Effect of Substance Abuse on Defibrillation Threshold in Patients with Implantable Cardioverter‐Defibrillator

Perrine, Shane A.; Nayak, Raghavendra; Bharadwaj, Aditya; McKelvey, George; Mohamad, Tamam; Jacob, Sony

doi:10.1111/j.1540-8159.2010.02907.x

Cited by 6 publications

(7 citation statements)

References 13 publications

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“…Patients in the high DFT group received a mean of 12.3 ± 7.5 ICD test shocks (range 2-30) compared to 2.0 ± 1.4 shocks (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] in the satisfactory DFT group (P < 0.0001). The average patient age was 60.2 years, of which the high DFT group was significantly younger (55.6 years vs 60.3 years, P = 0.04) than the satisfactory DFT group.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…4 Previous studies have shown an association between a high DFT and the severity of left ventricular (LV) dysfunction (measured by increased LV end-diastolic diameter), cocaine use, previous cardiac surgery, impaired renal function, prolonged procedure time, and pneumothorax. [5][6][7][8] Amiodarone use may also be associated with a low defibrillation safety margin. 9 Because of these concerns, some operators still perform device testing at the time of implantation to ensure an adequate safety margin between the successful defibrillation energy and the maximum device output.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reassessing Risk Factors for High Defibrillation Threshold: The EF‐SAGA Risk Score and Implications for Device Testing

Shih

Kakodkar

Kaid

et al. 2016

Pacing Clinical Electrophis

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Section: Patient Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reassessing Risk Factors for High Defibrillation Threshold: The EF‐SAGA Risk Score and Implications for Device Testing

Shih

Kakodkar

Kaid

et al. 2016

Pacing Clinical Electrophis

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“…This increased rate of hospitalization was also noted to occur in association with an increased rate of cocaine use. Cocaine use is additionally important herein, as detailed previously, because it also increases the defibrillation threshold,24, 37 leading to a reduced likelihood of response to a standard ICD discharge and an increase in mortality.…”

Section: Discussionmentioning

confidence: 88%

Incidence, Predictors, and Outcomes of Implantable Cardioverter‐Defibrillator Discharge Among People Living With HIV

Alvi

Neilan

Tariq

et al. 2018

JAHA

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BackgroundPeople living with HIV (PHIV) are at an increased risk for sudden cardiac death, and implantable cardioverter‐defibrillators (ICDs) prevent SCD. There are no data on the incidence, predictors, and effects of ICD therapies among PHIV.Methods and ResultsWe compared ICD discharge rates between 59 PHIV and 267 uninfected controls. For PHIV, we tested the association of traditional cardiovascular risk factors and HIV‐specific parameters with an ICD discharge and then tested whether an ICD discharge among PHIV was associated with cardiovascular mortality or an admission for heart failure. The indication for ICD insertion was similar among groups. Compared with controls, PHIV with an ICD were more likely to have coronary artery disease and to use cocaine. In follow‐up, PHIV had a higher ICD discharge rate (39% versus 20%; P=0.001; median follow‐up period, 19 months). Among PHIV, cocaine use, coronary artery disease, QRS duration, and higher New York Heart Association class were associated with an ICD discharge. An ICD discharge had a prognostic effect, with a subsequent 1.7‐fold increase in heart failure admission and a 2‐fold increase in cardiovascular mortality, an effect consistent across racial/ethnic and sex categories.Conclusions ICD discharge rates are higher among PHIV compared with uninfected controls. Among PHIV, cocaine use and New York Heart Association class are associated with increased ICD discharge, and an ICD discharge is associated with a subsequent increase in admission for heart failure and cardiovascular mortality.

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“…117 Similarly, studies comparing chronic cocaine users to control patients showed up to 13 joules higher defibrillation threshold in cocaine users receiving ICDs. 118,119 We observed a direct time-dependent correlation between cocaine use and failed ICD therapies. A 36-year-old patient with ischemic cardiomyopathy and ICD implantation 6 years ago was admitted with ventricular tachycardia/ventricular fibrillation storm and multiple ICD shocks, including multiple failed shocks 16 hours after cocaine use with no evidence of ischemia.…”

Section: The Ethics Of Defibrillator Use In Patients With Stimulant U...mentioning

confidence: 79%

Stimulant Drugs of Abuse and Cardiac Arrhythmias

Dominic

Ahmad

Awwab

et al. 2022

Circ: Arrhythmia and Electrophysiology

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Nonmedical use of prescription and nonprescription drugs is a worldwide epidemic, rapidly growing in magnitude with deaths because of overdose and chronic use. A vast majority of these drugs are stimulants that have various effects on the cardiovascular system including the cardiac rhythm. Drugs, like cocaine and methamphetamine, have measured effects on the conduction system and through several direct and indirect pathways, utilizing multiple second messenger systems, change the structural and electrical substrate of the heart, thereby promoting cardiac dysrhythmias. Substituted amphetamines and cocaine affect the expression and activation kinetics of multiple ion channels and calcium signaling proteins resulting in EKG changes, and atrial and ventricular brady and tachyarrhythmias. Preexisting conditions cause substrate changes in the heart, which decrease the threshold for such drug-induced cardiac arrhythmias. The treatment of cardiac arrhythmias in patients who take drugs of abuse may be specialized and will require an understanding of the unique underlying mechanisms and necessitates a multidisciplinary approach. The use of primary or secondary prevention defibrillators in drug abusers with chronic systolic heart failure is both sensitive and controversial. This review provides a broad overview of cardiac arrhythmias associated with stimulant substance abuse and their management.

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Effect of Substance Abuse on Defibrillation Threshold in Patients with Implantable Cardioverter‐Defibrillator

Abstract: Background-The use of recreational drugs has been observed to have deleterious effects on the heart. The aim of our study was to evaluate the effect of substance abuse on the defibrillation threshold (DFT) in patients with implantable cardioverter-defibrillators (ICDs).

Cited by 6 publications

References 13 publications

Reassessing Risk Factors for High Defibrillation Threshold: The EF‐SAGA Risk Score and Implications for Device Testing

Reassessing Risk Factors for High Defibrillation Threshold: The EF‐SAGA Risk Score and Implications for Device Testing

Incidence, Predictors, and Outcomes of Implantable Cardioverter‐Defibrillator Discharge Among People Living With HIV

Stimulant Drugs of Abuse and Cardiac Arrhythmias

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