Sunday, September 10, 2006
hemroids heal more quickly
Friday, June 30, 2006
Factoring
Until recently, external defibrillators relied on monophasic shock waves. Electrical pulses are sent rapidly from one electrode to the other, only in one direction. Biphasic defibrillation, however, alternates the direction of the pulses, completing one cycle in approximately 10 milliseconds. Biphasic defibrillation was originally developed and used for implantable cardioverter-defibrillators. When applied to external defibrillators, biphasic defibrillation significantly decreases the energy level necessary for successful defibrillation. This, in turn, decreases risk of burns and myocardial damage. However, there is limited evidence to suggest that biphasic defibrillation is superior to monophasic defibrillators, although the small capacitor size required for the defibrillator can result in significant cost and size savings-- essential for the proliferation of Automated External Defibrillators.
Friday, April 07, 2006
Guidant Recall - Guidant Pacemaker Defibrillator Recall
Heart disease continues as one of the biggest killers in the United States. Heart failure, also known as cardiac arrest, occurs when the heart stops pumping blood properly. This illness leads to 200,000 to 400,000 deaths per year.
The Guidant devices are designed to extend the lives of heart disease patients, but if a defibrillator is defective, it could have devastating effects, including patient death. When the Guidant devices are defective, either the irregularity of the heart rate is not detected or the proper electrical impulses for treatment are not delivered to the heart. If the proper therapy is not provided, the heart can cease proper functioning and the patient could perish or suffer serious injuries due to lack of proper blood flow.
It is Guidant's responsibility to maintain the highest quality standards for their pacemaker and defibrillator products and insure that if any quality issue arises, immediate steps are taken to protect the patients. Two deaths have been reported to date related to the Guidant defibrillator recall defect."
Thursday, April 06, 2006
Defibrillator - Wikipedia, the free encyclopedia
Until recently, external defibrillators relied on monophasic shock waves. Electrical pulses are sent rapidly from one electrode to the other, only in one direction. Biphasic defibrillation, however, alternates the direction of the pulses, completing one cycle in approximately 10 milliseconds. Biphasic defibrillation was originally developed and used for implantable cardioverter-defibrillators. When applied to external defibrillators, biphasic defibrillation significantly decreases the energy level necessary for successful defibrillation. This, in turn, decreases risk of burns and myocardial damage. However, there is limited evidence to suggest that biphasic defibrillation is superior to monophasic defibrillators, although the small capacitor size required for the defibrillator can result in significant cost and size savings-- essential for the proliferation of Automated External Defibrillators."
Sunday, April 02, 2006
LIFECOR - LifeVest
When to Use the LifeVest™ System
The LifeVest was designed as an intermediate-term treatment option for people at high risk for sudden cardiac arrest (SCA). Right now, people at a high, short-term risk of SCA are typically monitored in a hospital intensive care (ICU) or coronary care unit (CCU). With monitored beds costing up to $2,000 a day, this option quickly becomes very expensive and is primarily reserved for critical care patients.
Patients with a high, long-term risk of SCA are often candidates for an implantable cardioverter defibrillator (ICD), but this option is also expensive (up to $65,000) and requires surgery. According to Morgan Stanley, only one out of six US patients who need an ICD actually get one.*
The LifeVest fills the therapeutic gap between hospitalization and an ICD. The LifeVest has the same important characteristics of both an ICU/CCU and the ICD; it continuously monitors the heart and is designed to provide prompt defibrillation when needed. LIFECOR®, Inc. believes that the LifeVest has the potential to become the standard of care for intermediate-term patients. And, in cases when an ICD is not feasible, it also can serve as a longer-term alternative."
Tuesday, March 14, 2006
American Heart Association Praises Senate Passage of Defibrillator Legislation
This legislation, which was passed by the New York State Assembly on May 26th, empowers New York State residents to respond to a cardiac emergency.
Now, it awaits the signature of New York State Governor George Pataki.
'The Senate has shown it understands how critical improving the chain of survival for cardiac arrest victims is,' said Paul Hartman, Director of Advocacy for the American Heart Association. 'If signed by Governor Pataki, this legislation will grow New York's current public access defibrillation program by bringing lifesaving defibrillators into our state's largest public and private venues.'
This legislation, which was passed by the New York State Assembly on May 26th, empowers New York State residents to respond to a cardiac emergency.
Now, it awaits the signature of New York State Governor George Pataki.
"The Senate has shown it understands how critical improving the chain of survival for cardiac arrest victims is," said Paul Hartman, Director of Advocacy for the American Heart Association. "If signed by Governor Pataki, this legislation will grow New York's current public access defibrillation program by bringing lifesaving defibrillators into our state's largest public and private venues."
The legislation (S.1074), sponsored by Senator James Alesi (R - East Rochester), extends "Good Samaritan" protections to trained employees and volunteers who use the AED in an emergency situation at such facilities. Identical legislation (A.112) was sponsored by Assemblyman Harvey Weisenberg (D - Long Beach).
About 250,000 people die each year from sudden cardiac arrest. Defibrillation is the only known therapy to treat an individual in cardiac arrest. The delivering of an electrical shock to the heart can restore the heart's normal rhythm. However, it must be done within minutes of the arrest. For every minute that passes without defibrillation, a victim's chance of survival decreases by seven to 10 percent. After as few as 10 minutes, very few resuscitation attempts are successful.
In the past, the ability to defibrillate rested solely in the hands of emergency medical personnel. Unfortunately, quick emergency medical response isn't always possible.
"The best way to give New Yorkers who suffer sudden cardiac arrest a chance for survival is to ensure the high-capacity facilities are equipped with lifesaving equipment, and that appropriate personnel are trained in CPR and in the use of an AED," Hartman said. "We know that this legislation will save lives, and we can't stress that fact enough."
