Use of Cardiac Pacemakers and Antiarrythmia Devices: ACC/AHA Guidelines Summary
|
|
- Nancy Rodgers
- 5 years ago
- Views:
Transcription
1 A/AHA ardiology Guideline Summaries Volume 101 Number 101 raunwald: Heart Disease: A Textbook of ardiovascular Medicine, 6e. Use of ardiac Pacemakers and Antiarrythmia Devices: A/AHA Guidelines Summary Thomas H. Lee An American ollege of ardiology/american Heart Association (A/ AHA) task force updated guidelines for the implantation of cardiac pacemakers and antiarrhythmia devices in [1] These guidelines evaluate potential indications for the implantation of pacemakers and antiarrhythmic devices. The guidelines use the same system as other guidelines from these organizations; i.e., they divide them into classes according to their appropriateness. lass signifies general agree ment that the device or therapy is indicated. lass indicates a divergence of opinion with respect to their usefulness, with lass a favoring and lass b not favoring usefulness. The level of evidence to support each position is rated on a scale from A to (see Electrocardiography: A/AHA Guidelines Summary), in which "A" indicates that data were derived from multiple randomized trials involving a large number of individuals, "" indicates that data were derived from a limited number of trials involv ing a relatively small number of patients or from well-designed obser vational studies, and "" indicates that expert consensus was the primary source of the recommendation. NDATONS FOR PERMANENT PANG (Table G-1) Acquired Atrioventricular lock For patients with acquired atrioventricular (AV), bifascicular or trifascicular, or sinus node dysfunction, permanent pacing was considered appropri ate when the abnormality caused complications and was not precipi tated by a drug that could be discontinued. Examples of complications include symptomatic bradycardia, congestive heart failure, and confu sional states. Permanent pacing was also deemed appropriate for asymptomatic patients with a high risk for the subsequent develop ment of complications, such as patients with complete heart and periods of asystole of 3 seconds or more or a slow escape rate or patients with bifascicular or trifascicular with intermittent third- degree AV. For patients with first-degree AV who have symptoms sug gestive of pacemaker syndrome, these guidelines include a new indi cation for permanent pacing that is considered equivocal but sup ported by some data (lass a). Patients with pacemaker syndrome need a dual-chamber pacemaker to restore normal AV synchrony. A lass b indication for permanent pacing was described for patients with a prolonged PR interval and drug-refractory dilated cardiomyopa thy if acute hemodynamic studies demonstrate the benefit of pacing. ndications for permanent pacing for patients who do not have symptoms or complications are less certain. n asymptomatic patients, complete heart with a ventricular escape rate of 40 or more beats/min or type seconddegree AV was considered an equivocal (lass a) indication for permanent pacing. ifascicular or trifascicular in patients with syncope was also not a clear indica tion for permanent pacing but was regarded as acceptable if other possible causes of syncope cannot be identified. Pacemakers were explicitly discouraged for patients with mild asymptomatic conduction abnormalities, such as type second-degree AV at the supra- His level, fascicular with no or only a first-degree AV, and sinus node dysfunction. Symptoms do not play as important a role in determination of the appropriateness of permanent pacing in patients with acute myocar dial infarction because of the poor prognosis and high incidence of sudden death in postinfarction patients with conduction system distur bances. The A/AHA task force emphasized that the requirement for temporary pacing after acute myocardial infarction is not in itself an indication for permanent pacing (see Guidelines to hap. 35 for guidelines on temporary pacing in acute myocardial infarction). How ever, permanent pacemakers were considered appropriate for patients with persistent advanced-degree AV or transient infranodal AV and associated bundle branch. The usefulness of electro physiology study to determine the site of was acknowledged. The usefulness of permanent pacemakers for patients with advanced at the AV node was less clear (lass ), but permanent pacing was discouraged if the sole indication was transient AV conduction disturbances or left anterior hemi.
2 The A/AHA guidelines also defined explicit criteria for the ap propriateness of permanent pacing in patients with hypersensitive ca rotid sinus and neurovascular syndromes. The only lass indication was recurrent syncope [2] associated with clear, spontaneous events provoked by carotid sinus stimulation. n such patients, minimal ca rotid sinus pressure should induce asystole of 3 seconds or more in the absence of medications that depress the sinus node. Recommendations were also included for the use of permanent pacemakers for termination of tachyarrhythmias. Antitachycardia de vices include permanent pacemakers that can be programmed to interrupt reentrant arrhythmias or prevent their occurrence, as well as automatic defibrillator devices. The A/AHA guidelines stressed that these devices should be implanted only after careful evaluation by experienced electrophysiologists. Permanent pacemakers were considered appropriate for use for recurrent supraventricular tachycardias in patients who were sympto matic and whose arrhythmias could not be controlled with drug ther apy or catheter ablation. For patients with symptomatic ventricular tachycardia, permanent pacemakers were considered appropriate as part of an automatic defibrillator system. For patients with hypertrophic cardiomyopathy or dilated cardiomy opathy, clearly appropriate indications for permanent pacemakers were similar to those for patients without these conditions. The task force thought there was some evidence to support the use of dual- chamber or right ventricular pacemakers in some patients with medi cally refractory, symptomatic hypertrophic cardiomyopathy and signifi cant resting or provoked left ventricular outflow obstruction (lass b). Similarly, permanent pacemakers for patients with symptomatic, drug- refractory dilated cardiomyopathy with a prolonged PR interval were considered to be possibly appropriate when acute hemodynamic stud ies demonstrated hemodynamic benefit from pacing. For patients