Nearly six months have passed since “emergency†meetings were called. Gosh, if I had a dollar for every emergency meeting. It’s amazing how looking back at these crises makes our angst seem silly. Like many things medical, time and deep breaths have a way of sorting things out. The latest heart-rhythm crisis centered on the […]
Category: ICD/Pacemaker
Heart rhythm doctoring made news again. This time it was a WSJ report on CRT—cardiac resynchronization therapy. What is CRT? (Briefly) CRT devices, formerly known as bi-ventricular devices, involve placing an extra lead in a vein branch of the left ventricle at the time of pacemaker or ICD implantation. The extra lead allows the right […]
Guess what made the heart rhythm news wire yesterday? It wasn’t a new medicine, or a new stent, not even a new ablation catheter, and, it surely wasn’t a revolution in motivating people to exercise. It was words. Rhetoric… It seems that one man, Dr John Wilson, read all of the major ICD trials, dating […]
There are few other medical specialties that boast more guidelines than Cardiology. We don’t say a specific treatment plan was good or bad; we say it was “I, IIa, IIb, or III” Today, a well publicized health story (WSJ, and NY Times) from the Archives of Internal Medicine reported that more than 50 percent of […]
Whenever someone asks about the cost of an ICD (Implantable Cardiac Defibrillator), an image pops into my brain. The image that I see is how the ICD gets handed to me during the implant surgery. Imagine: Careful. Cautious. Consider how you would pass your new brand new iPad 2 to a friend, then multiply that […]
My friend called to tell me what happened. His voice cracked. Jim thought that it was a normal Sunday morning ride. He was meeting his friends, and they were riding their normal route, on roads called Covered Bridge, Sleepy Hollow and Wolf Pen Branch. It was one of those Sunday mornings in Kentucky that makes […]
Protocols and mandates cannot govern all of medical practice. Few better examples of cookbook failure exist than the decision-making surrounding the Medtronic Sprint Fidelis lead. You may know the story already. Here’s my brief summary: In the early 2000’s, Medtronic released a family of defibrillator leads that were promoted as thinner and easier to maneuver. […]
For some patients it’s a terrible sensation; they are left scared and persistently anxious. For others it’s just a thump in the chest. But for nearly all patients shocked by their ICD (internal cardiac defibrillator), it means they are still alive. Today was a sad day for electrophysiology–a branch of cardiology that has the prevention […]
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Are ICDs overused?
The medical news of the week nearly shocked me off my bike trainer. It isn’t often that electrophysiology makes the major-network evening news broadcast. The teaser proclaimed…“thousands of heart patients have unnecessary expensive cardiac devices…Should they be removed?” They were talking about ICDs (internal cardiac defibrillators), and were referring to the widely publicized JAMA study […]
As the commenters correctly pointed out, this Sunday’s case involving the patient with recurrent syncope is indeed polymorphic ventricular tachycardia–aptly named torsades de pointes (‘twisting of the points’). TDP is associated with prolongation of the QT interval, and pause-dependent PVCs (and VT). A serious malady indeed. ICD evaluation showed hundreds of these episodes The initial ECG strengthened […]
This year’s American Heart Association (AHA) meeting is brimming with news. Since the WSJ had ICD devices in its corporate news section today, it seems a good place to start. Here is the summary: (The short version) According to the RAFT study, patients who are ICD candidates, and have a left bundle branch block fare […]