Programming Implanted Defibrillators to React More Slowly Might Be Safer: Study

Unnecessary shocks from the heart devices are often distressing, come with their own risks, experts say

By Serena Gordon

HealthDay Reporter

TUESDAY, May 7 (HealthDay News) -- By slowing down the programmed response rate on implantable cardioverter defibrillators (ICDs), doctors can reduce the number of shocks these devices deliver without causing a significant increase in the risk of fainting or death, new research suggests.

"The aim of [our] study was to evaluate a different programming strategy to reduce unnecessary therapies delivered by the ICD," explained study author Dr. Maurizio Gasparini, chief of the pacing and electrophysiology unit at the Humanitas Clinical and Research Center in Rozzano, Italy.

"The study found that the strategy utilizing a long detection period to recognize arrhythmias [irregular heartbeats] is associated not only to an overall reduction of therapies, but also to less inappropriate shocks experienced by the patients as well as fewer hospitalizations in the 12 months following ICD implant," Gasparini said.

ICDs are small devices implanted in the upper chest. Electrodes from the device are attached to the heart. If an ICD senses a dangerous heartbeat or no heartbeat, it can help correct that through electrical pacing -- like a pacemaker -- or it can deliver a shock to the heart to restore a normal heartbeat, according to the U.S. National Heart, Lung, and Blood Institute.

Results of the study are published in the May 8 issue of the Journal of the American Medical Association. The study was funded by Medtronic Inc., which makes ICDs.

While ICDs can literally be lifesavers, they can also cause problems for some patients.

"Defibrillator shocks, whether for appropriate or inappropriate indications, are associated with adverse effects. These adverse effects include the acute discomfort of the shock, as well as late and longer-lasting psychological trauma including depression and post-traumatic stress disorder," wrote Dr. Merritt Raitt, author of an accompanying journal editorial. Raitt is with the Oregon Health and Science University and the Portland Veterans Administration Medical Center, in Oregon.

The current study included about 1,900 people who were receiving their first ICD implant. Their average age was 65, and 84 percent of the study volunteers were male.

The volunteers were randomly placed into one of two groups: standard programming or programming with a long detection interval.

"Every time the heart beats, an electrical activity is recorded by the device. An interval is the time between two consecutives beats. Basically it is the time between two heartbeats. So, a long detection interval simply means a longer period of time to permit recognition of arrhythmias," Gasparini explained.

During an average of 12 months of follow-up, 530 episodes of an arrhythmia were recorded. The long detection group had a 37 percent lower rate of delivered therapies (pacing or shocks) than the standard therapy group, according to the study.

There were no significant differences in mortality or in fainting (syncope) episodes between the groups.

View the original article here

iPads Could Affect Implanted Heart Devices, Early Study Finds

Young researcher suggests that users avoid placing tablets too close to the chest

By Barbara Bronson Gray

HealthDay Reporter

THURSDAY, May 9 (HealthDay News) -- Sprawled out on the couch, reading the news on your iPad, you'd never think you could be putting yourself at risk. But you might be, if you happen to have an implanted heart device.

Magnetic interference could alter the settings and even deactivate the technology of implantable cardioverter defibrillators (ICDs), according to a small new study -- conducted by a 14-year-old investigator and her colleagues.

The researchers found that magnets imbedded in the iPad 2 and its Smart Cover may cause electromagnetic interference that can disrupt a cardiac rhythm device.

Specialized magnets are imbedded in the heart devices to allow physicians to routinely adjust their settings. The magnets can suspend the ability of the devices to prevent sudden rapid heart rates, such as tachycardia and fibrillation.

That risk occurs when a person falls asleep with the tablet on the chest. Thirty percent of study participants had interference with their devices when the iPad 2 was placed there, the researchers found. Yet electromagnetic interference was not found when the iPad was at a normal reading distance from the chest.

The magnetic field drops off quickly with distance, explained Gianna Chien, the lead study author. And heavier people who happen to have more fat on their chest -- not just in their abdomen -- also seem to be less sensitive to the interference, she added.

The research is scheduled to be presented Thursday at the Heart Rhythm Society's annual meeting in Denver. Chien, a high school freshman, worked with her father, Dr. Walter Chien, a cardiologist with Central Valley Arrhythmia in Stockton, Calif., to coordinate patient testing.

Other devices with imbedded magnets -- such as cellphones and magnetic resonance imaging (MRI) machines -- may also affect cardiac rhythm devices, but were not tested in this study.

Last year, research published in the Journal of Neurosurgery: Pediatrics suggested that the iPad 2 can interfere with the settings of magnetically programmable shunt devices in the brain when held within two inches of the technology.

That study reported on a 4-month-old girl with hydrocephalus -- abnormal accumulation of cerebrospinal fluid (CSF) in the brain -- who developed a shunt malfunction. This was due to a changed setting of the magnetically programmable valve that regulates the flow of CSF out of the brain cavity, or ventricle. The mother had been using an iPad 2 while holding the infant.

