[Effectiveness of education based on orem's self-care model in self-care activity of patients with implantable cardioverter defibrillators]

Several studies have shown that the self-care activity of patients with implantable cardioverter defibrillator is inadequate. This study was conducted to assess the effect of an educational program based on the Orem's self-care model in self-care ability of the patients. This clinical trial was conducted among 66 patients with implantable cardioverter defibrillator. Four educational sessions were held based on the patient's needs and Orem's self-care model. Data was collected using a self-report questionnaire at baseline and one month after the intervention. Data were analyzed using statistical tests [x[2], t-test, paired t-test] in the SPSS-18. There were no significant differences in the self-care awareness, tendency to self-care, self-care skills, and self-care ability between the control and intervention groups. After the intervention, the self-care awareness score remained 22.06 +/- 3.26 in the control group and increased [28.69 +/- 1.51] in the intervention group [P<0.000]. There was also significant difference in the tendency to self-care between the control [25 +/- 3.31] and intervention [28.9 +/- 1.33] groups [P<0.000]. The self-care skills differed significantly between the control [14.9 +/- 3.06] and intervention [29.03 +/- 1.15] groups after the intervention [P<0.000]. After the intervention, the self-care ability was also significantly different among the control [61.96 +/- 8.06] and intervention [86.63 +/- 2.93] groups [P<0.000]. The results of this study showed that implementing educational programs based on the Orem's self-care model can improve self-care ability in patients with implantable cardioverter defibrillator. Applying this method is recommended in nursing interventions to promote health status of the patients

Interventional electrophysiology in children: a single-center experience

Ablation techniques in children arrhythmia have significantly progressed in the past decade; however, the number of pediatric ablations is still significantly lower than that in adults. Accordingly, there is less information regarding the success rate and complications in this age group. All pediatric ablations conducted Between March 2005 and February 2011 at Rajaie Heart center were studied. Abolishing the arrhythmia source by the end of procedure was considered as success. Recurrences before hospital discharge and those thereafter were named early recurrence and late recurrence, respectively. A total of 125 catheter ablations were performed for 112 patients. Of them 118 [94.4%] procedures were successful. The success rate was significantly higher in the patients with atrioventricular nodal reentry tachycardia [AVNRT]. Of 105 patients who continued followed up program, 7 [6.7%] cases experienced recurrence; the recurrence rate was inversely dependent on the patients' body size [p value<0.05]. There was no mortality. Five cases were complicated during or early after the procedures, all the complications were cured completely. Therapeutic electrophysiology in children is as an effective and relatively low-risk method. The recurrence and complication rates are similar to those reported in adults. Considering our results and the previous reports, pediatric patients with serious arrhythmia should not be deprived from ablation and should not be exposed to long-term toxic drugs

Hyperglycemia-induced t-wave oversensing as a cause of cardiac resynchronization therapy [CRT] failure

T-wave overs ens ing occurs when the counter starts giving dual beeps for every cardiac cycle instead of one. This usually happens when the monitoring lead displays a tall T wave, which is also sharp. R wave sensing algorithms of the devices do not sense Twave because the slow rate of the Twave is much less than that of the R wave. But the slow rate of'T'waves may change with time and also because of parameters like potassium levels and hyperglycemia. We present a 67-year-old female who underwent the implantation of cardiac resynchronization therapy [cardiac resynchronization and implantable cardioverter defibrilator [CRT-D]] because of severe left ventricular systolic dysfunction and ventricular dyssynchrony experienced recurrent inappropriate implantable cardioveYter-defibrillator [ICD] shocks and CRT failure. Device analysis showed that the CRT failure was in consequence of T-wave oversensing due to hyperglycemia. Elimination of the T-wave oversensing after hyperglycemia control conferred good biventricular pacing and good response to CRT during a 6-month follow-up period

Efficacy of adenosine for acute treatment of supraventricular tachycardia in infants and children

This study was done to assess the efficacy and adverse effects of the different doses of adenosine in the pediatric age group with respect to multiple patient variables. Over a period of 1 year, 86 occasions of supraventricular tachycardia [SVT] were treated with adenosine in 81 infants and children aged between 18 days and 12 years [median of 1.3 years, SD=3]. Adenosine efficacy was evaluated in terms of the patients' demographics, SVT rate, electrocardiogram characteristics, and route of drug administration. The dose of 50microg/kg was effective only in 24% of the SVT cases, and the additional doses of 100microg/kg, 150microg/kg, and 200microg/kg were effective in another 29% of the cases. The drug efficacy was higher in the infants than that in the older children. There were no predictors other than age for the estimation of the efficacy of the drug. Our findings showed that the current recommended doses of adenosine are ineffective in the vast majority of children and infants with SVT. No patient-related factor other than age seems to affect the efficacy of the drug