Cardiac electrophysiology review最新文献

{"title":"More than a device: today's medical technology companies provide value through service.","authors":"Fred McCoy","doi":"10.1023/a:1023643107474","DOIUrl":"https://doi.org/10.1023/a:1023643107474","url":null,"abstract":"<p><p>When physicians implant cardiac rhythm management devices, they establish a long-term relationship with those devices and with the manufacturers of those devices. The therapeutic value that each device will provide to its patient is enhanced throughout the life of the device by the services that the manufacturer provides. Services are provided prior to, during and long after implantation. Services include physician and allied health professional training, quality assurance programs, therapy outreach initiatives, on site technical support during device implantation and follow-up, technical service expertise and customer service support. The costs of these services are substantial. When assessed on a per device basis, the service costs may actually exceed the costs of manufacture. Further, the costs of these services are rising. Over the past five years, the number of implanted cardiac rhythm management devices has doubled. Industry field forces have tripled in size. Clearly, industry is dedicated to providing service as a critical element in achieving excellent patient outcomes.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 1","pages":"54-7"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/a:1023643107474","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22401771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Driving and arrhythmias: implications of new data.","authors":"Jeffrey F Bleakley,&nbsp;Toshio Akiyama","doi":"10.1023/a:1023655410200","DOIUrl":"https://doi.org/10.1023/a:1023655410200","url":null,"abstract":"<p><p>Patients with ventricular arrhythmias are often restricted from driving by their physicians for several months. These recommendations are based more on convention than evidence, due to the paucity of data previously available on the safety of driving in these patients. Over the past few years, however, more data have become available that suggests that it is safe to drive within three months of their ventricular tachyarrhythmia. In this paper, we look at this more recent data and make the suggestion that patients with well maintained cardiac function, no recurrent ventricular arrhythmias (i.e. electrical storm) and no persistent medical condition predisposing them to ventricular arrhythmias should be allowed to resume driving soon after their ventricular tachyarrhythmia.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 1","pages":"77-9"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/a:1023655410200","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22401225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"With a little more soul.","authors":"Blair P Grubb","doi":"10.1023/a:1023659511108","DOIUrl":"https://doi.org/10.1023/a:1023659511108","url":null,"abstract":"<p><p>In addition to the well-publicized problems with reimbursement and manpower in electrophysiology, there is a less well publicized crisis brewing in regards to physicians' social and mental health. The last decades have witnessed tremendous increases in divorce, alcoholism, substance abuse, and suicide among physicians. While the causative factors involved are complex and varied they are, in part, related to a loss of the \"soul\" in modern medical practice. The following paper tries to address the factors behind this loss and suggests ways to correct it.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 1","pages":"85-7"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/a:1023659511108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22401227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New device indications: impact on the individual electrophysiology (EP) practitioner in a predominantly managed care environment.","authors":"Mary Rose Patejak,&nbsp;David S Cannom","doi":"10.1023/a:1023634922495","DOIUrl":"https://doi.org/10.1023/a:1023634922495","url":null,"abstract":"<p><p>The high penetration of managed care as a payment source in cardiology practice is a fact of life in many areas of the country. Understanding the system of reimbursement used by managed care is helpful in order to maximize physician payment for work done, to minimize practice overhead, and to reduce physician and managerial frustration. The key ingredient for success in any cardiology practice environment is high quality procedural outcomes and good communication with patients and referring physicians. This is true in both a managed care and fee for service environment. This article describes the relationship between an indicated electrophysiology procedure (e.g., an implantable cardioverter defibrillator in a low ejection fraction coronary patient) at one end and its reimbursement by a local managed care payer to an electrophysiologist at the other end.