In December 2002, New York State became the first state in the nation to require AEDs in schools and at all school sporting and extracurricular events. In February, the New York City Council unanimously passed legislation, and Mayor Bloomberg signed into law legislation that requires AEDs to be available in many public places, including city-owned buildings, parks, stadiums, senior centers, nursing homes, and golf courses. New York State has served as the national leader in enacting public policy to expand public access defibrillation -- requiring AEDs in schools, health clubs, and all state buildings and institutions. Most importantly, the AEDs-in-schools law alone has resulted in 18 saved lives since December 2002.
Defective Heart Defibrillators Recalled by Guidant Corporation
Defective Heart Defibrillators Recalled by Guidant Corporation 2
• E Defibrillator com Explains the Benefits of Portable Defibrillators
• E Defibrillator com Explains the Function of Defibrillators
• Frequently Asked Questions about the Guidant Recall
• Guidant Defibrillator Patients Urged to Register For Information Updates
• Plano Man Sues Over Flawed Heart Defibrillator
Sitemap
Sunday, March 12, 2006
Implantable Cardioverter Defibrillator
Implantable Cardioverter Defibrillator
An implantable cardioverter defibrillator is used in patients at risk for recurrent, sustained ventricular tachycardia or fibrillation.
The device is connected to leads positioned inside the heart or on its surface. These leads are used to deliver electrical shocks, sense the cardiac rhythm and sometimes pace the heart, as needed. The various leads are tunnelled to a pulse generator, which is implanted in a pouch beneath the skin of the chest or abdomen. These generators are typically a little larger than a wallet and have electronics that automatically monitor and treat heart rhythms recognized as abnormal. Newer devices are smaller and have simpler lead systems. They can be installed through blood vessels, eliminating the need for open chest surgery.
When an implantable cardioverter defibrillator detects ventricular tachycardia or fibrillation, it shocks the heart to restore the normal rhythm. New devices also provide overdrive pacing to electrically convert a sustained ventricular tachycardia, and 'backup' pacing if bradycardia occurs. They also offer a host of other sophisticated functions (such as storage of detected arrhythmic events and the ability to do 'noninvasive' electrophysiologic testing).
Implantable cardioverter defibrillators have been very useful in preventing sudden death in patients with known, sustained ventricular tachycardia or fibrillation. Studies are now being done to find out how best to use them and whether they may have a role in preventing cardiac arrest in high-risk patients who haven't had, but are at risk for, life-threatening ventricular arrhythmias.
According to the American Heart Association Heart and Stroke Statistical Update, in 1998 (the most recent statistics available) there were 26,000 ICD procedures.
Thursday, March 09, 2006
Great Defibrillators win "The Ridge Goes Red 2005"
The Defibrillators showed that they’ve got a lot of heart on Feb. 4 and 5. The team of four teenagers took first place in The Ridge Goes Red 2005 – a 24-hour ski and snowboard relay race at Maple Ski Ridge in Schenectady – tallying 1,313 runs in 24 hours.
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The race got underway at 7 p.m. on Friday, Feb. 4, and 18 teams worked through the night and day before kicking off their skis and boards at 7 p.m. Feb. 5. Each team consisted of four people, and one person from each team was required to be on the mountain at all times.
The Ridge Goes Red 2005 served as a fund-raiser for the American Heart Association’s Go Red For Women program. Heart disease and stroke are the No. 1 and No. 3 killers of women – one in every 2.5 women die of heart disease or stroke – and Go Red For Women raises funds and awareness in an effort to change those statistics.
Each team was required to raise at least $100 in donations for the Go Red For Women program, and the event raised a total of $3,600. Exceeds Expectations, a team from Duanesburg (Kyle Burton, Chelsey Charpentier, Justin Dykeman and Stephanie Seigel), led the way with $476. The Flakes, also from Duanesburg, turned in $453.
The Defibrillators, of Guilderland, were made up of Kevin Butler, J.P. MacFartlan, Frank Tralongo and Mike Tralongo. They finished more than 300 runs ahead of the next team.
The American Heart Association’s Capital Region Go Red For Women events are made possible by the generosity of the following sponsors: National Sponsors Macy’s and Pfizer; Daily Newspaper Sponsor the Albany Times Union; Television Sponsor WNYT; and Radio Sponsors 94 Rock and 93.7 The New Eagle. KeyBank also is a supporter of Go Red For Women.
Monday, March 06, 2006
American Heart Association Provides Area Police with Lifesaving Defibrillators
American Heart Association Provides Area Police with Lifesaving Defibrillators
August 8, 2003
DAYTON -- The American Heart Association today presented police chiefs throughout the Miami Valley with a total of 20 lifesaving automated external defibrillators (AEDs). The portable devices, which restore a cardiac arrest victim’s normal heart rhythm by shocking the heart, will be placed in police cruisers in each municipality.
“When it comes to cardiac arrest, every second counts,” said Mark Gebhart, M.D., Vice President of the Miami Valley American Heart Association. “We’re thrilled to partner with these responders to save lives throughout the Miami Valley.”
In many rural areas of Ohio, it can take emergency vehicles several minutes to reach the scene of an emergency. Police vehicles are often first on the scene and have the best opportunity to save the life of someone suffering from cardiac arrest. In most cases, resuscitation attempts are unsuccessful in as little as ten minutes after a cardiac event.
Nationwide, 220,000 people die annually from sudden cardiac arrest. The survival rate is less than five percent, but the rate is much higher in areas where defibrillators are common.
Funds for the AEDs, which cost $2000 each including
training, were provided through a $40,000 grant from the Levin Family Foundation to the association’s Operation Heartbeat program, which focuses on saving lives from sudden cardiac arrest.
The association provided AEDs to police departments in Beavercreek, Bradford, Englewood, Greenville, Monroe, Miamisburg, Miami Township, Riverside, Trotwood, Union, and Yellow Springs, as well as the South Dayton Jewish Center.
Sunday, March 05, 2006
Ventricular Fibrillation
What is ventricular fibrillation?
The heart beats when electrical signals move through it. Ventricular fibrillation (ven-TRIK'u-ler fib"rih-LA'shun) ("V fib") is a condition in which the heart's electrical activity becomes disordered. When this happens, the heart's lower (pumping) chambers contract in a rapid, unsynchronized way. (The ventricles "flutter" rather than beat.) The heart pumps little or no blood.
