The traditional transvenous defibrillator has been one of the greatest advancement in Cardiology in the last 30
years and has demonstrated to reduce arrhythmic and total mortality in selected ...patients. However the traditional defibrillator
can have a high price to pay in terms of complications, the "weakest link" being the transvenous/endocardial leads.
The entirely subcutaneous defibrillator (S-ICD) has recently entered into the clinical scenario and represents a valid alternative
to the transvenous device. S-ICD can provide substantial advantages, especially among some subgroups of patients
(i.e. after device infection, in young patients and arrhythmogenic syndromes). However, given its characteristics, it is fundamental
to choose patients that can benefit the most. In this review we will describe advantages and limitations of the SICD
and point-out how to select the "ideal candidate" for the implantation.
BACKGROUND—The clinical profile and arrhythmic outcome of competitive athletes with isolated nonischemic left ventricular (LV) scar as evidenced by contrast-enhanced cardiac magnetic resonance remain ...to be elucidated.
METHODS AND RESULTS—We compared 35 athletes (80% men, age14–48 years) with ventricular arrhythmias and isolated LV subepicardial/midmyocardial late gadolinium enhancement (LGE) on contrast-enhanced cardiac magnetic resonance (group A) with 38 athletes with ventricular arrhythmias and no LGE (group B) and 40 healthy control athletes (group C). A stria LGE pattern with subepicardial/midmyocardial distribution, mostly involving the lateral LV wall, was found in 27 (77%) of group A versus 0 controls (group C; P<0.001), whereas a spotty pattern of LGE localized at the junction of the right ventricle to the septum was respectively observed in 11 (31%) versus 10 (25%; P=0.52). All athletes with stria pattern showed ventricular arrhythmias with a predominant right bundle branch block morphology, 13 of 27 (48%) showed ECG repolarization abnormalities, and 5 of 27 (19%) showed echocardiographic hypokinesis of the lateral LV wall. The majority of athletes with no or spotty LGE pattern had ventricular arrhythmias with a predominant left bundle branch block morphology and no ECG or echocardiographic abnormalities. During a follow-up of 38±25 months, 6 of 27 (22%) athletes with stria pattern experienced malignant arrhythmic events such as appropriate implantable cardiac defibrillator shock (n=4), sustained ventricular tachycardia (n=1), or sudden death (n=1), compared with none of athletes with no or LGE spotty pattern and controls.
CONCLUSIONS—Isolated nonischemic LV LGE with a stria pattern may be associated with life-threatening arrhythmias and sudden death in the athlete. Because of its subepicardial/midmyocardial location, LV scar is often not detected by echocardiography.
Introduction
Atrial tachycardia/fibrillation (AT/AF) episodes are common in implantable cardioverter‐defibrillator (ICD) recipients and can be undetected by standard single‐chamber devices. This ...study aims to explore whether a single‐lead ICD with an atrial dipole (ICD DX; BIOTRONIK SE & Co, Berlin, Germany) could improve the AT/AF diagnosis and management as compared to standard ICD (ICD VR).
Methods and Results
We selected patients without AT/AF history from the THINGS registry which included consecutive patients implanted with ICD for standard indications. The ICD VR and the ICD DX groups included 236 (62.8%) and 140 (37.2%) patients, respectively, and had no significant differences in baseline characteristics. During a median follow‐up of 27 months, there were 7 AT/AF diagnoses in the ICD VR and 18 in the ICD DX group. The 2‐year incidence of AT/AF diagnosis was 3.6% (95% confidence interval CI: 1.6%‐9.6%) for the ICD VR and 11.4% (95% CI: 6.8%‐18.9%) for the ICD DX group (adjusted hazard ratio HR: 3.85 95% CI: 1.58‐9.41; P = .003). Initiation of oral anticoagulation (OAC) due to AT/AF diagnosis was reported in 15 patients. The 2‐year incidence of OAC onset was 3.6% (95% CI: 1.6%‐7.8%) for the ICD VR and 6.3% (95% CI: 3.0%‐12.7%) for ICD DX group (adjusted HR: 1.99 95% CI: 0.72‐5.56; P = .184).
Conclusion
We observed that atrial sensing capability in single‐chamber ICD patients without evidence of atrial arrhythmias at implant is associated with a greater likelihood of detecting AT/AF episodes. The management of these diagnosed arrhythmias often led to clinical interventions, mainly represented by initiation of OAC therapy.
The manuscript describes the efficacy of a new skin closure system (ZipLine™) for wound closure after pacemaker/implantable cardioverter defibrillator surgery. The system is particularly useful when ...wound healing is difficult with traditional methods and in patients at high risk for surgical site infections (SSIs). This skin closure option is easy and quick to apply and remove, and produces excellent cosmetic results. Although it is associated with a minimal expense upcharge, the benefits, including the potential for decrease in SSI, make it attractive and worth considering for skin closure in device patients, particularly those at increased risk of complications.
Implantable cardioverter defibrillator(ICD) programminginvolves several parameters. In recent years antitachycardia pacing(ATP) has gained an increasing importance in the treatment of ventricular ...arrhythmias, whether slow or fast. It reduces the number of unnecessary and inappropriate shocks and improves both patient’s quality of life and device longevity. There is no clear indication regarding the type of ATP to be used, except for the treatment of fast ventricular tachycardias(188 bpm-250 bpm) where it has been shown a greater efficacy and safety of burst compared to ramp; 8 impulses in each sequence of ATP appears to be the best programming option in this setting. Beyond ATP use, excellent clinical results were obtained with programming standardization following these principles: extended detection time in ventricular fibrillation(VF) zone; supraventricular discrimination criteria up to 200 bpm; first shock in VF zone at the maximum energy in order to reduce the risk of multiple shocks. The MADIT-RIT trial and some observational registries have also recently demonstrated that programming with a widespread use of ATP, higher cut-off rates or delayed intervention reduces the number of inappropriate and unnecessary therapies and improves the survival of patients during mid-term follow-up.
Los modelos asociativos basados en los principios de la Economía Social, han mostrado que favorecen al reparto equitativo del ingreso, además que promueven la autogestión, la democracia interna, la ...solidaridad y el desarrollo local. El Proyecto Economía Social Idit Ibero tiene como objetivo es incubar, impulsar, y/o consolidar empresas de economía social, preferente ubicadas en zonas pobres o vulnerables, incorporando un “componente significativo” de desarrollo tecnológico e innovación. La innovación social, empresarial y tecnológica alineadas a los principios de la Economía Social, propician la formación y subsistencia de empresas y colectivos que resuelven sus necesidades individuales y de grupo.
We investigated the unique effects of morphological awareness on several aspects of reading in Portuguese. We tested 132 Portuguese-speaking children in the fourth grade. Morphological awareness was ...assessed with a word analogy task that included inflectional and derivational transformations. Results indicated that morphological awareness was a significant predictor of word reading accuracy, word reading fluency, and reading comprehension after controlling for the effects of nonverbal ability and phonological awareness. Morphological awareness also explained unique variance in reading comprehension after adding word reading as a control. In conclusion, morphological awareness has important roles in both word reading and reading comprehension in Portuguese. Educational and clinical implications are discussed.
PDF
