Our findings show that primary prevention

Our findings show that primary prevention ICD recipients experienced an impaired QOL on vitality subscales, which were included in the physical health domain, compared to secondary prevention ICD recipients. Similarly, Berg et al. also found that ICD patients with a primary prevention indication had lower scores in all subscales of QOL, and larger differences were found in physical scores using other types of QOL questionnaires [11]. These results are consistent with the fact that patients with an ICD for primary prevention differ from those who receive the device for secondary prevention, particularly because primary prevention patients may fail to understand why they need the ICD [28]. Furthermore, they may have fears concerning device malfunction and recall, and device-associated complications including perforation, infection, and perhaps of greatest importance, receipt of inappropriate shocks [28,29]. On the other hand, Pedersen et al. reviewed the literature in 2009 and found five studies reporting patient-centered outcomes, and none of them found an association between indication and patient-centered outcomes such as QOL [8]. Taken together, this study suggests that although close monitoring related to education and psychological interventions targeting anxiety, depression, PTSD, worries about the ICD, and health-related QOL are important to all ICD patients, recipients of a primary prevention indication may have different needs following ICD GSK J4 compared to a secondary prevention indication. A recent study of remote monitoring in ICD patients showed that a clear understanding of ICD implantation was associated with a higher acceptance of remote monitoring, which has been shown to be related to patient safety and survival [30,31]. Remote monitoring benefits include more rapid clinical event detection and a reduction in inappropriate shocks. In conclusion, in this study, which mostly consisted of NYHA class I and II subjects, patients with a primary prevention ICD were more likely to experience anxiety, high levels of worry about their ICD, and an impaired health-related QOL compared to patients with a secondary prevention ICD. However, no differences were found in depression or PTSD. In clinical practice, primary prevention ICD recipients should be closely monitored. If warranted, they should be offered a psychological intervention, because anxiety and low QOL were predictors of mortality [11]. In the future, further longitudinal and larger studies are needed to examine these differences in psychological distress and QOL.
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Introduction Extensive encircling ipsilateral pulmonary vein (PV) isolation (EEPVI) has been validated as a curative therapy for paroxysmal and persistent atrial fibrillation (AF) [1–3]. Complete conduction block requires a contiguous line of ablation lesions [4]. Although previous studies have shown that power titration guided by amplitude reduction in the local atrial electrogram succeeds in avoiding complications [5–7], whether the amplitude reduction observed in local bipolar (BP) and unipolar (UP) electrograms recorded after an ablation can reliably predict transmural lesion formation is controversial [5–8]. The effect of different catheter orientations relative to the endocardial surface, the direction of the wavefront on the BP electrogram recorded from transmural and non-transmural lesions, and a comparison of the UP and BP electrograms for the identification of transmural lesion formation at different catheter orientations were reported in an animal model [9]. However, it is difficult to monitor unfiltered UP electrograms during the application of radiofrequency (RF) energy because of electrogram drift. Therefore, we compared filtered UP electrograms and filtered BP electrograms for their usefulness in guiding the creation of transmural atrial lesions during the application of RF energy in EEPVI.
Material and methods