AHA Scientific Position
Ventricular fibrillation is very serious. Collapse and sudden cardiac death will follow in minutes unless medical help is provided immediately. If treated in time, V fib and ventricular tachycardia (ven-TRIK'u-ler tak"eh-KAR'de-ah) (extremely rapid heartbeat) can be converted into normal rhythm. This requires shocking the heart with a device called a defibrillator (de-FIB'rih-la-tor).
Today one effective way to correct life-threatening rhythms is by using an electronic device called an implantable cardioverter-defibrillator. This device shocks the heart to normalize the heartbeat if the heart's own electrical signals become disordered.
Friday, March 03, 2006
Public Use of Automated External Defibrillators
The New England Journal of Medicine published a report today showing that public access defibrillation programs, in which lay rescuers provide CPR and use automated external defibrillators (AEDs), can increase survival from sudden cardiac arrest. The study documents a 67 percent survival rate for those with witnessed sudden cardiac arrest who received bystander CPR and treatment with an AED within 5 minutes. The study was conducted between June 1, 1999 and May 31, 2001 in three Chicago airports.
“The results of the Chicago airport study fortify the American Heart Association’s efforts to encourage bystander CPR and AED programs in high-traffic public locations,” said Vinay Nadkarni, M.D., chairman of the American Heart Association’s emergency cardiovascular care committee.
The three airports studied—Chicago O’Hare, Midway and Meigs Field—report serving more than 100 million passengers annually. During the study, 18 people had ventricular fibrillation (VF) cardiac arrest and 11 survived. All of the survivors received bystander CPR. Nine survivors were defibrillated within 5 minutes and two were defibrillated within 7 minutes. Survival was highest in the group that received CPR and defibrillation within 5 minutes.
“The combination of effective CPR and rapid defibrillation is a proven formula for success,” said Dr. Nadkarni. "These survivors were saved because bystanders acted quickly—in other situations, victims die because no one near them provides CPR and defibrillators cannot be accessed soon enough.”
The American Heart Association recommends that effective AED programs include proper training in CPR and AED use, medical oversight in developing a response plan, integration with the emergency medical services (EMS) system and proper quality improvement monitoring, including equipment maintenance.
“The Chicago airport program met all the Association’s recommendations and was extremely well-designed,” Dr. Nadkarni added.
In six of 11 cases, rescuers had no prior training in the use of automated defibrillators, although all were trained in CPR and three held medical degrees. AEDs were placed no more than a 60-90-second walk apart and retrieval of an AED caused automatic notification and dispatch of EMS.
According to the American Heart Association, approximately 250,000 people die annually from sudden cardiac arrest suffered outside the hospital setting.
Thursday, March 02, 2006
Automated External Defibrillators (AEDs)
What is an Automated External Defibrillator (AED)?
It is a device used to administer an electric shock through the chest wall to the heart.
Why are AEDs important?
To date, nothing can restart a stopped heart except an electric shock. When a person suffers a sudden cardiac arrest, for each minute that passes without defibrillation their chance of survival decreases by 7-10 percent. AEDs save lives!
Who can use an AED?
Most AEDs are designed to be used by non-medical personnel who have been properly trained.
Is an AED safe to use?
An AED is safe to use by anyone who has been trained to operate it properly.
What are the legal liabilities?
Everyone trained in AED usage is protected under Florida's Good Samaritan Law.
Wednesday, March 01, 2006
Implantable Cardioverter Defibrillator
Implantable Cardioverter Defibrillator
An implantable cardioverter defibrillator is used in patients at risk for recurrent, sustained ventricular tachycardia or fibrillation.
The device is connected to leads positioned inside the heart or on its surface. These leads are used to deliver electrical shocks, sense the cardiac rhythm and sometimes pace the heart, as needed. The various leads are tunnelled to a pulse generator, which is implanted in a pouch beneath the skin of the chest or abdomen. These generators are typically a little larger than a wallet and have electronics that automatically monitor and treat heart rhythms recognized as abnormal. Newer devices are smaller and have simpler lead systems. They can be installed through blood vessels, eliminating the need for open chest surgery.
When an implantable cardioverter defibrillator detects ventricular tachycardia or fibrillation, it shocks the heart to restore the normal rhythm. New devices also provide overdrive pacing to electrically convert a sustained ventricular tachycardia, and "backup" pacing if bradycardia occurs. They also offer a host of other sophisticated functions (such as storage of detected arrhythmic events and the ability to do "noninvasive" electrophysiologic testing).
Implantable cardioverter defibrillators have been very useful in preventing sudden death in patients with known, sustained ventricular tachycardia or fibrillation. Studies are now being done to find out how best to use them and whether they may have a role in preventing cardiac arrest in high-risk patients who haven't had, but are at risk for, life-threatening ventricular arrhythmias.
According to the American Heart Association Heart and Stroke Statistical Update, in 1998 (the most recent statistics available) there were 26,000 ICD procedures.
American Heart Association Praises Senate Passage of Defibrillator Legislation
ALBANY - The American Heart Association today commends the New York State Senate for passing legislation that will expand New York State's Public Access to Defibrillation program by requiring all high occupany facilities to be equipped with an automated external defibrillator (AED). All publicly- and privately-operated facilities having a capacity for occupancy by 1,000 or more persons will be required to be equipped with a minimum of one AED and have at least one employee trained in CPR and the use of an AED to be present when the facility is in use.
This legislation, which was passed by the New York State Assembly on May 26th, empowers New York State residents to respond to a cardiac emergency.
Now, it awaits the signature of New York State Governor George Pataki.
"The Senate has shown it understands how critical improving the chain of survival for cardiac arrest victims is," said Paul Hartman, Director of Advocacy for the American Heart Association. "If signed by Governor Pataki, this legislation will grow New York's current public access defibrillation program by bringing lifesaving defibrillators into our state's largest public and private venues."
