Mechanisms of inappropriate defibrillator therapy in a modern cohort of remotely monitored patients.

Introduction: Defibrillator (ICD) technology and monitoring are evolving rapidly. We investigated the mechanisms of inappropriate ICD therapies in a modern cohort of patients followed at our institution via remote monitoring.

Methods: From September 2009 to March 2011, a total of 2,050 ICD patients (19,600 patient-months) were remotely followed.

Location of acute myocardial infarction and associated arrhythmias and outcome.

Background: Cardiac arrhythmias and conduction abnormalities complicating acute myocardial infarction (AMI) have been associated with adverse prognosis in numerous reports. Small studies have frequently associated different arrhythmias with various distributions of myocardial infarctions. We analyzed a nationally representative hospital discharge database to evaluate the relationship between the location of AMI and the associated arrhythmias and conduction abnormalities and their impact on in-hospital mortality.

Clinical predictors of late death in survivors of acute myocardial infarction.

Survivors of acute myocardial infarction have higher mortality rates than do the general population. This study examined the value of multiple clinical characteristics in predicting late death among patients who present with acute myocardial infarction.We reviewed the electronic medical records of patients who had been treated for acute myocardial infarction at our institution from 1992 through 2000.

Derivation and validation of a diagnostic model for the evaluation of left ventricular filling pressures and diastolic function using mitral annulus tissue Doppler imaging.

Background: Several modalities to diagnose diastolic dysfunction by transthoracic echocardiography (TTE) exist. We compared the ratio of early mitral filling velocity (E) to early diastolic velocity by tissue Doppler imaging at the medial (E/E'm) and the lateral (E/E'l) mitral annulus and developed a model to diagnose elevated left ventricular end-diastolic pressure (LVEDP).

Methods: Sixty patients underwent same-day cardiac catheterization and TTE.

Risk of death and recurrent ventricular arrhythmias in survivors of cardiac arrest concurrent with acute myocardial infarction.

Aims: Cardiac arrest (CA) is an indication for defibrillator (ICD) implantation unless it occurs in the context of an acute myocardial infarction (AMI). We investigated the ventricular arrhythmia (VA)-free survival of patients resuscitated from CA in the setting of AMI.

Methods: We reviewed a database of 1600 AMI and CA survivors from which 48 patients were identified as having concurrent CA and AMI (CA+AMI group).

Predictors of mortality amongst recipients of implantable cardioverter defibrillators for secondary prevention of cardiac arrest.

Background: Implantable Cardioverter-defibrillators (ICD) reduce mortality in survivors of cardiac arrest (CA). We investigated the predictors of mortality after ICD implantation in survivors of CA.

Methods: Retrospective review of clinical records and social security death index of all patients who received an ICD in a preexisting database of survivors of CA at the University of Pittsburgh Medical Center was performed.

Predictors of cardiac arrest occurring in the context of acute myocardial infarction.

Background: Cardiac arrest (CA) concurrent with acute myocardial infarction (AMI) claims the life of many patients with coronary artery disease (CAD). In this study, we investigated the predictors of CA during AMI.

Method: Patients admitted with CA concurrent with AMI (n = 31) were matched by age, gender, race, and left ventricular ejection fraction (LVEF) to patients with AMI but no CA (n = 70).

Effect of end-stage renal failure and hemodialysis on mortality rates in implantable cardioverter-defibrillator recipients.

Background: Most defibrillator (ICD) trials have excluded patients on hemodialysis (HD). It is therefore not known whether the ICD, when indicated, confers the same mortality benefit to HD and non-HD patients.

Method: HD patients implanted with an ICD from July 2001 to June 2004 were matched by age, gender, left ventricular ejection fraction (LVEF), and class of heart failure to non-HD ICD recipients.

A clinical risk score to predict the time to first appropriate device therapy in recipients of implantable cardioverter defibrillators.

Background: To develop a risk score to predict the occurrence of appropriate defibrillator [implantable cardioverter-defibrillator (ICD)] therapies. A simple clinical score predicting the risk of appropriate ICD therapy is lacking.

Methods: A Cox regression model was developed from a database of ICD patients at a single tertiary center to predict the time to appropriate ICD therapy defined as shock or antitachycardia pacing.

Renal insufficiency predicts the time to first appropriate defibrillator shock.

Background: Indications for implantable cardioverter defibrillator (ICD) implantation are expanding, but many primary and secondary ICD trials have excluded patients with advanced renal insufficiency. We investigated the effect of renal function on the incidence and time to first appropriate ICD shock.

Method: We analyzed data from all new ICD implantations at a tertiary care center from July 2001 to December 2002.

Noncardiac surgery and the risk of death and other cardiovascular events in patients with hypertrophic cardiomyopathy.

Background: There is a paucity of reports evaluating the perioperative risk of noncardiac surgery in patients with hypertrophic cardiomyopathy (HCM).

Hypothesis: The study was undertaken to evaluate the incidence of acute myocardial infarction (MI) and all-cause inhospital mortality following noncardiac surgery in patients with HCM.

Methods: We searched the National Hospital Discharge Survey database for patients with a diagnosis of HCM who had undergone noncardiac surgery.

Relation of advanced heart failure symptoms to risk of inappropriate defibrillator shocks.

Inappropriate implantable cardioverter-defibrillator (ICD) shocks continue to be a major source of distress to patients and a drain on the health care system. Expanding indications for ICD implantation include a large portion of patients with heart failure. This study investigated the relation between inappropriate ICD shocks and the severity of heart failure symptoms.

Indications for internal cardioverter defibrillator implantation predict time to first shock and the modulating effect of beta-blockers.

Background: Patients receive implantable cardioverter defibrillator (ICD) for varying indications. Whether these indications influence the time to first ICD shock is suspected but not confirmed. The modulating effect of beta-blockers on shock-free survival is not fully elucidated.

Hip fractures in lebanese patients: determinants and prognosis.

Hip fractures are the most costly of osteoporotic fractures, but little is known about their epidemiology in the Middle East. Hip fracture patients and controls with osteoarthritis admitted to our institution from 1992 to 2002 were studied. Information on gender, age, type of fracture, comorbid conditions, and medications use was obtained.

Effects of race and health insurance on the rates of pacemaker implantation for complete heart block in the United States.

Although indicated for adults with complete heart block, pacemaker implantation is not always practiced. There are gross discrepancies by race, type of health insurance coverage, and size of hospital of admission in the utilization of pacemakers.