eLearning on Cardiovascular Electronic device by Pamelia Joan Suyin Lee https://padlet.com/lpj2/wqknxkzrps34 Enter your name when you share on the tabs. Read the articles to discuss. Your classmates should be replying your questions as peer discussions. This is a self-directed learning. en-us 2019-10-28 13:02:14 UTC 2025-09-25 04:55:04 UTC hello@padlet.com https://padlet.net/icons/png/1f493.png lpj2 https://padlet.com/lpj2/wqknxkzrps34/wish/403294341 2019-10-28 13:16:29 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/403294341 lpj2 https://padlet.com/lpj2/wqknxkzrps34/wish/403294966 2019-10-28 13:17:21 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/403294966 lpj2 https://padlet.com/lpj2/wqknxkzrps34/wish/403299579 2019-10-28 13:24:07 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/403299579 lpj2 https://padlet.com/lpj2/wqknxkzrps34/wish/403302856 2019-10-28 13:29:30 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/403302856 Deactivation process.. https://padlet.com/lpj2/wqknxkzrps34/wish/1828943775 In singapore settings:
1.  Are there any criteria on when this device should be deactivated?
2. Is signed consent (written) needed to deavtivate it?

Christian..

]]> 2021-10-20 01:26:33 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1828943775 Is there a risk and benefits of ICD (Implanted Cardioverter Defibrillator) following LVAD implantation? I understand that ICD need to reactivate for LVAD patients. s10224327 https://padlet.com/lpj2/wqknxkzrps34/wish/1828967150 -KRIS]]> 2021-10-20 01:36:01 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1828967150 Most LVDs patients cause of death is due to cardiovascular issues likely due complication of LVAD. Patients with LVAD who died within 1 month post implant most commonly died due to multi system organ failure. s10224327 https://padlet.com/lpj2/wqknxkzrps34/wish/1828987152 -KRIS]]> 2021-10-20 01:44:23 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1828987152 Why do LVAD patient have no pulse / measurable blood pressure? in this case how to determine their vitals? -Prema- https://padlet.com/lpj2/wqknxkzrps34/wish/1829047186 2021-10-20 02:09:39 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1829047186 we need with respect to patient autonomy, they have the right to choose which treatments to undertake and which to be with-held. Medical team need to assess whether patient has the mental capacity to make decision and need to explain to them if not go for battery replacement what will happen and the estimated prognosis. -Jin https://padlet.com/lpj2/wqknxkzrps34/wish/1829094735

]]> 2021-10-20 02:28:59 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1829094735 one of my patient with peacemaker in SGH, not sure about whether is the new Gen type. The battery is wireless like our handphone. we need to charge the portable battery and place near the patient, it will auto charge for the peacemaker. Besides, the peacemaker will auto send heart function report to NHCS for detecting any abnormalities.- JIN https://padlet.com/lpj2/wqknxkzrps34/wish/1829132744 2021-10-20 02:44:31 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1829132744 any home team from national heart center/device vendor go to pt's house for deactivation if pt is nearing end of life......? https://padlet.com/lpj2/wqknxkzrps34/wish/1829286752 -christine Loh-]]> 2021-10-20 03:55:39 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1829286752 how much $$ for a leadless pacemaker? https://padlet.com/lpj2/wqknxkzrps34/wish/1829309638 -christine Loh-]]> 2021-10-20 04:09:55 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1829309638 https://padlet.com/lpj2/wqknxkzrps34/wish/1829328912 LVAD complications such as bleeding, stroke, infection and death wherein serious infections and sepsis were identified as the most common complications post LVAD implantation.
(Gordon et al, 2006)


-Lio]]> 2021-10-20 04:23:25 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1829328912 Anonymous https://padlet.com/lpj2/wqknxkzrps34/wish/1841119382 End-of -life care and cardia implantable  devices, however  patient and family  understanding of CIED function and expected consequences  of   de-activation, after done , if patient is suffering the worst very important to support  patient ,care giver and family.

Marlar]]> 2021-10-25 09:18:40 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1841119382 Anonymous https://padlet.com/lpj2/wqknxkzrps34/wish/1841259768 The patient need to take  a long term for aspirin and warfarin.
They have to do daily dressing  to the driveline. The batteries last  up to 8 hours and to carry spare batteries if they go out. They can only shower with an adequate protection  of the driveline exit site and electrical equipment. They cannot swim.