The legislation (S.1074), sponsored by Senator James Alesi (R - East Rochester), extends "Good Samaritan" protections to trained employees and volunteers who use the AED in an emergency situation at such facilities. Identical legislation (A.112) was sponsored by Assemblyman Harvey Weisenberg (D - Long Beach).
About 250,000 people die each year from sudden cardiac arrest. Defibrillation is the only known therapy to treat an individual in cardiac arrest. The delivering of an electrical shock to the heart can restore the heart's normal rhythm. However, it must be done within minutes of the arrest. For every minute that passes without defibrillation, a victim's chance of survival decreases by seven to 10 percent. After as few as 10 minutes, very few resuscitation attempts are successful.
In the past, the ability to defibrillate rested solely in the hands of emergency medical personnel. Unfortunately, quick emergency medical response isn't always possible.
"The best way to give New Yorkers who suffer sudden cardiac arrest a chance for survival is to ensure the high-capacity facilities are equipped with lifesaving equipment, and that appropriate personnel are trained in CPR and in the use of an AED," Hartman said. "We know that this legislation will save lives, and we can't stress that fact enough."
In December 2002, New York State became the first state in the nation to require AEDs in schools and at all school sporting and extracurricular events. In February, the New York City Council unanimously passed legislation, and Mayor Bloomberg signed into law legislation that requires AEDs to be available in many public places, including city-owned buildings, parks, stadiums, senior centers, nursing homes, and golf courses. New York State has served as the national leader in enacting public policy to expand public access defibrillation -- requiring AEDs in schools, health clubs, and all state buildings and institutions. Most importantly, the AEDs-in-schools law alone has resulted in 18 saved lives since December 2002.
Terrorist attacks increased dangerous irregular heartbeats
Terrorist attacks increased dangerous irregular heartbeats
CHICAGO, Nov. 20 – The rate of life-threatening heart rhythms more than doubled among New York heart patients the month after the September 11, 2001 terrorist attacks, researchers reported today at the American Heart Association’s Scientific Sessions 2002.
The study evaluated patients with an implantable cardioverter-defibrillator (ICD). An ICD is an electrical generator the size of a pocket watch that is inserted into the heart to monitor heart rhythm. It detects life-threatening abnormal rhythms, called arrhythmias, and delivers an electrical shock to restore normal rhythm.
Beginning a few days after the terrorist attack on the World Trade Center, the rate of ICD discharges increased and remained elevated throughout the next month.
Researchers evaluated 200 patients (average age 69) with ICDs at six clinics within 100 miles of the World Trade Center. The devices had been implanted an average of 2.5 years before the terrorist attack.
ICDs can store monitoring data, allowing comparison of rhythm patterns and shock rates from different times. The researchers compared ICD discharge rates for the 30 days before and after the terrorist attack. In the month before the attack, 3.5 percent (seven patients) had heart rhythm disturbances that required electrical shocks from their ICDs. In the 30 days after the attack, 8 percent (16 patients) did – a 2.3-fold increase.
The results provide compelling evidence of the impact of stress on the heart, says Marcin Kowalski, M.D., a resident at St. Luke’s-Roosevelt Hospital Center in New York. Even more important, the findings demonstrate the life-saving value of ICDs, he says.
“These patients all had potentially lethal arrhythmias in the 30 days after the attack, and they were all successfully treated by ICDs,” Kowalski says. “This is just another example showing that patients really benefit from ICDs and that ICDs can help save lives.”
Previous studies have evaluated how stressful events such as earthquakes and missile attacks have affected the heart in terms of heart attack and sudden death.
“These previous studies showed a spike in the occurrence of heart attack or sudden death for a short period after the incidents,” says Jonathan S. Steinberg, M.D., chief of cardiology at St. Luke’s-Roosevelt. “The increase in cardiac events tends to be short-lived and very closely coupled to the inciting event, such as an earthquake.”
However, the New York spike in ICD activity was not short-lived, perhaps documenting the persistence of increased psychological stress after the World Trade Center disaster.
The increases in ICD discharge did not occur until three days after the terrorist attack and continued to occur at a cumulative rate throughout the remainder of the 30-day study period. The discharge rate returned to pre-attack levels and remained at 2 percent to 3 percent per month during several months of monitoring.
Why the pattern of cardiac events in the arrhythmia study differed from the patterns seen in other studies is unclear.
“We don’t know why arrhythmias occur at a particular time or have a full understanding of why stress causes arrhythmias,” Steinberg says.
Stress induces several physiologic changes that could predispose a person to a heart attack, heart rhythm disturbance, or other cardiac events, he says. Chief among the changes are increased clot formation and nervous-system stimulation.
“If these changes occur on a regular basis or if they are persistently present, they could promote arrhythmias or heart attacks; and heart attacks can cause arrhythmias,” Steinberg says.
The researchers looked at various medical and demographic factors that might have contributed to the increase in arrhythmias. The only predictor of an arrhythmia after the terrorist attack was the patients’ history of life-threatening heart rhythm disturbances.
“It’s not surprising to find that people who have had arrhythmias are more likely to have arrhythmias again,” Steinberg says.
A future study will evaluate whether proximity to the attack site – specifically, living closer to Ground Zero – influenced a patient’s likelihood of having an arrhythmia after the terrorist attack. Several medical centers around the country will participate.
“Physicians and patients need to be aware that real-life, stressful events can trigger arrhythmias,” Steinberg says. “Physicians should encourage patients with ICDs to practice stress-reduction and stress-avoidance techniques. It’s also important to protect patients against the effects of increased nervous-system stimulation by giving them beta-blockers.”
Tuesday, February 28, 2006
Public access defibrillator use increasing
Public access defibrillator use increasing
ORLANDO, Fla., Nov. 9 – Use of portable defibrillators by non-emergency responders on victims of cardiac arrest doubled during a four-year period in Seattle and King County, Washington. Survival rates were similar to or better than those of people treated by emergency medical service workers, researchers reported at the American Heart Association’s Scientific Sessions 2003.