who have undergone cardiac transplantation, permanent pacemakers were considered appropriate when the patients had symptomatic bradyar rhythmias that were not expected to resolve. The guidelines offer general recommendations on the type of per manent pacemaker most appropriate for specific patient subsets but noted that technologies are evolving quickly and prospective random ized data are few. TALE G-1 -- A/AHA GUDELNES FOR PERMANENT PANG * ssue lass Recommendation Level of Evidence Permanent pacing in acquired AV Third-degree AV at any anatomical level associated with any one of the following conditions: radycardia with symptoms presumed to be due to AV Arrhythmias and other medical conditions that require drugs that result in symptomatic bradycardia Documented periods of asystole of 3.0 sec or any escape rate of < 40 beats/min in awake, symptom-free patients After catheter ablation of the AV junction Postoperative AV that is not expected to resolve Neuromuscular diseases with AV such as myotonic muscular dystrophy, Kearns- Sayre syndrome, Erb's dystrophy (limb-girdle), and,,
3 TALE G-1 -- A/AHA GUDELNES FOR PERMANENT PANG * ssue lass Recommendation Level of Evidence Permanent pacing in chronic bifascicular and trifascicular a peroneal muscular atrophy Second-degree AV, regardless of the type or site of, with associated symptomatic bradycardia Asymptomatic third-degree AV at any anatomical site with average awake ventricular rates of 40 beats/min or faster Asymptomatic type seconddegree AV Asymptomatic type seconddegree AV at the intra- or infra-his levels found incidentally at electrophysiological study performed for other indications First-degree AV with symptoms suggestive of pacemaker syndrome and documented alleviation of symptoms with temporary AV pacing b Marked first-degree AV (> 0.30 sec) in patients with LV dysfunction and symptoms of congestive heart failure in whom a shorter AV interval results in hemodynamic improvement, presumably by decreasing left atrial filling pressure a Asymptomatic first-degree AV Asymptomatic type 1 seconddegree AV at the supra- His (AV node) level or not known to be intra- or infra- Hisian AV expected to resolve and unlikely to recur (e.g., drug toxicity, Lyme disease) ntermittent third-degree AV Type second-degree AV Syncope not proved to be due to AV when other likely causes have been excluded, specifically VT ncidental finding at electrophysiological study of markedly prolonged H-V interval (> 100 msec) in asymptomatic patients ncidental finding at,,
4 TALE G-1 -- A/AHA GUDELNES FOR PERMANENT PANG * ssue lass Recommendation Level of Evidence Permanent pacing after the acute phase of myocardial infarction Permanent pacing in sinus node dysfunction b a electrophysiological study of a pacing-induced infra-his that is not physiological Fascicular without AV or symptoms Fascicular with firstdegree AV without symptoms Persistent second-degree AV in the His-Purkinje system with a bilateral bundle branch or third-degree AV within or below the His-Purkinje system after acute M Transient advanced (secondor third-degree) infranodal AV and associated bundle branch. f the site of is uncertain, an electrophysiological study may be necessary Persistent and symptomatic second- or third-degree AV Persistent second- or thirddegree AV at the AV node level Transient AV in the absence of intraventricular conduction defects Transient AV in the presence of isolated left anterior fascicular Acquired left anterior in the absence of AV Persistent first-degree AV in the presence of a bundle branch that is old or age indeterminate Sinus node dysfunction with documented symptomatic bradycardia, including frequent sinus pauses that produce symptoms Symptomatic chronotropic incompetence Sinus node dysfunction occurring spontaneously or as a result of necessary drug therapy, with a heart rate of <40 beats/min when a clear association between significant symptoms consistent with bradycardia and the actual presence of bradycardia has
5 TALE G-1 -- A/AHA GUDELNES FOR PERMANENT PANG * ssue lass Recommendation Level of Evidence Permanent pacemakers that automatically detect and pace to terminate tachycardias Pacing indications to prevent tachycardia b b a b not been documented n minimally symptomatic patients, chronic heart rate of less than 30 beats/min while awake Sinus node dysfunction in asymptomatic patients, including those in whom substantial sinus bradycardia (heart rate of <40 beats/min) is a consequence of long-term drug treatment Sinus node dysfunction in patients with symptoms suggestive of bradycardia that are clearly documented as not associated with a slow heart rate Sinus node dysfunction with symptomatic bradycardia from nonessential drug therapy Symptomatic recurrent supraventricular tachycardia that is reproducibly terminated by pacing after drugs and catheter ablation fail to control the arrhythmia or produce intolerable side effects Symptomatic recurrent sustained VT as part of an automatic defibrillator system Recurrent supraventricular tachycardia or atrial flutter that is reproducibly terminated by pacing as an alternative to drug therapy or ablation Tachycardias frequently accelerated or converted to fibrillation by pacing The presence of accessory pathways with the capacity for rapid anterograde conduction regardless of whether the pathways participate in the mechanism of the tachycardia Sustained pause-dependent VT, with or without a prolonged QT, in which the efficacy of pacing is thoroughly documented High-risk patients with congenital long QT syndrome AV reentrant or AV node reentrant supraventricular tachycardia not responsive to medical or ablative therapy
