guidelines suggest that the appropriateness of maintaining implantable cardiac defibrillator therapy be regularly reviewed as part of monitoring of the patient's disease trajectory. It is recommended that implantable cardiac defibrillators are deactivated as patients approach the end of life. Patients with a better understanding of their current state of health and the role that the implantable cardiac defibrillator plays within it are more likely to make informed decisions about the timing of deactivation. Methods: A quality improvement project was undertaken on appropriate deactivation of implantable cardiac defibrillators within a large tertiary cardiac centre. This was driven by audit data showing inadequate patient communication and documentation around deactivation. Drivers for change included the introduction of electronic data records, clinical review of comorbid patients approaching elective battery change and an ongoing forum for patient and carer education. Measured outcomes included the number of deactivations performed, evidence of patient discussion and consent, and timing of deactivation of the implantable cardiac defibrillator. Results There were increased numbers of timely device deactivations undertaken following the interventions with improved documented evidence of patient discussion and consent. The educational forum was received favourably. Conclusions Focused multidisciplinary interventions can impact favourably on appropriate implantable cardiac defibrillator deactivation and improve patient engagement.

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Onan, Arif, and Nurettin Simsek. "Interprofessional education and social interaction: The use of automated external defibrillators in team-based basic life support." Health Informatics Journal 25, no. 1 (April 24, 2017): 139–48. http://dx.doi.org/10.1177/1460458217704252.

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Automated external defibrillators are pervasive computing devices designed for the treatment and management of acute sudden cardiac arrest. This study aims to explain users’ actual use behavior in teams formed by different professions taken after a short time span of interaction with automated external defibrillator. Before the intervention, all the participants were certified with the American Heart Association Basic Life Support for healthcare providers. A statistically significant difference was revealed in mean individual automated external defibrillator technical skills between uniprofessional and interprofessional groups. The technical automated external defibrillator team scores were greater for groups with interprofessional than for those with uniprofessional education. The nontechnical automated external defibrillator skills of interprofessional and uniprofessional teams revealed differences in advantage of interprofessional teams. Students positively accept automated external defibrillators if well-defined and validated training opportunities to use them expertly are available. Uniprofessional teams were successfully supported by their members and, thereby, used automated external defibrillator effectively. Furthermore, the interprofessional approach resulted in as much effective teamwork as the uniprofessional approach.

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Wang, Yunling, Zhiqiang Zhan, and Lei Yu. "Establishment of calibration equipment for defibrillator analyzer and evaluation of measurement uncertainty." MATEC Web of Conferences 336 (2021): 02010. http://dx.doi.org/10.1051/matecconf/202133602010.

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A cardiac defibrillator is a medical electrical device used to defibrillate the heart of patients. In JJF1149-2014, defibrillator analyzers are used to measure the output energy of cardiac defibrillators, whose energy accuracy is an important parameter. This manuscript describes establishment of calibration equipment for defibrillator analyzer, including voltage divider module, sampling module and data processing module. Measurement uncertainty is evaluated for measurement results at last.

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Bocka, Joseph J., and Robert Swor. "In-Field Comparison between Fully Automatic and Semi-Automatic Defibrillators." Prehospital and Disaster Medicine 6, no. 4 (December 1991): 415–20. http://dx.doi.org/10.1017/s1049023x00038899.

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AbstractThe purpose of this clinical study was to compare the prehospital use of fully automatic defibrillators versus semi-automatic defibrillators.Methods:Fully and semi-automatic defibrillator use by EMTs in neighboring communities was compared.Results:Both programs had similar response times, age and gender distribution, proportion of witnessed arrests, and proportion of patients found initially with ventricular fibrillation (VF). The time-to-shock from proper lead placement was shorter when the fully automatic defibrillator was used (16.6 vs. 44.3 seconds; p<.001) and the survival to hospital discharge rate was greater (26% vs. 0%; p=.O4). The semi-automatic defibrillators were more sensitive in detecting VF than were the fully automatic devices.Conclusions:These data support the need for further comparison of the efficacy and effectiveness of semi- and fully automatic, external defibrillators.

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Bahl, Rahul, and Simon Dubrey. "Discussing deactivation of implantable cardiac defibrillators." British Journal of Hospital Medicine 81, no. 8 (August 2, 2020): 1–5. http://dx.doi.org/10.12968/hmed.2020.0343.

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Implantable cardiac defibrillators are a key component in preventing sudden cardiac death for patients with life-threatening arrhythmias. Through ageing, frailty and the progression of cardiac and non-cardiac morbidity, many will develop a ‘life-limiting’ condition. This raises the challenge of how to approach making decisions to deactivate the defibrillator function. This article discusses the background to deactivation of implantable cardioverter defibrillators and the practical considerations for different circumstances.

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Rothmier, Justin D., and Jonathan A. Drezner. "The Role of Automated External Defibrillators in Athletics." Sports Health: A Multidisciplinary Approach 1, no. 1 (January 2009): 16–20. http://dx.doi.org/10.1177/1941738108326979.

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Context: Sudden cardiac arrest is the leading cause of death in young athletes. The purpose of this review is to summarize the role of automated external defibrillators and emergency planning for sudden cardiac arrest in the athletic setting. Evidence Acquisition: Relevant studies on automated external defibrillators, early defibrillation, and public-access defibrillation programs were reviewed. Recommendations from consensus guidelines and position statements applicable to automated external defibrillators in athletics were also considered. Results: Early defibrillation programs involving access to automated external defibrillators by targeted local responders have demonstrated a survival benefit for sudden cardiac arrest in many public and athletic settings. Conclusion: Schools and organizations sponsoring athletic programs should implement automated external defibrillators as part of a comprehensive emergency action plan for sudden cardiac arrest. In a collapsed and unresponsive athlete, sudden cardiac arrest should be suspected and an automated external defibrillator applied as soon as possible, as decreasing the time interval to defibrillation is the most important priority to improve survival in sudden cardiac arrest.

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Raman, Ajay Sundara, Farshad Raissi Shabari, Biswajit Kar, Pranav Loyalka, and Ramesh Hariharan. "No Electromagnetic Interference Occurred in a Patient with a HeartMate II Left Ventricular Assist System and a Subcutaneous Implantable Cardioverter-Defibrillator." Texas Heart Institute Journal 43, no. 2 (April 1, 2016): 183–85. http://dx.doi.org/10.14503/thij-14-4795.

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The use of subcutaneous implantable cardioverter-defibrillators is a novel option for preventing arrhythmia-mediated cardiac death in patients who are at risk of endovascular-device infection or in whom venous access is difficult. However, the potential for electromagnetic interference between subcutaneous defibrillators and left ventricular assist devices is largely unknown. We report the case of a 24-year-old man in whom we observed no electromagnetic interference between a subcutaneous implanted cardioverter-defibrillator and a HeartMate II Left Ventricular Assist System, at 3 different pump speeds. To our knowledge, this is the first report of such findings in this circumstance.

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BERNARDO, PASQUALE, MARIA LETIZIA CONFORTI, SILVIA BELLANDO-RANDONE, PAOLO PIERAGNOLI, JELENA BLAGOJEVIC, OLGA KALOUDI, SERENA GUIDUCCI, et al. "Implantable Cardioverter Defibrillator Prevents Sudden Cardiac Death in Systemic Sclerosis." Journal of Rheumatology 38, no. 8 (June 1, 2011): 1617–21. http://dx.doi.org/10.3899/jrheum.100480.

