Background: Mortality is increased among implantable cardioverter-defibrillator (ICD) recipients who receive shocks; however, whether shocks cause this increase or are simply a marker of risk is unknown. Antiarrhythmic medications, catheter ablation, and enhanced ICD programming all may reduce ICD shocks, but whether shock reduction decreases mortality is unknown.
Objective: The purpose of this study was to conduct a meta-analysis to estimate the impact of ICD shock reduction on survival.
Methods: Two independent reviewers searched MEDLINE, EMBASE, and clinicaltrials.gov and extracted data from randomized controlled trials assessing the efficacy of interventions to prevent ICD shocks.
Results: Seventeen randomized trials were included in this analysis, including 5875 patients. Mean ejection fraction of all trial participants was 32%, and 25% of the patients received ICD therapy for primary prophylaxis. Antiarrhythmic medications (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.36-0.96, P = .03) and catheter ablation of ventricular tachycardia (OR 0.35, 95% CI 0.19-0.62, P = .0004) significantly reduced the proportion of patients receiving shocks. However, there was no significant reduction in mortality among trials of antiarrhythmic medications (OR 1.07, 95% CI 0.72-1.59, P = .73) or catheter ablation (OR 0.72, 95% CI 0.32-1.64, P = .44). The 5 ICD programming trials had sufficiently heterogeneous interventions that pooling of their results was not performed. However, only the PAINFREE-II (Pacing Fast Ventricular Tachycardia Reduces Shock Therapies) trial demonstrated a significant reduction in shocks (OR 0.38, 95% CI 0.22-0.65), but this was not associated with any significant reduction in mortality (OR 1.41, 95% CI 0.81-2.45).
Conclusion: There is no compelling evidence that existing interventions that reduce ICD shocks significantly improve survival.
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http://dx.doi.org/10.1016/j.hrthm.2012.08.032 | DOI Listing |
Resuscitation
January 2025
West Virginia University School of Medicine, Department of Emergency Medicine, Division of Prehospital Medicine.
Objective: The administration of amiodarone or lidocaine is recommended during the resuscitation of out-of-hospital cardiac arrest (OHCA) patients presenting with defibrillation-refractory or recurrent ventricular fibrillation or ventricular tachycardia. Our objective was to use 'target trial emulation' methodology to compare the outcomes of patients who received amiodarone or lidocaine during resuscitation.
Methods: Adult, non-traumatic OHCA patients in the ESO Data Collaborative 2018-2023 datasets who experienced OHCA prior to EMS arrival, presented with a shockable rhythm, and received amiodarone or lidocaine during resuscitation were evaluated for inclusion.
Int J Mol Sci
January 2025
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan 33304, Taiwan.
The electrophysiological mechanisms underlying melatonin's actions and the electrophysiological consequences of superimposed therapeutic hypothermia (TH) in preventing cardiac ischemia-reperfusion (IR) injury-induced arrhythmias remain largely unknown. This study aimed to unveil these issues using acute IR-injured hearts. Rabbits were divided into heart failure (HF), HF+melatonin, control, and control+melatonin groups.
View Article and Find Full Text PDFMedicina (Kaunas)
December 2024
Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan.
The rising prevalence of myopia is a significant global health concern. Atropine eye drops are commonly used to slow myopia progression in children, but their long-term use raises concern about intraocular pressure (IOP). This study uses SHapley Additive exPlanations (SHAP) to improve the interpretability of machine learning (ML) model predicting end IOP, offering clinicians explainable insights for personalized patient management.
View Article and Find Full Text PDFDiagnostics (Basel)
January 2025
Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy.
Anderson-Fabry disease (AFD) is a rare X-linked lysosomal storage disorder characterized by the accumulation of globotriaosylceramide, leading to multi-organ involvement and significant morbidity. Cardiovascular manifestations, particularly arrhythmias, are common and pose a considerable risk to affected individuals. This overview examines current approaches to arrhythmic risk stratification in AFD, focusing on the identification, assessment, and management of cardiac arrhythmias associated with the disease.
View Article and Find Full Text PDFBeijing Da Xue Xue Bao Yi Xue Ban
February 2025
Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & NMPA Key Laboratory for Dental Materials, Beijing 100081, China.
Objective: To explore whether microneedle pretreatment can significantly improve the efficacy and safety of 5-aminolevulinic acid (ALA)-photodynamic therapy (PDT) in the treatment of oral leukoplakia.
Methods: A non-randomized controlled clinical trial was conducted. Patients with clinical and pathological diagnosis of oral leukoplakia in the Department of Oral Mucosa, Peking University School and Hospital of Stomatology were divided into experimental group and control group.
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