PubMed · 13320547
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S A WESOLOWSKI, E GORDY, D COLE. 1956. A simple defibrillator electrode.. https://pubmed.ncbi.nlm.nih.gov/13320547/
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Myocardial perfusion single photon emission computed tomography (SPECT) is a widely utilized noninvasive imaging modality for the diagnosis, prognosis, and risk stratification of coronary artery disease. It is clearly superior to the traditional planar technique in terms of imaging contrast and consequent diagnostic and prognostic yield. The strength of SPECT images is largely derived from the three-dimensional, volumetric nature of its image. Thus, this modality permits three-dimensional assessment and quantitation of the perfused myocardium and functional assessment through electrocardiographic gating of the perfusion images.
More than a decade of dramatic changes in US and global health care has affected the practice of and payment for nuclear cardiology services. The clear diagnostic and prognostic power of nuclear cardiology procedures to detect coronary artery disease and predict patient outcomes has resulted in the rapid growth of these procedures in clinical practice. This has focused the attention of public and private payers on the high use of medical resources required to carry out nuclear cardiology testing. Two recent, major multicenter trials, one in the United States and another in Europe, have demonstrated the cost effectiveness of stress myocardial perfusion imaging strategies compared with coronary angiography in patients with known or suspected coronary artery disease, across the spectrum of pretest risks and both sexes. These studies, and more extensive data from more than 10 years of decision analysis, have reinforced the value of nuclear cardiology in modern cardiovascular health care. Future challenges will include assurance of provider and laboratory quality in the burgeoning outpatient imaging centers across the country, and wider acceptance by payers and expert panels of the evidence supporting the cost effectiveness of nuclear cardiology in most clinical settings.
PURPOSE OF REVIEW: This review describes changes in indications for implantable cardioverter-defibrillator (ICD) implantation made in the American College of Cardiology, American Heart Association, and North American Society of Pacing and Electrophysiology 2002 update of the 1998 guideline for the implantation of cardiac pacemakers and antiarrhythmia devices. RECENT FINDINGS: Recent observational and clinical data support changes in the guidelines for ICD implantation to include patients with no structural heart disease and spontaneous ventricular tachycardia not amenable to other treatments; left ventricular ejection fractions of 0.30 or less at least 1 month after myocardial infarction and at least 3 months after coronary revascularization surgery (the Multicenter Automatic Defibrillator Implantation Trial II); syncope of unexplained origin or a family history of unexplained sudden cardiac death in association with typical or atypical right bundle branch block and ST-segment elevations (Brugada syndrome); and syncope in the setting of advanced structural heart disease when thorough invasive and noninvasive investigations have failed to define a cause. SUMMARY: With the completion of multiple important randomized clinical trials, the application of ICD technology continues to evolve. Indications have expanded from secondary to primary prevention. Most importantly, currently available data support the prophylactic use of ICDs in patients with coronary artery disease and poor left ventricular function. Further trial data are awaited to determine if the same benefits for survival and quality of life will be afforded to patients with nonischemic heart diseases and poor left ventricular function.