Cardiac Resynchronization Therapy in the Young Patient: Current Status and Future Directions

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74749/1/j.1540-8167.2006.00591.x.pd

Comparative genomics of Bacillus thuringiensis phage 0305φ8-36: defining patterns of descent in a novel ancient phage lineage

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Propagating the missing bacteriophages: a large bacteriophage in a new class

The number of successful propagations/isolations of soil-borne bacteriophages is small in comparison to the number of bacteriophages observed by microscopy (great plaque count anomaly). As one resolution of the great plaque count anomaly, we use propagation in ultra-dilute agarose gels to isolate a Bacillus thuringiensis bacteriophage with a large head (95 nm in diameter), tail (486 × 26 nm), corkscrew-like tail fibers (187 × 10 nm) and genome (221 Kb) that cannot be detected by the usual procedures of microbiology. This new bacteriophage, called 0305φ8-36 (first number is month/year of isolation; remaining two numbers identify the host and bacteriophage), has a high dependence of plaque size on the concentration of a supporting agarose gel. Bacteriophage 0305φ8-36 does not propagate in the traditional gels used for bacteriophage plaque formation and also does not produce visible lysis of liquid cultures. Bacteriophage 0305φ8-36 aggregates and, during de novo isolation from the environment, is likely to be invisible to procedures of physical detection that use either filtration or centrifugal pelleting to remove bacteria. Bacteriophage 0305φ8-36 is in a new genomic class, based on genes for both structural components and DNA packaging ATPase. Thus, knowledge of environmental virus diversity is expanded with prospect of greater future expansion

PCR-Directed Formation of Viral Hybridsin Vitro

AbstractWhen constructing viruses that have desired hybrid phenotypes, anticipated difficulties include the nonviability of many, possibly most, of the hybrid genomes that can be constructed by incorporation of DNA fragments. Therefore, many different hybrid genomes may have to be constructed in order to find one that is viable. To perform this combinatorial work in a single experiment, we have used bacteriophage T7-infected cell extracts to transfer DNAin vitro.In an extract, we have incubated T7 DNA, together with DNA obtained by polymerase chain reaction (PCR) amplification of the gene (gene 17) for the tail fiber of the T7-related bacteriophage, T3. Afterin vitropackaging of DNA in the extract, hybrid progeny bacteriophage were detected by probing with a T3-specific oligonucleotide; hybrids are found at a frequency of 0.1%. By determination of the nucleotide sequence of the entire gene 17 of 14 independently isolated hybrids, both right and left ends of the PCR fragment are found to be truncated in all hybrids. For all 14 hybrids, the right end is in the same location; the left end is found at 3 different locations. The nonrandom location of the ends is explained by selection among different inserts for viability; that is, most of the hybrid genomes are nonviable. Some hybrids acquire from T3 the desirable phenotype of nonadherence to agarose gels during agarose gel electrophoresis

Delayed Response to Radiofrequency Ablation of Accessory Connections

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72240/1/j.1540-8159.1993.tb01019.x.pd

Antitachycardia Pacemakers in Congenital Heart Disease

BackgroundMany patients with congenital heart disease (CHD) acquire rhythm abnormalities related to their repair, most commonly intraatrial reentrant tachycardia (IART). Treatment of IART in CHD is often multifaceted, and may include medication, ablation, and pacing. Evidence regarding the use of antitachycardia pacing therapies is limited.ObjectiveThe aim of the study is to define the use and efficacy of antitachycardia pacing in patients with CHD at a single center.ResultsEighty implants were performed on 72 patients between 2000 and 2010. Follow‐up data of more than 3 months were available for 56 patients; median follow‐up time was 2.8 years. Twenty (36%) patients received successful antitachycardia pacing at a median 1.3 years postimplant. For those patients with IART after implant, antitachycardia pacing was successful in 57%. Patients with two‐ventricle repairs were more likely to have successful antitachycardia pacing than those with one‐ventricle palliation (45% vs. 17%, P = .04). Patients with documented IART had more successful antitachycardia pacing than those with no documented atrial tachycardia prior to implant (46% vs. 7%, P = .006). Early complications of antitachycardia pacemaker implant occurred in six patients (11%); late complications after implant occurred in three patients (5.6%). Of the initial 72 patients implanted, there were six deaths (8%).ConclusionsAntitachycardia pacing therapies were successful in the majority of CHD patients who had IART after implant. Patients without documented atrial tachycardia prior to implant were unlikely to require or receive successful therapy from antitachycardia pacemaker. Those patients postatrial switch procedure who had documented IART prior to implant had the highest incidence of successful antitachycardia pacing therapies. Antitachycardia pacemaker implantation is an adjunct to the management of IART in CHD patients, but may not benefit patients who have not yet demonstrated IART.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111221/1/chd12230.pd