6 TALE G-1 -- A/AHA GUDELNES FOR PERMANENT PANG * ssue lass Recommendation Level of Evidence Permanent pacing in hypersensitive carotid sinus syndrome and neurally mediated syncope Hypertrophic cardiomyopathy a b b Prevention of symptomatic, drug-refractory, recurrent atrial fibrillation Frequent or complex ventricular ectopic activity without sustained VT in the absence of long QT syndrome Long QT syndrome from reversible causes Recurrent syncope caused by carotid sinus stimulation; minimal carotid sinus pressure induces ventricular asystole of >3-sec duration in the absence of any medication that depresses the sinus node or AV conduction Recurrent syncope without clear, provocative events and with a hypersensitive cardioinhibitory response Syncope of unexplained origin when major abnormalities of sinus node function or AV conduction are discovered or provoked in electrophysiological studies Neurally mediated syncope with significant bradycardia reproduced by a head-up tilt with or without isoproterenol or other provocative maneuvers A hyperactive cardioinhibitory response to carotid sinus stimulation in the absence of symptoms A hyperactive cardioinhibitory response to carotid sinus stimulation in the presence of vague symptoms such as dizziness, lightheadedness, or both Recurrent syncope, lightheadedness, or dizziness in the absence of a hyperactive cardioinhibitory response Situational vasovagal syncope in which avoidance behavior is effective lass indications for sinus node dysfunction or AV as previously described Medically refractory, symptomatic hypertrophic cardiomyopathy with significant resting or provoked LV outflow obstruction
7 Dilated cardiomyopathy TALE G-1 -- A/AHA GUDELNES FOR PERMANENT PANG * ssue lass Recommendation Level of Evidence b Patients who are asymptomatic or medically controlled Symptomatic patients without evidence of LV outflow obstruction lass indications for sinus node dysfunction or AV as previously described Symptomatic, drug-refractory dilated cardiomyopathy with a prolonged PR interval when acute hemodynamic studies have demonstrated a hemodynamic benefit of pacing Asymptomatic dilated cardiomyopathy Symptomatic dilated cardiomyopathy when patients are rendered asymptomatic by drug therapy Symptomatic ischemic cardiomyopathy ardiac transplantation Symptomatic bradyarrhythmias/chronotropic incompetence not expected to resolve and other lass indications for permanent pacing AV = atrioventricular; LV = left ventricular; M = myocardial infarction; VF = ventricular fibrillation; VT = ventricular tachycardia. From Gregoratos G, heitlin M, onill A, et al: A/AHA guidelines for implantation of cardiac pacemakers and antiarrhythmia devices. A report of the American ollege of ardiology/american Heart Association Task Force on Practice Guidelines (ommittee on Pacemaker mplantation). J Am oll ardiol 31: , *For definition of classes and levels of evidence, see guildelines AHA/A guidelines for Electrocardiography. MPLANTALE ARDOVERTER-DEFRLLATOR THERAPY The enthusiasm for implanting cardioverter-defibrillator devices has been increasing because of disappointing data on the lack of impact of antiarrhythmic medications on survival and data showing low rates of sudden cardiac death and improved quality of life after device implantation. mplantable cardioverter-defibrillators (Ds) can be combined with drug therapy or ablation techniques applied at surgery or percutaneously via catheter techniques. Ablation techniques are in particularly rapid evolution, which hinders the ability to develop formal guidelines for their appropriateness and relative merits in comparison to alternative strategies. Ds are now regarded as clearly appropriate therapy for patients who have had cardiac arrest as a result of ventricular fibrillation or ventricular tachycardia without a transient or reversible cause, as well as for patients with spontaneous sustained ventricular tachycardia (Table G-2). The A/AHA guidelines consider Ds appropriate for patients who have electrophysiological studies that suggest ar rhythmia as a likely cause of syncope and other patients with high- risk electrophysiology tests. Ds are not recommended by the A/AHA task force for sev eral groups, including the following: a) Patients for whom a reversible triggering factor for arrhythmia can be identified, such as evolving myocardial infarction or elec trolyte abnormalities.
8 b) Patients with coronary disease without inducible or spontaneous ventricular tachycardia who are undergoing routine coronary ar tery bypass graft surgery. c) Patients with Wolff-Parkinson-White syndrome and ventricular fibrillation secondary to atrial fibrillation. (These patients should undergo catheter or surgical ablation if their accessory pathways are amenable to such treatment.) d) Patients with frequent tachyarrhythmias that may trigger shock therapy. TALE G-2 -- A/AHA GUDELNES FOR MPLANTALE ARDOVERTER-DEFRLLATOR THERAPY * lass Recommendation Level of Evidence b ardiac arrest due to VF or VT not due to a transient or reversible cause Spontaneous sustained VT Syncope of undetermined origin with clinically relevant, hemodynamically significant sustained VT or VF induced at electrophysiological study when drug therapy is ineffective, not tolerated, or not preferred Nonsustained VT with coronary disease, prior M, LV dysfunction, and inducible VF or sustained VT at electrophysiological study that is not suppressible by a class antiarrhythmic drug ardiac arrest presumed to be due to VF when electrophysiological testing is precluded by other medical conditions Severe symptoms attributable to sustained ventricular tachyarrhythmias while awaiting cardiac transplantation Familial or inherited conditions with a high risk for life-threatening ventricular tachyarrhythmias such as long QT syndrome or hypertrophic cardiomyopathy Nonsustained VT with coronary artery disease, prior M, and LV dysfunction and inducible sustained VT or VF at electrophysiological study Recurrent syncope of undetermined etiology in the presence of ventricular dysfunction and inducible ventricular arrhythmias at electrophysiological study when other causes of syncope have been excluded Syncope of undetermined cause in a patient without inducible ventricular tachyarrhythmias ncessant VT or VF LV = left ventricular; M = myocardial infarction; VF = ventricular fibrillation; VT = ventricular tachycardia. From Gregoratos G, heitlin M, onill A, et al: A/AHA guidelines for implantation of cardiac pacemakers and antiarrhythmia devices. A report of the American ollege of ardiology/american Heart Association Task Force on Practice Guidelines (ommittee on Pacemaker mplantation). J Am oll ardiol 31: , *For definition of classes and levels of evidence, see guildelines AHA/A guidelines for Electrocardiography. A References 1. Gregoratos G, heitlin M, onill A, et al: A/AHA guidelines for implanta tion of cardiac pacemakers and antiarrhythmia devices. A report of the Amer ican ollege of ardiology/american Heart Association Task Force on Prac tice Guidelines (ommittee on Pacemaker mplantation). J Am oll ardiol 31: , onnolly SJ, Sheldon R, Roberts RS, Gent M: The North American Vasova gal Pacemaker Study (VPS): A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am oll ardiol 36:16-20, 1999.
