Skin prick testing in patients using beta-blockers: a retrospective analysis

<p>Abstract</p> <p>Rationale</p> <p>The use of beta-blockers is a relative contraindication in allergen skin testing yet there is a paucity of literature on adverse events in this circumstance. We examined a population of skin tested patients on beta-blockers to look for any adverse effects.</p> <p>Methods</p> <p>Charts from 2004-2008 in a single allergy clinic were reviewed for any patients taking a beta-blocker when skin tested. Data was examined for skin test reactivity, type of skin test, concomitant asthma diagnosis, allergens tested, and adverse events.</p> <p>Results</p> <p>One hundred and ninety-one patients were taking beta-blockers when skin testing occurred. Seventy-two patients had positive skin tests. No tests resulted in an adverse event.</p> <p>Conclusions</p> <p>This data demonstrates the relative safety of administrating of skin prick tests to patients on beta-blocker treatment. Larger prospective studies are needed to substantiate the findings of this study.</p

20 years of cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) is an accepted treatment for patients with heart failure (HF), impaired left ventricular (LV) function, and a wide QRS complex. It has been revolutionary for patients with advanced HF whose only previous option was cardiac transplantation, and it is now a realistic option for patients with mild HF. The development of CRT also has united the previously disparate cardiological subspecialties of electrophysiology and HF. This review, written on the occasion of the 20th anniversary of the first clinical use of CRT for HF, takes a historical perspective on CRT's evolution from "bench to bedside." We also comment on the task faced by electrophysiologists and HF specialists as they make this life-saving therapy available to an increasing number of eligible patients

To Replace or Not to Replace: A Systematic Approach to Respond to Device Advisories

AIM: The decision of whether and when to replace a device in response to an "advisory" letter requires careful consideration, because device replacement carries related risks and is influenced by the clinical characteristics of the patient. METHODS AND RESULTS: The risk/benefit of device replacement depends on four parameters: expected annual sudden cardiac death rate; residual device life; difference in failure rate between the device listed on the advisory letter and the replacement device; and the replacement procedure mortality risk. Using these four factors, we have developed an equation that provides the "number needed to replace" (NNR) to save one life. Per our model, patients implanted with a device with a failure rate approaching 1% and a probability of requiring device intervention >or=25% per year-in particular, pacemaker-dependent patients-have an NNR or=0.5%, have an NNR <100. Patients with arrhythmic risk <or=2.5% per year and those with devices having failure rates <0.1% have a high NNR and stand more risk to be harmed than benefited from device replacement. CONCLUSIONS: Pacemaker-dependent patients and those with high arrhythmic risk (>or=25% annually) when having "advisory" devices with high failure rate (>or=1%) have an NNR <250 and, hence, could be considered for device replacement. Conversely, patients with arrhythmic risk <or=2.5% per year and those with devices having failure rates <or=0.1% have a high NNR or even risk of "harm" from device replacement. In all the intermediate cases, the NNR will quantify the benefit/risk ratio of replacement, thus helping physicians and patients decide on the preferred approach. The NNR methodology proposed here is also applicable to advisory notices issued to leads, but the high morbidity associated with lead replacement will generally rule out interventions to replace leads