Continuing Cardiology Education最新文献

{"title":"Remote monitoring of patients with CIEDs following the updated recommendations—Easing or adding to postimplant responsibilities?","authors":"N. Varma","doi":"10.1002/cce2.45","DOIUrl":"10.1002/cce2.45","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 \u0000 <p>Follow-up of patients with cardiac implantable electronic devices is challenging due to both their increasing volume and technical complexity coupled to increasing clinical complexity of recipient patients. Remote monitoring (RM) offers an opportunity to resolve some of these difficulties by improving clinic efficiencies and providing a mechanism for device monitoring and patient management. Recent recommendations advocate for RM to be standard of care for this purpose. Several randomized clinical trials and registries have demonstrated that RM may reduce in-hospital visit numbers, time required for patient follow-up, physician and nurse time, and hospital and social costs. Furthermore, patient retention and adherence to follow-up schedule are significantly improved by RM. Continuous wireless monitoring of data stored in the device memory with automatic alerts allows early detection of device malfunctions and of events, such as atrial fibrillation, ventricular arrhythmias, and heart failure suitable for clinical intervention. Early reaction may improve patient outcome. RM is easy to use and patients showed a high level of acceptance and satisfaction. Implementing RM in daily practice may require changes in clinic workflow. New organizational models promote significant efficiencies regarding physician and nursing time. Data management techniques are under development. Despite these demonstrable advantages of RM, adoption still remains modest, even in health care systems incentivized to use this follow-up method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME</b>: https://wileyhealthlearning.com/Activity2/4596352/Activity.aspx.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 4","pages":"198-204"},"PeriodicalIF":0.0,"publicationDate":"2016-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.45","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81981887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to follow a patient with heart failure and a biventricular device","authors":"E. K. Theofilogiannakos,&nbsp;V. P. Vassilikos","doi":"10.1002/cce2.39","DOIUrl":"10.1002/cce2.39","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 \u0000 <p>Cardiac resynchronization therapy is the gold standard therapy for patients with moderate to severe heart failure symptoms on optimal medical treatment, with left ventricular ejection fraction &lt;35% and broad QRS (&gt;120 msec). However, one-third of them do not respond to CRT (defines as no any functional/symptomatic improvement and/or without left ventricular reverse remodeling). Some patients might potentially be responders if manages properly and for this reason, patient after CRT implantation should be followed up regularly. Given that a CRT patient is mainly a heart failure patient, follow up should not be focused only on device interrogation but it is essential to optimize the overall heart failure of the patient. This paper reviews the stages of an outpatient follow up of a CRT patient focusing primarily on the nonresponders management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME</b>: https://wileyhealthlearning.com/Activity2/4596349/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 4","pages":"192-197"},"PeriodicalIF":0.0,"publicationDate":"2016-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.39","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84585671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced atrioventricular block with a very prolonged ventricular asystole detected four hours after placement of an impantable loop recorder","authors":"P. Korantzopoulos,&nbsp;I. V. Ntalas,&nbsp;M. I. Papafaklis,&nbsp;J. A. Goudevenos","doi":"10.1002/cce2.40","DOIUrl":"10.1002/cce2.40","url":null,"abstract":"<div>\u0000 \u0000 <p>In this report, we present a 42-year-old woman without structural heart disease who underwent an implantable loop recorder implantation for recurrent syncopal episodes during the past 12 years. Four hours after implantation, the patient suffered sudden loss of consciousness while sitting on her bed in the ward. Interestingly, interrogation of the device revealed an episode of advanced atrioventricular block with a very prolonged ventricular asystole of 25 sec. We also provide a concise overview of the literature regarding the implantable loop recorder use in recurrent unexplained syncope as well as regarding idiopathic advanced atrioventricular block.</p>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 4","pages":"205-208"},"PeriodicalIF":0.0,"publicationDate":"2016-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.40","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85051210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing infected cardiovascular implantable electronic devices","authors":"A. S. Manolis,&nbsp;H. Melita","doi":"10.1002/cce2.38","DOIUrl":"10.1002/cce2.38","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 \u0000 <p>The number of cardiac implantable electronic device (CIED) implants is growing; unfortunately, the rate of device infections is also rising, outpacing the increase in device implantation and paralleling the complexity of current CIEDs and CIED recipients, incurring high morbidity and mortality, long hospital stays, and increased financial cost. For either pocket or lead infection, percutaneous complete removal of the infected device and lead system combined with prolonged antibiotic treatment is the standard approach to patient management. A variety of mechanical and/or laser-assisted techniques and tools are employed with high success rates in experienced centers. Surgery is reserved for cases with very large vegetations, need for other concomitant cardiac surgery or for failed or complicated percutaneous approach. Following removal of an infected CIED, the need for reimplantation of a new device