Five-year safety and efficacy of leadless pacemakers in a Dutch cohort

BACKGROUND: Adequate real-world safety and efficacy of leadless pacemakers (LPs) have been demonstrated up to 3 years after implantation. Longer-term data are warranted to assess the net clinical benefit of leadless pacing.OBJECTIVE: The purpose of this study was to evaluate the long-term safety and efficacy of LP therapy in a real-world cohort.METHODS: In this retrospective cohort study, all consecutive patients with a first LP implantation from December 21, 2012, to December 13, 2016, in 6 Dutch high-volume centers were included. The primary safety endpoint was the rate of major procedure- or device-related complications (ie, requiring surgery) at 5-year follow-up. Analyses were performed with and without Nanostim battery advisory-related complications. The primary efficacy endpoint was the percentage of patients with a pacing capture threshold ≤2.0 V at implantation and without ≥1.5-V increase at the last follow-up visit.RESULTS: A total of 179 patients were included (mean age 79 ± 9 years), 93 (52%) with a Nanostim and 86 (48%) with a Micra VR LP. Mean follow-up duration was 44 ± 26 months. Forty-one major complications occurred, of which 7 were not advisory related. The 5-year major complication rate was 4% without advisory-related complications and 27% including advisory-related complications. No advisory-related major complications occurred a median 10 days (range 0-88 days) postimplantation. The pacing capture threshold was low in 163 of 167 patients (98%) and stable in 157 of 160 (98%).CONCLUSION: The long-term major complication rate without advisory-related complications was low with LPs. No complications occurred after the acute phase and no infections occurred, which may be a specific benefit of LPs. The performance was adequate with a stable pacing capture threshold.</p

ADHD-like symptoms and attachment in internationally adopted children.

Internationally adopted children seem to be more likely to show ADHD-like symptoms than non-adopted children. The aims of this study were to explore the existence of ADHD-like symptoms and/or diagnosis in a sample of internationally adopted children depending on their country of origin and to describe the links that may exist between the display of these symptoms and observed narrative-based attachment patterns. A Catalan sample of 58 adopted children aged 7-8 (24 from Eastern Europe, 23 from China, and 11 from Ethiopia) was assessed with the Behavioral Assessment System for Children to identify ADHD-like symptoms, and the Friends and Family Interview to identify children's' attachment patterns. Results indicated that children adopted from Eastern Europe showed a trend toward more hyperactivity and significantly more attention problems than girls adopted from China. Children with a secure attachment showed significantly less attention problems and a trend toward less hyperactivity. More studies focusing on the etiology and treatment of these symptoms in adopted children are needed