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Objective.Cardiac involvement means a poor prognosis in systemic sclerosis (SSc). Conduction defects and arrhythmias are frequent in patients with SSc, and may result in sudden cardiac death. We tested whether electrophysiologic studies and implantation of cardioverter defibrillators are recommended when ventricular arrhythmias are present.Method.A cardioverter defibrillator was implanted in 10 patients with SSc who had heart involvement.Result.After 36 months, analysis of the device showed several episodes of ventricular tachycardia in 3 patients, which were promptly reverted by electrical shock delivery.Conclusion.In patients with SSc who are affected by ventricular arrhythmias, the implantation of a cardioverter defibrillator may prevent sudden cardiac death.

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Karlsson, Lena, Carolina M. Hansen, Christina Vourakis, Christopher LF Sun, Shahzleen Rajan, Kathrine B. Søndergaard, Linn Andelius, et al. "Improving bystander defibrillation in out-of-hospital cardiac arrests at home." European Heart Journal: Acute Cardiovascular Care 9, no. 4_suppl (March 13, 2020): S74—S81. http://dx.doi.org/10.1177/2048872619891675.

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Aims: Most out-of-hospital cardiac arrests occur at home with dismal bystander defibrillation rates. We investigated automated external defibrillator coverage of home arrests, and the proportion potentially reachable with an automated external defibrillator before emergency medical service arrival according to different bystander activation strategies. Methods and results: Cardiac arrests in homes (private/nursing/senior homes) in Copenhagen, Denmark (2008–2016) and registered automated external defibrillators (2007–2016), were identified. Automated external defibrillator coverage (distance from arrest to automated external defibrillator) and accessibility at the time of arrest were examined according to route distance to nearest automated external defibrillator and emergency medical service response time. The proportion of arrests reachable with an automated external defibrillator by bystander was calculated using two-way (from patient to automated external defibrillator and back) and one-way (from automated external defibrillator to patient) potential activation strategies. Of 1879 home arrests, automated external defibrillator coverage ≤100 m was low (6.3%) and a two-way bystander could potentially only retrieve an accessible automated external defibrillator before emergency medical service in 31.1% ( n=37) of cases. If a bystander only needed to travel one-way to bring an automated external defibrillator (≤100 m, ≤250 m and ≤500 m), 45.4% ( n=54/119), 37.1% ( n=196/529) and 29.8% ( n=350/1174) could potentially be reached before the emergency medical service based on current automated external defibrillator accessibility. Conclusions: Few home arrests were reachable with an automated external defibrillator before emergency medical service if bystanders needed to travel from patient to automated external defibrillator and back. However, nearly one-third of arrests ≤500 m of an automated external defibrillator could be reached before emergency medical service arrival if the bystander only needed to travel one-way from the automated external defibrillator to the patient.

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McEvedy, Samantha M., Jan Cameron, Eugene Lugg, Jennifer Miller, Chris Haedtke, Muna Hammash, Martha J. Biddle, et al. "Implantable cardioverter defibrillator knowledge and end-of-life device deactivation: A cross-sectional survey." Palliative Medicine 32, no. 1 (July 5, 2017): 156–63. http://dx.doi.org/10.1177/0269216317718438.

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Background: End-of-life implantable cardioverter defibrillator deactivation discussions should commence before device implantation and be ongoing, yet many implantable cardioverter defibrillators remain active in patients’ last days. Aim: To examine associations among implantable cardioverter defibrillator knowledge, patient characteristics and attitudes to implantable cardioverter defibrillator deactivation. Design: Cross-sectional survey using the Experiences, Attitudes and Knowledge of End-of-Life Issues in Implantable Cardioverter Defibrillator Patients Questionnaire. Participants were classified as insufficient or sufficient implantable cardioverter defibrillator knowledge and the two groups were compared. Setting/participants: Implantable cardioverter defibrillator recipients ( n = 270, mean age 61 ± 14 years; 73% male) were recruited from cardiology and implantable cardioverter defibrillator clinics attached to two tertiary hospitals in Melbourne, Australia, and two in Kentucky, the United States. Results: Participants with insufficient implantable cardioverter defibrillator knowledge ( n = 77, 29%) were significantly older (mean age 66 vs 60 years, p = 0.001), less likely to be Caucasian (77% vs 87%, p = 0.047), less likely to have received implantable cardioverter defibrillator shocks (26% vs 40%, p = 0.031), and more likely to have indications of mild cognitive impairment (Montreal Cognitive Assessment score <24: 44% vs 16%, p < 0.001). Insufficient implantable cardioverter defibrillator knowledge was associated with attitudes suggesting unwillingness to discuss implantable cardioverter defibrillator deactivation, even during the last days towards end of life ( p < 0.05). Conclusion: Implantable cardioverter defibrillator recipients, especially those who are older or have mild cognitive impairment, often have limited knowledge about implantable cardioverter defibrillator deactivation. This study identified several potential teachable moments throughout the patients’ treatment trajectory. An interdisciplinary approach is required to ensure that discussions about implantable cardioverter defibrillator deactivation issues are initiated at appropriate time points, with family members ideally also included.

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Spentzou, Georgia, Kaitlin Mayne, Helen Fulton, and Karen McLeod. "Virtual clinics for follow-up of pacemakers and implantable cardioverter defibrillators in children." Cardiology in the Young 29, no. 10 (September 2, 2019): 1243–47. http://dx.doi.org/10.1017/s1047951119001823.

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AbstractThere is growing interest in the use of digital medicine to reduce the need for traditional outpatient follow-up. Remote interrogation of pacemakers and implantable cardioverter defibrillators is now possible with most devices. The aim of our study was to evaluate the safety and efficacy of virtual pacing clinics in following up children with pacemakers and implantable cardioverter defibrillators, including epicardial systems.Methods:The study was retrospective over 8 years (2010–2017), with review of patient records and analysis of downloads from the implantable cardiac devices to the virtual clinics.Results:A total of 75 patients were set up for virtual clinic follow-up during the study period, 94.5% with a pacemaker and 5.5% an implantable cardioverter defibrillator. The majority (76.8%) had an epicardial system. Data on lead impedance, battery longevity, programmed parameters, detected arrhythmias, percentage pacing and delivered defibrillator therapies were obtainable by download. Lead threshold measurements were obtainable via download in 83.7% of the devices, including epicardial systems. No concerning device issue was missed. In 15% of patients a major issue was detected remotely, including three patients with lead fractures. The virtual clinics resulted in fewer hospital attendances while enhancing monitoring and enabling more frequent device checks. The vast majority (91.4%) of families who responded to a questionnaire were satisfied with the virtual clinic follow-up.Conclusions:Virtual clinics allow safe and effective follow-up of children with pacemakers and implantable cardioverter defibrillators, including those with epicardial systems and are associated with high levels of parent satisfaction.

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Jagielski, Dariusz, Dorota Zyśko, Klaudiusz Nadolny, Joanna Wizowska, Bartosz Biel, Waldemar Banasiak, and Piotr Ponikowski. "PREDICTORS OF INAPPROPRIATE SHOCKS FROM IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS." Wiadomości Lekarskie 72, no. 7 (2019): 1243–46. http://dx.doi.org/10.36740/wlek201907103.

