Evaluation of subcutaneous implantable cardioverter-defibrillator performance in patients with ion channelopathies from the EFFORTLESS cohort and comparison with a meta-analysis of transvenous ICD outcomes

Background: The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative to conventional transvenous ICD (TV-ICD) therapy to reduce lead complications. Objective: To evaluate outcomes in channelopathy vs patients with structural heart disease in the EFFORTLESS-SICD Registry and with a previously reported TV-ICD meta-analysis in channnelopathies. Methods: The EFFORTLESS registry includes 199 patients with channelopathies (Brugada syndrome 83, long QT syndrome 24, idiopathic ventricular fibrillation 78, others 14) and 786 patients with structural heart disease. Results: Channelopathy patients were younger (39 ± 14 years vs 51 ± 17 years; P 200 beats per minute (P = .0002). Annualized appropriate shock, IAS, and complication rates appear to be lower for the S-ICD vs meta-analysis TV-ICD patients, particularly lead complications. Conclusion: EFFORTLESS demonstrates similar S-ICD efficacy and a nonsignificant, lower rate of IAS in channelopathy patients as compared to structural heart disease. Comparable IAS rates were achieved with the device programmed to higher rates for channelopathy patients

Sunyaev-Zel'dovich clusters in millennium gas simulations

Large surveys using the Sunyaev–Zel’dovich (SZ) effect to find clusters of galaxies are now starting to yield large numbers of systems out to high redshift, many of which are new dis- coveries. In order to provide theoretical interpretation for the release of the full SZ cluster samples over the next few years, we have exploited the large-volume Millennium gas cosmo- logical N-body hydrodynamics simulations to study the SZ cluster population at low and high redshift, for three models with varying gas physics. We confirm previous results using smaller samplesthattheintrinsic(spherical)Y500–M500relationhasverylittlescatter(σlog10Y ≃0.04), is insensitive to cluster gas physics and evolves to redshift 1 in accordance with self-similar expectations. Our preheating and feedback models predict scaling relations that are in excel- lent agreement with the recent analysis from combined Planck and XMM–Newton data by the Planck Collaboration. This agreement is largely preserved when r500 and M500 are derived using thehydrostaticmassproxy,YX,500,albeitwithsignificantlyreducedscatter(σlog10Y ≃0.02),a result that is due to the tight correlation between Y500 and YX,500. Interestingly, this assumption also hides any bias in the relation due to dynamical activity. We also assess the importance of projection effects from large-scale structure along the line of sight, by extracting cluster Y500 values from 50 simulated 5 × 5-deg2 sky maps. Once the (model-dependent) mean signal is subtracted from the maps we find that the integrated SZ signal is unbiased with respect to the underlying clusters, although the scatter in the (cylindrical) Y500–M500 relation increases in the preheating case, where a significant amount of energy was injected into the intergalactic medium at high redshift. Finally, we study the hot gas pressure profiles to investigate the origin of the SZ signal and find that the largest contribution comes from radii close to r500 in all cases. The profiles themselves are well described by generalized Navarro, Frenk & White profiles but there is significant cluster-to-cluster scatter. In conclusion, our results support the notion that Y500 is a robust mass proxy for use in cosmological analyses with clusters

Diffuse Light in Hickson Compact Groups: The Dynamically Young System HCG 44

Compact groups are associations of a few galaxies in which the environment plays an important role in galaxy evolution. The low group velocity dispersion favors tidal interactions and mergers, which may bring stars from galaxies to the diffuse intragroup light. Numerical simulations of galaxy clusters in hierarchical cosmologies show that the amount of the diffuse light increases with the dynamical evolution of the cluster. We search for diffuse light in the galaxy group HCG 44 in order to determine its luminosity and luminosity fraction. Combining with literature data, we aim to constrain the dynamical status of Hickson compact groups. We use Intra Group planetary nebulae (IGPNe) as tracers of diffuse light. These are detected by the so-called on band-off band technique. We found 12 emission line objects in HCG 44, none of them associated with the galaxies of the group. 6/12 emission line objects are consistent with being IGPNe in HCG 44, but are also consistent with being Ly$\alpha$ background galaxies. Thus we derive an upper limit to the diffuse light fraction in HCG 44 of 4.7%. We find a correlation between the fraction of elliptical galaxies and the amount of diffuse light in Hickson compact groups. Those with large fraction of diffuse light are those with large fractions in number and luminosity of E/S0 galaxies. We propose an evolutionary sequence for Hickson compact groups in which the amount of diffuse light increases with the dynamical evolution of the group.Comment: 9 pages, 4 figures, accepted for publication at A&

Measurements of the UV background at 4.6 < z < 6.4 using the quasar proximity effect