Marlar]]> 2021-10-25 10:44:08 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1841259768 patient's rights to deactivate pacemaker/ICD therapy https://padlet.com/lpj2/wqknxkzrps34/wish/1842648168 Overall, we will accede to the patient's requests so that ethical and legal considerations practised here. Ensure patient and family members are being informed and clear to make decisions at this palliative phase. We will respect and be comfortable towards their decision.
-Siti Radiah-]]> 2021-10-25 18:22:09 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1842648168 does pacemaker increase life expectancy? https://padlet.com/lpj2/wqknxkzrps34/wish/1842674771 is pacemaker that effective till can increase life expectancy even though doctor informed patient has poor prognosis?
-Siti Radiah- ]]> 2021-10-25 18:31:48 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1842674771 advancement of CVAD https://padlet.com/lpj2/wqknxkzrps34/wish/1842693014 hope it also has other benefits at the same time which can treat and resolve the heart issues like example, wearing glasses to correct myopia?
-Siti Radiah-]]> 2021-10-25 18:38:44 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1842693014 benefits of new ICD https://padlet.com/lpj2/wqknxkzrps34/wish/1842707940 Noted that for new ICD, there is no need to go through central venous access and this reduces systemic infection. 
-Siti Radiah-]]> 2021-10-25 18:44:40 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1842707940 most common complication associated with implanted LVAD https://padlet.com/lpj2/wqknxkzrps34/wish/1842739630 BLEEDING. Patient may stay alive for 5 and a half years with LVAD (Kilic, 2015).
-Siti Radiah-]]> 2021-10-25 18:55:57 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1842739630 EOL issues for LVAD patients https://padlet.com/lpj2/wqknxkzrps34/wish/1842766255 QOL can be affected. Presence of serious infections, neurologic complications (stroke, cognitive dysfunction) and device malfunction. Caregivers will experience significant burden, depression, anxiety and post-traumatic stress (Rizzieri et al, 2008).
-Siti Radiah-]]> 2021-10-25 19:06:37 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1842766255 Sounds more economical https://padlet.com/lpj2/wqknxkzrps34/wish/1845017683 The next gen cardiovascular electronic device (if done well) appears to be useful in terms of looking at the hospital workload. With a shorter surgical time, hopefully it would also translate into shorter hospital in-flight days. In addition, if proven to reduce infections, it would also reduce the number of admissions and/or complications related to pacemaker-related infections which again translates to lesser hospitalisations. Infections resulting from the pacemaker sounds fatal, seeing as it is placed right into the right ventricle, where any bacterial growth can rapidly result in a systemic infection  - Cass

]]> 2021-10-26 13:46:52 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1845017683 Pacemaker deactivation process https://padlet.com/lpj2/wqknxkzrps34/wish/1846616893 patient on end of life in practical, we do not deactivate the pacemaker function with vendor (when pt agreed for DNR) to stop to shock pt when the heart stops. This actually triggers me thinking the effectiveness of pacemaker for EOL patient. because the patients actually still RIP, then we have to use a magnet to disrupt the impulses sent by pacemaker during LO, to get an asystole ECG reading so as to certify death. So, is deactivating the function of pacemaker necessary?]]> 2021-10-27 00:37:52 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1846616893 Dilemma with pacemaker deactivation in terminally ill destitute patient who has lack of mental capacity. https://padlet.com/lpj2/wqknxkzrps34/wish/1847250673 This is a real case scenario that I encountered. Based on patient's poor prognosis with multi-factorial competing risk, the agent with enduring power of attorney, together with EOL/Palliative Team have to carefully decide on the termination of the pacemaker, in the best interest of patient's comfort care and non-active management of the dying patient.]]> 2021-10-27 05:24:31 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1847250673 https://padlet.com/lpj2/wqknxkzrps34/wish/1847304462 In the event of patient become unconscious, the tendency that CPR ( not suppose to do CPR when the pump is still on operating mode), would likely to be performed if healthcare worker or passer-by who attended to the patient is unaware of the function of LVAD. Cardiac compression should only be performed when there is no signs of life. Hasliza.]]> 2021-10-27 05:57:57 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1847304462 Discussion on issues of battery replacement to end of life issues https://padlet.com/lpj2/wqknxkzrps34/wish/1847588173 Currently  there are no national guideline and specific set of consensus on deactivating of CIED. 
Generally accepted that withdrawal of extraordinary measures at the end of life as do not prolong the dying process, but that will raise legal and moral issues.
Patient's autonomy , capacity and understanding of CIED function and consequences of de-activation are key.
Physician have right to decide and if felt uncomfortable with these decision , should consider referral to another physician comfortable to provide  the management of request.