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Introduction: Inappropriate shocks in patients with an implantable cardioverter-defibrillator (ICD) are associated with significant psychological and physical consequences and increased long-term mortality. The aim: To assess predictors associated with inappropriate high-energy discharges of implantable cardioverter-defibrillators. Material and Methods: Retrospective data analysis of 150 patients aged 64.2±12.8 years (84.7% male) admitted to the Hospital Emergency Department due to at least one cardioverter-defibrillator discharge was performed. All of the discharges were inappropriate in the group of 33 patients, and in the group of 117 patients at least one discharge was appropriate. The following data: age, gender, concomitant diseases, type of ICD implantation (primary vs. secondary prevention), type of discharge, number of discharges, serum potassium, and sodium concentration were collected. Results: Patients with only inappropriate discharges were younger, significantly more often had chronic atrial fibrillation, a significantly higher number of discharges, and ischaemic cardiomyopathy. Logistic regression analysis revealed that the occurrence of only inappropriate discharges was related to the number of discharges over three, the age of patients below 60 years, the serum sodium concentration between 135 mEq/L and 142 mEq/L, and the primary type of prevention of sudden cardiac death. Conclusions: 1. Predictors of inappropriate discharges include: age, serum sodium concentration, and primary type of indications for cardioverter-defibrillator implantation. 2. Further research is necessary to determine the influence of disturbances in the sodium economy on the occurrence of appropriate and inappropriate interventions of implantable cardioverter-defibrillators.

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Bryant, Randall M. "How implantable cardioverter-defibrillators work and simple programming." Cardiology in the Young 27, S1 (January 2017): S121—S125. http://dx.doi.org/10.1017/s1047951116002353.

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AbstractFollowing the sudden death of a friend in 1966, Dr Michel Mirowski began pioneering work on the first implantable cardioverter-defibrillator. By 1969 he had developed an experimental model and performed the first transvenous defibrillation. In 1970 he reported on the use of a “standby automatic defibrillator” that was tested successfully in dogs. He postulated that such a device “when adapted for clinical use, might be implanted temporarily or permanently in selected patients particularly prone to develop ventricular fibrillation and thus provide them with some degree of protection from sudden coronary death”. In 1980 he reported on the first human implants of an “electronic device designed to monitor cardiac electrical activity, to recognise ventricular fibrillation and ventricular tachyarrhythmias … and then to deliver corrective defibrillatory discharges”. Through innovations in circuitry, battery, and capacitor technologies, the current implantable cardioverter-defibrillator is 10 times smaller and exponentially more sophisticated than that first iteration. This article will review the inner workings of the implantable cardioverter-defibrillator and outline several features that make it the wonder in technology that it has become.

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Rosenow, Joshua M., Howard Tarkin, Elias Zias, Carmine Sorbera, and Alon Mogilner. "Simultaneous use of bilateral subthalamic nucleus stimulators and an implantable cardiac defibrillator." Journal of Neurosurgery 99, no. 1 (July 2003): 167–69. http://dx.doi.org/10.3171/jns.2003.99.1.0167.

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✓ Bilateral electrical stimulation of the subthalamic nucleus is being used with increasing frequency as a treatment for severe Parkinson disease (PD). Implantable cardiac defibrillators improve survival in certain high-risk patients with coronary artery disease and ventricular arrhythmias. Because of concern about possible interaction between these devices, deep brain stimulation (DBS) systems are routinely disconnected before defibrillators are implanted in patients with PD and arrhythmia. The authors report on a patient with bilateral subthalamic stimulators who underwent successful placement of an implantable defibrillator. Testing of the devices over a wide range of settings revealed no interaction. The patient subsequently underwent multiple episodes of cardioversion when the ventricular lead became dislodged. There was no evidence of adverse neurological effects, and interrogation of the DBS devices after cardioversion revealed no changes in stimulus parameters. The outcome in this case indicates that DBS systems may be safely retained in selected patients who require implantable cardiac defibrillators.

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Galati, Francesca, Antonio Galati, and Serafina Massari. "RyR2 QQ2958 Genotype and Risk of Malignant Ventricular Arrhythmias." Cardiology Research and Practice 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/2868604.

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Ventricular arrhythmias are one of the most common causes of death in developed countries. The use of implantable cardiac defibrillators is the most effective treatment to prevent sudden cardiac death. To date, the ejection fraction is the only approved clinical variable used to determine suitability for defibrillator placement in subjects with heart failure. The purpose of this study was to assess whether genetic polymorphisms found in the ryanodine receptor type 2 (Q2958R) and histidine-rich calcium-binding protein (S96A) might serve as markers for arrhythmias. Genotyping was performed in 235 patients treated with defibrillator for primary and secondary prevention of arrhythmias. No significant association was found between the S96A polymorphism and arrhythmia onset, whereas the QQ2958 genotype in the ryanodine receptor gene was correlated with an increased risk of life-threatening arrhythmias. Concurrent stressor conditions, such as hypertension, seem to increase this effect. Our findings might help to better identify patients who could benefit from defibrillator implantation.

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Shiner, Stephen L., and Martin I. Gold. "DC Defibrillators: The Difference Between Selected and Delivered Energy." Journal of the World Association for Emergency and Disaster Medicine 3, no. 1 (1987): 1–6. http://dx.doi.org/10.1017/s1049023x00028582.

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AbstractThere is controversy over the “ideal” electrical energy needed for defibrillation. Furthermore, too massive an electrical shock decreases the possibility of survival by direct damage to an already ailing myocardium and too little energy results in further deterioration of myocardial physiology and metabolism. Therefore, delivery of an erroneous amount of electrical energy decreases the likelihood of successful defibrillation and survival. All 190 defibrillators within 3 medical school hospitals were investigated. Each defibrillator was analyzed at four selected settings ranging from 100-400 Joules (J). Only 29 of 190 defibrillators delivered 100% of the energy selected, while 161 of the 190 (85%) delivered an average of 74% of the energy selected. This discrepancy between selected and delivered energy should be corrected by regulations and standards for manufacturers.

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Gierula, John, Maria F. Paton, and Klaus K. Witte. "Advances in cardiac resynchronization and implantable cardioverter/defibrillator therapy: Medtronic Cobalt and Crome." Future Cardiology 17, no. 4 (July 2021): 609–18. http://dx.doi.org/10.2217/fca-2020-0117.

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Cardiovascular implantable electronic devices have revolutionized the management of heart failure with reduced ejection fraction. New device generations tend to be launched every few years, with incremental improvements in performance and safety and with an expectation that these will improve patient management and outcomes while remaining cost-effective. As a result, today’s cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillator devices are quite different from the pioneering but often bulky devices of the late 20th century. This review discusses new and improved features developed to target specific needs in managing heart failure patients, some of which are especially pertinent to the current worldwide healthcare situation, with focus on the latest generation of CRTs with defibrillator (CRT-Ds) and implantable cardioverter defibrillators from Medtronic.

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Forman, Jacqueline, Jennifer Baumbusch, Heather Jackson, Jen Lindenberg, Alyssa Shook, and Jamil Bashir. "Exploring the patients’ experiences of living with a subcutaneous implantable cardioverter defibrillator." European Journal of Cardiovascular Nursing 17, no. 8 (May 18, 2018): 698–706. http://dx.doi.org/10.1177/1474515118777419.