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 1","pages":"40-2"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/a:1023634922495","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22401768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resynchronization therapy: implications for pacemaker implantation in Europe.","authors":"Panos E Vardas,&nbsp;Emmanuel N Simantirakis","doi":"10.1023/a:1023626603839","DOIUrl":"https://doi.org/10.1023/a:1023626603839","url":null,"abstract":"<p><p>Cardiac resynchronization has proved a valuable adjunctive therapy in heart failure patients with ventricular conduction disturbances. It improves the patient's clinical status and quality of life, increases functional capacity and causes left ventricular reverse remodeling. The application of this new therapeutic method is expected to affect the pacemaker implantation rate, although the exact degree cannot yet be calculated. One of the main determining factors is the number of patients who are candidates for resynchronization therapy. Although this cannot be estimated precisely, it seems that it does not exceed 10-14% of heart failure patients. Additional factors that will influence the implantation rate, at least during the next few years, are the familiarization of cardiologists with the new implantation technique and follow-up, the availability of cardiac laboratory time and the cost of this new therapy. Although the latter seems high, the financial burden will be minimal when it is taken into consideration that it will lead to a decrease in the number of hospital admissions and a significant reduction in the number of hospitalization days, the greatest determining factors in the current high management cost of heart failure patients. Further to the above, taking the differences between the implantation rates of conventional pacing systems into account in different European countries, the same could be expected of biventricular systems. Thus, although the incidence of heart failure is constantly increasing and conduction disturbances are frequent in such patients, we believe that the implantation rate of biventricular systems in Europe will not exceed an average of 10 per million population, fluctuating according to the country. In conclusion, resynchronization therapy has been established in special subsets of heart failure patients. Due to the epidemiological characteristics of heart failure, the implantation rate is expected to rise. Possible education and/or training issues that appear will be addressed respectively, enabling all suitable patients to enjoy the benefits this new therapeutic technique ensures.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 1","pages":"27-9"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/a:1023626603839","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22401812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of expanding indications on the safety of pacemakers and defibrillators.","authors":"William H Maisel","doi":"10.1023/a:1023678620678","DOIUrl":"https://doi.org/10.1023/a:1023678620678","url":null,"abstract":"<p><p>The number of patients living with a pacemaker or implantable cardioverter defibrillator (ICD) increased markedly during the 1990's. Expanding device indications and increasing device sophistication has important implications for patient and device safety. While the FDA is responsible for assessing the safety and efficacy of medical devices, manufacturers, physicians, patients, medical professional societies, and legislators will all play a role in ensuring that medical device patients continue to receive safe, quality medical care.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 1","pages":"30-2"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/a:1023678620678","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22401813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Chicago School of Arrhythmology: revisited.","authors":"Agustin Castellanos,&nbsp;Robert J Myerburg","doi":"10.1023/a:1023615828855","DOIUrl":"https://doi.org/10.1023/a:1023615828855","url":null,"abstract":"<p><p>The Chicago School of Arrhythmology (Katz, Langendorf and Pick) dominated the field of arrhythmias for at least 20 years until the advent of intracardiac electrophysiology in the late sixties. Thereafter they still played a fundamental role. Whereas other arrhythmologists also made contributions, they did not develop \"schools\" in the classical Platonic sense. The Chicago School's intuitive, deductive and inductive contributions to the understanding of multiple electrophysiological mechanisms were well appreciated, recognized and corroborated by basic and clinical electrophysiologists. Less known was their ability to propagate this knowledge in semi-tutorial courses which were so unique in explaining complex arrhythmic concepts that it is still used today by those who inherited their prominent position in the ever expanding world of invasive electrophysiology.