]]> 2021-10-27 08:30:20 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1847588173 Need to respect patient last wishes and autonomy on end of their life limited time if they are still have capacity and able to make decision. https://padlet.com/lpj2/wqknxkzrps34/wish/1847649485 Patient have the right to choose treatment to continuous or to be withheld for their poor prognosis and terminal illness.
Physician need to document the discussion clearly that what have been discussed, what have been decided, who was informed  and who have involved during discussion to avoid euthanasia .


]]> 2021-10-27 09:01:51 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1847649485 This next generation of cardiovascular electronic device is better than old pacemaker. https://padlet.com/lpj2/wqknxkzrps34/wish/1847770064 This device is leadless pacemaker, most suitable for older patient who required only Right Ventricular pacing or patient with bilateral occluded subclavian veins. 
-implanted time is short (about 30 mins) 
-no longer leave a scar/ unsightly bulge over the chest 
- reduce the risk of systemic infection and eliminates the needed for central venous access. 
-some ICD have battery life is more than 10 years. 
- Monitor heart rhythm all the time and detects VF and delivers a life saving shock automatically.]]> 2021-10-27 10:15:11 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1847770064 Personal thoughts related to the device. https://padlet.com/lpj2/wqknxkzrps34/wish/1847811187 My personal thoughts on this are that since the patient will still die even if the device is not deactivated, I will keep the device until it serves its purpose, unless the device hastens the patient's death due to complications.

Deactivation of the device, in my opinion, is equivalent to euthanasia, even if this device is a foreign body, but I believe it was invented for a greater purpose to every individual who chose to have this device in their body. ]]> 2021-10-27 10:41:43 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1847811187 Issues of patient's with LVAD https://padlet.com/lpj2/wqknxkzrps34/wish/1847887169 - Need to be long term for aspirin and warfarin, must carry out daily dressing, battery only last up to 8 hour and need to carry spare batteries if they go out, only can shower with an adequate dressing to protective line exit site and electrical equipment, cannot swim .
-Travelling oversea is inconvenient as need to carry extra batteries and charger.
-Difficulty assess for no sign of life  when need for initiate to perform cardiac compression due to no pulsation. 
-Some complication are stoke, pump thrombosis, RVF , GI bleeding ,Pump pocket infection, kidney failure. 
- Need one of caregiver who have known how to change her controller when patient become unconscious due to device malfunction and who need to contact for getting instructions.]]> 2021-10-27 11:28:59 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1847887169 Some differences to this new device compare to existing device https://padlet.com/lpj2/wqknxkzrps34/wish/1847924559 - Leadless pacemaker, implanted short time , no longer leave scar, unsightly bulge, minimizing infection, eliminate the needed for central venous access. 
-battery life 0f more than 10 years
-monitor heart rhythm all the time and detects VF and delivers a life saving shock automatically.
-most suitable for older patient who required only Right Ventricular pacing or patient with bilateral occluded subclavian veins.]]> 2021-10-27 11:49:54 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1847924559 End of life concerns with LVAD patient- https://padlet.com/lpj2/wqknxkzrps34/wish/1847970361 -Difficulty to assess vital sign to patient with no pulse at all time and management will be confused when patient become unconscious condition or unresponsive ( need to contact controller or to be continuous as treatment plan )
-Extra treatments and care will be add for complications eg; GI bleeding, kidney failure, stoke ,pump thrombosis ,pump pocket infection, depression]]> 2021-10-27 12:12:24 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1847970361 https://padlet.com/lpj2/wqknxkzrps34/wish/1850294013 If the LVAD were to suddenly fail, then the heart has to be strong enough to push the blood through the device and out to the body.]]> 2021-10-28 04:19:56 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1850294013 I think the most common issues patient with LVAD face is coping with the inconveniences like the daily dressing to the driveline, must cover the driveline and electrical equipment properly so it won't get wet during shower, need to carry spare batteries as it only last for 8hours. - Faith https://padlet.com/lpj2/wqknxkzrps34/wish/1850482449 2021-10-28 06:12:43 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1850482449 As with any surgical procedure, LVAD implantation is associated with an adverse event profile. Such complications of LVAD therapy include bleeding, infection, pump thrombosis, right heart failure, device malfunction, and stroke. -KRIS https://padlet.com/lpj2/wqknxkzrps34/wish/1850485851 2021-10-28 06:14:45 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1850485851 For patients with LVAD who are deteriorating, quality of life is affected. LVAD is considered life-support, but when patient is deteriorating, discussion on whether to keep LVAD activated or not is very important, will it still be beneficial to patient? These issues must be discussed with family. -Faith https://padlet.com/lpj2/wqknxkzrps34/wish/1850513776 2021-10-28 06:30:45 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1850513776 Recent findings https://padlet.com/lpj2/wqknxkzrps34/wish/1850516266 For many patients with advanced heart failure, LVADs as destination therapy improve survival and quality of life. However, LVADs can be associated with complications, new comorbidities or worsening of previous conditions, resulting in decreased quality of life and limited prognosis, raising the need for planning palliative and end-of-life care. Open communication addressing the consequences of the LVAD implantation for daily life and the future (including advance directives) is advised in different stages of the treatment, involving a multidisciplinary team taking care of these complex patients and their caregivers.Healthcare professionals treating patients before and after LVAD implantation need to take an active role in end-of-life discussions and be able to communicate information regarding expected complications, quality of life and prognosis to the patients and caregivers. Research is needed addressing optimal ways and timing of communication with LVAD patients and families. (Tuvia Ben Gal et al. Curr Opin Support Palliat Care. 2013 Mar.). -KRIS-]]> 2021-10-28 06:32:11 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1850516266 end of life issues s10224323 https://padlet.com/lpj2/wqknxkzrps34/wish/1850618241 from my understanding, physician and team will discuss on PPC and consequences of de-activation of CIED. 

