[Show abstract][Hide abstract] ABSTRACT: The management and treatment of patients with suicidal behavior is one of the most challenging tasks for health-care professionals. Patients with affective disorders are at high risk for suicidal behavior, therefore, should be a target for prevention. Numerous international studies of lithium use have documented anti-suicidal effects since the 1970s. Despite the unambiguous evidence of lithium's anti-suicidal effects and recommendations in national and international guidelines for its use in acute and maintenance therapy of affective disorders, the use of lithium is still underrepresented. The following article provides a comprehensive review of studies investigating the anti-suicidal effect of lithium in patients with affective disorders.
[Show abstract][Hide abstract] ABSTRACT: Pacemaker mediated tachycardia (PMT) is the term used to describe a repetitive sequence of sensed retrograde P waves followed by ventricular pacing at or below the maximum tracking rate. The following events can promote AV dissociation, retrograde conduction and the onset of PMT: ventricular or atrial extrasystole, an excessively long programmed AV delay, external interference or myopotentials sensed by the atrial channel, atrial sensing or pacing failure, the absence of post ventricular atrial refractory period extension after removal of a magnet, VDD pacing at a higher rate than sinus rate. In contemporary devices, each manufacturer has a proprietary algorithm to detect and terminate PMT. Because of the increase in the number and complexity of the pacing algorithms and because of manufacturer-driven differences, a basic understanding of these new algorithms is important for patient care. We review here the main elements of the physiopathology of this type of tachycardia, describe the specific characteristics of the different manufacturers and present representative clinical cases. This article is protected by copyright. All rights reserved.
Pacing and Clinical Electrophysiology 09/2015; DOI:10.1111/pace.12750 · 1.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Remote monitoring of cardiac implantable devices is rapidly becoming the standard of care for implantable cardiac device follow-up. Large randomized trials demonstrate early detection of technical and clinical problems, but this depends on device-based diagnosis. Transmission of random EGM (rEGM) is a new feature of recent devices which allows for human assessment of the device function. Random EGMs consist in a 7 to 30 second sequence of endocavitary signals (1 to 4 channels), acquired randomly. The objectives of this review are to 1/explain the rEGM specificities according to devices type and manufacturer; 2/ highlight the value of rEGM for device and patient management. Representative examples of rEGM mediated diagnosis of device malfunctions/arrhythmias are presented. The series includes rEGM with apparent: 1) P wave, R wave and noise ventricular oversensing, 2) P wave and R wave undersensing, 3) loss of right ventricular and left ventricular capture, 4) non detected atrial fibrillation and ventricular tachycardia. None triggered conventional alert notifications. Methods to improve rEGM efficiency are also proposed. Detailed analysis of each rEGM must be included in a complete cardiac device remote monitoring evaluation. rEGMs may contain information potentially critical to patients' outcomes.
Heart rhythm: the official journal of the Heart Rhythm Society 09/2015; DOI:10.1016/j.hrthm.2015.09.031 · 5.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Lithium salts are the recommended first-line treatment (gold standard) in national and international treatment guidelines for acute and maintenance treatment of affective disorders, such as bipolar disorders. Lithium has also been shown to have a unique protective effect against suicide in patients suffering from affective disorders. Despite the well-known acute and long-term adverse effects lithium therapy can be safely administered if patients are properly educated and carefully monitored. A recent study from France now shows that patients with severely impaired renal function who had been treated with lithium salts for more than 10 years could have an increased risk for kidney tumors (benign and malignant). This resulted in an adjustment concerning information within the package leaflet by European authorities. The authors of this article reflect the currently available data in order to better understand and handle this new finding and to warn about uncritical reactions including withdrawal of lithium in successfully treated patients. This article provides clinical recommendations to provide further insight relating to the risk of kidney cancer in long-term lithium therapy.
Der Nervenarzt 09/2015; 86(9):1157-61. DOI:10.1007/s00115-015-4413-7 · 0.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Lithium has proven suicide preventing effects in the long-term treatment of patients with affective disorders. Clinical evidence from case reports indicate that this effect may occur early on at the beginning of lithium treatment. The impact of lithium treatment on acute suicidal thoughts and/or behavior has not been systematically studied in a controlled trial. The primary objective of this confirmatory study is to determine the association between lithium therapy and acute suicidal ideation and/or suicidal behavior in inpatients with a major depressive episode (MDE, unipolar and bipolar disorder according to DSM IV criteria). The specific aim is to test the hypothesis that lithium plus treatment as usual (TAU), compared to placebo plus TAU, results in a significantly greater decrease in suicidal ideation and/or behavior over 5 weeks in inpatients with MDE.
We initiated a randomized, placebo-controlled multicenter trial. Patients with the diagnosis of a moderate to severe depressive episode and suicidal thoughts and/or suicidal behavior measured with the Sheehan-Suicidality-Tracking Scale (S-STS) will be randomly allocated to add lithium or placebo to their treatment as usual. Change in the clinician administered S-STS from the initial to the final visit will be the primary outcome.
There is an urgent need to identify treatments that will acutely decrease suicidal ideation and/or suicidal behavior. The results of this study will demonstrate whether lithium reduces suicidal ideation and behavior within the first 5 weeks of treatment.
ClinicalTrials.gov identifier: NCT02039479.
[Show abstract][Hide abstract] ABSTRACT: -Left ventricular assist devices (LVADs) are increasingly used as a bridge to cardiac transplantation or as destination therapy. Patients with LVADs are at high risk for ventricular arrhythmias (VA). This study describes VA characteristics and ablation in patients implanted with a Heart Mate 2 (HM2) device.
-All patients with a HM2 device who underwent VA catheter ablation at 9 tertiary centers were included. Thirty-four patients (30 male, age 58 ± 10 years) underwent 39 ablation procedures. The underlying cardiomyopathy etiology was ischemic in 21 and non-ischemic in 13 patients with a mean left ventricular ejection fraction of 17±5% before LVAD implantation. One hundred and ten ventricular tachycardias (VTs) (cycle lengths: 230-740ms, arrhythmic storm n=28) and 2 ventricular fibrillation triggers were targeted (25 transseptal, 14 retrograde aortic approaches). Nine patients required VT ablation <1 month after LVAD implantation due to intractable VT. Only 10/110 (9%) of the targeted VTs were related to the HM2 cannula. During follow-up, 7 patients were transplanted and 10 died. Of the remaining 17 patients, 13 were arrhythmia-free at 25 ± 15 months. In 1 patient with VT recurrence, change of turbine speed from 9400 to 9000 rpm extinguished VT.
-Catheter ablation of VT among LVAD recipients is feasible and reasonably safe even soon after LVAD implantation. Intrinsic myocardial scar, rather than the apical cannula, appears to be the dominant substrate.