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Biomedical subjects

Neil Sulke

Publications and source records attributed to Neil Sulke.

6 recordsLinked to original sources
PubMed2003

Effect of an implantable cardioverter defibrillator with atrial detection and shock therapies on patient-perceived, health-related quality of life.

BACKGROUND: This study used a device (DDD implantable cardioverter defibrillator [ICD]) capable of delivering pacing and shock therapies to restore normal sinus rhythm in patients with atrial tachycardias or atrial fibrillation (AF). The purpose of this study was to assess the effect of the device on patient-perceived, health-related quality of life (QOL). METHODS: The DDD ICD was implanted in 267 patients with drug refractory, symptomatic AF from 45 centers across Europe, the United States, and Canada. Patients completed self-reported, validated QOL assessments at baseline and at 3- and 6-month follow-up visits (The Medical Outcomes Short Form 36 [SF-36] and the Symptom Checklist [SCL]). RESULTS: The mean age of the study group was 62 +/- 12 years, and 73% of the patients were male. A total of 150 patients completed SF-36 assessments, and 138 patients completed SCL assessments at all 3 times. Baseline scores were more impaired (P <.05) on most SF-36 scales compared with norms for a general population, but were similar to a comparison group of patients with AF who were referred to tertiary care centers. The role-physical, physical functioning, vitality, mental health, and social functioning scales all improved significantly with time (all P <.04). Similarly, symptom frequency and severity (SCL) also improved significantly from baseline to 6 months (both P <.01). Shock therapy was delivered in 86 of the 150 patients (57%) with complete SF-36 evaluations. There was no evidence that receiving shocks decreased the relative improvement in QOL associated with implantation of the device. CONCLUSIONS: In a 6-month period, QOL improves after implantation of a DDD ICD with atrial shock and pacing therapies. These improvements were not attenuated by receipt of shocks.

Atrial Fibrillation↗
PubMed2003

Echocardiographic changes and predictors of arrhythmia recurrence after long-term use of the atrial defibrillator.

BACKGROUND: The patient-activated atrial defibrillator allows patients to cardiovert themselves from atrial fibrillation soon after the onset of symptoms. The long-term effects of early cardioversion from persistent atrial fibrillation on left ventricular performance and left atrial size are unknown. METHODS: Eighteen patients, mean age 63.4, 83% male, had the Jewel((R)) AF atrial defibrillator implanted for persistent atrial fibrillation only. Transthoracic echocardiography was performed 3-monthly following implant. Parasternal long axis measurements were taken using conventional M-mode techniques. RESULTS: Over follow-up of 28.0+/-9 months, 377 episodes of persistent atrial fibrillation were terminated by patient-activated cardioversion (median 15 per patient). Echocardiographic measurements at implant were; left atrium 44+/-6 mm, left ventricular end-diastolic diameter 49+/-7 mm, left ventricular end-systolic diameter 34+/-7 mm, fractional shortening 33+/-10% and ejection fraction 65+/-17%. After 1 year there had been a significant decrease in mean left atrial size to 41+/-6 mm (P=0.02) and an increase in mean ejection fraction to 73+/-8% (P=0.04). At long-term follow-up however, all parameters reverted to pre-implant levels. Baseline echocardiographic variables did not predict which patients would demonstrate serial increases in sinus rhythm duration between shocks during long-term follow-up. Patients on antiarrhythmic drug therapy however were more likely to demonstrate "sinus rhythm begetting sinus rhythm". CONCLUSIONS: Use of the atrial defibrillator for spontaneous persistent atrial fibrillation is associated with a medium-term (1 year) reduction in left atrial size and an increase in ejection fraction. These changes were not maintained in the long-term. Synergistic therapy with antiarrhythmic drugs may prolong periods of sinus rhythm between arrhythmia recurrences.

Adult↗
PubMed2003

Psychosocial aspects of patient-activated atrial defibrillation.

UNLABELLED: Atrial Defibrillator. INTRODUCTION: The atrial defibrillator empowers patients to cardiovert themselves from atrial arrhythmias at a time that is socially and physically acceptable, thereby preventing hospitalization. The long-term psychosocial effects of repeated use of the patient-activated atrial defibrillator at home are unknown. METHODS AND RESULTS: Eighteen patients underwent placement of the Jewel AF atrial defibrillator for persistent atrial fibrillation only. All patients performed manually activated cardioversions at home under self-administered sedation. Automatic shock therapies were disabled. Hospital Anxiety and Depression Scale and Multidimensional Health Locus of Control questionnaires were obtained before implant. All patients completed questionnaires 1 year after device implant and at long-term follow-up. The spouse or partner of each patient was interviewed to identify positive and negative aspects of manual cardioversion at home. The baseline patient scores for both anxiety (5.7 +/- 2.7) and depression (3.4 +/- 2.3) fell within the predefined range of normality. At 1 year, there was no significant change in anxiety (4.9 +/- 3.7, P = 0.39) or depression (2.4 +/- 1.8, P = 0.06). At long-term follow-up (mean 28 months), a total of 377 patient-activated cardioversions were performed out of hospital (median 15 per patient). Scores for anxiety (6.0 +/- 4.0, P = 0.70) and depression (3.2 +/- 2.5, P = 0.68) remained unchanged. CONCLUSION: During long-term follow-up, patient-activated cardioversion using the atrial defibrillator was not associated with increased anxiety or depression. The procedure was well tolerated by patients and their partners, offering an acceptable treatment option for patients with recurrent persistent atrial fibrillation.

Adult↗
PubMed2002

How do we diagnose syncope?

INTRODUCTION: The Eastbourne Syncope Assessment Study aims to increase diagnostic yield in unexplained syncope while reducing investigational costs. The initial study phase was a retrospective analysis of every presentation to the Eastbourne General Hospital (a busy nontertiary center in the United Kingdom serving a population of 250,000; 24% are older than 65 years) with syncope for the year 1998. METHODS AND RESULTS: A total of 1,334 cases with syncopal codes were identified. Six hundred sixty patients (mean age 64 years) had actually suffered an episode of syncope. Forty percent had recurrent syncope, with a mean of 4.7 previous episodes. Twenty-nine percent of syncope cases remained undiagnosed. Forty-four percent were diagnosed as vasovagal, 12% neurologic, 6% due to an arrhythmia, 2% drug related, and 2% due to hemorrhage. Thirteen different types of investigation were undertaken, with an overall total of 3,264 investigations performed at a cost of Pound Sterling 104,285. Diagnosis was achieved by history and examination alone in 61% of cases. Excluding history and examination, the most cost-effective diagnostic tools were the 7-day patient-activated recorder (R test) and tilt testing (Pound Sterling 260 and Pound Sterling 401 per diagnosis, respectively). Investigations also were graded by their relative diagnostic power. Hospital admission alone accounted for 67% of the cost of investigating syncope. CONCLUSION: In syncope, diagnostic rates can be improved and investigational costs reduced by concentrating on the most specific, sensitive, and cost-effective investigations and by minimizing hospital stay. Such a protocol currently is under investigation at our institution.

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