Indications for Permanent Pacing Joe Gallinghouse, M.D. Texas Cardiac Arrhythmia Austin, Texas
Indications for Permanent Pacing Joe Gallinghouse, M.D. Texas Cardiac Arrhythmia Austin, Texas Remember the Suture! Impulse Formation and Conduction Disturbances Cardiac Electrical Anatomy Sinoatrial Node
More informationPractice Guideline: Executive Summary
Practice Guideline: Executive Summary Practice Guideline: Executive Summary ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: Executive Summary A Report of the American
More informationIHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT JANUARY 24, 2012
IHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT201203 JANUARY 24, 2012 The IHCP to reimburse implantable cardioverter defibrillators separately from outpatient implantation Effective March 1, 2012, the
More informationNational Coverage Determination (NCD) for Cardiac Pacemakers (20.8)
Page 1 of 12 Centers for Medicare & Medicaid Services National Coverage Determination (NCD) for Cardiac Pacemakers (20.8) Tracking Information Publication Number 100-3 Manual Section Number 20.8 Manual
More informationInterQual Care Planning SIM plus Criteria 2014 Clinical Revisions
InterQual Care Planning SIM plus Criteria 2014 Clinical Revisions The Clinical Revisions provide details of changes to InterQual Clinical Criteria. They do not provide information on changes made to CareEnhance
More informationPediatrics. Arrhythmias in Children: Bradycardia and Tachycardia Diagnosis and Treatment. Overview
Pediatrics Arrhythmias in Children: Bradycardia and Tachycardia Diagnosis and Treatment See online here The most common form of cardiac arrhythmia in children is sinus tachycardia which can be caused by
More informationThe current update of the ACC/AHA/NASPE Guidelines
ACC/AHA/NASPE Practice Guidelines ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Summary Article A Report of the American College of Cardiology/American
More informationGuidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices
JACC Vol. 18, No. I Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices A Report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic
More informationAHA Medical/Scientific Statement
AHA Medical/Scientific Statement Special Report Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices A Report of the American College of Cardiology/ American Heart Association Task
More informationChapter 16: Arrhythmias and Conduction Disturbances
Complete the following. Chapter 16: Arrhythmias and Conduction Disturbances 1. Cardiac arrhythmias result from abnormal impulse, abnormal impulse, or both mechanisms together. 2. is the ability of certain
More informationACC/AHA Guidelines for Ambulatory Electrocardiography: Executive Summary and Recommendations
(Circulation. 1999;100:886-893.) 1999 American Heart Association, Inc. ACC/AHA Practice Guidelines ACC/AHA Guidelines for Ambulatory Electrocardiography: Executive Summary and Recommendations A Report
More informationEHRA Accreditation Exam - Sample MCQs Cardiac Pacing and ICDs
EHRA Accreditation Exam - Sample MCQs Cardiac Pacing and ICDs Dear EHRA Member, Dear Colleague, As you know, the EHRA Accreditation Process is becoming increasingly recognised as an important step for
More informationVentricular tachycardia Ventricular fibrillation and ICD
EKG Conference Ventricular tachycardia Ventricular fibrillation and ICD Samsung Medical Center CCU D.I. Hur Ji Won 2006.05.20 Ventricular tachyarrhythmia ventricular tachycardia ventricular fibrillation
More informationClinical Policy: Holter Monitors Reference Number: CP.MP.113
Clinical Policy: Reference Number: CP.MP.113 Effective Date: 05/18 Last Review Date: 04/18 Coding Implications Revision Log Description Ambulatory electrocardiogram (ECG) monitoring provides a view of
More informationDeath after Syncope: Can we predict it? Daniel Zamarripa, MD Senior Medical Director December 2013
Death after Syncope: Can we predict it? Daniel Zamarripa, MD Senior Medical Director December 2013 Death after Syncope: Can we predict it? Those who suffer from frequent and severe fainting often die suddenly
More informationCardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition
Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Table of Contents Volume 1 Chapter 1: Cardiovascular Anatomy and Physiology Basic Cardiac
More informationClinical Cardiac Electrophysiology
Clinical Cardiac Electrophysiology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of
More informationChapter 9. Learning Objectives. Learning Objectives 9/11/2012. Cardiac Arrhythmias. Define electrical therapy
Chapter 9 Cardiac Arrhythmias Learning Objectives Define electrical therapy Explain why electrical therapy is preferred initial therapy over drug administration for cardiac arrest and some arrhythmias
More informationCardiac Pacemakers» 2013 HOSPITAL REIMBURSEMENT GUIDE
Cardiac Pacemakers» 2013 HOSPITAL REIMBURSEMENT GUIDE 2 Contents Page Introduction Medicare Coding and Payment Overview Hospital Inpatient Hospital Outpatient HCPCS Device Category C-Codes Coverage for
More informationRevisions to the BC Guide for Physicians in Determining Fitness to Drive a Motor Vehicle
Revisions to the BC Guide for Physicians in Determining Fitness to Drive a Motor Vehicle Thank you for taking the time to review the draft Cardiovascular Diseases and Disorders chapter. Please provide
More informationDifferent indications for pacemaker implantation are the following:
Patient Resources: ICD/Pacemaker Overview ICD/Pacemaker Overview What is a pacemaker? A pacemaker is a device that uses low energy electrical pulses to prompt the heart to beat whenever a pause in the
More informationArrhythmias Focused Review. Who Needs An ICD?
