EP Lab Digest - April 2008 - (Page 17)

APRIL 2008 EP 101 17 risk of thromboembolism in patients with nonvalvular AF should be based on a CHADS2 score per the 2006 ACC/AHA/ESC Guidelines for the Management of Patients with AF. The CHADS2 score is a point-based risk score assigning one point to each of the following: history of congestive heart failure, history of hypertension, age greater than 65 years, history of diabetes mellitus, and 2 points assigned to history of stroke or a transient ischemic attack. Anesthesia and Sedation Anesthesia and sedation are administered in a number of ways: local anesthesia, conscious sedation and general anesthesia. Most endovascular procedures, including diagnostic electrophysiology studies and catheter-based ablations, can be performed safely with a combination of a local anesthetic at the site(s) of vascular access and conscious sedation. Conscious sedation is a method of anesthesia whereby patients are given intravenous medications at doses that do not require complete airway protection (i.e., endotracheal intubation). For prolonged procedures, conscious sedation may not be adequate and general anesthesia may be preferred. It may be challenging to adequately sedate and anesthetize an elderly patient in a safe manner. Elderly patients typically present with co-morbidities, including primary lung disease such as chronic obstructive pulmonary disease, which can make airway management difficult. Their ability to metabolize sedatives and painkillers is variable and often unpredictable. Procedures in these patients require clinicians and support staff expert in geriatric physiology and a preparedness to confront challenges that may arise. Older elders undergoing conscious sedation often require more prolonged observation post-operatively owing to both the reduced metabolism of these medications and the occasional atypical reaction, especially to benzodiazepines and antihistamines. General anesthesia not only presents similar medication-related challenges, but also the cardiovascular stress of induction and termination of anesthesia. In those patients with substantial underlying atherosclerotic cardiovascular disease, careful management is required to avoid hypotension and subsequent ischemic events. Sedation can be challenging, but it is not contraindicated in the elderly. Invasive procedures in these patients require a thorough screening and workup as well as expert intraoperative and postoperative staff. In order to choose appropriate medical strategies for these patients, we must use not only evidence-based data, as it is often lacking in this group, but also our clinical judgement to offer optimal treatments. Up Next: In the next installment of the ECG 101 section, author Dr. Abraham Kocheril will provide an extensive overview on Holter monitors, event monitors, and implantable loop recorders. This article is scheduled to appear in our May 2008 issue, so stay tuned! In addition, if you have an article idea for this section, let us know. Please email the editor at “jelrod@hmpcommunications.com”. We look forward to hearing from you! Conclusion Elderly patients are a large part of our cardiac electrophysiology practice. In order to choose appropriate medical strategies for these patients, we must use not only evidence-based data, as it is often lacking in this group, but also our clinical judgement to offer optimal treatments. In that way, we will consider age, but we will not use it as a sole factor in our management decision. In the News: Heart Rhythm Society Statement on ICD Safety In light of the study that was released on March 12, 2008 titled Pacemakers and Implantable Cardiac Defibrillators: Software Radio Attacks and Zero-Powered Defenses, the Heart Rhythm Society would like to reiterate its stance on the importance of implantable cardiac defibrillators (ICDs) in patients with life-threatening arrhythmias and its dedication to patient safety and privacy. ICDs are 99 percent effective in stopping life-threatening arrhythmias and are the most successful therapy to treat ventricular fibrillation, the major cause of sudden cardiac arrest which claims more than 250,000 lives in the United States each year. However, only 35 percent of patients who could be helped by an ICD have one. ICDs continuously monitor the heart rhythm, automatically function as pacemakers for heart rates that are too slow, and deliver life-saving shocks if a dangerously fast heart rhythm is detected. “Although the experiment by Dr. Maisel and colleagues is a technical study that may be of interest to engineers who design wireless transmission systems, the results do not have any important implications for patients and there is no reason for alarm,”said Dr. Bruce Lindsay, President of the Heart Rhythm Society.“This is not a product failure or safety recall. Millions of patients worldwide have benefited from the use of ICDs and this technology will continue to be critical in the treatment of patients who are at risk for life threatening heart rhythm disorders.” It is important to note that the study was performed on one ICD model, the tests were only performed from distances up to several centimeters from the device and the researchers have highly specialized electronic engineering skills. In addition, current ICDs do contain safeguards such as electronic filters and there is no knowledge of any instances of a patient being harmed by an unknown manipulation to an ICD. The Heart Rhythm Society is dedicated to improving the care of patients by promoting research, education and optimal health care policies and standards.The Society strongly supports additional measures that would advance the safety and privacy of patients living with these devices.

Table of Contents Feed for the Digital Edition of EP Lab Digest - April 2008

EP Lab Digest - April 2008 Pediatric Electrophysiology Medical Relief Work on the Yucatan Peninsula: A Labor of Love EP 101: Considerations for the Elderly EP Patient Contents Letter from the Editor Spotlight Interview: University of Maryland A Summary of the ACC/AHA/Physician Consortium 2008 Clinical Performance Measures for Adults with Nonvalvular Atrial Fibrillation or Flutter Can Psychosocial Characteristics Predict Fatal Outcomes in Patients? Interview with Jonathan S. Steinberg, MD, FACC 10-Minute Interview: Diane D. Sheffield, RN, BSN AED Access for All: An Organization for SCA Survivors New Column: 5 Quick Clues to AV Nodal Reentry Tachycardia CMS 2008 OPPS Final Rule Review New Online AED and CPR Training Opportunities: Q & A with Keith Weaver Highlights from the 5th Annual International Arrhythmia Winter School Email Discussion Group Events Calendar Second Annual Salary Survey Industry News and Products Classifieds Advertisers Index

EP Lab Digest - April 2008

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