Device Programming for His Bundle Pacing Burri, Haran; Keene, Daniel; Whinnett, Zachary ...
Circulation. Arrhythmia and electrophysiology,
2019-February, 2019-02-00, 20190201, Letnik:
12, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Although permanent His bundle pacing was first reported almost 2 decades ago, it is only recently gaining wider adoption, following facilitation of the implant procedure by dedicated tools. An ...additional challenge is programming the system, as His bundle pacing may have specific configurations and require special considerations which current implantable pulse generators are not designed for. The aim of this article is to provide practical recommendations for programming His bundle pacing, to deliver optimal therapy and ensure patient safety.
The ketogenic diet has been used in the treatment of intractable childhood epilepsy since the 1920s. A systematic review of the efficacy, adverse reactions, and costs associated with using the diet ...was performed. PubMed and Ovid searches were performed using the keywords epilepsy/therapy, dietary therapy, ketogenic diet, adverse events, and costs. Cochrane library was searched. Bibliographies of papers located by searches and review articles were compiled. Papers published after 1990 were selected if they were written in either English or French and reported on the use of classic ketogenic diet in patients under age 18 years of age with medically refractory epilepsy. Outcome measures were degree of seizure control, duration patient remained on diet, and occurrence of adverse events. Twenty-six studies were found. No prospective-controlled studies were found. Fourteen studies met all criteria for inclusion. The studies indicated that some children report reduction in seizure frequency. The estimated rate for obtaining complete seizure control was 15.6% (95% confidence interval 10.4-20.8%) with 33% (95% confidence interval 24.3-41.8%) reporting greater than 50% reduction in seizures. Adverse events were not frequent; however, 16 cases of death occurring while on the diet were found. No cost/benefit studies were located. There is evidence to support the cautious use of ketogenic diet in children with refractory epilepsy
Background
His‐bundle pacing (HBP) provides physiological ventricular activation. Observational studies have demonstrated the techniques’ feasibility; however, data have come from a limited number of ...centers.
Objectives
We set out to explore the contemporary global practice in HBP focusing on the learning curve, procedural characteristics, and outcomes.
Methods
This is a retrospective, multicenter observational study of patients undergoing attempted HBP at seven centers. Pacing indication, fluoroscopy time, HBP thresholds, and lead reintervention and deactivation rates were recorded. Where centers had systematically recorded implant success rates from the outset, these were collated.
Results
A total of 529 patients underwent attempted HBP during the study period (2014‐19) with a mean follow‐up of 217 ± 303 days. Most implants were for bradycardia indications.
In the three centers with the systematic collation of all attempts, the overall implant success rate was 81%, which improved to 87% after completion of 40 cases.
All seven centers reported data on successful implants. The mean fluoroscopy time was 11.7 ± 12.0 minutes, the His‐bundle capture threshold at implant was 1.4 ± 0.9 V at 0.8 ± 0.3 ms, and it was 1.3 ± 1.2 V at 0.9 ± 0.2 ms at last device check.
HBP lead reintervention or deactivation (for lead displacement or rise in threshold) occurred in 7.5% of successful implants.
There was evidence of a learning curve: fluoroscopy time and HBP capture threshold reduced with greater experience, plateauing after approximately 30‐50 cases.
Conclusion
We found that it is feasible to establish a successful HBP program, using the currently available implantation tools. For physicians who are experienced at pacemaker implantation, the steepest part of the learning curve appears to be over the first 30‐50 cases.
Abstract More than 40% of all deaths in children under 5 years of age occur during the neonatal period: the first month of life. Immunization of pregnant women has proven beneficial to both mother ...and infant by decreasing morbidity and mortality. With an increasing number of immunization trials being conducted in pregnant women, as well as roll-out of recommended vaccines to pregnant women, there is a need to clarify details of a neonatal death. This manuscript defines levels of certainty of a neonatal death, related to the viability of the neonate, who confirmed the death, and the timing of the death during the neonatal period and in relation to immunization of the mother.