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Background: The implantable cardioverter defibrillator provides effective treatment for the prevention of sudden cardiac arrest but significant risks associated with transvenous implantation persist. The subcutaneous implantable cardioverter defibrillator has proven to be an alternative and innovative treatment option for select patients to mitigate these risks. Obtaining the patients’ perspectives can provide clinicians with essential information to guide implant selection, procedural decision-making, and support patient management. Conventional implantable cardioverter defibrillator patients have reported shock-related anxiety, fear, insufficient education, and challenges adapting to physical and psychological changes. Little evidence exists to determine whether differences between the subcutaneous implantable cardioverter defibrillator and conventional implantable cardioverter defibrillator allow for the transferability of our current knowledge to the care and management of this population. Aims: The purpose of this study was to explore patients’ experiences of living with a subcutaneous implantable cardioverter defibrillator including the decision-making process, implant, and follow-up care processes. Methods: Using an exploratory qualitative approach, semi-structured interviews were conducted by telephone with 15 participants who underwent subcutaneous implantable cardioverter defibrillator implant. Results: Analysis revealed five main themes: (a) influences on decision-making; (b) unmet education needs; (c) physical impact; (d) psychological impact; and (e) recommendations. Conclusion: As a new technology, little knowledge of the subcutaneous implantable cardioverter defibrillator exists outside of the tertiary implanting sites, therefore developing new strategies to increase learning and dissemination is essential. Although similarities exist in our findings to those of conventional implantable cardioverter defibrillators, there are significant differences in the decision-making process and physical impact which require individualized care planning and development of strategies to provide a patient-centered approach to care.

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Craney, JM, CL Mandle, BH Munro, and S. Rankin. "Implantable cardioverter defibrillators: physical and psychosocial outcomes." American Journal of Critical Care 6, no. 6 (November 1, 1997): 445–51. http://dx.doi.org/10.4037/ajcc1997.6.6.445.

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BACKGROUND: The long-term outcomes of living with an implantable cardioverter defibrillator are an important consideration in recovery. However, little is known about physical and psychosocial outcomes beyond 1 year after implantation. OBJECTIVE: To describe the long-term physical and psychosocial adaptation of persons who have had an implantable cardioverter defibrillator for approximately 2 years or more. METHODS: This nonexperimental cross-sectional study used telephone interviews to ascertain the responses of 80 recipients of implantable cardioverter defibrillators to physical and psychosocial questionnaires to explore the long-term outcomes of living with the devices. Subjects eligible for inclusion were selected from the files of an arrhythmia clinic. RESULTS: Hierarchical regression analysis showed that subjects who are not emotional are likely to be more physically active, especially if they are young and male, and that subjects who tend to be emotional are likely to be psychologically distressed and have poorer social and domestic adaptation. Furthermore, use of emotions was a positive predictor of psychological distress and poor social and domestic adaptation. Subjects reported the use of both emotion- and problem-focused coping. Subjects' scores on physical and psychosocial functioning were comparable to scores reported in the literature for patients who have had myocardial infarction or dysrhythmia. CONCLUSIONS: Emotional responses to distress were predictive of little physical activity and psychological distress. Furthermore, young recipients of implantable cardioverter defibrillators and men were predicted to be physically active. Persons who have had an implantable cardioverter defibrillator for approximately 2 years or more can anticipate that their physical and psychosocial functioning will be similar to that of patients who have myocardial infarction or dysrhythmia.

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Zeitz, Kathryn, Hugh Grantham, Robert Elliot, and Chris Zeitz. "Out-of-Hospital Cardiac Arrest—Review of Demographics in South Australia to Inform Decisions about the Provision of Automatic External Defibrillators within the Community." Prehospital and Disaster Medicine 25, no. 6 (December 2010): 521–26. http://dx.doi.org/10.1017/s1049023x00008700.

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AbstractIntroduction:Sudden, out-of-hospital cardiac arrest (OHCA) has an annual incidence of approximately 50 per 100,000 population. Public access defibrillation is seen as one of the key strategies in the chain-of-survival for OHCA. Positioning of these devices is important for the maximization of public health outcomes. The literature strongly advocates widespread public access to automated external defibrillatiors (AEDs). The most efficient placement of AEDs within individual communities remains unclear.Methods:A retrospective case review of OHCAs attended by the South Australia Ambulance Service in metropolitan and rural South Australia over a 30-month period was performed. Data were analyzed using Utstein-type indicators. Detailed demographics, summative data, and clinical data were recorded.Results:A total of 1,305 cases of cardiac arrest were reviewed. The annual rate of OHCA was 35 per 100,000 population. Of the cases, the mean value for the ages was 66.3 years, 517 (39.6%) were transported to hospital, 761 (58.3%) were judged by the paramedic to be cardiac, and 838 (64.2%) were witnessed. Bystander cardiopulmonary resuscitation (CPR) was performed in 495 (37.9%) of cases. The rhythm on arrival was ventricular fibrillation (VF) or ventricular tachycardia (VT) in 419 (32.1%) cases, and 315 (24.1%) of all arrests had return of spontaneous circulation (ROSC) before or on arrival at the hospital. For cardiac arrest cases that were witnessed by the ambulance service (n = 121), the incidence of ROSC was 47.1%.During the 30-month period, there only was one location that recorded more than one cardiac arrest. No other location recorded recurrent episodes.Conclusions:This study did not identify any specific location that would justify defibrillator placement over any other location without an existing defibrillator. The impact of bystander CPR and the relatively low rate of bystander CPR in this study points to an area of need. The relative potential impact of increasing bystander CPR rates versus investing in defibrillators in the community is worthy of further consideration.

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Hairston, Danielle R., Ralph H. de Similien, Seth Himelhoch, and Anique Forrester. "Treatment of phantom shocks: A case report." International Journal of Psychiatry in Medicine 54, no. 3 (September 23, 2018): 181–87. http://dx.doi.org/10.1177/0091217418802153.

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Implantable cardioverter-defibrillators have become standard preventive treatment for patients with ventricular arrhythmias and other life-threatening cardiac conditions. The advantages and efficiency of the device are supported by multiple clinical trials and outcome studies, leading to its popularity among cardiologists. Implantation of the device is not without adverse outcomes. Implantable cardioverter-defibrillator placement has been found to lead to negative psychological and psychosocial sequelae such as apprehension to engage in physical activity, chronic anxiety, decreased physical and social functioning, a nagging fear of being shocked by the device, and the development of “phantom shocks.” Defined as patient-reported shocks in the absence of evidence that the implantable cardioverter-defibrillator device has discharged, phantom shocks could impact the mental health of those affected. This article reviews the case of Mr. L, a 47-year-old man with ischemic cardiomyopathy who was seen by the psychiatry consultation team while under cardiologic care because he reported that his implantable cardioverter-defibrillator device had been shocking him despite no objective evidence after interrogating the device. A literature review of phantom shocks, their associated symptomatology, and psychological consequences are outlined and discussed.

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Madjarov, Jeko, Brad Poole, Svetozar Madzharov, John Fedor, Francis Robicsek, and Michael Katz. "An Extrapericardial Minimally Invasive Approach for Implantable Cardioverter Defibrillator." Thoracic and Cardiovascular Surgeon 65, no. 06 (March 21, 2017): 475–78. http://dx.doi.org/10.1055/s-0037-1601313.