Automatic Atrial Threshold Measurement and Adjustment in Pediatric Patients

Background: Automatic threshold measurement and output adjustment are used as default settings in modern pacemakers. The purpose of the study was to assess Atrial Capture Management (ACM) of Medtronic pacemakers in pediatric patients. Methods: Forty children were enrolled in two centers. Median age was 9.8 years (range 0.8–17.5 years). Half had undergone surgery for congenital heart defects; 45% of patients had an epicardial atrial lead. The pacing indication was atrioventricular block in 82% of patients and sinus node disease in 18%. Manually determined atrial thresholds and ACM measurements were compared. Results: ACM measurements were within the expected variation in 37/40 (93%) of the patients. In one patient the threshold was 0.625-V lower manually than with ACM. One patient had too high an intrinsic atrial rate for ACM to be able to measure threshold. The mean threshold at 0.4 ms was 0.69 ± 0.32 V manually and 0.68 ± 0.35 V with ACM (two-tailed paired t- test, P = 0.52) in all patients. The mean difference was 0.012 V (95% confidence interval: −0.027, 0.053). The mean endocardial threshold was 0.70 ± 0.36 V manually and 0.69 ± 0.38 V with ACM; epicardial threshold was 0.67 ± 0.27 V manually and 0.68 ± 0.32 V with ACM. The difference between the measurements was 0.012 V for endocardial and 0.014 V for epicardial leads. No atrial arrhythmias due to ACM measurements were observed. Conclusions: ACM measures atrial thresholds reliably in pediatric patients with both endocardial and epicardial leads, allowing its use in both. Constant high intrinsic atrial rate may prevent automatic threshold measurement in young children. (PACE 2010; 33:309–313)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79326/1/j.1540-8159.2009.02619.x.pd

Frequency of CIED remote monitoring: A quality improvement follow‐up study

BackgroundBased on the findings of a prior study of CIED (Cardiac Implantable Electrical Device) remote monitoring (RM) frequency at the same center, the University of Michigan Congenital Heart Center (UMCHC) instituted a quality improvement (QI) change to reduce the frequency of routine CIED RM from every 2 months to every 3 months. The objective of this study is to determine the impact of this QI initiative to reduce workload without compromising patient care.MethodsThis is a single‐center, retrospective cohort study of all UMCHC patients with CIEDs followed via Medtronic CareLink CIED remote monitoring system from July 2015 to June 2017, after the QI change in 2014. The primary outcome was success of transition to new monitoring schedule. Secondary outcomes included complications, incidence of actionable events (AES), patient compliance, and change in workload. Outcomes were compared to the prior study.ResultsThere were 325 patients (mean age was 24  ±  14 years) included, of who 293 (90%) completely transitioned to the new RM schedule. During the study period, 96 transmissions included AES (4% of total), of which 50 (52%) were asymptomatic and discovered on routine monitoring. No patient experienced a complication attributable to decreased RM frequency. The mean number of interrogations decreased by 1.6 per patient over the 2‐year period compared to prior study.ConclusionsThis study demonstrated successful implementation of a QI initiative to reduce CIED monitoring frequency at a single center with no patient adverse events. The intervention reduced workload and potentially improved patient compliance with routine RM.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150575/1/pace13707_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150575/2/pace13707.pd

Implantable Cardioverter Defibrillator Outcomes in Pediatric and Congenital Heart Disease: Time to System Revision

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/122425/1/pace12878.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/122425/2/pace12878_am.pd