1,721,052 research outputs found
Patients with ventricular arrhythmias: who should be referred to an electrophysiologist?
No full textThe MADIT II and COMPANION studies: will they affect uptake of device treatment?
No full textPrimary prophylaxis of sudden cardiac death by implantable cardioverter-defibrillator (ICD) treatment will greatly increase ICD implant numbers. This will have major cost and infrastructure consequences. Those studies that have demonstrated the clinical need have been industry driven. Whether their conclusions should now expand ICD indications is debated, but it would be perverse to suggest that hesitancy in ICD treatment expansion relates to reservation about the clinical science rather than to concern about cost and resource implications
New device indications: practice and cost implications in Europe
No full textThe potential clinical value of implantable devices, for both diagnostic and therapeutic uses in cardiology practice, has increased greatly with technical innovation. This coupled with an increased recipient population size (as the population ages) and increased referral rates (as that population and its healthcarers are educated), has increased the demand for such devices and the associated economic burden is impacting on healthcare resources. Although there is a commonality of approach to clinical practice in Europe, aided by the publication of European guidelines, the implementation of these is hindered by the need to overcome national obstacles, particularly for new indications for established therapies and for innovative therapies. Cost efficacy assessments and evidence-based medicine are blurred and used as rationing tools. National inequalities and disparate healthcare systems will become divisive in a European theatre that is otherwise seeing greater political and economic integration. There needs to be a mature and honest debate on how to bring the benefits of implantable device medical technology to the patient population which will benefit
Cost-effectiveness of implantable cardioverter defibrillator therapy
No full textCost-efficacy assessment of implantable cardioverter defibrillator (ICD) therapy has proved contentious and may have limited uptake of ICD therapy, particularly in Europe. Published modeling assessments are too inaccurate to determine clinical practice, and assessments based on clinical studies are incomplete (from the cost-efficacy viewpoint). Although ICD therapy seems certain to be most cost-effective in patients who are likely to have good longevity if their risk of sudden cardiac death is countered, the benefit of ICD therapy is not necessarily limited to such groups. Physicians and health economists need to develop a better understanding of how to assess high-technology therapy costs so that uptake of such therapy is appropriately expedited with due regard to ethical and cost constraints
Not letting the left side know what the right is doing!
No full textArrhythmogenic right ventricular dysplasia (ARVD) encompasses a spectrum of presentations including ventricular tachycardia, sudden cardiac death and heart failure. Complete right ventricular disarticulation was effective in a young athletic male who was refractory to drug therapy and experienced recurrent shock therapies from an implantable cardioverter-defibrillator that were incapacitating. The case highlights the challenging management of ARVD despite over two decades of research and the resurgent interest in ventricular disarticulatio
Importance of using biphasic shock waveforms for cardioversion from atrial fibrillation: an unresolved issue
No full textIn a previous issue of Heart, Scholten and colleagues presented data to show that a biphasic external atrial defibrillation shock waveform offers no significant advantage over a monophasic shock waveform in current clinical practice.1 However, there is evidence in this study and elsewhere to suggest that a biphasic defibrillation waveform is "better" than monophasic.2–5 The sense that this should be so may be engendered by the past experience of electrophysiologists with ventricular defibrillators and the decrease in defibrillation threshold that was seen with the advent of biphasic shock waveforms in these devices.6 The question is whether the perceived advantages of biphasic waveforms for atrial defibrillation can be translated into clinical benefit for patients
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