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Implementation of a Highly-Performing Electrophysiology Device Implant Program: Is There a Role for Niche Hospitals?

Categories Defibrillators, News and Technology, Patient InformationLeave a Comment on Implementation of a Highly-Performing Electrophysiology Device Implant Program: Is There a Role for Niche Hospitals?

Background: Single-center reports on patient demographics and early (<6 weeks) device complication rates in academic hospitals are scant and non-existent for non-academic community hospital electrophysiology (EP) programs. Objective: The objective of our study was to examine the demographics, complications, re-admissions, and accessibility of care in a community EP program to add to the body of knowledge of ‘real-world’ defibrillator implant complications. Methods: Two hundred and fifty consecutive patients who underwent device implantation by a single electrophysiologist in a new non-academic community hospital EP program starting from its inception in July 2008 were included for analysis. Standard procedures for implantation were used. Pacemakers, defibrillators, and generator changes were included; temporary pacemakers were excluded. Major complications were defined as in-hospital death, cardiac arrest, cardiac perforation, cardiac valve injury, coronary venous dissection, hemothorax, pneumothorax, transient ischemic attack, stroke, myocardial infarction, pericardial tamponade, and arteriovenous fistula. Minor complications were defined as drug reaction, conduction block, hematoma or lead dislodgement requiring re-operation, peripheral embolus, phlebitis, peripheral nerve injury, and device-related infection. Results: This community cohort had similar ejection fractions but was older with worse kidney function than those studied in prior reports. There was one major early complication (0.4%) and seven minor early complications (2.8%). Left ventricular lead placement was successful in 64 of 66 patients (97%). Conclusions: This is the first community-hospital based EP program to examine device implant demographics and outcomes, and revealed an elderly, ill population with lower overall rates of complications than seen in national trials and available reports from single non-community centers. Contrary to current perceptions, these data suggest that community centers may subselect an elderly, ill patient population and can provide high-quality, cost-effective, and more accessible care.

For More Details Please See:

American Heart Hospital Journal: http://www.touchbriefings.com/ebooks/A1oe7m/ahhj81/resources/35.htm

EP Lab Digest: http://www.eplabdigest.com/articles/Implementation-a-Highly-Performing-Electrophysiology-Device-Implant-Program-Is-There-a-Role.

 

Implantable Biosensors and Future Role in Electrophysiology

Categories Heart Rhythm Disorders, News and Technology, Patient InformationLeave a Comment on Implantable Biosensors and Future Role in Electrophysiology

Implantable loop recorders (ILR) are used for long-term arrhythmia monitoring inpatients that have had syncope or cryptogenic strokes (possible from atrial fibrillation).  There are two primary models of loop recorders: St. Jude Medical’s Confirm (http://www.sjmprofessional.com/Products/US/Implantable-Cardiac-Diagnostics/SJM-Confirm-Implantable-Cardiac-Monitor.aspx) and Medtronic’s Reveal (http://www.medtronic.com/for-healthcare-professionals/products-therapies/cardiac-rhythm/cardiac-monitors-insert/reveal-dx-and-reveal-xt-insertable-cardiac-monitors-icms/index.htm).

ILR are placed just under the skin in the left chest and are able to record a patient’s heart rhythm.  It helps to diagnose the cause of syncope (fainting) or any number of heart rhythm disorders.  Initially, doctors try to diagnose heart rhythm disorders with monitors that are worn for 48hours to 2-4weeks; however, an arrhythmia that may only occur every few months will not be detected by a brief snapshot in a patient’s life.  ILR generally last 2-3 years before the battery wears out.

The exciting future of implantable monitors is not simply heart rhythm diagnosis.  Recently, the company MicroCHIPS announced results of the first human clinical trial of an implantable, wireless microchip drug delivery device (http://www.mchips.com/technology.html).  This type of implantable device can allow automated drug delivery over a period of several years.  One can imagine a device that can track a person’s heart rate and dose medication to permit precise control of heart during an abnormal heart rhythm.