lijiao ]]> 2021-10-28 07:27:47 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1850618241 Leadless pacemaker vs pacemaker s10224323 https://padlet.com/lpj2/wqknxkzrps34/wish/1850658374 just wonder, what is duration for device check scan for leadless pacemaker 

li jiao]]> 2021-10-28 07:49:26 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1850658374 concern: can do CPR for patients with LVAD s10224323 https://padlet.com/lpj2/wqknxkzrps34/wish/1850670070 If someone with LVAD turn unconscious in public/ hospital and require CPR, can we still do CPR ? 

lijiao ]]> 2021-10-28 07:56:12 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1850670070 https://padlet.com/lpj2/wqknxkzrps34/wish/1852549474 It’s really hard for home care to tell family to deactivate CIED when primary consultants did not suggest. 

Nicole]]> 2021-10-28 23:20:07 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1852549474 https://padlet.com/lpj2/wqknxkzrps34/wish/1852552944 Does patient have to go back to hospital for deactivation? Do they look for the vendor or primary cardiologist? What if they do not want to go back to hospital. How to deactivate?

Nicole]]> 2021-10-28 23:23:33 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1852552944 https://padlet.com/lpj2/wqknxkzrps34/wish/1854506742 getting pregnant is considered hazardous for a woman with LVAD :( - candy]]> 2021-10-29 17:46:02 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1854506742 https://padlet.com/lpj2/wqknxkzrps34/wish/1855029154 Battery replacement is still recommended for patients who have a prognosis in months but still have good ECOG status. If they deteriorate rapidly, Dr will discuss with the family. Once agreed, Dr will reach out to the Cardiologist who inserted the device to contact the vendor accompanied by the home care Dr to deactivate it (for home care setting) - Doreen

]]> 2021-10-30 02:20:42 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1855029154 https://padlet.com/lpj2/wqknxkzrps34/wish/1855073974 Glad LVAD has bought hopes and buying times for some of them. Some of the complications are expected, as mentioned. I'm thinking more about day-to-day living, such as showering and abstaining from some activities (swimming or causing sweating +++). Otherwise, they are living their normal active lifestyle ; )

Doreen]]> 2021-10-30 03:11:16 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1855073974 https://padlet.com/lpj2/wqknxkzrps34/wish/1855626599 Deactivated CIED is it reused for other patients?
-Prema-]]> 2021-10-30 15:25:18 UTC https://padlet.com/lpj2/wqknxkzrps34/wish/1855626599