We present measurements of the ionising ultraviolet background (UVB) at z ~ 5-6 using the quasar proximity effect. The fifteen quasars in our sample cover the range 4.6 < z_q < 6.4, enabling the first proximity effect measurements of the UVB at z > 5. The metagalactic hydrogen ionisation rate, Gamma_bkg, was determined by modelling the combined ionisation field from the quasar and the UVB in the proximity zone on a pixel-by-pixel basis. The optical depths in the spectra were corrected for the expected effect of the quasar until the mean flux in the proximity region equalled that in the average Ly-alpha forest, and from this we make a measurement of Gamma_bkg. A number of systematic effects were tested using synthetic spectra. Noise in the flux was found to be the largest source of bias at z ~ 5, while uncertainties in the mean transmitted Ly-alpha flux are responsible for the largest bias at z ~ 6. The impacts of large-scale overdensities and Lyman limit systems on Gamma_bkg were also investigated, but found to be small at z > 5. We find a decline in Gamma_bkg with redshift, from log(Gamma_bkg) = -12.15 $\pm$ 0.16 at z ~ 5 to log(Gamma_bkg) = -12.84 $\pm$ 0.18 at z ~ 6 (1 sigma errors). Compared to UVB measurements at lower redshifts, our measurements suggest a drop of a factor of five in the HI photoionisation rate between z ~ 4 and z ~ 6. The decline of Gamma_bkg appears to be gradual, and we find no evidence for a sudden change in the UVB at any redshift that would indicate a rapid change in the attenuation length of ionising photons. Combined with recent measurements of the evolution of the mean free path of ionising photons, our results imply decline in the emissivity of ionising photons by roughly a factor of two from z ~ 5 to 6, albeit with significant uncertainty due to the measurement errors in both Gamma_bkg and the mean free path.Comment: 22 pages, 19 figures, 5 tables; accepted for publication in MNRA

Spectroscopic binaries among Hipparcos M giants I. Data, orbits, and intrinsic variations

This paper is a follow-up of the vast effort to collect radial velocity data for stars belonging to the Hipparcos survey. We aim at extending the orbital data available for binaries with M giant primaries. The data will be used in the companion papers of this series to (i) derive the binary frequency among M giants and compare it to that of K giants (Paper II), and (ii) analyse the eccentricity-period diagram and the mass-function distribution (Paper III). Keplerian solutions are fitted to radial-velocity data. However, for several stars, no satisfactory solution could be found, despite the fact that the radial-velocity standard deviation is larger than the instrumental error, because M giants suffer from intrinsic radial-velocity variations due to pulsations. We show that these intrinsic radial-velocity variations can be linked with both the average spectral-line width and the photometric variability. We present an extensive collection of spectroscopic orbits for M giants, with 12 new orbits, plus 17 from the literature. Moreover, to illustrate the fact that the large radial-velocity jitter present in Mira and semi-regular variables may easily be confused with orbital variations, we also present examples of pseudo-orbital variations (in S UMa, X Cnc and possibly in HD 115521, a former IAU radial-velocity standard). Because of this difficulty, M giants involving Mira variables were excluded from our monitored sample. We finally show that the majority of M giants detected as X-ray sources are actually binaries.Comment: 17 pages, 15 figures, accepted for publication in A&A, language editing changes onl

Remote monitoring and follow-up of cardiovascular implantable electronic devices in the Netherlands: An expert consensus report of the Netherlands Society of Cardiology

Remote monitoring of cardiac implanted electronic devices (CIED: pacemaker, cardiac resynchronisation therapy device and implantable cardioverter defibrillator) has been developed for technical control and follow-up using transtelephonic data transmission. In addition, automatic or patient-triggered alerts are sent to the cardiologist or allied professional who can respond if necessary with various interventions. The advantage of remote monitoring appears obvious in impending CIED failures and suspected symptoms but is less likely in routine follow-up of CIED. For this follow-up the indications, quality of care, cost-effectiveneness and patient satisfaction have to be determined before remote CIED monitoring can be applied in daily practice. Nevertheless remote CIED monitoring is expanding rapidly in the Netherlands without professional agreements about methodology, responsibilities of all the parties involved and that of the device patient, and reimbursement. The purpose of this consensus document on remote CIED monitoring and follow-up is to lay the base for a nationwide, uniform implementation in the Netherlands. This report describes the technical communication, current indications, benefits and limitations of remote CIED monitoring and follow-up, the role of the patient and device manufacturer, and costs and reimbursement. The view of cardiology experts and of other disciplines in conjunction with literature was incorporated in a preliminary series of recommendations. In addition, an overview of the questions related to remote CIED monitoring that need to be answered is given. This consensus document can be used for future guidelines for the Dutch profession

Telecardiology and Remote Monitoring of Implanted Electrical Devices: The Potential for Fresh Clinical Care Perspectives

Telecardiology may help confront the growing burden of monitoring the reliability of implantable defibrillators/pacemakers. Herein, we suggest that the evolving capabilities of implanted devices to monitor patients’ status (heart rhythm, fluid overload, right ventricular pressure, oximetry, etc.) may imply a shift from strictly device-centered follow-up to perspectives centered on the patient (and patient-device interactions). Such approaches could provide improvements in health care delivery and clinical outcomes, especially in the field of heart failure. Major professional, policy, and ethical issues will have to be overcome to enable real-world implementation. This challenge may be relevant for the evolution of our health care systems