Who Needs An ICD? Cesar Alberte, MD, Douglas P. Zipes, MD, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN Sudden cardiac arrest is one of the most common causes
More informationArrhythmia Management Joshua M. Cooper, MD, FHRS, FACC
Arrhythmia Management Joshua M. Cooper, MD, FHRS, FACC Professor of Medicine Director of Cardiac Electrophysiology Temple University Health System Plumbing Electrical System Bradyarrhythmias Sinus Node
More informationConduction disorders
Conduction disorders L.V. Bogun, N.I. Yabluchansky, F.M. Abdueva, O.Y. Bichkova, A.N. Fomich, P.A. Garkavyi, A.L. Kulik, N.V. Lysenko, N.V. Makienko, L.A. Martimyanova, I.V. Soldatenko, E.E. Tomina Department
More informationCLINICAL CARDIAC ELECTROPHYSIOLOGY Maintenance of Certification (MOC) Examination Blueprint
CLINICAL CARDIAC ELECTROPHYSIOLOGY Maintenance of Certification (MOC) Examination Blueprint ABIM invites diplomates to help develop the Clinical Cardiac Electrophysiology MOC exam blueprint Based on feedback
More informationStep by step approach to EKG rhythm interpretation:
Sinus Rhythms Normal sinus arrhythmia Small, slow variation of the R-R interval i.e. variation of the normal sinus heart rate with respiration, etc. Sinus Tachycardia Defined as sinus rhythm with a rate
More information2016 NIA Clinical Guidelines for Medical Necessity Review HORIZON NJ CARDIAC MANAGEMENT
2016 for Medical Necessity Review HORIZON NJ CARDIAC MANAGEMENT 2016 Magellan Health, Inc. Proprietary Page 1 of 58 Guidelines for Clinical Review Determination Preamble NIA is committed to the philosophy
More informationEmergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: WPW Revised: 11/2013
Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: WPW Revised: 11/2013 Wolff-Parkinson-White syndrome (WPW) is a syndrome of pre-excitation of the
More informationCardiac Implanted Electronic Devices Pacemakers, Defibrillators, Cardiac Resynchronization Devices, Loop Recorders, etc.
Cardiac Implanted Electronic Devices Pacemakers, Defibrillators, Cardiac Resynchronization Devices, Loop Recorders, etc. The Miracle of Living February 21, 2018 Matthew Ostrom MD,FACC,FHRS Division of
More informationPERMANENT PACEMAKERS AND IMPLANTABLE DEFIBRILLATORS Considerations for intensivists
PERMANENT PACEMAKERS AND IMPLANTABLE DEFIBRILLATORS Considerations for intensivists Craig A. McPherson, MD, FACC Associate Professor of Medicine Constantine Manthous, MD, FACP, FCCP Associate Clinical
More informationParoxysmal Supraventricular Tachycardia PSVT.
Atrial Tachycardia; is the name for an arrhythmia caused by a disorder of the impulse generation in the atrium or the AV node. An area in the atrium sends out rapid signals, which are faster than those
More informationAutomatic External Defibrillators
Last Review Date: April 21, 2017 Number: MG.MM.DM.10dC3v4 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure (review
More informationNEIL CISPER TECHNICAL FIELD ENGINEER ICD/CRTD BASICS
NEIL CISPER TECHNICAL FIELD ENGINEER ICD/CRTD BASICS OBJECTIVES Discuss history of ICDs Review the indications for ICD and CRT therapy Describe basic lead and device technology Discuss different therapies
More informationAtrioventricular Block
emedicine.medscape.com emedicine Specialties > Cardiology > Arrhythmias Atrioventricular Block Chirag M Sandesara, MD, Fellow, Department of Internal Medicine, Division of Cardiovascular Diseases, University
More informationRhythm Control: Is There a Role for the PCP? Blake Norris, MD, FACC BHHI Primary Care Symposium February 28, 2014
Rhythm Control: Is There a Role for the PCP? Blake Norris, MD, FACC BHHI Primary Care Symposium February 28, 2014 Financial disclosures Consultant Medtronic 3 reasons to evaluate and treat arrhythmias
More informationCardiac Considerations and Care in Children with Neuromuscular Disorders
Cardiac Considerations and Care in Children with Neuromuscular Disorders - importance of early and ongoing treatment, management and available able medications. Dr Bo Remenyi Department of Cardiology The
More informationKNOW YOUR ECG. G. Somasekhar MD DM FEp Consultant Electro physiologist, Aayush Hospital, Vijayawada
KNOW YOUR ECG G. Somasekhar MD DM FEp Consultant Electro physiologist, Aayush Hospital, Vijayawada CASE DETAILS A 48-year-old female non hypertensive, non diabetic presented with history of shortness of
More informationClinical Results with the Dual-Chamber Cardioverter Defibrillator Phylax AV - Efficacy of the SMART I Discrimination Algorithm
April 2000 107 Clinical Results with the Dual-Chamber Cardioverter Defibrillator Phylax AV - Efficacy of the SMART I Discrimination Algorithm B. MERKELY Semmelweis University, Dept. of Cardiovascular Surgery,
More informationUNDERSTANDING YOUR ECG: A REVIEW
UNDERSTANDING YOUR ECG: A REVIEW Health professionals use the electrocardiograph (ECG) rhythm strip to systematically analyse the cardiac rhythm. Before the systematic process of ECG analysis is described
More informationCATHETER ABLATION FOR TACHYCARDIAS
190 CATHETER ABLATION FOR TACHYCARDIAS MASOOD AKHTAR, M.D. T ACHY ARRHYTHMIAS constitute a major cause of mortality and morbidity. The most serious manifestation of cardiac arrhythmia is sudden cardiac
More informationBradyarrhythmias are frequently
Bradyarrhythmias, temporary and permanent pacing Vineet Kaushik, MD; Angel R. Leon, MD; James S. Forrester Jr, MD; Richard G. Trohman, MD Bradycardia is common in critical care units. It may be transient,
More informationIntraoperative and Postoperative Arrhythmias: Diagnosis and Treatment
