Patient work up – the arrhythmia nurse perspective
Hilary Bugden RN, MScPapworth Hospital
Cambridge
• Proof of concept 2000• Commenced my role in 2003• Patients enrolled in the feasibility study• Initially attracted to the simple, not-in-heart
approach• Concerns regarding comfort and reliability
The early days
• Patient acceptance• Comfort• Effective• Safe removal• Evolving design
Today
Transvenous issues
InfectionLead failure/damageExtraction risksInappropriate therapy (AF)
• 45yr old male with Brugada syndrome• ICD implanted 2006 for primary prevention• No therapies delivered in 9 years• Now presents with Riata lead externalisation• SVC occlusion• Lead extraction with complications
Case study
• Offers protection without those risks• Initially considered only for young people• Now recognised as appropriate for other age
groups• Not only for primary prevention• Either may be suitable
S-ICD
• If either is suitable, they should both be considered and discussed with the patient (if appropriate)
• Principles of the ICD• Pros and cons of each
Patient involvement
• Lead into the heart• Pacing capability• ATP• Smaller device• Lower energy• More widely used
(tried and tested)• Complications more
widely known
Transvenous vs S-ICD
• Lead not touching the heart
• No pacing capability • No ATP• Different position• Unlikely to be awake for
appropriate therapy• Numbers increasing• Still evolving
• Provide information• Be honest and open• Allow discussion• Use resources (booklets, internet, other
ICD patients)• Discuss the role of screening
New technology
• Why not S-ICD?• ‘Might need pacing’• ‘Might benefit from
ATP’• ‘My patient has HCM’• Brugada • ARVC
ICD or S-ICD?
• 47yr old, with HCM• Brother had tranvenous ICD• Implanted in 2010, first DFT successful• Lung surgery• EUR
HCM
• First implant 2009, 63yr old, family history of SCD, Brugada ECG, EUR 2014
• 30yr old with syncope with febrile illness, found to have Brugada ECG
Brugada
• 45yr old recurrent VF arrest on haemodialysis, implanted 2010. Appropriate therapy, recent EUR, good quality of life.
• 22yr old OOHCA probably due to myocarditis, implanted 2010.Fully recovered in 3 years.
Patient progress
• Valuable alternative when seeking a less invasive device
• Avoids the risks associated with leads in the heart
• Suitable for more than just the very young or very sick
• Appropriate as first line therapy option
Conclusion
Thank you
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