is individualized, although the timing is variable, mainly based on the absence of signs of continued infection. In general, CIED-related infective endocarditis and the presence of comorbid conditions are associated with increased mortality. These and other important relevant issues of contemporary management of patients with infected CIEDs are herein reviewed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/4596336/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 4","pages":"182-191"},"PeriodicalIF":0.0,"publicationDate":"2016-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.38","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83222861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decision making for upgrading or downgrading a CRT device regarding ethical, medical, and economic issues","authors":"E. M. Kallergis,&nbsp;E. N. Simantirakis,&nbsp;E. S. Nakou,&nbsp;P. E. Vardas","doi":"10.1002/cce2.37","DOIUrl":"10.1002/cce2.37","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 \u0000 <p>There are limited data about the management of patients presenting for elective generator replacements in the setting of previously implanted implantable cardioverter defibrillator <b>(</b>ICD) or cardiac resynchronization therapy (CRT) devices that are nearing end of life. Over a patient's life span, clinical situations evolve and previously present conditions that merited CRT implantation may change. The individual patient's clinical status and concomitant illnesses may evolve so that considerations may include not only replacement of the pulse generator but also potentially changing the type of device [e.g., downgrading CRT-defibrillator (CRT-D) to CRT-pacemaker (CRT-P) or ICD or upgrading of CRT-P to CRT-D]. Moreover, the clinical evidence for CRT-D/CRT-P placement may evolve over time, with ongoing research and availability of new trial data. In this review we discuss the ethical, medical, and financial implications related to CRT generator replacements and the need for additional clinical trials to better understand which patients should undergo downgrading or upgrading.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME</b>: https://wileyhealthlearning.com/Activity2/4596227/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 4","pages":"176-181"},"PeriodicalIF":0.0,"publicationDate":"2016-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.37","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81332504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote monitoring of the cardiac rhythm: where do we stand today?","authors":"S. Deftereos,&nbsp;N. Papoutsidakis,&nbsp;G. Giannopoulos,&nbsp;C. Kossyvakis,&nbsp;J. Lekakis","doi":"10.1002/cce2.36","DOIUrl":"10.1002/cce2.36","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 \u0000 <p>Remote monitoring systems, in their current forms, are networked communication solutions allowing exchange of digitized data from implanted or wearable devices. These data usually include electrocardiographic recordings, but nowadays they may encompass much more than that, allowing a continuously updated knowledge of a multitude of device- or patient-related parameters. Remote monitoring has been shown, as one would have expected, to reduce the need for office visits and allow earlier detection—and thus management—of arrhythmic events. However, although there are hints that they may also be associated with improved clinical outcomes, the absence of randomized trials dictates a cautious interpretation of existing evidence. Furthermore, there are still several questions regarding their cost-effectiveness, the patient populations that could benefit from them, as well as how the transmitted data should be interpreted and acted upon by physicians. In this review, we present and critically examine the current state of affairs of remote cardiac rhythm monitoring systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn </b><b>CME</b>: https://wileyhealthlearning.com/Activity2/4596216/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 4","pages":"168-175"},"PeriodicalIF":0.0,"publicationDate":"2016-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.36","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89707387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive management of atrial fibrillation","authors":"K. Vlachos,&nbsp;K. P. Letsas,&nbsp;M. Efremidis","doi":"10.1002/cce2.35","DOIUrl":"10.1002/cce2.35","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 \u0000 <p>Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, affects 1% of the general population with increased incidence in the elderly population and is an important contributor to population morbidity and mortality. This article reviews the current invasive management of AF. Pulmonary vein isolation (PVI) is the cornerstone of current ablation techniques for the treatment of paroxysmal atrial fibrillation (AF). Despite proven PVI, a subset of patients still experience recurrent arrhythmia, mostly due to a higher prevalence of non-PV triggers. PVI is associated with worse arrhythmia-free survival in patients with persistent AF than those with paroxysmal AF. Accumulating data have shown that elimination of atrial fibrillation 9 (AF) sources (rotors or rotational activity, drivers, electrograms with continuous activity) should be the goal in persistent AF ablation. Pulmonary vein isolation, linear lesions, and complex fractionated atrial electrograms (CFAEs) ablation have shown limited efficacy in patients with persistent AF. A combined approach using voltage, CFAEs, and dominant frequency (DF) mapping may be helpful for the identification of AF sources and subsequent focal substrate modification. The fibrillatory activity is maintained by intramural reentry centered on fibrotic patches. Voltage mapping may assist in the identification of fibrotic areas. Stable rotors display the higher DF and possibly drive AF. Furthermore, the single rotor is usually consistent with organized AF electrograms without fractionation. It is therefore quite possible that rotors are located at relatively “healthy islands” within the patchy fibrosis. This is