Undetected displacement of a subcutaneous implantable cardioverter-defibrillator lead

Background: In recent years, subcutaneous implantable cardioverter-defibrillator (S-ICD) implants have progressively increased and have been shown to be safe and highly successful, affording low reintervention rates regardless of the technique used. Case summary: We present a case of S-ICD implantation in a patient diagnosed with idiopathic ventricular fibrillation. In the first follow-up consultation the patient showed appropriate detection parameters in the three configurations. However, chest X-ray revealed lead displacement with a tip migration from the manubrium area of the sternum to the xiphoid process. Discussion: This case highlights the importance of performing at least one chest X-ray during the first weeks after S-ICD implantation, allowing the detection of a problem such as lead displacement, which can lead to undersensing of ventricular arrhythmias or S-ICD oversensing

Ventricular tachycardia burden reduction after substrate ablation: predictors of recurrence.

BACKGROUND Substrate-based ventricular tachycardia (VT) ablation is a first-line treatment in patients with structural cardiac disease and sustained VT refractory to medical therapy. Despite technological improvements and increased knowledge of VT substrate, recurrence still is frequent. Published data are lacking on the possible reduction in VT burden after ablation despite recurrence. OBJECTIVE The purpose of this study was to assess VT burden reduction during long-term follow-up after substrate ablation and identify predictors of VT recurrence. METHODS We analyzed 234 consecutive VT ablation procedures in 207 patients (age 63 6 14.9 years; 92% male; ischemic heart disease in 65%) who underwent substrate ablation in a single center from 2013 to 2018. RESULTS After follow-up of 3.14 6 1.8 years, the VT recurrence rate was 41.4%. Overall, a 99.6% reduction in VT burden (median VT episodes per year: preprocedural 3.546 [1.347-13.951] vs postprocedural 0.001 [0-0.689]; P 5 .001) and a 96.3% decrease in implantable cardioverter-defibrillator (ICD) shocks (preprocedural 1.145 [0.118-4.467] vs postprocedural 0.042 [0-0.111] per year; P 5 .017) were observed. In the subgroup of patients who experienced VT recurrences, VT burden decreased by 69.2% (median VT episodes per year: preprocedural 2.876 [1.105-8.801] vs postprocedural 0.882 [0.505-2.283]; P ,.001). Multivariable analysis showed persistence of late potentials (67% vs 19%; hazard ratio 3.18 [2.18- 6.65]; P ,.001) and lower left ventricular ejection fraction (EF) (30 [25-40] vs 39 [30-50]; P 5 .022) as predictors of VT recurrence. CONCLUSION Despite a high recurrence rate during long-term follow-up, substrate-based VT ablation is related to a large reduction in VT burden and a decrease in ICD therapies. Lower EF and persistence of late potentials are predictors of recurrence. KEYWORDS Arrhythmic burden reduction; Implantable cardioverter-defibrillator shock prevention; Ventricular tachycardia ablation; Ventricular tachycardia recurrence predictors; Ventricular tachycardia storm; Ventricular tachycardia substrate ablatio

Clinical impact of aging on outcomes of cardioneuroablation for reflex syncope or functional bradycardia. Results from the cardionEuroabLation: patiEnt selection, imaGe integrAtioN and outComEs. The ELEGANCE multicenter study

Background: Cardioneuroablation (CNA) is a novel treatment for reflex syncope. The effect of aging on CNA efficacy is not fully understood. Objective: We assessed the impact of aging on candidacy and efficacy of CNA for treating vasovagal syncope (VVS), carotid sinus syndrome (CSS) and functional bradyarrhythmia. Methods: The ELEGANCE multicenter study assessed CNA in patients with reflex syncope or severe functional bradyarrhythmia. Patients underwent pre-CNA Holter ECG, head-up tilt testing (HUT) and electrophysiologic study. CNA candidacy and efficacy was assessed in 14 young (18-40 years), 26 middle-aged (41-60 years) and 20 older (>60 years) patients. Results: Sixty patients (37 men; mean age: 51±16 years) underwent CNA. The majority (80%) had VVS, 8% CSS, and 12% functional bradycardia/AV block. Pre-CNA Holter ECG, HUT and EP findings did not differ across age groups. Acute CNA success was 93%, without differences between age groups (p=0.42). Post-CNA HUT response was negative in 53%, vasodepressor in 38%, cardioinhibitory in 7% and mixed in 2%, without differences across age groups (p=0.59). At follow-up (8 months, IQR:4-15), 53 (88%) patients were free of symptoms. Kaplan-Meier curves did not show differences in event-free survival between age groups (p=0.29). The negative predictive value of a negative HUT was 91.7%. Conclusions: CNA is a viable treatment for reflex syncope and functional bradyarrhythmia in all ages, and is highly effective in mixed VVS. HUT is a key-step of post-ablation clinical assessment

Failure-free survival of the Riata implantable cardioverter-defibrillator lead after a very long-term follow-up

Aims: Riata® implantable cardioverter-defibrillator (ICD) leads from St. Jude Medical are prone to malfunction. This study aimed to describe the rate of this lead's malfunction in a very long-term follow-up. Methods: This single-centre observational study included 50 patients who received a Riata 7Fr dual-coil lead between 2003 and 2008. Follow-up was conducted both in person and remotely, and analysed at 8-month intervals. We evaluated the rates of cable externalization (CE), electrical failure (EF), and the interaction of these two complications. Structural lead failure was defined as radiographic CE. Oversensing of non-cardiac signal or sudden changes in impedance, sensing, or pacing thresholds constituted EF. Results: During a mean follow-up of 10.2 ± 2.9 years, 16 patients (32%) died. We observed lead malfunction in 13 patients (26%): three (23%) due to CE, six (46%) to EF and four (31%) to both complications. Of the malfunctioning leads, 77% failed after seven years of follow-up. The incidence rate (IR) of overall malfunction per 100 patients per year was 0.9 during the first seven years post-implantation, increased to 7.0 after the 7th year and more than doubled (to 16.7) after 10 years. Beyond seven years post-implantation, IR per 100 patient-years increased in both EF and CE (from 0.6 to 5.6 vs. 0.3 to 4.2, respectively). Presence of CE was associated with a 4-fold increase in the proportion of EF. Conclusion: The incidence of Riata ICD lead malfunction, both for EF and CE, increased dramatically after seven years and then more than doubled after 10 years post-implantation