A numerical heat and mass transfer model is used to study the effects of the morphological features of a porous medium composed of ceria when it is placed in a cavity and exposed to high-flux solar ...irradiation to drive a nonstoichiometric reduction. The morphological features are described by the porosity and pore-level Sauter mean diameter. For porosities of 0.60, 0.75, and 0.90, the rate of oxygen production and the efficiency of solar-to-chemical energy conversion increase monotonically as the Sauter mean diameter is decreased from 1000 to 30µm. For a porosity of 0.90, these performance metrics continue to increase down to 10µm. The primary effect of the changes in porosity and Sauter mean diameter are through their influence on the permeability and the extinction coefficient of the medium. For appropriately selected time duration, an energy conversion efficiency of 10.9% is achieved with a Sauter mean diameter of 10µm and a porosity of 0.90.
•The extinction coefficient and the permeability have the greatest impact on conversion efficiency.•The effects of morphology on the extinction coefficient and the permeability are strongly coupled.•For each porosity, there is an associated Sauter mean diameter that will optimize oxygen release.•Operational conditions are anticipated to impact the optimal morphological parameters.
Monoclonal antibodies have become an important treatment option for a number of serious conditions. Concerns have arisen about the potential association of these products with progressive multifocal ...leukoencephalopathy (PML). A list of monoclonal antibodies authorized for sale was derived from the Health Canada Drug Product Database. Case reports of PML after exposure to a monoclonal antibody authorized for use in Canada were retrieved by searching Canada Vigilance and WHO adverse event databases and through a Pub MED/Medline literature search. 182 adverse event case reports were retrieved (adalimumab -1 case, alemtuzumab-14, bevacizumab -3, cetuximab -1, efalizumab - 8, ibritumomab tiuxetan-5, infliximab-4, natalizumab-32, and rituximab-114). The Canadian Product Monographs for natalizumab and ritiximab contain box warnings for PML. A natalizumab registry has been established.
BACKGROUND
Hemolysis is a rare adverse event associated with the use of intravenous immune globulin (IVIG). Using the Canadian experience, this article compares two methods used for case ...ascertainment of hemolysis after IVIG.
STUDY DESIGN AND METHODS
This is a retrospective, descriptive analysis of case reports of hemolytic reaction after exposure to IVIG. The cases were ascertained from the Canada Vigilance database using the standardized MedDRA query for hemolytic disorders between the years 2006 and 2012 inclusively. The presence of a causal relationship was determined by using the Transfusion Transmitted Injuries Surveillance System (TTISS) algorithm. Cases were then reviewed against the standardized case definition of IVIG‐associated hemolysis proposed by the IVIG Hemolysis Pharmacovigilance Group.
RESULTS
A total of 942 adverse event reports after exposure to IVIG had been received by Canada Vigilance during the study period. A search for the adverse event of hemolytic disorder retrieved 313 reports (33%). Using a modified TTISS definition of hemolysis and the TTISS causality assessment algorithm, 226 cases were found to be at least possibly related to administration of IVIG, whereas 69 cases met the definition of the IVIG Hemolysis Pharmacovigilance Group. The amount of IVIG distributed increased over the study period; this trend was not reflected in the number of adverse reaction reports for “hemolytic disorder” received.
CONCLUSION
The number of case reports per year received for the adverse event “hemolytic disorder” after exposure to IVIG fluctuated. The number of confirmed case reports varied depending on the case definition being used.
Most patients who have heart failure with a reduced ejection fraction, when left ventricular ejection fraction (LVEF) is 40% or lower, are diagnosed in hospital. This is despite previous ...presentations to primary care with symptoms. We aimed to test an artificial intelligence (AI) algorithm applied to a single-lead ECG, recorded during ECG-enabled stethoscope examination, to validate a potential point-of-care screening tool for LVEF of 40% or lower.
