CARDIAC DEFIBRILLATION PREDICTION, PREVENTION AND MANAGEMENT OF CARDIOVASCULAR ARRHYTHMIC EVENTS Edited by Joyelle J. Harris CARDIAC DEFIBRILLATION – PREDICTION, PREVENTION AND MANAGEMENT OF CARDIOVASCULAR ARRHYTHMIC EVENTS Edited by Joyelle J. Harris Cardiac Defibrillation – Prediction, Prevention and Management of Cardiovascular Arrhythmic Events Edited by Joyelle J. Harris Copyright © 2015 Second Edition All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. First published October, 2011, second - 2015 ISBN-10: 953-307-692-5 ISBN-13: 978-953-307-692-8 Contents Preface IX Part 1 Defibrillation Introduction and Assessments 1 Chapter 1 Implantable Cardioverter Defibrillators 3 Behzad Ghanavati Chapter 2 Defibrillation Shock Amplitude, Location and Timing 19 Shimon Rosenheck Chapter 3 Prognostic Significance of Implantable Cardioverter-Defibrillator Shocks 41 Dan Blendea, Razvan Dadu and Craig McPherson Chapter 4 Ventricular Tachyarrhythmias in Implantable Cardioverter Defibrillator Recipients: Differences Between Ischemic and Dilated Cardiomyopathies 53 Aldo Casaleggio, Tiziana Guidotto, Vincenzo Malavasi and Paolo Rossi Part 2 Prediction, Prevention, and Management of Cardiovascular Events 67 Chapter 5 Prediction of Ventricular Arrhythmias in Patients at Risk of Sudden Cardiac Death 69 K.H. Haugaa, J.P. Amlie and T. Edvardsen Chapter 6 Prevention of Sudden Death – Implantable Cardioverter Defibrillator and/or Ventricular Radiofrequency Ablation 83 Andrea Colella, Marzia Giaccardi, Antonella Sabatini, Alfredo Zuppiroli and Gian Franco Gensini Chapter 7 Just in Time Support to Aide Cardio-Pulmonary Resuscitation 105 Frank A. Drews and Paul M. Picciano VI Contents Chapter 8 Electrical Storm in the Era of Implantable Cardioverter Defibrillators 131 David T. Huang and Darren Traub Part 3 Applications and Clinical Relevance 147 Chapter 9 Ventricular Arrhythmias Due to a Transient of Correctable Cause in MADIT-II Patients: Prevalence and Clinical Relevance 149 Michela Casella, Pasquale Santangeli, Ghaliah Al-Mohani, Antonio Dello Russo, Francesco Perna, Stefano Bartoletti, Joseph Gallinghouse, Luigi Di Biase, Andrea Natale and Claudio Tondo Chapter 10 ICDs in Clinical Trials: Assessment of the Effects of Omega-3 Polyunsaturated Fatty Acids from Fish Oils on Ventricular Tachycardia and Ventricular Fibrillation 155 A. Mirrahimi, L. Chiavaroli, K. Srichaikul, J.L. Sievenpiper, C.W.C. Kendall and D.J.A. Jenkins Chapter 11 Application of the Bispectral Index (BIS) During Deep Sedation for Patients with ICD Testing 163 Małgorzata Kuc, Maciej Kempa, Magdalena A.Wujtewicz, Radosław Owczuk and Maria Wujtewicz Preface Throughout the world, approximately 23 million people suffer from heart failure each year. Of all patients who experience heart failure, the mortality rate due to sudden cardiac death (SCD) is between 28% and 68%. SCD is most often due to ventricular tachycardia (VT) or ventricular fibrillation (VF). To alleviate SCD by VT and VF, one effective and common treatment is the use of implanted cardioverter-defibrillators (ICDs). An ICD is a device that monitors the electrical activity of the user’s heart and delivers an electrical shock upon detecting certain arrhythmias. While ICDs have decreased the number of deaths due to sudden cardiac arrhythmic events, studies suggests that patients with ICDs who receive shocks have a worse prognosis than similar patients who do not receive shocks. These poor projections for patients who receive shocks are spurred by several factors. While the electrical shocks from ICDs save lives, they are also reported to be quite painful. Therefore, patients who have experienced a shock tend to suffer from psychological stress and a lower quality of life afterwards. Furthermore, about one third of ICD patients will experience inappropriate or unnecessary shocks from their ICDs. Inappropriate shocks have been linked to higher mortality rates in ICD patients. Other research suggests that after patients receive a shock, heart failure tends to progress more rapidly. Each of these factors highlights a gap in the body of knowledge relevant to ICDs. Therefore, a significant amount of research and clinical studies are needed to guarantee continued improvement for these devices. One topic worthy of further exploration is the manner in which ICDs detect arrhythmias. At present, many ICDs use timing to classify heart rhythms. As a result, some safe rhythms are indistinguishable from life-threatening rhythms that have the same timing. For example, sinus tachycardia (ST) arrhythmia is safe and occurs during exercises in which the heart rate rises to about 120 beats per minute. On the other hand, ventricular tachycardia (VT) arrhythmia is fatal and occurs at the same heart rate. In spite of similar timing, ST and VT have different morphologies, suggesting that additional detection mechanisms could help avoid unnecessary shocks in ICD patients. X Preface Another question to consider is how defibrillators can be employed to protect low risk patients from SCD. Patients who have a high risk of suffering from SCD are most likely identified by healthcare professionals, and then they receive life-saving ICDs. As a result, the majority of SCD victims are now low-risk patients because they remain unidentified and thus unprotected. A suggested answer to this quandary is to increase public access to defibrillators and to improve real-time, automated training on how to use such devices. More research could also be done to determine ways of preventing shocks in ICD patients. For instance, examining the connection between diet, lifestyle, and ventricular arrhythmias could lead to such prevention. Diets rich in fish oils have shown promise in decreasing the risk of arrhythmatic cardiovascular events. However, to date, only a few studies have examined the use of fish oils to prevent ICD discharge. More studies could be done to increase this body of knowledge. The chapters in this book explore the issues posed above in addition to discussing methods for improving ICDs and answering critical questions about ICD technology. The authors examine determinants for successful defibrillation and assess patients who receive defibrillation. Special cases in ICD patients are also considered along with clinical trials involving patients with defibrillators. The chapters presented herein contain a comprehensive overview of prediction, prevention, and management of cardiovascular events. Joyelle J. Harris, Ph.D. Exponent Failure Analysis Associates Phoenix, Arizona USA