Public access defibrillation (PAD) is when someone other than a traditional emergency medical worker applies an automated external defibrillator (AED) to treat out-of-hospital cardiac arrest. Cardiac arrest occurs when the heart suddenly stops beating normally and cannot pump blood to the rest of the body, causing death within minutes, unless the patient gets cardiopulmonary resuscitation (CPR). For many victims, an electrical shock to the heart from an AED is their only chance for survival.
“PAD was used in only a small proportion of all treated out-of-hospital arrests, but the proportion increased over time,” said Thomas D. Rea, M.D., M.P.H., an epidemiologist at the Division of Emergency Medical Services, Public Health for Seattle and King County, Wash.
Researchers tracked out-of-hospital cardiac arrests treated by public access defibrillation between January 1, 1999 and December 31, 2002 in Seattle and King County. They wanted to determine how frequently public defibrillators were used.
PAD accounted for 1.3 percent (50 people) of 3,754 cardiac arrests treated during the study period, increasing from 0.82 percent in 1999 to 2.05 percent in 2002.
For those treated with PAD, survival was 50 percent according to hospital discharge data.
“This survival rate is encouraging,” said Rea, though he added that the study was not designed to determine whether PAD improves survival.
Businesses and other entities in the community that bought their own AEDs and trained responders registered with the Seattle area’s voluntary Community Responder AED Program. In all, 457 AEDs were registered, and more than 4,000 people were trained to use them.
“The primary aim of the PAD program was to make sure that, in a cardiac arrest, everything was in place so the victim would have the best chance at survival,” Rea said.
About 250,000 U.S. residents die from sudden cardiac arrest each year, according to the American Heart Association. This is about half of all deaths from coronary heart disease.
Defective Heart Defibrillators Recalled by Guidant Corporation
Defective Heart Defibrillators Recalled by Guidant Corporation 2
• E Defibrillator com Explains the Benefits of Portable Defibrillators
• E Defibrillator com Explains the Function of Defibrillators
• Frequently Asked Questions about the Guidant Recall
• Guidant Defibrillator Patients Urged to Register For Information Updates
• Plano Man Sues Over Flawed Heart Defibrillator
Sitemap
Saturday, February 25, 2006
Anger, exertion can spark irregular beat in patients with implantable defibrillators
Anger, exertion can spark irregular beat in patients with implantable defibrillators
DALLAS, Sept. 10 – People with implantable defibrillators are more likely to experience a life-threatening irregular heart rhythm when they exercise or get angry, according to research published in today’s rapid access issue of Circulation: Journal of the American Heart Association.
Implantable cardioverter-defibrillators (ICDs) are placed in the hearts of people who have had abnormal heart rhythms (arrhythmias), such as rapid heartbeats or quivering of the left ventricle (ventricular fibrillation), which are potentially life-threatening. The devices identify arrhythmias and give an electrical shock to restore normal rhythm. The shock has been likened to a kick in the chest. People who have ventricular fibrillation and don’t receive a shock are at risk for sudden death.
“We were interested in finding what triggers these dangerous rhythms,” says the study’s senior author Diwakar Jain, M.D., professor of cardiovascular medicine and director of nuclear cardiology at the Drexel University College of Medicine in Philadelphia. “We were able to take recordings from the defibrillators, identify when arrhythmias occurred, and correlate that information with reports of mood and physical exertion.”
Observational studies have suggested that psychological stress increases the risk of sudden death in the population at large. Until now, only indirect or anecdotal evidence suggested that anger and vigorous exercise played a role in arrhythmias, according to Jain.
Between 1996 and 1999, 240 patients completed diaries that reflected their mood and physical exertion levels, each on a five-point intensity scale. After receiving an ICD shock, patients recorded the emotions they were feeling shortly before the shock. They served as their own controls by recording their emotions at the same time a week later (the control period).
Forty-two patients (33 men, average age 65) had 107 confirmed ventricular arrhythmias requiring shock. Anger level was rated three or higher in 15 percent of shock events versus 3 percent during control periods. The 15 percent who were shocked at these times were driving, arguing, gambling or had received bad news.
Patients were engaged in physical activity (level 4 or greater) within 15 minutes preceding 53 percent of shocks and during 32 percent of control periods. The exertion included walking slowly or vigorously, recreational activity or physical activity at work.
The study suggests that anger management techniques and ways to block responses to physical stressors may help avoid arrhythmia incidents, says Jain.
Thursday, February 23, 2006
MADIT II Trial -- Prophylactic Implantation of a Defibrillator in Patients with Myocardial Infarction and Reduced Ejection Fraction
MADIT II Trial -- Prophylactic Implantation of a Defibrillator in Patients with Myocardial Infarction and Reduced Ejection Fraction
Brian McGovern, M.D.
Massachusetts General Hospital; Chairman, Atrial Fibrillation Foundation
Over the last decades, there has been great progress in reducing death from cardiovascular causes, but there is much to be done. Cardiovascular disease is still the single most common cause of death in the United States. Patients with myocardial infarction (MI) and reduced left ventricular function are at the highest risk for congestive heart failure (CHF) and arrhythmia-related sudden cardiac death (SCD). Statistics show that there are 340,000 out-of-hospital or emergency room cardiac arrests per year in the United States — 50 percent in absence of acute MI. There is a 95 percent out-of-hospital mortality for these patients. This extremely low survival rate has motivated the prophylactic implantation of a defibrillator for primary prevention.
For treatment of patients at risk for SCD due to ventricular tachyarrhythmias, the implantable cardioverter/defibrillator (ICD) has revolutionized treatment. Advances in technology have improved ICDs, making them easier to implant and safer for patients. They are smaller, much more complex and have improved battery life from the days of their inception in 1980 and approval by the Food and Drug Administration (FDA) in 1985.