We conducted an observational, prospective, multicentre study of a convolutional neural network (known as AI-ECG) that was previously validated for the detection of reduced LVEF using 12-lead ECG as input. We used AI-ECG retrained to interpret single-lead ECG input alone. Patients (aged ≥18 years) attending for transthoracic echocardiogram in London (UK) were recruited. All participants had 15 s of supine, single-lead ECG recorded at the four standard anatomical positions for cardiac auscultation, plus one handheld position, using an ECG-enabled stethoscope. Transthoracic echocardiogram-derived percentage LVEF was used as ground truth. The primary outcome was performance of AI-ECG at classifying reduced LVEF (LVEF ≤40%), measured using metrics including the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity, with two-sided 95% CIs. The primary outcome was reported for each position individually and with an optimal combination of AI-ECG outputs (interval range 0–1) from two positions using a rule-based approach and several classification models. This study is registered with ClinicalTrials.gov, NCT04601415.
Between Feb 6 and May 27, 2021, we recruited 1050 patients (mean age 62 years SD 17·4, 535 51% male, 432 41% non-White). 945 (90%) had an ejection fraction of at least 40%, and 105 (10%) had an ejection fraction of 40% or lower. Across all positions, ECGs were most frequently of adequate quality for AI-ECG interpretation at the pulmonary position (979 93·3% of 1050). Quality was lowest for the aortic position (846 80·6%). AI-ECG performed best at the pulmonary valve position (p=0·02), with an AUROC of 0·85 (95% CI 0·81–0·89), sensitivity of 84·8% (76·2–91·3), and specificity of 69·5% (66·4–72·6). Diagnostic odds ratios did not differ by age, sex, or non-White ethnicity. Taking the optimal combination of two positions (pulmonary and handheld positions), the rule-based approach resulted in an AUROC of 0·85 (0·81–0·89), sensitivity of 82·7% (72·7–90·2), and specificity of 79·9% (77·0–82·6). Using AI-ECG outputs from these two positions, a weighted logistic regression with l2 regularisation resulted in an AUROC of 0·91 (0·88–0·95), sensitivity of 91·9% (78·1–98·3), and specificity of 80·2% (75·5–84·3).
A deep learning system applied to single-lead ECGs acquired during a routine examination with an ECG-enabled stethoscope can detect LVEF of 40% or lower. These findings highlight the potential for inexpensive, non-invasive, workflow-adapted, point-of-care screening, for earlier diagnosis and prognostically beneficial treatment.
NHS Accelerated Access Collaborative, NHSX, and the National Institute for Health Research.
Summary
Objective: We aimed to determine the type, frequency, and size of microchromosomal copy number variations (CNVs) affecting the neuronal sodium channel α 1 subunit gene (SCN1A) in Dravet ...syndrome (DS), other epileptic encephalopathies, and generalized epilepsy with febrile seizures plus (GEFS+).
Methods: Multiplex ligation‐dependent probe amplification (MLPA) was applied to detect SCN1A CNVs among 289 cases (126 DS, 97 GEFS+, and 66 with other phenotypes). CNVs extending beyond SCN1A were further characterized by comparative genome hybridization (array CGH).
Results: Novel SCN1A CNVs were found in 12.5% of DS patients where sequence‐based mutations had been excluded. We identified the first partial SCN1A duplications in two siblings with typical DS and in a patient with early‐onset symptomatic generalized epilepsy. In addition, a patient with DS had a partial SCN1A amplification of 5–6 copies. The remaining CNVs abnormalities were four partial and nine whole SCN1A deletions involving contiguous genes. Two CNVs (a partial SCN1A deletion and a duplication) were inherited from a parent, in whom there was mosaicism. Array CGH showed intragenic deletions of 90 kb and larger, with the largest of 9.3 Mb deleting 49 contiguous genes and extending beyond SCN1A.
Discussion: Duplication and amplification involving SCN1A are now added to molecular mechanisms of DS patients. Our findings showed that 12.5% of DS patients who are mutation negative have MLPA‐detected SCN1A CNVs with an overall frequency of about 2–3%. MLPA is the established second‐line testing strategy to reliably detect all CNVs of SCN1A from the megabase range down to one exon. Large CNVs extending outside SCN1A and involving contiguous genes can be precisely characterized by array CGH.
PDF