Intraoperative and Postoperative Arrhythmias: Diagnosis and Treatment Karen L. Booth, MD, Lucile Packard Children s Hospital Arrhythmias are common after congenital heart surgery [1]. Postoperative electrolyte
More informationTachycardia Devices Indications and Basic Trouble Shooting
Tachycardia Devices Indications and Basic Trouble Shooting Peter A. Brady, MD., FRCP Cardiology Review Course London, March 6 th, 2014 2011 MFMER 3134946-1 Tachycardia Devices ICD Indications Primary and
More informationPATIENT WITH ARRHYTHMIA IN DENTIST S OFFICE. Małgorzata Kurpesa, MD., PhD. Chair&Department of Cardiology
PATIENT WITH ARRHYTHMIA IN DENTIST S OFFICE Małgorzata Kurpesa, MD., PhD. Chair&Department of Cardiology Medical University of Łódź The heart is made up of four chambers Left Atrium Right Atrium Left Ventricle
More informationMEDICAL POLICY Cardioverter Defibrillators
POLICY........ PG-0224 EFFECTIVE......06/01/09 LAST REVIEW... 01/27/17 MEDICAL POLICY Cardioverter Defibrillators GUIDELINES This policy does not certify benefits or authorization of benefits, which is
More informationImproving Patient Outcomes with a Syncope Center. Suneet Mittal, MD
Improving Patient Outcomes with a Syncope Center Suneet Mittal, MD Improving Patient Outcomes with a Syncope Center: Early Risk Stratification of Patients who Require Device Therapy Suneet Mittal, MD Director,
More informationARRHYTHMIAS IN THE ICU
ARRHYTHMIAS IN THE ICU Nora Goldschlager, MD MACP, FACC, FAHA, FHRS SFGH Division of Cardiology UCSF IDENTIFIED VARIABLES IN ARRHYTHMOGENESIS Ischemia/infarction (scar) Electrolyte imbalance Proarrhythmia
More informationARRHYTHMIAS IN THE ICU: DIAGNOSIS AND PRINCIPLES OF MANAGEMENT
ARRHYTHMIAS IN THE ICU: DIAGNOSIS AND PRINCIPLES OF MANAGEMENT Nora Goldschlager, M.D. MACP, FACC, FAHA, FHRS SFGH Division of Cardiogy UCSF CLINICAL VARIABLES IN ARRHYTHMOGENESIS Ischemia/infarction (scar)
More informationTitle: Automatic External Defibrillators Division: Medical Management Department: Utilization Management
Retired Date: Page 1 of 7 1. POLICY DESCRIPTION: Automatic External Defibrillators 2. RESPONSIBLE PARTIES: Medical Management Administration, Utilization Management, Integrated Care Management, Pharmacy,
More informationClinical Case 1 A patient with a syncope Panos E. Vardas President Elect of the ESC, Prof of Cardiology, University Hospital of Crete
Clinical Case 1 A patient with a syncope Panos E. Vardas President Elect of the ESC, Prof. of Cardiology, University Hospital of Crete Case presentation A 64-year-old male smoker, with arterial hypertension
More informationUNDERSTANDING ELECTROPHYSIOLOGY STUDIES
UNDERSTANDING ELECTROPHYSIOLOGY STUDIES Testing and Treating Your Heart s Electrical System A Problem with Your Heart Rhythm The speed and pattern of a heartbeat is called the heart rhythm. The rhythm
More informationAntiarrhythmic Drugs
Antiarrhythmic Drugs DR ATIF ALQUBBANY A S S I S T A N T P R O F E S S O R O F M E D I C I N E / C A R D I O L O G Y C O N S U L T A N T C A R D I O L O G Y & I N T E R V E N T I O N A L E P A C H D /
More informationUnusual Tachycardia Association In A patient Without Structural Heart Disease
www.ipej.org 233 Case Report Unusual Tachycardia Association In A patient Without Structural Heart Disease Eduardo Arana-Rueda, Alonso Pedrote, Lorena Garcia-Riesco, Manuel Frutos-Lopez, Juan A. Sanchez-Brotons
More informationHatim Al Lawati. MD, FRCPC, DABIM(CV), FACC
Hatim Al Lawati. MD, FRCPC, DABIM(CV), FACC Consultant Interventional Cardiology & Structural Heart Disease Department of Medicine Sultan Qaboos University Hospital hatim.al.lawati@gmail.com April 2017
More informationSince the first permanent pacemaker
Indications and Recommendations for Pacemaker Therapy GABRIEL GREGORATOS, M.D., University of California, San Francisco, School of Medicine, San Francisco, California Each year, pacemaker therapy is prescribed
More informationArrhythmic Complications of MI. Teferi Mitiku, MD Assistant Clinical Professor of Medicine University of California Irvine
Arrhythmic Complications of MI Teferi Mitiku, MD Assistant Clinical Professor of Medicine University of California Irvine Objectives Brief overview -Pathophysiology of Arrhythmia ECG review of typical
More informationAHA/ACC Scientific Statement
AHA/ACC Scientific Statement Eligibility and Disqualification for Competitive Athletes With Cardiovascular Abnormalities: Task Force 9: Arrhythmias and Conduction Defects A Scientific Statement From the
More informationSyncope: Evaluation of the Weak and Dizzy
Syncope: Evaluation of the Weak and Dizzy William M. Miles, MD, FACC, FHRS Professor of Medicine Silverstein Chair for Cardiovascular Education University of Florida College of Medicine Disclosures Medtronic,
More informationThe Therapeutic Role of the Implantable Cardioverter Defibrillator in Arrhythmogenic Right Ventricular Dysplasia
The Therapeutic Role of the Implantable Cardioverter Defibrillator in Arrhythmogenic Right Ventricular Dysplasia By Sandeep Joshi, MD and Jonathan S. Steinberg, MD Arrhythmia Service, Division of Cardiology
More informationAppendix D Output Code and Interpretation of Analysis
Appendix D Output Code and Interpretation of Analysis 8 Arrhythmia Code No. Description 8002 Marked rhythm irregularity 8110 Sinus rhythm 8102 Sinus arrhythmia 8108 Marked sinus arrhythmia 8120 Sinus tachycardia
More informationSyncope: Evaluation of the Weak and Dizzy
Syncope: Evaluation of the Weak and Dizzy William M. Miles, MD, FACC, FHRS Professor of Medicine Silverstein Chair for Cardiovascular Education University of Florida College of Medicine Disclosures Medtronic,