The second Multicenter Automatic Defibrillator Implantation Trial (MADIT II) was conducted to help better identify patients with coronary heart disease who would benefit from an ICD. MADIT II is the latest in a series of trials involving the use of ICDs to improve management and clinical treatment of arrhythmia patients. The Antiarrhythmics versus Implantable Defibrillators (AVID) Trial compared ICDs with antiarrhythmic-drug therapy (amiodarone or sotalol, predominantly the former) in patients who had survived life-threatening ventricular arrhythmias. Once it was established that defibrillator therapy had a clear advantage over drug therapy, the trial was stopped. (1)
Previous trials examined the role of the ICD as primary therapy in patients who have never experienced symptomatic arrhythmias but have risk markers for sudden death. The first Multicenter Automatic Defibrillator Implantation Trial (MADIT) and the Multicenter Unsustained Tachycardia Trial (MUSTT) showed that patients with coronary heart disease, a reduced left ventricular ejection fraction, unsustained ventricular tachycardia and inducible sustained ventricular tachyarrhythmias in the electrophysiology lab benefited from ICD implantation. (2) Read brief reviews of all trials.
The Coronary Artery Bypass Graft (CABG) Patch Trial evaluated the prophylactic use of ICDs in patients undergoing coronary revascularization surgery. A high risk of death due to arrhythmia was considered to be indicated by a noninvasive marker — an abnormal signal-averaged electrocardiogram — plus an ejection fraction below 36 percent. (3) The CABG Patch Trial showed no benefit to ICD therapy.
In MADIT II patients with a prior MI and a left ventricular ejection fraction of 0.30 or less were randomly assigned in a 3:2 ratio to receive an ICD (742 patients) or conventional medical therapy (490 patients), with all-cause mortality as the primary end point. Electrophysiologic testing or inducible ventricular arrhythmias were not eligibility criteria for MADIT II. The findings revealed that in patients with a previous MI and reduced left ventricular ejection fraction, the prophylactic use of an ICD, in addition to medications, significantly reduced the risk of death.
Results from MADIT II have been widely anticipated because the trial was well designed with excellent follow-up. Other strong features of the trial included:
- Low rate of crossover
- High frequency of adjunctive medications in both groups
- Primary endpoint of all-cause mortality
- Timing of mortality benefit
- CHF admissions and other long-term risks
During 20 months of follow-up of the study group, there was a 31 percent reduction in the relative risk of mortality among patients in the ICD group compared with those in the conventional therapy group. Because of the reduced risk of mortality seen in the trial, the Data Safety and Monitoring Board stopped the trial early (November 2001). The results are especially significant because ICD therapy was “on top of optimal medical management.” Use of beta-blockers in both treatment arms, for example, was 70 percent, and use of statins was 67 percent in the ICD group and 64 percent in the conventional therapy group.
ICD therapy was associated with the expected rates of device-related complications, but, more importantly, was also associated with a higher rate of new or worsened heart failure than was conventional therapy. While this was a troublesome finding, the research team speculated that effective treatment of potential lethal arrhythmias leads to longer survival, thus allowing heart failure to develop. It is possible that other explanations, such as adverse effects of chronic pacing, may have contributed to this observation.
In general, the conclusion of MADIT II is:
- In patients with reduced EF and history of MI, ICD implantation confers a mortality benefit.
- There is a concerning trend toward an increase in CHF admissions in the ICD group.
- Cost considerations are substantial, but will require an assessment of full survival benefit.
- Subgroup analysis, in particular, assessment of EPS in risk stratification, may be helpful in transitioning these results into clinical practice.
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Internal Cardioverter Defibrillator (ICD) and Antiarrhythmic Drug Interaction
Internal Cardioverter Defibrillator (ICD) and Antiarrhythmic Drug Interaction
Steven Singh, M.D.
ICDs were developed and have been most frequently used for prevention of sudden cardiac death in patients with life-threatening ventricular arrhythmias such as sustained VT or VF. Epidemiological studies report high rates of recurrence of these life-threatening arrhythmias (30% to 50% in 2 years) during follow-up. Early observational reports documenting efficacy in reversion of sustained VT and VF have now been supplemented by large prospective and sometimes randomized single-center and multicenter studies with long-term outcome data. Enrollment in these trials has included patients with coronary and noncoronary heart diseases with a wide range of ventricular function and coexisting disorders.
These studies uniformly document sudden cardiac death recurrence rates that average 1% to 2% annually after device implantation in these populations. Simultaneously, rapid technological evolution of ICD systems has occurred. The ICD has evolved from a short-lived nonprogrammable device requiring a thoracotomy for lead insertion into a multiprogrammable antiarrhythmia device inserted almost exclusively without thoracotomy, now capable of treating bradycardia, VT, and VF. Clinical studies have recorded major improvements in implant risk, system longevity, symptoms associated with arrhythmia recurrences, quality of life and diagnosis and management of inappropriate device therapy. Implantation, follow-up and replacement of these devices is a complex process requiring familiarity with device capabilities, adequate case volume, continuing education and skill in the management of ventricular arrhythmias, therefore mandating involvement of a trained electrophysiologist to provide an optimal personnel team for patient safety and device management. A substantial new body of information has emerged regarding the clinical outcome of patients with VT or VF treated with currently available antiarrhythmic therapies. There are currently three major therapeutic options to reduce or prevent VT or VF in patients at risk for these arrhythmias. These are:
- Antiarrhythmic drug therapy selected by electrophysiological study or ambulatory monitoring or prescribed empirically.
- Ablative techniques applied at cardiac surgery or percutaneously using catheter techniques.
- Implantation of a cardioverter-defibrillator device system.
A combination of ICD therapy with drugs or ablation is also frequently used. Currently the largest clinical experience is with combined antiarrhythmic drug and ICD therapy. The role of antiarrhythmic drugs combined with an ICD has not been thoroughly evaluated, though several clinical trials have been conducted. The results of these studies raise a number of important clinical issues in patients with life-threatening ventricular arrhythmias. Antiarrhythmic therapy, with the possible exception of sotalol, should be prescribed selectively in patients with ICDs, given their potential for cardiac and noncardiac toxicity.
