Heart rhythm : the official journal of the Heart Rhythm Society
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Randomized Controlled Trial Multicenter Study Comparative Study
Prospective comparison of discrimination algorithms to prevent inappropriate ICD therapy: primary results of the Rhythm ID Going Head to Head Trial.
Inappropriate therapy for supraventricular arrhythmias remains a significant source of morbidity in implantable cardioverter-defibrillator (ICD) recipients. ⋯ Rhythm discrimination performed better in the specific Medtronic than in VITALITY 2 ICDs evaluated, particularly for single-chamber devices. Inappropriate therapies, and differences in performance, may be reduced with the use of rate cutoff above 175 bpm.
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Randomized Controlled Trial Multicenter Study
Arrhythmia rate distribution and tachyarrhythmia therapy in an ICD population: results from the INTRINSIC RV trial.
Appropriate implantable cardioverter-defibrillator (ICD) therapy for ventricular tachycardia (VT) or ventricular fibrillation (VF) depends, in part, on the programming of tachycardia zones. ⋯ In a general ICD population, ATP treated VT effectively or obviated the need for shock. Most ventricular arrhythmias <250 bpm were not VF. Proper zone programming may identify and treat VT without shock.
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Perioperative management of oral anticoagulation (OAC) in patients receiving pacemakers or implantable cardioverter-defibrillators remains an issue of concern. ⋯ Implantation of the new standardized protocol resulted in a significant reduction in bleeding complications and hospital stays, with adequate protection against TE events and significant cost savings.
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There is a known association between obstructive sleep apnea (OSA) and atrial fibrillation (AF); however, how OSA affects the atrial myocardium is not well described. ⋯ OSA is associated with significant atrial remodeling characterized by atrial enlargement, reduction in voltage, site-specific and widespread conduction abnormalities, and longer sinus node recovery. These features may in part explain the association between OSA and AF.
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There is controversy whether proceduralist-directed, nurse-administered propofol sedation (PDNAPS) is safe. ⋯ PDNAPS for shorter ICD procedures including single- and dual-chamber implants, generator changes, and defibrillation threshold testing have acceptable rates of serious adverse events and manageable nonserious adverse events and should be considered for further study. Biventricular implants and other complex procedures should be done with an anesthesiologist.