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 1","pages":"96-8"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/a:1023615828855","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22401230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-related changes in arrhythmias and electrophysiologic properties.","authors":"Béatrice Brembilla-Perrot","doi":"10.1023/a:1023611727947","DOIUrl":"https://doi.org/10.1023/a:1023611727947","url":null,"abstract":"<p><p>There are few data on the relationships between age and arrhythmias, except for the Wolff-Parkinson-White syndrome. In clinical practice, the most frequent arrhythmia is the atrial fibrillation (AF). It is well-known, that the prevalence of AF increases with age from 2 to 4% before 70 years up to 9 to 15% in patients older than 80 years. However, it is unknown if the increased prevalence of AF is related to the increase of the cardiac and extracardiac diseases, noted in the elderly, or to atrial electrophysiological changes. Probably, the incidence and mechanism of arrhythmia do not differ between adults and elderly patients when the other clinical data are similar. Arrhythmias in elderly patients represent most of the urgencies, consultations or hospitalizations. They could become more and more frequent because we now know that the management of most of these elderly patients should be identical to that of younger patients. However, the treatment frequently is difficult. The difficulties in elderly patients are due to the associated non-cardiac and cardiac diseases which are more frequent than in adults. Therefore, the quality of management should be particularly careful in elderly patients.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 1","pages":"88-91"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/a:1023611727947","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22401228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of life and psychological impact of implantable cardioverter defibrillators: focus on randomized controlled trial data.","authors":"Michael John McCready,&nbsp;Derek V Exner","doi":"10.1023/a:1023699225221","DOIUrl":"https://doi.org/10.1023/a:1023699225221","url":null,"abstract":"<p><p>The defibrillator has been shown to reduce mortality in a number of patient groups with cardiac disease. Given the number of individuals with defibrillators it is important to understand the influence of these devices quality of life. Advances have led to smaller devices, less-invasive implantation, and more refined arrhythmia management. The potential impact of the defibrillator on quality of life continues to evolve with these advances. This review discusses the impact of the defibrillator on psychological well-being and quality of life, particularly the results of recent large randomized trials. Observational studies evaluating the relationship between defibrillator implantation and quality of life have not shown consistent results, but recent data from randomized trials provide important insights. Among patients who have survived life-threatening arrhythmias the defibrillator is associated with similar or perhaps superior quality of life versus antiarrhythmic drug therapy. However, patients who experience shocks have poorer quality of life versus those who do not. The reduction in quality of life with multiple shocks is of similar magnitude to serious side effects from antiarrhythmic drugs. While patients with defibrillators are at risk for poor quality of life. The advantages and disadvantages of defibrillator therapy versus amiodarone or usual medical care should be discussed with patients in whom a defibrillator is recommended. Those undergoing defibrillator implantation should be advised that adverse events and/or multiple shocks occur in a minority of patients, but may lead to reduced quality of life and it is vital that support resources be made available for these individuals.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 1","pages":"63-70"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/a:1023699225221","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22401774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of implantable defibrillators in Africa.","authors":"R N Scott Millar,&nbsp;B M Mayosi","doi":"10.1023/a:1023622502931","DOIUrl":"https://doi.org/10.1023/a:1023622502931","url":null,"abstract":"<p><p>Sub-Saharan Africa is dominated by diseases of poverty. HIV/AIDS affects 28.5 out of a total of 600 million in the region. South Africa is the only country in sub-Saharan Africa in which implantable cardiovertor defibrillators (ICDs) are implanted (0.8/million in 2001). Only 3 of the 35 new ICDs were implanted in state-funded public hospitals. The pacemaker implantation rate for South Africa was 41/million in 2001. Approximately 20% of the population consume 56% of the health care expenditure, mainly funded by Medical Insurance. A tax-funded state health care system serves the rest of the population, but is concentrated on improving sanitation and primary health care. Diversion of funds from academic tertiary hospitals has reduced specialised services, particularly cardiology and cardiac surgery, and has resulted in an exodus of skilled personnel to the private sector. In the rest of sub-Saharan Africa, tertiary health care is mainly privately funded. Cardiology and cardiac surgery is not widely available. Many countries are crippled by debt and chronic local conflicts. Only one state hospital (Groote Schuur, Cape Town) provides an electrophysiology (EP) service including catheter ablation and ICD implantation, and training in EP, by two electrophysiologists. EP services are available privately in 3 centres. No EP service exists in the rest of sub-Saharan Africa.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 1","pages":"14-6"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/a:1023622502931","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22401810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}