Subject(s)
Cardiac Resynchronization Therapy , Heart Failure/therapy , Patient Selection , Aged , Female , Humans , Male , Practice Guidelines as TopicABSTRACT
An abundance of evidence exists in support of primary and secondary prevention for tackling the scourge of cardiovascular disease. Despite our wealth of knowledge, certain deficiencies still remain. One such example is the association between sleep disordered breathing (SDB) and cardiovascular disease. A clear body of evidence exists to link these two disease entities (independent of other factors such as obesity and smoking), yet our awareness of this association and its clinical implication does not match that of other established cardiovascular risk factors. Here, we outline the available evidence linking SDB and cardiovascular disease as well as discussing the potential consequences and management in the cardiovascular disease population.
ABSTRACT
A substantial proportion of patients who undergo cardiac rhythm device implantation receive anticoagulation to prevent thromboembolism. Many patients have coexisting cardiovascular diseases treated with antiplatelet therapy. Anticoagulation may increase the risk of hemorrhagic complication, while withdrawal of anticoagulation may increase thromboembolic risk. In this article, we review and describe the available evidence, in order to inform best practice .
Subject(s)
Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Defibrillators, Implantable , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/adverse effects , Practice Guidelines as Topic , Blood Loss, Surgical/prevention & control , Evidence-Based Medicine , Humans , Pacemaker, Artificial , Perioperative Care , Postoperative Hemorrhage/epidemiology , Postoperative Hemorrhage/prevention & control , Thromboembolism/epidemiology , Thromboembolism/prevention & controlABSTRACT
The number of cardiac resynchronization therapy (CRT) device implantations has been increasing exponentially, with the implant rate doubling over the past few years. While the majority of CRT recipients enjoy symptomatic relief, approximately 30% of individuals reap no benefit and only a minority are rendered completely symptom free. In response, many clinicians engage in the theoretically advantageous process of postimplantation optimization of atrial and ventricular stimulation by altering atrioventricular and interventricular pacing intervals. However, the rationale for routine CRT optimization and the methods of doing so have been the subjects of recent debate. Here, we present an overview of the background, techniques and evidence for CRT optimization.
Subject(s)
Cardiac Resynchronization Therapy , Heart Failure/physiopathology , Heart Failure/therapy , Heart/physiology , Cardiac Output , Cardiac Resynchronization Therapy Devices , Evidence-Based Medicine , Humans , Monitoring, Physiologic , Practice Guidelines as TopicABSTRACT
A 79-year-old man presented with relapse of non-Hodgkin's B-cell lymphoma within the scar from his implantable cardioverter defibrillator (ICD) implantation. The ICD was re-sited before he proceeded to chest wall radiotherapy, which resulted in complete remission of the lymphoma. This is the first reported case of lymphoma recurrence within an ICD wound scar.
Subject(s)
Cicatrix , Defibrillators, Implantable , Lymphoma, B-Cell/diagnosis , Out-of-Hospital Cardiac Arrest/therapy , Skin Neoplasms/diagnosis , Aged , Cicatrix/complications , Humans , Lymphoma, B-Cell/etiology , Lymphoma, B-Cell/radiotherapy , Male , Radiography , Radiotherapy , Recurrence , Skin Neoplasms/diagnostic imaging , Skin Neoplasms/etiology , Treatment OutcomeSubject(s)
Carcinoma, Hepatocellular/secondary , Heart Failure/etiology , Heart Neoplasms/secondary , Liver Neoplasms , Lung Neoplasms/secondary , Carcinoma, Hepatocellular/diagnostic imaging , Echocardiography , Female , Heart Neoplasms/diagnostic imaging , Humans , Liver Neoplasms/diagnostic imaging , Middle Aged , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Tomography, X-Ray ComputedABSTRACT
Heart failure is posing an increasing burden on healthcare systems around the world, a consequence of increased survival from acute coronary syndromes and life-prolonging medications. Cardiac resynchronization therapy has become a ratified and established therapy for heart failure to reduce both the morbidity and mortality of the condition. Its prophylactic role in patients who have minimal symptoms to delay future deterioration is a novel development. The indications for this therapy continue to evolve, mainly as a result of company-sponsored multicenter trial data aimed at broadening its usage. Uncertainty remains on how to accurately identify individuals who will respond to resynchronization therapy and how best to manage patients following device implant.