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AbstractThe indications for placement of an implantable cardioverter defibrillators (ICDs) have greatly expanded over the last years. However, standard transvenous approach is not suitable for a subset of patients who cannot benefit from ICD therapy. Here, we have demonstrated the feasibility and efficacy of extrapericardial ICD placement through a minimally invasive access in intact hearts as well as in postmyocardial infarction large animal models. Based on our data, we conclude that extrapericardial ICD placement is a feasible approach that may be a valuable alternative or adjunct to current defibrillator lead systems.

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Paech, Christian, Victoria Ebel, Franziska Wagner, Stephanie Stadelmann, Annette M. Klein, Mirko Döhnert, Ingo Dähnert, and Roman Antonin Gebauer. "Quality of life and psychological co-morbidities in children and adolescents with cardiac pacemakers and implanted defibrillators: a cohort study in Eastern Germany." Cardiology in the Young 30, no. 4 (April 2020): 549–59. http://dx.doi.org/10.1017/s104795112000061x.

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AbstractIntroduction:The implantation of a pacemaker or an implantable cardioverter-defibrillator during childhood may reduce quality of life and lead to mental health problems. This study aimed to evaluate potential mental health problems (i.e., depressive and anxiety symptoms) and quality of life in children with cardiac active devices in comparison to healthy peers.Methods:We analysed data of children with pacemakers or implantable cardioverter-defibrillators aged 6–18 years. Quality of life, depressive and anxiety symptoms were assessed by standardised questionnaires. The results were compared to age-matched reference groups.Results:Children with implantable cardioverter-defibrillator showed significant lower quality of life in comparison to reference group (p = 0.03), but there was no difference in quality of life between children with pacemaker and reference group. There was no significant difference in depressive symptoms between children with a cardiac rhythm device compared to reference group (self-report: p = 0.67; proxy report: p = 0.49). There was no significant difference in anxiety (p = 0.53) and depressive symptoms (p = 0.86) between children with pacemaker and children with implantable cardioverter-defibrillator.Conclusions:Living with an implantable cardioverter-defibrillator in childhood seems to decrease the patients’ quality of life. Although children with pacemaker and implantable cardioverter-defibrillator don’t seem to show more depressive and anxiety symptoms in comparison to their healthy peers, there still can be an increased risk for those children to develop mental health problems. Therefore, treating physicians should be aware of potential mental health problems and provide the patients and their families with appropriate therapeutic offers.

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Egbe, Alexander C., William R. Miranda, Malini Madhavan, Naser M. Ammash, Venkata R. Missula, Mohammed Al-Otaibi, Ayotola Fatola, Srikanth Kothapalli, and Heidi M. Connolly. "Cardiac implantable electronic devices in adults with tetralogy of Fallot." Heart 105, no. 7 (October 30, 2018): 538–44. http://dx.doi.org/10.1136/heartjnl-2018-314072.

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BackgroundTachyarrhythmias and bradyarrhythmias affect 20%–50% of adult patients with tetralogy of Fallot (TOF) and some of these patients will require cardiac implantable electronic devices (CIED) such as pacemaker and/or internal cardioverter defibrillator.MethodsThe Mayo Adult Congenital Heart Disease database was queried for patients with repaired TOF and history of CIED implantation, 1990–2017. The study objectives were: (1) determine the occurrence of device-related complications defined as lead failure, lead recall, device infection and lead thrombus; and (2) determine the occurrence and risk factors for defibrillator shock.ResultsThere were 99 patients (age 46±14 years and 66 (66%) men) with CIED, and the CIEDs were 41 (41%) pacemakers and 73 (73%) defibrillators. Indication for defibrillator implantation was for primary prevention in 28 (38%) and secondary prevention in 45 (62%). Device-related complications occurred in 20 (20%) patients (lead failure 17, lead recall 4, device infection 12 and thrombus 3). Twenty-five per cent of all device infections occurred within 30 days from the time of device generator change. Annualised rates of appropriate and inappropriate shocks were 5.7% and 6.2%, respectively. The use of class III antiarrhythmic drug was protective against defibrillator shock.ConclusionThe current study provides useful outcome data to aid patient counselling and clinical decision-making. Further studies are required to explore ways to decrease the risk of postprocedural infection after device generator change, and to determine which patients will benefit from empirical antiarrhythmic therapy as a strategy to decrease incidence of inappropriate defibrillator shock.

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MCNEILL, ELIZABETH, ROY E. GAGNON, JAMES E. POTTS, JOHN A. YEUNG-LAI-WAH, CHARLES R. KERR, and SHUBHAYAN SANATANI. "Cerebral Oxygenation During Defibrillator Threshold Testing of Implantable Cardioverter Defibrillators." Pacing and Clinical Electrophysiology 28, no. 6 (June 2005): 528–33. http://dx.doi.org/10.1111/j.1540-8159.2005.09518.x.

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Ślęzak, Daniel, Marlena Robakowska, Przemysław Żuratyński, Joanna Synoweć, Katarzyna Pogorzelczyk, Kamil Krzyżanowski, Magdalena Błażek, and Jarosław Woroń. "Analysis of the Way and Correctness of Using Automated External Defibrillators Placed in Public Space in Polish Cities—Continuation of Research." International Journal of Environmental Research and Public Health 18, no. 18 (September 20, 2021): 9892. http://dx.doi.org/10.3390/ijerph18189892.

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Immediate resuscitation is required for any sudden cardiac arrest. To improve the survival of the patient, a device to be operated by witnesses of the event—automated external defibrillator (AED)—has been produced. The aim of this study is to analyze the way and correctness of use of automated external defibrillators placed in public spaces in Polish cities. The data analyzed (using Excel 2019 and R 3.5.3 software) are 120 cases of use of automated external defibrillators, placed in public spaces in the territory of Poland in 2008–2018. The predominant location of AED use is in public transportation facilities, and the injured party is the traveler. AED use in non-hospital settings is more common in male victims aged 50–60 years. Owners of AEDs inadequately provide information about their use. The documentation that forms the basis of the emergency medical services intervention needs to be refined. There is no mention of resuscitation performed by a witness of an event or of the use of an AED. In addition, Poland lacks the legal basis for maintaining a register of automated external defibrillators. There is a need to develop appropriate documents to determine the process of reporting by the owners of the use of AEDs in out-of-hospital conditions (OHCA).

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Żuratyński, Przemysław, Daniel Ślęzak, Sebastian Dąbrowski, Kamil Krzyżanowski, Wioletta Mędrzycka-Dąbrowska, and Przemysław Rutkowski. "Use of Public Automated External Defibrillators in Out-of-Hospital Cardiac Arrest in Poland." Medicina 57, no. 3 (March 22, 2021): 298. http://dx.doi.org/10.3390/medicina57030298.

