Combining Shock Reduction Strategies to Enhance ICD Therapy: A Role for Computer Modeling.
. To develop a computer model to test shock reduction strategies such as antitachycardia pacing and shock withholding for supraventricular rhythms, oversensing, and nonsustained ventricular tachycardia. While the implantable cardioverter defibrillator (ICD) can reduce mortality, inappropriate ICD sh...
| Publicado en: | Journal of Cardiovascular Electrophysiology Vol. 22; no. 3; pp. 280 - 290 |
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| Autores principales: | , , , , , |
| Formato: | algorithm research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Mar2011
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104839119&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104839119 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10453873 GSB jtl: Journal of Cardiovascular Electrophysiology issn: 10453873 maglogo: Y pubinfo: dt: Mar2011 vid: 22 iid: 3 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 104839119 59191774 10.1111/j.1540-8167.2010.01918.x NLM20958831 104839119 ppf: 280 ppct: 10 formats: fmt: @attributes: type: P tig: atl: Combining Shock Reduction Strategies to Enhance ICD Therapy: A Role for Computer Modeling. aug: au: Volosin, Kent J. Exner, Derek V. Wathen, Mark S. Sherfesee, Lou Scinicariello, Anthony P. Gillberg, Jeffrey M. affil: University of Pennsylvania, Philadelphia, Pennsylvania, USA sug: subj: Defibrillators, Implantable Adverse Effects Computer Simulation Cardioversion Methods Death, Sudden, Cardiac Prevention and Control Equipment Failure Algorithms Ventricular Fibrillation Therapy Tachycardia, Ventricular Therapy Descriptive Statistics Human Funding Source ab: . To develop a computer model to test shock reduction strategies such as antitachycardia pacing and shock withholding for supraventricular rhythms, oversensing, and nonsustained ventricular tachycardia. While the implantable cardioverter defibrillator (ICD) can reduce mortality, inappropriate ICD shocks remain a limitation. Randomized trials provide evidence of efficacy, but they are not always practical. Computer models provide an alternative approach, and are particularly useful when evaluating multiple interventions. A computer model was developed using clinical data and validated in a large ICD data set (EMPIRIC). After validation, the model was applied to 736 adjudicated clinical episodes from the ICD arm of Sudden Cardiac Death Heart Failure Trial (SCD-HeFT). The shock reduction strategies hypothetically reduced the number of VT/VF shocked episodes in SCD-HeFT by an estimated 59% (from 952 observed to 395 modeled shocks, probability of >0.999) at detection duration settings (18 of 24 intervals). The percentage of patients experiencing inappropriate shocks over 5 years was decreased by 15% (23.5-8.4%), and the number of shocks for non-VT/VF episodes was decreased from 423 to 77 (82% reduction). The percentage of patients receiving shocks for VT/VF was reduced from 30.7% (SCD-HeFT) to 26.1% with the addition of ATP. Extended detection (24 of 32 or 30 of 40 intervals) showed modest additional improvement compared to 18 of 24 intervals. Computer modeling is able to predict the results of a known clinical trial and demonstrate that shock reduction strategies have the potential to significantly reduce inappropriate and unnecessary ICD shocks versus the mandated programming used in SCD-HeFT. (J Cardiovasc Electrophysiol, Vol. 22, pp. 280-289, March 2011) pubtype: Academic Journal doctype: algorithm research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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