The cardiac resynchronisation therapy (CRT) survey II is a joint initiative between the European Heart Rhythm Association and the Heart Failure Association. It compiles real world data about cardiac ...resynchronisation therapy in European Society of Cardiology member states. 11 088 patients assigned to implantation of CRT with pacemaker function (CRT-P) or CRT with an incorporated defibrillator (CRT-D) were enrolled in the survey starting 1 October 2015 till 31 December 2016 and for each patient, an electronic case report form (eCRF) was completed. Each participating country had each eCRF data-point benchmarked against the total cohort. In total, 79 patients were included from Latvia. The mean age of patients was 68.1, similar to the total cohort of other ESC member states, and 21.8% of patients were female. Latvian patients compared to other countries more often had permanent atrial fibrillation, NYHA class III and IV, ejection fraction 35 %. CRT-Ds and multipolar lead implantation rates were higher. Peri-procedural complication rates were similarly low in both groups. At discharge, prescribed medication rates were similar but more frequently MRAs, ivabradine and calcium channel blockers were prescribed and slightly less frequently ACE inhibitors/ARBs were prescribed. The CRT survey II is a valuable resource that describes ongoing practice of cardiac resynchronisation therapy around Europe and benchmarking against the total cohort is nationally significant for each participating country.
: Over the last five decades cardiac implantable electronic devices (CIED) have become established as the mainstay for the treatment of permanent bradycardias, chronic heart failure and dangerous ...heart rhythm disturbances. These devices improve survival and quality of life in many patients. However, infections associated with CIED implantation, particularly lead-related infective endocarditis (LRIE), can offset all benefits and make more harm than good for the patient. To date, there are no other studies in Latvia, addressing patients with lead-related infective endocarditis. The objective of this study was to identify the most common pathogens associated with LRIE and their antimicrobial resistance and to identify possible risk factors of patients who present with LRIE.
The study was performed retrospectively at Pauls Stradins Clinical University Hospital (PSCUH). The study included patients who were referred to PSCUH due to LRIE for lead extraction. Patients were identified from procedural journals. Information about isolated microorganisms, patient comorbidities and visual diagnostics data was taken from patient records.
Forty-nine patients with CIED related infective endocarditis were included in the study, 34 (69.4%) were male, median age of all patients was 65.0 (50.5-73.0) years, median hospital stay was 15.5 (22.0-30.5) days. Successful and complete lead extraction was achieved in all patients. Thirty-two (65.3%) had received antibiotics prior to blood sample. Only in 31 (63.3%) positive culture results were seen. The most common isolated pathogens were
(23.5%) and coagulase negative staphylococci (23.5%). Other bacteria were isolated considerably less often. The atrial lead was most common location for lead vegetations, seen in 50.0% of cases. Five (10.2%) patients have died due to the disease.
Lead-related infective endocarditis is a major complication of cardiac implantable electronic devices with considerable morbidity and mortality, which in our study was as high as 10.2%.
Background
Many patients requiring a pacemaker have persistent hypertension with systolic blood pressures above recommended levels. We evaluated a pacemaker‐based Programmable Hypertension Control ...(PHC) therapy that uses a sequence of variably timed shorter and longer atrioventricular intervals.
Methods and Results
Patients indicated for dual‐chamber pacing with office systolic blood pressure (oSBP) >150 mm Hg despite stable medical therapy were implanted with a Moderato™ pulse generator that delivers PHC therapy. Patients were followed for 1 month (Run‐In period) with conventional pacing; those with persistent oSBP >140 mm Hg were included in the study and had PHC therapy activated. The co‐primary efficacy end points were changes in 24‐hour ambulatory systolic blood pressure and oSBP between baseline and 3 months. Safety was assessed by tracking adverse events. Thirty‐five patients met the initial inclusion criteria and underwent Moderato implantation. At 1 month, oSBP was <140 mm Hg in 7 patients who were excluded. PHC was activated in the remaining 27 patients with baseline office blood pressure 166±11/80±10 mm Hg despite an average of 3.2 antihypertensive medications. During the Run‐In period, oSBP and 24‐hour ambulatory systolic blood pressure decreased by 8±13 and 5±12 mm Hg (P<0.002), respectively. Compared with pre‐PHC activation measurements, oSBP decreased by another 16±15 mm Hg and 24‐hour ambulatory systolic blood pressure decreased by an additional 10±13 mm Hg (both P<0.01) at 3 months. No device‐related serious adverse effects were noted.
Conclusions
In pacemaker patients with persistent hypertension despite medical therapy, oSBP and 24‐hour ambulatory systolic blood pressure are decreased by PHC therapy. Initial indications are that this therapy is a safe and promising therapy for such patients.
Clinical Trial Registration
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02282033.
We describe demographic, clinical and programming characteristics of a geographically diverse population implanted with an IPG, with a focus of patients enrolled from Middle East (ME).
Data were ...obtained from PANORAMA, a long term, prospective observational study of 8522 patients from 34 countries implanted with a cardiac rhythm management device between 2005 and 2011. This analysis is based on the 5580 (65%) that were implanted with an IPG, of which 782 patients were enrolled from the ME (Kuwait n=361 and Saudi Arabia n=421).
Compared to the other regions patients from the ME were more likely to present with diabetes (20% vs 37%, p<0.001) and less likely to have NYHA class II, III or IV (34% vs 7%, p<0.001) or atrial fibrillation (33% vs 17%, p<0.001). The ME region had the highest proportion of patients implanted with a single chamber device and AV block indication.
The Panorama IPG cohort provides a unique opportunity to examine the implant practices and clinical profiles of patients implanted with an IPG in the Middle East region. We found significant differences in patient characteristics, type of IPG, and choice of programming. Further work is needed to understand how these differences might contribute to differences in patient management and outcomes.
No standard dosage of warfarin will work for all people or even for the same person in all situations. Dosing of this medication must be individualized. The purpose was to investigate mechanisms of ...warfarin – drug interactions, identify possible warfarin interactions in the hospital drug prescribing for cardiologic patients. In this study patients from cardiological department of the hospital were included who received warfarin therapy from May 2008 to September 2008. A total of 100 patients (60 male, 40 female) met the study inclusion criteria. The mean age was 69 years. Patients received warfarin treatment for the following indications: atrial fibrillation (43 patients), tachyarrytmia (29 patients), prosthetic valve (7 patients), dilated cardiomyopathy (21 patients). Concomitant other drugs were analysed known either to prolong the prothrombin time or INR or to interact with warfarin. It is recommended that for patients who received combinations of warfarin with other drugs such as amiodarone (25%), anti-inflamatory drugs (aspirin (4%)), statins (13%), proton pump inhibitor (omeprazole (4%)) the daily warfarin dose is reduced to avoid increased bleeding risk. Conclusions: (1) risk of warfarin – drug interactions were found for combined use with amiodarone, digoxin, statins, spironolactone, aspirin, omeprazole, thyroid hormones and antithyroid drugs; (2) physician and clinical pharmacist collaboration is important to recognize, analyze and manage potential warfarin – drug interactions during hospitalizations and if necessary prescribe other medications or adjust dose of warfarin.
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