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Background and objectives: National medical records indicate that approximately 350,000–700,000 people die each year from sudden cardiac arrest. The guidelines of the European Resuscitation Council (ERC) and the International Liaison Committee on Resuscitation (ILCOR) indicate that in addition to resuscitation, it is important—in the case of so-called defibrillation rhythms—to perform defibrillation as quickly as possible. The aim of this study was to assess the use of public automated external defibrillators in out of hospital cardiac arrest in Poland between 2008 and 2018. Materials and Methods: One hundred and twenty cases of use of an automated external defibrillator placed in a public space between 2008 and 2018 were analyzed. The study material consisted of data on cases of use of an automated external defibrillator in adults (over 18 years of age). Only cases of automated external defibrillators (AED) use in a public place other than a medical facility were analysed, additionally excluding emergency services, i.e., the State Fire Service and the Volunteer Fire Service, which have an AED as part of their emergency equipment. The survey questionnaire was sent electronically to 1165 sites with AEDs and AED manufacturers. A total of 298 relevant feedback responses were received. Results: The analysis yielded data on 120 cases of AED use in a public place. Conclusions: Since 2016, there has been a noticeable increase in the frequency of use of AEDs located in public spaces. This is most likely related to the spread of public access to defibrillation and increased public awareness.

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Kutkiene˙, Sandra, Lina Gumbiene, Juratę Aganauskiene, Rima Steponenienea, Germanas Marinskisa, and Audrius Aidietis. "Pregnancy in long QT syndrome with implantable cardioverter-defibrillator. A case report and review of the literature." Seminars in Cardiovascular Medicine 20, no. 1 (June 1, 2014): 1–4. http://dx.doi.org/10.2478/semcard-2014-0001.

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Summary Implantable cardioverters-defibrillators have decreasedmorbidity and mortality as well as improved quality of life in patients with life-threatening cardiac arrhythmias and allowed an increasing number of young women to reach their reproductive years. New questions and tasks arise for medical professionals as to organize appropriate management of these patients, because little is known regarding the risk and outcomes of such pregnancies. The aim of this report is to describe our centre’s first experience of pregnancy and delivery management in patient with an implantable cardioverter-defibrillator as primary prevention of ventricular arrhythmias in congenital long QT syndrome.

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Lampert, Rachel, and Ian Law. "Athletic participation in the young patient with an implantable cardioverter-defibrillator." Cardiology in the Young 27, S1 (January 2017): S132—S137. http://dx.doi.org/10.1017/s1047951116002377.

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AbstractThe decision of whether to allow a young patient with an implantable cardioverter-defibrillator to continue to participate in sports is complex and multi-factorial. The positive physical and psychosocial impact of sports participation must be weighed against the potential adverse events associated with implantable cardioverter-defibrillators. Arrhythmias appear to be more prevalent in athletes and occur more frequently during physical activity or competition/practice, but there is growing evidence that device therapy is effective in athletes across a wide range of competitive sports. Failure of a device to convert a life-threatening arrhythmia, major injury from a shock, and increased lead failure have thus far not been reported in the prospective Implantable Cardioverter-Defibrillator Sports Registry, but follow-up remains relatively short. Thoughtful consideration of disease state, arrhythmia risk, and the potential dangers of device therapy during the desired sports is imperative before allowing participation. Frank discussion with children and families regarding the possibility of shocks during sports, as well as at other times, is imperative. Ongoing and future studies will help guide these decisions.

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Bifulco, Paolo, Luigi Argenziano, Maria Romano, Mario Cesarelli, Mario Sansone, Stefano Casella, and Stefano Nardi. "Frequent Home Monitoring of ICD Is Effective to Prevent Inappropriate Defibrillator Shock Delivery." Case Reports in Medicine 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/579526.

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Recently, in the context of telemedicine, telemonitoring services are gaining attention. They are offered, for example, to patients with implantable cardioverter defibrillators (ICDs). A major problem associated with ICD therapy is the occurrence of inappropriate shocks which impair patients’ quality of life and may also be arrhythmogenic. The telemonitoring can provide a valid support to intensify followup visits, in order to improve the prevention of inappropriate defibrillator shock, thus enhancing patient safety. Inappropriate shock generally depends on atrial fibrillation, supraventricular tachycardia, and abnormal sensing (such as those caused by electromagnetic interferences). As a practical example, an unusual case of an ICD patient who risked an inappropriate shock while taking a shower is reported. Continuous remote telemonitoring was able to timely warn cardiologist via GSM-SMS, who were able to detect improper sensing examining the intracardiac electrogram via Web. Patient was promptly contacted and warned to not further come in contact with the hydraulic system and any electrical appliance to prevent an inappropriate defibrillator shock. This demonstrates the effectiveness and usefulness of continuous remote telemonitoring in supporting ICD patients.

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Gonzalez-Jaramillo, Valentina, Piotr Sobanski, Jose A. Calvache, Luisa F. Arenas-Ochoa, Oscar H. Franco, Lukas Hunziker, Steffen Eychmüller, and Maud Maessen. "Unmet device reprogramming needs at the end of life among patients with implantable cardioverter defibrillator: A systematic review and meta-analysis." Palliative Medicine 34, no. 8 (June 26, 2020): 1019–29. http://dx.doi.org/10.1177/0269216320929548.

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Background: Use of implantable cardioverter defibrillators is increasingly common. As patients approach the end of life, it is appropriate to deactivate the shock function. Aim: To assess the prevalence of implantable cardioverter defibrillator reprogramming to deactivate the shock function at the end of life and the prevalence of advance directives among this population. Design: Following a previously established protocol available in PROSPERO, we performed a narrative synthesis of our findings and used the logit transformation method to perform our quantitative synthesis. Data sources: We searched seven bibliographic databases (Embase, Cochrane Central register of controlled Trials, Medline-Ovid, Web-of-Science, Scopus, PsychInfo, and CINAHL) and additional sources until April 2019. Results: Of the references we identified, 14 were included. We found a pooled prevalence of implantable cardioverter defibrillator reprogramming at the end of life of 28% (95% confidence interval, 22%–36%) with higher reprogramming rates after the recommendations for managing the device at the end of life were published. Among patients with advance directives, the pooled prevalence of advance directives that explicitly mentioned the device was 1% (95% confidence interval, 1%–3%). Conclusions: The prevalence of implantable cardioverter defibrillator reprogramming and advance directives that explicitly mentioned the device was very low. Study data suggested reprogramming decisions were made very late, after the patient experienced multiple shocks. Patient suffering could be ameliorated if physicians and other healthcare professionals adhere to clinical guidelines for the good management of the device at the end of life and include deactivating the shock function in the discussion that leads to the advance directive.

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Stoevelaar, Rik, Arianne Stoppelenburg, Rozemarijn L. van Bruchem-Visser, Anne Geert van Driel, Dominic AMJ Theuns, Martine E. Lokker, Rohit E. Bhagwandien, Agnes van der Heide, and Judith AC Rietjens. "Advance care planning and end-of-life care in patients with an implantable cardioverter defibrillator: The perspective of relatives." Palliative Medicine 35, no. 5 (April 13, 2021): 904–15. http://dx.doi.org/10.1177/02692163211001288.

