204 Overdrive ventricular pacing in patients with permanent atrial arrhythmias and sleep apnea

BackgroundIn contrast to its efficacy in patients with heart failure (HF) and central (C) sleep apnea (SA), cardiac pacing is ineffective in obstructive SA. We examined whether overdrive ventricular pacing (OVP) has an effect on SA in pacemaker recipients with permanent atrial arrhythmias.MethodsAn apnea-hypopnea index (AHI) ≥ 15 was confirmed in 28 of 38 patients screened by finger oximetry during ventricular pacing at a backup rate of 40 bpm (BUV40). These 28 patients were randomly assigned in a crossover design to BUV40 versus OVP at 20 bpm above the mean heart rate measured during screening oximetry.ResultsAHI ≥ 30 and CSA were observed in 61% and 79% of patients, respectively. In 21 patients (19 with CSA) with a ≥ 5 OVP-induced decrease or no change in AHI, left ventricular ejection fraction (LVEF) was 40±16%, versus 55±18% (p=0.04) in 7 patients (3 with CSA, p=0.02) with a ≥ 5 OVP-induced increase in AHI. In 13 patients with histories of HF decompensation, AHI decreased from 32.8±12.9 during BUV40 to 24.9±16.5 during OVP, versus increased from 37.6±11.0 to 39.0±11.5 in 15 patients without histories of HF decompensation (p=0.02 vs. patients with histories of decompensated HF). In 9 patients with LVEF ≤ 35%, AHI decreased from 37.3±14.7 during BUV40 to 28.4±17.9 during OVP, versus from 34.5±10.7 to 34.4±14.3 in 19 patients with LVEF >35%, (p=0.04 vs. patients with LVEF ≤ 35%).ConclusionsIn patients with permanent atrial tachyarrhythmias, AHI decreased significantly during OVP in patients with a) histories of decompensated HF and CSA, or b) LVEF ≤ 35%, and increased or was unchanged by OVP in patients without these characteristics

Demand patterns for HIV-tests in general practice: information collected by sentinel networks in 5 European countries.

This study describes a 1 year international data collection on the demand pattern for HIV-antibody tests in general practice recorded by 6 sentinel networks in 5 European countries. The purpose of the recording was to evaluate the use of HIV-antibody testing by general practitioners and the demand for testing among the general population. Sentinel networks of general practitioners are a possible and available instrument for monitoring the perception of the HIV-test, and indirectly of the threat of the HIV-epidemic by the public and by the general practitioners (GPs). Differences were found between the countries in the frequency of testing, the person asking the test and the reason for testing. Possible explanatory factors, such as differences in the routine testing of specific groups, differences in the training and in the role of the GP, differences in the characteristics of prevention policy, are discussed. The European comparison also offers the opportunity to reflect on common medical practice in dealing with demands for HIV-tests. (aut. ref.

Predictive factors for ipsilateral recurrence after nephron-sparing surgery in renal cell carcinoma.

International audienceRCC ipsilateral recurrence risk after NSS is significantly associated with tumour size >4cm, tumour bilaterality (synchronous or asynchronous), and PSM. Careful follow-up should be advised in patients presenting with such characteristics