An expert noted how difficult it could be to detect such a malfunction.

"The real problem is that you don't even know; there is no trigger, no light goes off [to alert you]," said Dr. Salvatore Insinga, a neurosurgeon at the Cushing Neuroscience Institute at North Shore-LIJ Health System, in New York. "With all the tech devices people are using now and all the implanted things in patients, this is more of an issue now." Insinga was not associated with either study.

View the original article here

Programming Implanted Defibrillators to React More Slowly Might Be Safer: Study

By Serena Gordon
HealthDay Reporter

TUESDAY, May 7 (HealthDay News) -- By slowing down the programmed response rate on implantable cardioverter defibrillators (ICDs), doctors can reduce the number of shocks these devices deliver without causing a significant increase in the risk of fainting or death, new research suggests.

"The aim of [our] study was to evaluate a different programming strategy to reduce unnecessary therapies delivered by the ICD," explained study author Dr. Maurizio Gasparini, chief of the pacing and electrophysiology unit at the Humanitas Clinical and Research Center in Rozzano, Italy.

"The study found that the strategy utilizing a long detection period to recognize arrhythmias [irregular heartbeats] is associated not only to an overall reduction of therapies, but also to less inappropriate shocks experienced by the patients as well as fewer hospitalizations in the 12 months following ICD implant," Gasparini said.

ICDs are small devices implanted in the upper chest. Electrodes from the device are attached to the heart. If an ICD senses a dangerous heartbeat or no heartbeat, it can help correct that through electrical pacing -- like a pacemaker -- or it can deliver a shock to the heart to restore a normal heartbeat, according to the U.S. National Heart, Lung, and Blood Institute.

Results of the study are published in the May 8 issue of the Journal of the American Medical Association. The study was funded by Medtronic Inc., which makes ICDs.

While ICDs can literally be lifesavers, they can also cause problems for some patients.

"Defibrillator shocks, whether for appropriate or inappropriate indications, are associated with adverse effects. These adverse effects include the acute discomfort of the shock, as well as late and longer-lasting psychological trauma including depression and post-traumatic stress disorder," wrote Dr. Merritt Raitt, author of an accompanying journal editorial. Raitt is with the Oregon Health and Science University and the Portland Veterans Administration Medical Center, in Oregon.

The current study included about 1,900 people who were receiving their first ICD implant. Their average age was 65, and 84 percent of the study volunteers were male.

The volunteers were randomly placed into one of two groups: standard programming or programming with a long detection interval.

"Every time the heart beats, an electrical activity is recorded by the device. An interval is the time between two consecutives beats. Basically it is the time between two heartbeats. So, a long detection interval simply means a longer period of time to permit recognition of arrhythmias," Gasparini explained.

During an average of 12 months of follow-up, 530 episodes of an arrhythmia were recorded. The long detection group had a 37 percent lower rate of delivered therapies (pacing or shocks) than the standard therapy group, according to the study.

There were no significant differences in mortality or in fainting (syncope) episodes between the groups.

"This study shows that we can decrease inappropriate and unnecessary therapies, and clearly you make people feel better because they're not getting inappropriate or unnecessary therapy, said Dr. Ranjit Suri, director of the electrophysiology service and Cardiac Arrhythmia Center at Lenox Hill Hospital in New York City.

However, Suri said it's not yet clear what the ideal interval time is. The current study doesn't show a benefit in terms of reduced risk of death. Another study, published last December in the New England Journal of Medicine, did find a mortality benefit. But, the interval was longer in that study.

Still, Suri said, doctors could start programming ICDs with longer intervals, and making such a change to the device isn't difficult or time-consuming.

In his editorial, Raitt wrote: "Regardless of whether these programming interventions lead to reduced mortality, the unequivocal reduction in ICD shocks and the reduction in hospitalization without an increase in adverse events such as syncope suggests that this programming approach should be considered for adoption in the care of patients with ICDs and clinical characteristics similar to those enrolled in these studies."

Study author Gasparini noted that the research provides physicians with an easy programming guideline that's "applicable to the great majority of patients who may benefit from the reduction of unnecessary painful shocks and hospitalizations."

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Maurizio Gasparini, M.D., chief, pacing and electrophysiology unit, Humanitas Clinical and Research Center, Rozzano, Italy; Ranjit Suri, M.D., director, electrophysiology service and the Cardiac Arrhythmia Center, Lenox Hill Hospital, New York City; May 8, 2013, Journal of the American Medical Association

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Researchers Test Implanted Brain Stimulator for Alzheimer's

They hope the device will restore some thinking ability and improve focus, attention

By Barbara Bronson Gray

HealthDay Reporter

THURSDAY, March 28 (HealthDay News) -- Researchers are testing whether applying electrical stimulation directly to the brains of people with Alzheimer's disease might improve thinking, focus and alertness.

