The implantable cardioverter-defibrillator (ICD) is remarkably effective in preventing sudden cardiac death in high-risk patients, but it also has the capacity to provoke or worsen cardiac arrhythmias. Tachyarrhythmias or bradyarrhythmias may result from the delivery of antitachycardia or antibradycardia therapies by tiered-therapy defibrillators. This proarrhythmia, although rarely fatal, increases the morbidity associated with defibrillator therapy. Proarrhythmia is related as much to suboptimal programming as to technical limitations of the device. The proarrhythmic potential of ICD therapy can be minimized by tailoring the “electrical prescription” according to characteristics of the clinical arrhythmia and individual ICD idiosyncrasies.

The Proarrhythmic Potential of Implantable Cardioverter-Defibrillators

For the cost and cost-effectiveness outcomes, the authors searched the databases of MEDLINE, Health Planning and Administration, the Office of Health Economics and the NHS CRD's NHS EED. The search terms used are listed in an appendix to the review. The authors search strategy was developed using standard systematic review techniques and had five components: sources of evidence (the databases searched); inclusion and exclusion criteria for studies; methods for data extraction; data synthesis; and assessment of quality of evidence.

https://njl-admin.nihr.ac.uk/document/download/2002564

Resource allocation for chronic stable angina: a systematic review of effectiveness, costs and cost-effectiveness of alternative interventions

The Palmaz-Schatz coronary stent is used frequently to reduce the rate of restenosis of balloon angioplasty in saphenous vein grafts In many European centers, the stent, manually crimped on a balloon, is advanced across the stenosis without a protective sheath This report describes a patient in whom an attempt to deploy a stent in the orifice of a saphenous vein graft was complicated by dislodgement of the unexpanded stent from the balloon The unexpanded stent caused immediate occlusion of the vein graft and severe ischemic symptoms The stent was retrieved by inflation of another balloon in the graft, distal to the stent, pulling the balloon toward the guiding catheter, and then withdrawing the whole system

Retrieval of occluding unexpanded palmaz‐schatz stent from a saphenous aorto‐coronary vein graft

Purpose: To review clinical scenarios in which nonelectrophysiologist physicians may interact with patients who have implantable defibrillators. Data Sources: Peer-reviewed original articles and re...

Implantable Cardioverter-Defibrillators: Implications for the Nonelectrophysiologist

We report a case of unsuccessful stenting of a right coronary artery after acute dissection during percutaneous transluminal coronary angioplasty (PTCA). The stent was lost in the descending aorta and we used an original technique to remove it from the arterial bed by using both a very low profile balloon and a 6F bioptome. © 1993 Wiley-Liss, Inc.

Retrieval of a lost coronary stent from the descending aorta using a ptca balloon and biopsy forceps

The Palmaz-Schatz stent is a balloon expandable stent. Although easy to deploy, problems can occur. One problem is balloon rupture resulting in a partially expanded stent, which can be difficult to expand fully. This report illustrates how a Probing catheter and balloon can solve this potentially serious problem.

A solution to the problem of an unexpanded Palmaz-Schatz stent following balloon rupture.

Pacemaker generator reprogramming does not always present an adequate solution to the problem of pacemaker-mediated tachycardia. A case is described where direct current shock catheter ablation of ventriculoatrial conduction prevented pacemaker-mediated tachycardia and allowed optimal dual chamber pacemaker programming.

Catheter ablation of ventriculoatrial conduction in the treatment of pacemaker-mediated tachycardia.

A case of coexisting atrial fibrillation and ventricular tachycardia in a patient with an implantable cardioverter defibrillator is described. Despite careful reprogramming, the device was not always able to distinguish between the two arrhythmias and continued to deliver inappropriate antitachycardia therapy including DC shocks. Attempts to pharmacologically control the atrial fibrillation were unsuccessful so radiofrequency ablation of the atrioventricular node was performed. Following successful ablation, there have been no further false detections nor episodes of further ventricular tachycardia.

Radiofrequency catheter ablation of the AV node to improve the function of an antitachycardia implantable defibrillator.



Aims: This report reviews the outcome of percutaneous transluminal coronary angioplasty (PTCA) on patients aged 75 years or over at this institution, in order to provide statistics that may be useful in managing elderly patients



Methods: All elderly patients undergoing PTCA between January 1984 and December 1990 were included Data concerning the PTCA procedure and short term (hospital stay) outcome were compared to those of all patients less than 75 years who underwent PTCA during the same period Long term outcome was obtained for all surviving elderly patients



Results: One hundred and eleven procedures were performed on patients over 75 years, compared to 3183 procedures on patients under 75 The incidence of PTCA in the elderly increased to 67% of all procedures in 1990 Elderly patients were more symptomatic (97% vs 79% in patients under 75 years had Canadian Cardiovascular Society grade 3 or 4 angina), more frequently had the procedure performed urgently (39% vs 14%) and often (67%) had risk factors for PTCA (3 vessel disease, significant left ventricular dysfunction, or a complicating medical illness) Primary success rates (86%vs 90% in patients under 75 years), urgent coronary artery bypass grafting (18%vs 19%) and Q wave infarction (18%vs 10%) were similar in the two age groups In the elderly, procedural difficulties requiring non standard equipment were common (61%), and in-hospital mortality was increased (45%vs 07%) Additionally, three patients died after discharge resulting in a 30 day mortality of 72% A favourable long term outcome was obtained in 50% of patients at a mean follow up of 20 months Unfavourable or neutral outcome was due to one or more of the following; death (16%), coronary artery bypass grafting (19%), acute myocardial infarction (75%) or significant residual angina (17%)



Conclusions: Highly symptomatic patients over 75 years constitute a high risk group for PTCA, with approximately half obtaining a favourable long term outcome

Short and long-term results of coronary angioplasty in patients over 75 years.

Coronary arteries occluded by long lengths of thrombus are usually considered unattractive for angioplasty. Nine patients (8 male, mean age 50.1 years) undergoing angiography for unstable angina were found to have single vessel disease considered unsuitable for angioplasty as the vessel was occluded by a long length of thrombus. These patients were treated with 24 hr intracoronary infusions of 100 mg tPA in an attempt to make angioplasty feasible. Marked thrombolysis occurred in 7 patients who received uncomplicated infusions. One case was unsuccessful due to catheter displacement, while another had the infusion ceased due to an intracerebral bleed from a previously silent A-V malformation. This was the only major complication. Angioplasty was attempted in 6 of 7 cases where lysis had been achieved, with success in all lesions attempted. This reports shows that intracoronary tPA infused over prolonged periods produces excellent thrombolysis, making angioplasty feasible in some patients who were previously unsuitable. © 1992 Wiley-Liss, Inc.

Use of twenty-four hour infusions of intracoronary tissue plasminogen activator to increase the application of coronary angioplasty.

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