More informationMANAGEMENT OF ASYMPTOMATIC BRADYCARDIA. Pr. HABIB HAOUALA Service de Cardiologie Hôpital militaire de Tunis
MANAGEMENT OF ASYMPTOMATIC BRADYCARDIA Pr. HABIB HAOUALA Service de Cardiologie Hôpital militaire de Tunis DISCLOSURE STATEMENT OF FINANCIAL INTEREST Grant/research: Medtronic;Sanofi; Novartis Consulting
More informationRepetitive narrow QRS tachycardia in a 61-year-old female patient with recent palpitations
Journal of Geriatric Cardiology (2018) 15: 193 198 2018 JGC All rights reserved; www.jgc301.com Case Report Open Access Repetitive narrow QRS tachycardia in a 61-year-old female patient with recent palpitations
More informationTGA atrial vs arterial switch what do we need to look for and how to react
TGA atrial vs arterial switch what do we need to look for and how to react Folkert Meijboom, MD, PhD, FES Dept ardiology University Medical entre Utrecht The Netherlands TGA + atrial switch: Follow-up
More informationRecurrent Implantable Defibrillator Discharges (ICD) Discharges ICD Storm
Recurrent Implantable Defibrillator Discharges (ICD) Discharges ICD Storm Guy Amit, MD, MPH Soroka University Medical Center Ben-Gurion University of the Negev Beer-Sheva, Israel Disclosures Consultant:
More informationThe ECG Course. Boone County Fire Protection District EMS Education
The ECG Course Level I G rated material AV Blocks What Causes AV Block? Long list of bad things that includes ischemia and.. Old age / disease Medications or drugs Electrolyte imbalances Physiologic Blocks
More informationCURRICULUM GOALS AND OBJECTIVES CLINICAL CARDIOVASCULAR ELECTROPHYSIOLOGY TRAINING PROGRAM. University of Florida Gainesville, Florida
CURRICULUM GOALS AND OBJECTIVES CLINICAL CARDIOVASCULAR ELECTROPHYSIOLOGY TRAINING PROGRAM University of Florida Gainesville, Florida 1. Mission Statement To achieve excellence in the training of fourth
More informationAF Today: W. For the majority of patients with atrial. are the Options? Chris Case
AF Today: W hat are the Options? Management strategies for patients with atrial fibrillation should depend on the individual patient. Treatment with medications seems adequate for most patients with atrial
More informationPractice Guidelines: Full Text
Practice Guidelines: Full Text Practice Guidelines: Full Text ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities A Report of the American College of Cardiology/American
More information1 Cardiology Acute Care Day 22 April 2013 Arrhythmia Tutorial Course Material
1 Cardiology Acute Care Day 22 April 2013 Arrhythmia Tutorial Course Material Arrhythmia recognition This tutorial builds on the ECG lecture and provides a framework for approaching any ECG to allow the
More informationthat number is extremely high. It s 16 episodes, or in other words, it s 14, one-four, ICD shocks per patient per day.
Doctor Karlsner, Doctor Schumosky, ladies and gentlemen. It s my real pleasure to participate in this session on controversial issues in the management of ventricular tachycardia and I m sure that will
More informationPEDIATRIC SVT MANAGEMENT
PEDIATRIC SVT MANAGEMENT 1 INTRODUCTION Supraventricular tachycardia (SVT) can be defined as an abnormally rapid heart rhythm originating above the ventricles, often (but not always) with a narrow QRS
More informationTEST BANK FOR ECGS MADE EASY 5TH EDITION BY AEHLERT
Link download full: http://testbankair.com/download/test-bank-for-ecgs-made-easy-5thedition-by-aehlert/ TEST BANK FOR ECGS MADE EASY 5TH EDITION BY AEHLERT Chapter 5 TRUE/FALSE 1. The AV junction consists
More informationDiploma in Electrocardiography
The Society for Cardiological Science and Technology Diploma in Electrocardiography The Society makes this award to candidates who can demonstrate the ability to accurately record a resting 12-lead electrocardiogram
More informationAn Approach to the Patient with Syncope. Guy Amit MD, MPH Soroka University Medical Center Beer-Sheva
An Approach to the Patient with Syncope Guy Amit MD, MPH Soroka University Medical Center Beer-Sheva Case presentation A 23 y.o. man presented with 2 episodes of syncope One during exercise,one at rest
More informationICD-9-CM Expert. for Payers Volumes 1, 2 & 3. International Classification of Diseases 9th Revision Clinical Modification.
ICD-9-CM Expert for Payers Volumes 1, 2 & 3 International Classification of Diseases 9th Revision Clinical Modification Sixth Edition Edited by: Anita C. Hart, RHIA, S, S-P Catherine A. Hopkins Beth Ford,
More informationAmbulatory Cardiac Monitors and Outpatient Telemetry Corporate Medical Policy
Ambulatory Cardiac Monitors and Outpatient Telemetry Corporate Medical Policy File Name: Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry File Code: UM.SPSVC.13 Origination: 10/2015 Last
More informationCMS Limitations Guide - Cardiovascular Services
CMS Limitations Guide - Cardiovascular Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations
More informationAsymptomatic WPW Syndrome; Observation or Ablation? 전남대학교병원순환기내과 박형욱
Asymptomatic WPW Syndrome; Observation or Ablation? 전남대학교병원순환기내과 박형욱 Let It Be? Vs. Just Do It? Natural history of asymptomatic WPW Incidence of sudden cardiac death in natural history studies involving
More informationImplantable Cardioverter Defibrillator (ICD)
Medical Coverage Policy Effective Date... 3/15/2018 Next Review Date... 3/15/2019 Coverage Policy Number... 0181 Implantable Cardioverter Defibrillator (ICD) Table of Contents Related Coverage Resources
More informationFigure 2. Normal ECG tracing. Table 1.