Tuesday, February 21, 2006
Defibrillation
Defibrillation
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It's essential to integrate early defibrillation into an effective emergency cardiac care system. This means employing the "chain of survival" concept. The components of this concept are:
- Early access to the emergency medical services system (call 9-1-1 immediately)
- Early CPR (cardiopulmonary resuscitation) when needed
- Early defibrillation when indicated
- Early advanced cardiac care
To make early defibrillation possible, it's essential that a defibrillator be immediately available to emergency personnel responding to a cardiac arrest. Thus, all emergency ambulances and other emergency vehicles that respond to or transport heart patients should be equipped with a defibrillator.
What can I do to help improve access to AEDs in my community?
- Find out if the first-responder vehicles (ambulances, police cars and fire department vehicles) in your community are equipped with AEDs. If they are not, ask why.
- Speak to members of city councils, county boards and state legislatures. Advocate starting an early defibrillation program in your community, including equipping all first responders with AEDs.
- Support allocating funds to establish an early defibrillation program and to equip all first responders with AEDs in your community.
- Advocate and support regulatory changes in your state that expand the use of AEDs by a broader range of first responders.
Response to Food and Drug Administration clearance of automated external defibrillator for home use
November 13, 2002
The Food and Drug Administration recently gave clearance for an automated external defibrillator (AED) designed for use in the home. AEDs are portable medical devices that provide the most effective treatment for sudden cardiac arrest victims who have a deadly abnormal heart rhythm known as ventricular fibrillation.
Sudden cardiac arrest is responsible for approximately 340,000 adult deaths per year in the U.S. Approximately 95 percent of those who suffer sudden cardiac arrest outside a hospital die. For many people, sudden cardiac arrest is the first sign of cardiovascular disease.
More than 70 percent of all out-of-hospital sudden cardiac arrests occur in the home. Therefore, it has been suggested that family members of individuals at risk of sudden cardiac arrest should be trained and equipped to provide CPR and attempt defibrillation. The American Heart Association recommends early defibrillation as a potentially life-saving treatment and recognizes there are different approaches to making early defibrillation possible. Data from lay rescuer defibrillation programs in public locations have shown that the highest survival from sudden cardiac arrest occurs when the arrest is witnessed an and when bystanders provide immediate CPR and defibrillation within three to five minutes of the arrest.
Prior to making a formal recommendation about home defibrillation, the American Heart Association needs more data on the overall effectiveness of this approach. Data is limited on the number of times a cardiac arrest in the home is witnessed and who is most at risk. Questions also exist about the level of training necessary to make successful resuscitation likely. The American Heart Association looks forward to reviewing the results of an ongoing scientific trial, funded by the National Heart, Lung, and Blood Institute, which will provide valuable data about the home use of AEDs in a few years.
At this time, in the absence of scientific evidence of effectiveness, the American Heart Association can not recommend broad adoption of the home use of AEDs. The association does encourage anyone with questions about their risk factors for heart disease to discuss their treatment options with their physicians. Families of those at risk should learn to identify the signs of sudden cardiac arrest and call 9-1-1 immediately if any of the signs occur. In addition, the American Heart Association recommends that family members learn CPR so they’re prepared to help a loved one survive sudden cardiac arrest.
The American Heart Association is working to improve survival from sudden cardiac arrest by strengthening the chain of survival in every community. The chain of survival includes rapid recognition of a cardiac emergency, early access to emergency medical services (EMS) system by calling 9-1-1, effective bystander CPR, early defibrillation and early access to advanced care.
Monday, February 20, 2006
New drug reduces abnormal heart rhythms in patients with implanted cardioverter defibrillators
This is featured simultaneously in a news conference at Scientific Sessions 2004 and published in the rapid access issue of Circulation: Journal of the American Heart Association (7:30 a.m. CST, Monday, Nov. 8, 2004).
NEW ORLEANS, Nov. 8 – A new drug reduced the recurrence of abnormal heart rhythms in patients with a defibrillator implanted in their heart, researchers reported today in a late-breaking clinical trial session at the American Heart Association’s Scientific Sessions 2004.
Results were simultaneously published in Circulation: Journal of the American Heart Association.
An implantable cardioverter defibrillator (ICD) is a device that treats life-threatening abnormal heart rhythms by delivering an electrical shock to the heart. Defibrillators can treat the abnormal rhythms when they happen, but many patients need other treatment to prevent symptomatic arrhythmias and to reduce the number of device therapies, explained Paul Dorian, M.D., M.Sc., director of the arrhythmia service, St. Michael’s Hospital, Toronto and professor of medicine, University of Toronto, Toronto, Canada; and chair of the SHock Inhibition Evaluation with AzimiLiDe (SHIELD) steering committee.
ICDs can deliver a shock to restore a normal rhythm or provide anti-tachycardia pacing (ATP), a series of pacing pulses to steady the rhythm. The machine records each patient’s arrhythmic episodes, and physicians can download that data by placing a probe on the patient’s skin.
The investigational drug, azimilide dihydrocholoride, blocks potassium channel currents in the heart known as IKS and IKR that can cause abnormal heart rhythms. The drug is known as a class III anti-arrhythmic agent.
In this study, 633 ICD recipients from 121 sites in nine countries were randomized to one of three groups: one 75 milligram (mg) daily dose of the azimilide dihydrocholoride, one 125 mg daily dose of the drug, or a placebo. Participants included patients with newly implanted ICDs who had experienced a life-threatening arrhythmia during the 42 days prior to implantation and patients who had their ICDs for more than 30 days and had a documented episode of arrhythmia in the 180 days before receiving the device.
The researchers found that azimilide dihydrocholoride reduced the total number of all-cause shocks plus the number of times ATP was used to steady ventricular tachycardia (VT). A ventricular tachyarrhythmia is a condition in which the defibrillator correctly treats the arrhythmia but the patient can experience recurrences with symptoms that may include shortness of breath, chest pain, dizziness or fainting. Relative risk reductions were 57 percent with the 75 mg dose and 47 percent with the 125 mg dose (relative to those taking a placebo).
