Transveneuze versus subcutane defibrillator bij patiënten met hypertrofe cardio myopathie : een retrospectieve analyse in twee Belgische ziekenhuizen

Hypertrofe cardiomyopathie (HCM) is een erfelijke aandoening met een verhoogd risico op plotse dood (SCD). Er zijn geen gerandomiseerde studies om de implantatie van een implantable cardioverter-defibrillator (ICD) in patiënten met HCM te leiden. Aanbevelingen zijn gebaseerd op observationele, retrospectieve cohort studies

Basic components and patterns of acute ischemia recovery assessed from continuous ST monitoring in acute myocardial infarction treated by thrombolytic therapy

Continuous ST monitoring of the lead showing the highest ST elevation on the admission 12-lead electrocardiogram was performed in patients with acute myocardial infarction of 6 hours or less enrolled in the OSIRIS and GUSTO trials. ST elevation measured at j + 50 ms was averaged from all normal beats every 20 seconds. ST trends were visually analyzed by two observers blinded from the thrombolytic treatment, its onset, and coronary angiograms performed 21 hours (median) after thrombolysis. Three basic and consecutive components were considered for analysis: the initial amplitude of ST elevation (A1), the maximal amplitude recovery (REC), and the minimal ST amplitude (A2). Prespecified patterns (PAT) were considered: PAT 1 integrated permanent A1 elevation followed by REC, PAT 2 intermittent A1 elevation, and REC. Prespecified pattern 3 was considered in absence of REC. Twenty-four-hour trends were recorded in 347 patients and judged adequate in 306 (88%) followed by angiography in 268 (77%). This group was not clinically different from the 79 patients without ST/angiography. Prespecified pattern 1 was identified in 81%, PAT 2 in 8%, and PAT 3 in 11% of the patients. The positive predictive value of PAT 1 + 2 for coronary patency was 94%, the negative predictive value 72%, sensitivity 96%, and specificity 60%. A salient feature was the occurrence of ST overshoot defined by a > or = 1 mm increase above A1 within the first minutes of REC. Overshoot occurred in 35% of PAT 1 and predicted subsequent patency in all but two patients.(ABSTRACT TRUNCATED AT 250 WORDS

Method, safety, and outcomes of persistent AF ablation without a circular mapping catheter: 3 years experience of a Belgian Tertiary Centre.

We aimed to share our methods and experience of persistent AF ablation without a circular mapping catheter (CMC), thereby avoiding femoral venous and transseptal punctures, decreasing the cost of the procedure, and possibly reducing the duration of the procedure and fluoroscopy time. We report our experience with 261 persistent AF ablations performed without a CMC over the past 3 years. The procedures were performed with no apparent loss of efficacy or safety. Freedom from recurrence was defined as a 1-year absence of AF/atrial flutter (AFL) episodes >30 s, beyond the 3-month blanking period. At 1 year, 72% of the patients were free from arrythmias. Persistent AF ablation is feasible without a CMC, reducing the need for venous and transseptal punctures and the cost of the procedure. We suggest that prospective studies should aim to characterise the reduction in procedure and fluoroscopy times as a result of this technique

Treatment of unexplained syncope: a multicenter, randomized trial of cardiac pacing guided by adenosine 5'-triphosphate testing

BACKGROUND: The origin of 40% of syncope cases remains unknown even after a complete diagnostic workup. Previous studies have suggested that ATP testing has value in selecting successful therapy. This patient-blinded, multicenter, randomized superiority trial tested whether, in patients with syncope of unknown origin, selecting cardiac pacing in those with a positive ATP test leads to fewer recurrences than those who do not receive pacing. METHODS AND RESULTS: From 2000 to 2005, 80 consenting patients (mean age, 75.9±7.7 years; 81% women; 56% without diagnosed structural heart disease) with syncope of unknown origin and atrioventricular or sinoatrial block lasting >10 seconds (average, 17.9±6.8 seconds) under ATP administration (20-mg IV bolus) were recruited from 10 hospitals, implanted with programmable pacemakers, and randomized to either active pacing (dual-chamber pacing at 70 bpm) or backup pacing (atrial pacing at 30 bpm). Patients were followed up regularly for up to 5 years for any syncope recurrence, the primary outcome. Mean follow-up was 16 months. Syncope recurred in 8 of 39 patients (21%) randomized to active pacing and in 27 of 41 (66%) randomized to backup pacing (control), yielding a hazard ratio of 0.25 (95% confidence interval, 0.12-0.56). After recurrence, the 27 recurrent control patients were reprogrammed to active pacing, and only 1 reported subsequent syncope. CONCLUSION: This study suggests that, in elderly patients with syncope of unknown origin and positive ATP tests, active dual-chamber pacing reduces syncope recurrence risk by 75% (95% confidence interval, 44-88). CLINICAL TRIAL REGISTRATION: URL: http://www.controlled-trials.com/ISRCTN00029383. Unique identifier: ISRCTN00029383