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Background: Little is known about the last phase of life of patients with implantable cardioverter defibrillators and the practice of advance care planning in this population. Aim: To describe the last phase of life and advance care planning process of patients with an implantable cardioverter defibrillator, and to assess relatives’ satisfaction with treatment and care. Design: Mixed-methods study, including a survey and focus group study. Setting/participants: A survey among 170 relatives (response rate 59%) reporting about 154 deceased patients, and 5 subsequent focus groups with 23 relatives. Results: Relatives reported that 38% of patients had a conversation with a healthcare professional about implantable cardioverter defibrillator deactivation. Patients’ and relatives’ lack of knowledge about device functioning and the perceived lack of time of healthcare professionals were frequently mentioned barriers to advance care planning. Twenty-four percent of patients experienced a shock in the last month of life, which were, according to relatives, distressing for 74% of patients and 73% of relatives. Forty-two to sixty-one percent of relatives reported to be satisfied with different aspects of end-of-life care, such as the way in which wishes of the patient were respected. Quality of death was scored higher for patients with a deactivated device than those with an active device (6.74 vs 5.67 on a 10-point scale, p = 0.012). Conclusions: Implantable cardioverter defibrillator deactivation was discussed with a minority of patients. Device shocks were reported to be distressing to patients and relatives. Relatives of patients with a deactivated device reported a higher quality of death compared to relatives of patients with an active device.

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SOLOMON, ALLEN J., JOHN F. SWARTZ, DAVID J. KODAK, HANS J. MOORE, ROBERT L. HANNAN, CYNTHIA M. TRACY, and ROSS D. FLETCHER. "A Second Defibrillator Chest Patch Electrode Will Increase Implantation Rates for Nonthoracotomy Defibrillators." Pacing and Clinical Electrophysiology 19, no. 9 (September 1996): 1304–10. http://dx.doi.org/10.1111/j.1540-8159.1996.tb04208.x.

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Große Meininghaus, D., H. J. Habermalz, J. Siebels, W. Duckeck, and K. Langes. "Regelrechte Funktion eines implantierten Defibrillators nach hochdosierter Strahlentherapie unter Einbeziehung der Defibrillator-Loge." Herzschrittmachertherapie + Elektrophysiologie 12, no. 4 (December 2001): 225–29. http://dx.doi.org/10.1007/s003990170008.

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Kavousi, Ayoub, and Valiallah Saba. "GENERATION OF RECTANGULAR BIPHASIC WAVEFORM TO DECREASE DEFIBRILLATION THRESHOLD FOR EXTERNAL DEFIBRILLATOR." Biomedical Engineering: Applications, Basis and Communications 24, no. 05 (October 2012): 395–401. http://dx.doi.org/10.4015/s1016237212500354.

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Studies have shown that defibrillation threshold for current amplitude of biphasic truncated exponential (BTE) waveform has a hyperbolic strength–duration relationship. Theoretical and experimental results have shown that decreasing the tilt of BTE waveforms decreases the defibrillation threshold. On the other hand, low peak current waveform reduces probability of myocardium damage and burn. Therefore, achieving a waveform with low tilt and low peak current is desired. All DC defibrillators use a capacitor to store and deliver required energy. Because of capacitor discharging nature, the tilt of waveforms is high. In rectilinear biphasic waveform (RBW), which was generated by ZOLL M-series defibrillator, the tilt of the first phase was decreased using an adjustable resistor connected in series with current path. But the defibrillator cannot keep the current constant in the second phase and in the both phases for high transthoracic impedances (TTI) either. In this paper, for solving these problems, a circuit that generates rectangular biphasic waveform is designed. In this circuit, five resistors are used and connected in series. Then an IGBT switch is connected to each resistor in parallel. Also, control of minimum current ripple is applied in order to decide which resistors should be worked in each time. The circuit is simulated in MATLAB/Simulink and a prototype model is constructed. Results demonstrate that the tilt of the waveform is notably reduced to a value less than 10%.

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Mancini, ME, and W. Kaye. "In-hospital first-responder automated external defibrillation: what critical care practitioners need to know." American Journal of Critical Care 7, no. 4 (July 1, 1998): 314–19. http://dx.doi.org/10.4037/ajcc1998.7.4.314.

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Despite the development and widespread implementation of Basic Life Support and Advanced Cardiac Life Support, the percentage of patients who survive in-hospital cardiac arrest has remained stable at approximately 15%. Although survival rates may approach 90% in coronary care units, survival rates plummet outside of these units. The lower survival rates for cardiac arrest that occur outside of the coronary care unit may relate to the time elapsed between the onset of ventricular fibrillation and first defibrillation. The advent of automated external defibrillators has made it possible to decrease the time elapsed before first defibrillation in non-critical care areas of the hospital. First responders need only recognize that the patient is unresponsive, apneic, and pulseless before attaching and activating the automated external defibrillator. Our research shows that, as part of Basic Life Support training, non-critical care nurses can learn to use the device and can retain the knowledge and skill over time. Establishing an in-hospital automated external defibrillator program requires commitment from administration, physicians, and nursing personnel. Critical care practitioners should be aware of this technology and the literature that supports its safety and effectiveness when used by non-critical care first responders. Critical care nurses are in a unique position to effect changes that will decrease the time between the onset of cardiac arrest and first defibrillation.

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Graham, Adam J., Michele Orini, and Pier D. Lambiase. "Limitations and Challenges in Mapping Ventricular Tachycardia: New Technologies and Future Directions." Arrhythmia & Electrophysiology Review 6, no. 3 (2017): 118. http://dx.doi.org/10.15420/aer.2017.20.1.

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Recurrent episodes of ventricular tachycardia in patients with structural heart disease are associated with increased mortality and morbidity, despite the life-saving benefits of implantable cardiac defibrillators. Reducing implantable cardiac defibrillator therapies is important, as recurrent shocks can cause increased myocardial damage and stunning, despite the conversion of ventricular tachycardia/ventricular fibrillation. Catheter ablation has emerged as a potential therapeutic option either for primary or secondary prevention of these arrhythmias, particularly in post-myocardial infarction cases where the substrate is well defined. However, the outcomes of catheter ablation of ventricular tachycardia in structural heart disease remain unsatisfactory in comparison with other electrophysiological procedures. The disappointing efficacy of ventricular tachycardia ablation in structural heart disease is multifactorial. In this review, we discuss the issues surrounding this and examine the limitations of current mapping approaches, as well as newer technologies that might help address them.

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Amir Maruf, Muhammad, Bambang Guruh Irianto, and Tri Bowo Indrato. "DC SHOCK SIMULATOR." Journal of Electronics, Electromedical Engineering, and Medical Informatics 1, no. 2 (October 1, 2019): 18–24. http://dx.doi.org/10.35882/jeeemi.v1i2.4.

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Defibrillators are electronic devices that carry shock electrical signals (pulses) to the heart muscle to maintain myocardial depolarization that is undergoing cardiac fibrillation (ventricular fibrillation or atrial fibrillation) (Bronzino, 2000). There are several conditions that must be met for the occurrence of shock processes including shock time, energy to be provided, patient and operator safety. In this defibrillator the use of selectors / energy selection is linear in the range 1-30 Joules with the use of tools at 10, 15, 20, 25, 30 Joules. The energy will then be discarded or given to the patient via a paddle when pressed the Discharge / shock button. The result of the signal given to the patient is monophasic. This study used a pre-experimental type with a One Group post test design research design. Measurements were made 5 times the volt meter at the test points determined by the compiler.

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Richard Martis, Pascaline Vilash. "Implantable Cardioverted Defibrillator: The Lifesaving Device." INTERNATIONAL JOURNAL OF PRACTICAL NURSING 4, no. 2 (2016): 109–13. http://dx.doi.org/10.21088/ijpn.2347.7083.4216.13.