In addition, the incidence of all appropriate ICD therapies (shocks or pacing-terminated VT) was reduced 48 percent among patients on 75 mg of azimilide dihydrocholoride, and 62 percent in patients taking 125 mg. Five patients in the test group and one in the placebo group developed torsade de pointes, a rhythm disturbance. All were successfully treated with the ICD. One patient in the 75 mg group developed severe but reversible neutropenia, a diminished number of neutrophils (a type of white blood cells) in the blood.
Co-authors are: Martin Borggrefe, M.D.; Hussein R. Al-Khalidi, Ph.D.; Stefan H. Hohnloser, M.D.; Jose M. Brum, M.D.; Daljit S. Tatla, Ph.D.; Johannese Brachmann, M.D.; Robert J. Myerburg, M.D.; David S. Cannon, M.D.; Michael van der Laan, M.d.; Michael J. Holroyde, Ph.D.; Igor Singer, M.D.; Craig M. Pratt, M.D. Disclosure information is included in the journal article.
Statements and conclusions of study authors that are published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.
Implantable defibrillators cost-effective for preventing sudden death
DALLAS, April 16 - In the first study of its kind, an implantable cardioverter defibrillator (ICD), a device used to treat heart rhythm abnormalities, was found to be moderately cost-effective for preventing sudden cardiac death, according to a report in today's rapid access Circulation: Journal of the American Heart Association.
ICDs deliver electrical shocks to the heart to eliminate abnormal rhythms such as ventricular fibrillation or ventricular tachycardia. In the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial, the device was shown to be superior to therapy with antiarrhythmic medications for reducing all causes of death in survivors of ventricular fibrillation (irregular, chaotic heart rhythm that begins in the heart's lower chambers). It was also a better choice for people with ventricular tachycardia (an often serious rapid rhythm originating in the lower chambers) and ejection fractions of 40 percent or less. Ejection fraction is a measure of the heart's pumping ability.
AVID is the first study to prospectively determine the cost-effectiveness of ICDs for secondary prevention in the United States, according to lead author Greg Larsen, M.D, a staff cardiologist at the Portland VA Medical Center and associate professor of medicine at the Oregon Health and Sc"
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Sunday, February 19, 2006
Preventing sudden death with implantable defibrillators
In the current issue of the New England Journal of Medicine (March 21), researchers report results from a study in which individuals who had a prior heart attack received an implantable defibrillator to keep their hearts from stopping suddenly, causing sudden death. Implantable defibrillators are devices used in people who have fast heartbeats, conditions called recurrent or sustained ventricular tachycardia or fibrillation. Leads positioned inside the heart sense cardiac rhythm and deliver electric shocks to pace the heart as needed.
Results were released early today at the American College of Cardiology meeting in Atlanta by Arthur Moss, M.D., of the University of Rochester in New York, during the Late-Breaking Clinical Trials session.
The devices are used to prevent sudden death in patients with ventricular fibrillation, but this is the first large study that has tested the devices in individuals who do not have such abnormal rhythms, and who are at high risk for sudden death because their hearts are damaged from prior heart attacks.
The study, called MADIT-II (Multicenter Automatic Defibrillator Implantation Trial), included 1,232 patients who had suffered a heart attack and had an ejection fraction of 30 percent or less. Ejection fraction is a measure of how much blood is pumped from the heart chamber. Normal ejection fraction is between 50 and 75 percent.
Patients were randomly assigned to either receive the implantable defibrillator or treatment with conventional medical therapy. There was a 31 percent reduction in the risk of death in the defibrillator group compared with the conventional-therapy group.
On the downside, more patients treated with the defibrillator suffered worsening heart failure - 19.9 percent compared to 14.9 percent - for the medically-treated group.
According to David Faxon, M.D., president of the American Heart Association, "This study answers some important questions about whether implantable devices are better than medical therapy in preventing sudden death, which accounts for about one half of all deaths from coronary heart disease. The reduction seen in this study is substantial.
"Should patients with these characteristics - prior heart attack and ejection fraction less than 30 - be treated with an implantable defibrillator? It's too soon to make sweeping recommendations without considering the increased costs and complications from heart failure associated with defibrillators.
"The next step is to narrow in on the type of patient who would benefit most, maximizing the benefits, while keeping costs low."
It should also be stressed that the "high tech" approach in treating patients may not be needed if more individuals focused on "low tech" methods to prevent coronary artery disease, such as getting plenty of exercise, not smoking and watching one's diet.
It's also important for individuals to get to the hospital as soon as they have signs of heart attack, because we may be able to limit the amount of heart damage, thus averting the need for a defibrillator, says Faxon.
American Heart Association
Implantable Cardioverter Defibrillator
Implantable Cardioverter Defibrillator
An implantable cardioverter defibrillator is used in patients at risk for recurrent, sustained ventricular tachycardia or fibrillation.
The device is connected to leads positioned inside the heart or on its surface. These leads are used to deliver electrical shocks, sense the cardiac rhythm and sometimes pace the heart, as needed. The various leads are tunnelled to a pulse generator, which is implanted in a pouch beneath the skin of the chest or abdomen. These generators are typically a little larger than a wallet and have electronics that automatically monitor and treat heart rhythms recognized as abnormal. Newer devices are smaller and have simpler lead systems. They can be installed through blood vessels, eliminating the need for open chest surgery.
When an implantable cardioverter defibrillator detects ventricular tachycardia or fibrillation, it shocks the heart to restore the normal rhythm. New devices also provide overdrive pacing to electrically convert a sustained ventricular tachycardia, and "backup" pacing if bradycardia occurs. They also offer a host of other sophisticated functions (such as storage of detected arrhythmic events and the ability to do "noninvasive" electrophysiologic testing).
Implantable cardioverter defibrillators have been very useful in preventing sudden death in patients with known, sustained ventricular tachycardia or fibrillation. Studies are now being done to find out how best to use them and whether they may have a role in preventing cardiac arrest in high-risk patients who haven't had, but are at risk for, life-threatening ventricular arrhythmias.
According to the American Heart Association Heart and Stroke Statistical Update, in 1998 (the most recent statistics available) there were 26,000 ICD procedures.