supported by the fact that high DF sites have been negatively correlated with the amount of fibrosis. CFAEs are located in areas adjacent to high DF. In conclusion, patchy fibrotic areas displaying the maximum DF along with high organization index and the lower fractionation index are potential targets of ablation. Prospective studies are required to validate the efficacy of substrate modification in left atrial ablation outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/4469458/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 3","pages":"158-166"},"PeriodicalIF":0.0,"publicationDate":"2016-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.35","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82346345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supraventricular tachycardias: differential diagnosis at bedside and in the electrophysiology laboratory","authors":"D. G. Katritsis","doi":"10.1002/cce2.31","DOIUrl":"10.1002/cce2.31","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Clinical and electrophysiologic criteria used for the differential diagnosis of regular supraventricular tachycardias (SVT) are presented. Although several electrocardiographic clues may assist differential diagnosis, this is usually accomplished at electrophysiology study and, most often, is between atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia due to a concealed accessory pathway, and atrial tachycardia. Atrial and, mainly, ventricular pacing maneuvers during sinus rhythm or tachycardia have been used with variable success rate. In clinical practice, these techniques cannot be applied to all cases, and multiple criteria have to be used for the differential diagnosis of narrow complex tachycardias with atypical characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/4469457/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 3","pages":"126-134"},"PeriodicalIF":0.0,"publicationDate":"2016-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.31","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79519678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk stratification for the primary prevention of arrhythmic sudden cardiac death in postinfarction patients","authors":"P. Arsenos,&nbsp;S. Sideris,&nbsp;K. A. Gatzoulis","doi":"10.1002/cce2.32","DOIUrl":"10.1002/cce2.32","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Sudden cardiac death (SCD) threatens ischemic cardiomyopathy patients. Antiarrhythmic protection may be provided to these patients with implanted cardiac defibrillators (ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity. Current risk stratification strategies focus on markers that, by identifying the arrhythmic substrate and the severity of the arrhythmia mechanisms present, are also considered to quantify the risk of SCD. Such markers reflect: (1) myocardial substrate lesions and postinfarction fibrosis (LVEF, QRS, LBBB, SAECG, fragmented QRS, CMR, PVBs, NSVT), (2) abnormal repolarization (QT, QTd, T-wave alternans, QT/RR, QTVI, TWV), (3) impaired autonomic nervous system function (HR, heart rate variability (HRV), HRT, deceleration capacity (DC), BRS, HR recovery after exercise), and (4) inducibility on programmed ventricular stimulation during electrophysiological testing. Ventricular tachyarrhythmias have a strong dynamic component because transient and unpredictable factors can trigger a fatal arrhythmic episode. For this reason, SCD risk stratification is not simple and no ideal marker or a completely successful predictive model is existing. The evolution of technology made possible all the noninvasive markers to be incorporated in the Holter software. Noninvasive risk stratification has been simplified. Innovative Holter technology enforced the doctors, providing them with the tools for primarily screening their patients through the ICD protection process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME</b>: https://wileyhealthlearning.com/Activity2/4469459/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 3","pages":"135-143"},"PeriodicalIF":0.0,"publicationDate":"2016-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.32","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77959640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk stratification for the primary prevention of arrhythmic sudden cardiac death in post-infarction patients","authors":"P. Arsenos,&nbsp;S. Sideris,&nbsp;K. A. Gatzoulis","doi":"10.1002/cce2.33","DOIUrl":"10.1002/cce2.33","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Current trends on Sudden Cardiac Death (SCD) Risk Stratification complementary to the conventional markers that were presented in Part I, are Cardiac Magnetic Resonance that detects and quantifies the post-infarct tissue heterogeneity and the invasive method of Programmed Ventricular Stimulation on Electrophysiological study that reveals the vulnerable and inducible myocardial substrate. While the first generation of Risk Stratification trials examined one simple prognostic marker each time, the second generation of trials investigated in past combinations of SCD prediction markers and prognostic models reflecting different arrhythmogenesis mechanisms. The third generation of trials currently utilizes Risk Stratification strategies to indentify high-risk patients before an ICD prophylactic implantation connecting the Risk Stratification process with the ICD therapy. Intensive research on SCD is also nowadays directed to the unexplored era of patients with a Preserved Ejection Fraction and to the era of early post-myocardial infarction period. Both these subgroup patients are not protected by the current ICDs implantation guidelines because of gap in evidence. Research is going to fill in this gap.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME</b>: https://wileyhealthlearning.com/Activity2/4469470/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"2 3","pages":"144-150"},"PeriodicalIF":0.0,"publicationDate":"2016-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.33","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83557794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}