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KLEIN, RICHARD C., MERRITT H. RAITT, BRUCE L. WILKOFF, KAREN J. BECKMAN, JAMES COROMILAS, D. GEORGE WYSE, PETER L. FRIEDMAN, et al. "Analysis of Implantable Cardioverter Defibrillator Therapy in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial." Journal of Cardiovascular Electrophysiology 14, no. 9 (September 2003): 940–48. http://dx.doi.org/10.1046/j.1540-8167.2003.01554.x.

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Kruger, Adam, Wilbert S. Aronow, Hoang Lai, Harit Desai, Atul Singla, William H. Frishman, Martin Cohen, and Carmine Sorbera. "Prevalence of Appropriate Cardioverter-Defibrillator Shocks in 1038 Consecutive Patients With Implantable Cardioverter-Defibrillators." American Journal of Therapeutics 16, no. 4 (July 2009): 323–25. http://dx.doi.org/10.1097/mjt.0b013e3181727a59.

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Kruger, Adam, Wilbert S. Aronow, Hoang M. Lai, Harit Desai, Atul Singla, William H. Frishman, Martin Cohen, and Carmine Sorbera. "PREVALENCE OF APPROPRIATE CARDIOVERTER-DEFIBRILLATOR SHOCKS IN 1,038 CONSECUTIVE PATIENTS WITH IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS." Chest 134, no. 4 (October 2008): 1S. http://dx.doi.org/10.1378/chest.134.4_meetingabstracts.s1004.

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Kovacevic, Dragan, Anastazija Stojisic-Milosavljevic, Vasilije Topalov, Bogoljub Mihajlovic, Dejan Sakac, and Ziva Kozlovacki. "Prevention of sudden cardiac death by the implantable cardioverter defibrilator." Medical review 64, no. 5-6 (2011): 291–94. http://dx.doi.org/10.2298/mpns1106291k.

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Introduction. Sudden cardiac death or, as it is also called, a modern man?s killer occurs a few hours after the beginning of the disease. Sudden death is the one that happens within an hour from the onset of the subjective discomforts regardless of the existence of any previous disease. According to modern statistics, 450.000 people die suddenly in the USA and 150,000 in Germany. Causes of sudden death. The most frequent causes of sudden death are cardiologic or, in other words, a heart rhythm disorder such as ventricular tachycardia, ventricular fibrillation and bradycardiac rhythm disorder. All these reasons can be efficiently prevented by the implantation of the cardioverter defibrillators. Implantable cardioverter defibrillator. In comparison with the already known medications, the defibrillator seems to be the most efficient in prevention of sudden cardiac death. This fact has been confirmed by large multicentre studies. The implantation itself is a routine procedure. It lasts about an hour and it often passes without any complications. The patient leaves the hospital a few days after the procedure. About 150 of these procedures are performed per year at the Institute of Cardiovascular Diseases Vojvodina. The Social Insurance Fund bears medical costs and the patient only pays the participation fee, which is symbolical if compared to the value and use of the device. Owing to this fact, this device is available to every patient thus making the efficient sudden cardiac death prevention possible.

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Berger, Stuart. "How to develop and execute a public health agenda: From grass roots to legislation." Cardiology in the Young 27, S1 (January 2017): S101—S103. http://dx.doi.org/10.1017/s1047951116002316.

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AbstractRecent experiences with lay public cardiopulmonary resuscitation and use of ambulatory external defibrillators have been demonstrated to improve survival from out-of-hospital cardiac arrests from an abysmal 10% or less to as high as 30%. Though rare, sudden cardiac arrest in presumably healthy young people have been highly publicised over the last 25 years and have motivated the institution of school- and community-based programmes that facilitate first-responder resuscitation, including defibrillation. These efforts often begin at a grass roots level (usually parent-inspired advocacy groups) and through collaborative activities involving the schools, local businesses, and local administrative agencies are now having a meaningful impact in selected communities. The current focus of these activities is on school- and sports venue-based ambulatory external defibrillator programmes and formal cardiopulmonary resuscitation education in high schools. The extension of these programmes to the level of state mandates has been slower, and even when enacted, public funding has usually not been approved.

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Mirowski, M., Philip R. Reid, Morton M. Mower, Alois Langer, M. S. Heilman, and Steve A. Kolenik. "Automatic Implanted Defibrillator — Initial Clinical Experience." Prehospital and Disaster Medicine 1, S1 (1985): 243–44. http://dx.doi.org/10.1017/s1049023x00044630.

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The automatic implantable defibrillator is an electronic device designed to continuously monitor cardiac rhythm, identify ventricular fibrillation and deliver corrective defibrillatory discharges, when indicated. Physically similar to early pacemakers, it weights 250 grams and has a volume of 145 cc (Figure 1). All materials in contact with body tissue are biocompatible. The defibrillating electrodes are made from titanium and silicone rubber. One electrode, designed for placement in the superior vena cava near the right atrial junction, is located on the distal end of an intravascular catheter. The second electrode, in the form of a flexible rectangular patch, is placed extrapericardially over the apex of the heart. The outside surface of the apical electrode is insulated to achieve optimal current distribution.The device is powered by lithium batteries having a projected monitoring life of approximately 3 years or a discharge capability of approximately 100 shocks. The sensing system detects ventricular fibrillation by monitoring a sampled probability density function of ventricular electrical activity.

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Salmoirago-Blotcher, Elena, Sybil Crawford, Chau Tran, Robert Goldberg, Lawrence Rosenthal, and Ira Ockene. "Spiritual Well-Being May Buffer Psychological Distress in Patients With Implantable Cardioverter Defibrillators." Journal of Evidence-Based Complementary & Alternative Medicine 17, no. 3 (May 25, 2012): 148–54. http://dx.doi.org/10.1177/2156587212447627.

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Psychological distress is common in patients with implantable cardioverter defibrillators and has been associated with a worse prognosis. The authors examined whether spiritual well-being is associated with reduced psychological distress in patients with ICDs. The Functional Assessment of Chronic Illness Therapy–Spiritual Wellbeing (FACIT-SWB) questionnare and the Hospital Anxiety and Depression Scale (HADS) were used to measure spiritual well-being and overall psychological distress. Multivariate linear regression was used to explore the relationship between these variables. The study sample included 46 implantable cardioverter defibrillator outpatients (32 males, 14 females; age range = 43-83 years). An inverse association between HADS and FACIT-SWB scores was found, persisting after adjustment for demographics, anxiety/depression, medications, therapist support, and functional status ( F = .001; β = −0.31, confidence interval = −0.44, −0.19). In conclusion, spiritual well-being was independently associated with lower psychological distress in ICD outpatients. Spiritual well-being could act as a protective factor against psychological distress in these high-risk patients.

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Aronow, Wilbert S., Harit Desai, Kaushang Gandhi, Chul Ahn, Sadaf Hussain, Hoang M. Lai, Mala Sharma, William H. Frishman, Martin Cohen, and Carmine Sorbera. "RISK FACTORS FOR APPROPRIATE CARDIOVERTER-DEFIBRILLATOR SHOCKS, INAPPROPRIATE CARDIOVERTER-DEFIBRILLATOR SHOCKS, AND MORTALITY IN 549 PATIENTS WITH HEART FAILURE AND IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS." Journal of the American College of Cardiology 55, no. 10 (March 2010): A14.E134. http://dx.doi.org/10.1016/s0735-1097(10)60135-0.

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Journal articles on the topic 'Defibrillatori'

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