Figure 2. Normal ECG tracing that navigates through the left ventricle. Following these bundle branches the impulse finally passes to the terminal points called Purkinje fibers. These Purkinje fibers are
More informationCardiac Arrhythmias. Cathy Percival, RN, FALU, FLMI VP, Medical Director AIG Life and Retirement Company
Cardiac Arrhythmias Cathy Percival, RN, FALU, FLMI VP, Medical Director AIG Life and Retirement Company The Cardiovascular System Three primary functions Transport of oxygen, nutrients, and hormones to
More informationRemote Monitoring & the Smart Home of the 21 Century
Cardiostim EHRA Europace 2016, Nice - June 8-11, 2016 Remote Monitoring & the Smart Home of the 21 Century Antonio Raviele, MD, FESC, FHRS President ALFA -Alliance to Fight Atrial fibrillation- Venezia
More information2) Heart Arrhythmias 2 - Dr. Abdullah Sharif
2) Heart Arrhythmias 2 - Dr. Abdullah Sharif Rhythms from the Sinus Node Sinus Tachycardia: HR > 100 b/m Causes: o Withdrawal of vagal tone & Sympathetic stimulation (exercise, fight or flight) o Fever
More informationSupraventricular Tachycardia: From Fetus to Adult. Mohamed Hamdan, MD
Supraventricular Tachycardia: From Fetus to Adult Mohamed Hamdan, MD Learning Objectives Define type of SVT by age Describe clinical approach Describe prenatal and postnatal management of SVT 2 SVT Across
More informationNathan Cade, MD Brandon Fainstad, MD Andrew Prouse, MD
Nathan Cade, MD Brandon Fainstad, MD Andrew Prouse, MD OBJECTIVES 1. Identify the basic electrophysiology of the four causes of wide complex tachycardia. 2. Develop a simple framework for acute management
More informationTachycardias II. Štěpán Havránek
Tachycardias II Štěpán Havránek Summary 1) Supraventricular (supraventricular rhythms) Atrial fibrillation and flutter Atrial ectopic tachycardia / extrabeats AV nodal reentrant a AV reentrant tachycardia
More informationSupplementary Online Content
Supplementary Online Content Wahbi K, Meune C, Porcher R, et al. Electrophysiological study with prophylactic pacing and survival in adults with myotonic dystrophy and conduction system disease. JAMA.
More informationSudden cardiac death: Primary and secondary prevention
Sudden cardiac death: Primary and secondary prevention By Kai Chi Chan Penultimate Year Medical Student St George s University of London at UNic Sheba Medical Centre Definition Sudden cardiac arrest (SCA)
More informationPediatrics ECG Monitoring. Pediatric Intensive Care Unit Emergency Division
Pediatrics ECG Monitoring Pediatric Intensive Care Unit Emergency Division 1 Conditions Leading to Pediatric Cardiology Consultation 12.7% of annual consultation Is arrhythmias problems Geggel. Pediatrics.
More informationSynopsis of Management on Ventricular arrhythmias. M. Soni MD Interventional Cardiologist
Synopsis of Management on Ventricular arrhythmias M. Soni MD Interventional Cardiologist No financial disclosure Premature Ventricular Contraction (PVC) Ventricular Bigeminy Ventricular Trigeminy Multifocal
More information-RHYTHM PRACTICE- By Dr.moanes Msc.cardiology Assistant Lecturer of Cardiology Al Azhar University. OBHG Education Subcommittee
-RHYTHM PRACTICE- By Dr.moanes Msc.cardiology Assistant Lecturer of Cardiology Al Azhar University The Normal Conduction System Sinus Node Normal Sinus Rhythm (NSR) Sinus Bradycardia Sinus Tachycardia
More informationSeek and Ye Shall Find: Surprising Findings When Using the ILR-LINQ
Seek and Ye Shall Find: Surprising Findings When Using the ILR-LINQ Suneet Mittal, MD, FACC, FHRS Director, Electrophysiology Laboratory Valley Health System www.arrhythmia.org; @drsuneet October 31, 2015
More informationEKG Abnormalities. Adapted from:
EKG Abnormalities Adapted from: http://www.bem.fi/book/19/19.htm Some key terms: Arrhythmia-an abnormal rhythm or sequence of events in the EKG Flutter-rapid depolarizations (and therefore contractions)
More informationLa strategia diagnostica: il monitoraggio ecg prolungato. Michele Brignole
La strategia diagnostica: il monitoraggio ecg prolungato Michele Brignole ECG monitoring and syncope In-hospital monitoring Holter Monitoring External loop recorder Remote (at home) telemetry Implantable
More informationPRACTICE GUIDELINE: FULL TEXT. Andrew E. Epstein, MD, FACC, FAHA, FHRS, Chair*
Journal of the American College of Cardiology Vol. 51, No. 21, 2008 2008 by the American College of Cardiology Foundation, the American Heart Association, Inc., and the Heart Rhythm Society ISSN 0735-1097/08/$36.00
More informationWhat Every Physician Should Know:
What Every Physician Should Know: The Canadian Heart Rhythm Society estimates that, in Canada, sudden cardiac death (SCD) is responsible for about 40,000 deaths annually; more than AIDS, breast cancer
More informationTACHYARRHYTHMIAs. Pawel Balsam, MD, PhD
TACHYARRHYTHMIAs Pawel Balsam, MD, PhD SupraVentricular Tachycardia Atrial Extra Systole Sinus Tachycardia Focal A. Tachycardia AVRT AVNRT Atrial Flutter Atrial Fibrillation Ventricular Tachycardia Ventricular
More information13/09/2018. The ISSUE Studies. International (Italy & Spain) Study of Syncope of Uncertain Etiology. ISSUE study Pre-defined inclusion cathegories
The Studies Jean-Claude Deharo Aix-Marseille Université, France In Cardiac Electrophysiology Methods and Models Editors: Daniel C. Sigg, Paul A. Iaizzo, Yong-Fu Xiao, Bin He Springer 2010 study Pre-defined
More information