A migrant left ventricular lead

We report the case of 70-year-old woman with Reel syndrome and cardiac resynchronization therapy device who experienced severe device malfunction. Reel syndrome was misdiagnosed for several months and the patient manifested fatigue, discomfort and diaphragmatic stimulation

Frequency of “Pocket” Hematoma in Patients Receiving Vitamin K Antagonist and Antiplatelet Therapy at the Time of Pacemaker or Cardioverter Defibrillator Implantation (from the POCKET Study)

In patients undergoing cardiac device implantation, anticoagulant and antiplatelet therapy are associated with an increased risk of pocket hematoma. In case of vitamin K antagonist therapy, a strategy of continued warfarin with no heparin bridge showed a reduction of pocket hematoma. Evidence regarding antiplatelet therapy management is limited. This is a single-center observational study which reflects our systematic approach to the problem. In 2012, we proposed an improved management protocol for anticoagulant and antiplatelet therapy (no-bridge protocol) based on individual thromboembolic risk stratification, noninterruption of oral anticoagulation, no bridge with heparin and elastic adherence compression bandage. The primary end point was the incidence of clinically significant pocket hematoma in the first 30 days after implantation. A total of 1,035 patients were enrolled, of whom 522 received the standard management and 513 the new protocol. The primary end point occurred in 34 patients of the standard management group and 8 patients of the no-bridge protocol group (6.5% vs 1.6%, p <0.001). Patients in the standard management group had a higher incidence of pocket infections (2.3% vs 0.6%, p = 0.02), lead dislodgements (4.8% vs 2.1%, p = 0.02), and thromboembolic events (1.3% vs 0.0%, p <0.01). On a multivariate analysis, heparin and coronary artery disease were independent predictors of pocket hematoma (relative risk [RR] 3.48, 95% confidence interval [CI] 1.55 to 7.83 and RR 2.43, 95% CI 1.25 to 4.76, respectively), whereas the no-bridge protocol was associated with a reduction of pocket hematoma (RR 0.33, 95% CI 0.14 to 0.76). New anticoagulant and antiplatelet therapy management protocol was associated with a reduced incidence of clinically significant pocket hematomas, thromboembolic events, pocket infections, and lead dislodgements

STABLE CORONONARY ARTERY DISEASE 136 QUESTION AND ANSWERS

STABLE CORONONARY ARTERY DISEASE 136 QUESTION AND ANSWER

Epidemiology of Imported Leishmaniasis in Italy: Implications for a European Endemic Country

<div><p>In the past decade, the number of imported leishmaniasis cases has increased in countries of Western Europe. The trend is associated with increasing travels, ecotourism activity, military operations and immigration. While in endemic countries leishmaniasis is usually well diagnosed, accurate patient history and parasite identification are necessary to distinguish between autochthonous and imported cases. This is particularly important, as new <i>Leishmania</i> species/genotypes may be introduced and transmitted by local phlebotomine vectors without appropriate surveillance, with unpredictable consequences. We report on the surveillance of imported leishmaniasis performed by the <i>Leishmania </i>Identification Reference Centre of Rome from 1986 through 2012, involving health care centres from 16/20 Italian regions. Suspected imported cases were analyzed and conclusions were based on clinical, epidemiological and diagnostic findings. Over the years, different parasite identification methods were employed, including MultiLocus Enzyme Electrophoresis and molecular techniques combining disease diagnosis (SSU rDNA nested-PCR) and <i>Leishmania</i> typing (nuclear repetitive sequence and ITS-1 PCR-RFLPs). A total of 105 imported cases were recorded (annual range: 0-20) of which 36 were visceral (VL) (16 HIV-coinfections) and 69 cutaneous (CL) cases; 85 cases (52 CL) were from the Old World and 20 (17 CL) from the New World. Eight <i>Leishmania</i> species were identified, of which 7 were exotic to Italy. VL importation until 1995 was associated with the spread of Mediterranean <i>Leishmania</i>-HIV co-infections in early 1990s. Following the introduction of HAART treatment, such cases became occasional in Italians but relatively frequent among immigrants. In contrast, a steady increase of CL cases was observed from different areas of the Old and New Worlds, that in recent years included mainly immigrants ‘visiting friends and relatives’ and Italian tourists. This positive trend likely depends on better diagnosis and reporting; however, we suspect that many CL cases remained unrecognized. Given the relatively low incidence of leishmaniasis importation, the risk of introduction of exotic parasites appears limited, although the detection of anthroponotic species requires attention.</p></div

Algorithm used for the classification of suspected cases of imported leishmaniasis in “imported” (certainty degrees A1, A2, A3) and “probably imported” (certainty degrees B1, B2).

<p>Algorithm used for the classification of suspected cases of imported leishmaniasis in “imported” (certainty degrees A1, A2, A3) and “probably imported” (certainty degrees B1, B2).</p

<i>Leishmania</i> species identified in imported leishmaniasis cases according to area of infection and travel type.

<p>VL, Visceral leishmaniasis; CL, Cutaneous leishmaniasis.</p><p>^acountries where VL is not declared [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0129418#pone.0129418.ref001" target="_blank">1</a>]</p><p>^bcountries where VL and CL are recorded but the <i>Leishmania</i> species was not identified [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0129418#pone.0129418.ref001" target="_blank">1</a>].</p><p><i>Leishmania</i> species identified in imported leishmaniasis cases according to area of infection and travel type.</p