The process, called direct brain stimulation, or deep brain stimulation (DBS), has been used to treat Parkinson's disease and is being tested as a treatment for other conditions, including traumatic brain injuries and obesity, according to the researchers.

Two women have had the electronic brain stimulators implanted, and eight more patients will participate in this initial research.

"There are a lot of studies out there that say physical or mental stimulation may reduce the risk or impact of Alzheimer's disease, so we wondered if increasing stimulation to certain parts of the brain may be protective," explained study co-author Dr. Douglas Scharre, director of the division of cognitive neurology at Ohio State University.

Scharre said that while Alzheimer's tends to affect the temporal, parietal and frontal lobes of the brain, he wanted to focus particularly on the frontal lobe for two reasons: it's typically the last brain area to degenerate, and its functions -- decision-making, problem-solving, focus and alertness -- are necessary for a person to be independent.

Placing the DBS system involves two steps. First, in a surgical procedure that requires about a three-day hospital stay, the patient has tiny holes made in each side of the skull, and hair-thin wires are placed in precise spots of the brain using computer-guided technology. The wires are fed through the neck -- in the subcutaneous tissue just under the skin -- and left there for about a week while the burr holes heal, explained Scharre.

Then, in an outpatient surgery, the patient has two battery packs that look like heart pacemakers placed on each side of the chest. The wires placed the week before are then connected to the batteries.

Six weeks after the second surgery, the stimulator is turned on. "My job [as the neurologist] is to find the right settings to get the maximum benefit," said Scharre. Each wire has four contacts, providing a wide range of different voltage combinations, and the challenge is to determine the right amount to produce the best benefit, he explained.

The research could potentially be of value to millions of Americans: a recent report from the Alzheimer's Association found that one in every three seniors now dies while suffering from Alzheimer's or another form of dementia. Alzheimer's disease becomes progressively disabling with loss of memory, thinking skills, the ability to socialize and independence.

To assess the effects of DBS, the researchers give short tests to the patients, starting about two months after the surgeries, to evaluate their level of attention and alertness, and to see how fast they can complete a particular task. For example, one test shows a variety of different geometric shapes all over the page, and [the patient] is asked to pick out all the stars in a 30-second timeframe.

View the original article here

iPads Could Affect Implanted Heart Devices, Early Study Finds

Young researcher suggests that users avoid placing tablets too close to the chest

By Barbara Bronson Gray

HealthDay Reporter

THURSDAY, May 9 (HealthDay News) -- Sprawled out on the couch, reading the news on your iPad, you'd never think you could be putting yourself at risk. But you might be, if you happen to have an implanted heart device.

Magnetic interference could alter the settings and even deactivate the technology of implantable cardioverter defibrillators (ICDs), according to a small new study -- conducted by a 14-year-old investigator and her colleagues.

The researchers found that magnets imbedded in the iPad 2 and its Smart Cover may cause electromagnetic interference that can disrupt a cardiac rhythm device.

Specialized magnets are imbedded in the heart devices to allow physicians to routinely adjust their settings. The magnets can suspend the ability of the devices to prevent sudden rapid heart rates, such as tachycardia and fibrillation.

That risk occurs when a person falls asleep with the tablet on the chest. Thirty percent of study participants had interference with their devices when the iPad 2 was placed there, the researchers found. Yet electromagnetic interference was not found when the iPad was at a normal reading distance from the chest.

The magnetic field drops off quickly with distance, explained Gianna Chien, the lead study author. And heavier people who happen to have more fat on their chest -- not just in their abdomen -- also seem to be less sensitive to the interference, she added.

The research is scheduled to be presented Thursday at the Heart Rhythm Society's annual meeting in Denver. Chien, a high school freshman, worked with her father, Dr. Walter Chien, a cardiologist with Central Valley Arrhythmia in Stockton, Calif., to coordinate patient testing.

Other devices with imbedded magnets -- such as cellphones and magnetic resonance imaging (MRI) machines -- may also affect cardiac rhythm devices, but were not tested in this study.

Last year, research published in the Journal of Neurosurgery: Pediatrics suggested that the iPad 2 can interfere with the settings of magnetically programmable shunt devices in the brain when held within two inches of the technology.

That study reported on a 4-month-old girl with hydrocephalus -- abnormal accumulation of cerebrospinal fluid (CSF) in the brain -- who developed a shunt malfunction. This was due to a changed setting of the magnetically programmable valve that regulates the flow of CSF out of the brain cavity, or ventricle. The mother had been using an iPad 2 while holding the infant.

An expert noted how difficult it could be to detect such a malfunction.

"The real problem is that you don't even know; there is no trigger, no light goes off [to alert you]," said Dr. Salvatore Insinga, a neurosurgeon at the Cushing Neuroscience Institute at North Shore-LIJ Health System, in New York. "With all the tech devices people are using now and all the implanted things in patients, this is more of an issue now." Insinga was not associated with either study.

View the original article here