El cultivo de soya y su importancia para el Ecuador

El objetivo del estudio fue observar la producción de soya en el Ecuador y sus oportunidades de exportación al mundo, la metodología fue la revisión bibliográfica de artículos referentes a la producción y comercialización, con datos estadísticos del mercado global, regional y local, se realizó una criba de selección de artículos de inclusión, determinando que estos no podían superar los cinco años de antigüedad, de estar publicados en revistas indexadas, pertenecer a la línea de economía y producción, los resultados hallados fue que la producción en el mundo fue a julio de 2016 de 325.95 millones de toneladas métricas por hectárea (tm/ha), siendo su mayor productor Estados Unidos con 105,596,000tm/ha, seguido de Brasil, con 103,000,000, Ecuador llegó a un porcentaje de 2.04 de tm/ha, en comparación con EEUU y en relación a la producción de Brasil, el mayor productor regional (América del Sur). Esto permitió inferir que en el país no se ha tomado en cuenta la demanda a nivel mundial de esta oleaginosa, la Soya se constituye en una oportunidad de mercado para los productores y comercializadores de soya en el Ecuador, con lo cual se lograría participar en el plan nacional de buen vivir del ecuador Plan Nacional del Buen Vivir y a contribuir a la sublínea de investigación de economía y emprendimiento social, sostenibilidad y gestión territorial

Propuesta de productos alimenticios no tradicionales de fréjol

En Ecuador existen cultivos de diversas clases de fréjol negro, pero los principales son la calima y la caraota, esta última es conocida en el país como fréjol negro, siendo muy apetecida en países como México, Brasil, Colombia y Venezuela. Ecuador produce principalmente este producto para la exportación, siendo la exportación de este producto realizada al mercado europeo. La demanda en el mercado europeo se ha incrementado, principalmente por el valor que los consumidores de este mercado brindan a su valor nutritivo, ya que este producto contiene carbohidratos, proteínas, vitaminas A y B, calcio, magnesio, fósforo, potasio, entre otros. Actualmente, dado el mayor volumen y difusión de estudios científicos, por ejemplo el de la Organización Mundial de la Salud sobre el potencial peligro para la salud debido al consumo de embutidos y carne roja, el consumidor está demandando mayor variedad de productos que puedan ser nutritivos y a la vez deliciosos, por lo cual, siendo el fréjol negro rico en proteínas y nutrientes se convierte en una alternativa ideal, cuyo mercado se expande incluso a aquellos consumidores con necesidades especiales, y que demandan productos sin gluten ni lactosa, por lo que la apuesta a ofrecer productos derivados del fréjol negro, como harinas, galletas y derivados saludables (sin azúcar, integrales, bajas en sal o sin grasas trans) tienen una oportunidad de crecimiento a nivel interno, pero principalmente a la exportación. Palabras Clave: Cultivos, Productos Alimenticios No Tradicionales, Fréjol Negro

Los contratos sobre el buque en Derecho Español. Análisis práctico

Prólogo / José Luis Gabaldón García (pp. 9-13). -- Introducción (pp. 15-18). -- El contrato de construcción naval: aspectos prácticos / Gonzalo Alvar Ezquerra (pp. 19-37). -- El contrato de compraventa / Carlos López-Quiroga, Luz Martínez de Azcoitia y José Sánchez-Fayos Martín-Peña (pp. 39-58). -- El contrato de arrendamiento de buque / Rodolfo González Lebrero (pp. 59-75). -- El contrato de fletamento por tiempo / José María Alcántara González (pp. 77-102). -- El contrato de fletamento por viaje: contenido obligacional / Juan Pablo Rodríguez Delgado (pp. 103-144). -- El contrato de transporte marítimo en régimen de conocimiento de embarque / Javier del Corte (pp. 145-186). -- Los documentos de transporte / Carlos Llorente (pp. 187-205). -- Contratos de utilización del buque para fines distintos del transporte de mercancías / José Manuel G. Pellicer (pp. 207-221). -- El contrato de arrendamiento náutico / León von Ondarza (pp. 223-244). -- El contrato de pasaje marítimo / Hannah de Bustos, Antonio Quirós de Sas y Julio López Quiroga (pp. 245-260). -- Los contratos de gestión naval para la dotación del buque / Bernardo Ruiz Lima (pp. 261-279). -- El contrato de gestión naval / Víctor Mata Garrido (pp. 281-302). -- El contrato de consignación de buques /Jesús Barbadillo Eyzaguirre (pp. 303-323). -- El contrato de manipulación portuaria / Carlos Pérez (pp. 325-338). -- El contrato de practicaje / Alicia Velasco Nates (pp. 339-356). -- Los contratos de mediación en la explotación del buque / Carmen Codes Cid y Martín Prieto Sulleiro (pp. 357-372). -- El contrato de remolque / Ana Sánchez Horneros (pp. 373- 392). -- El contrato de remolque / Jaime de Castro (pp. 393-412). -- El contrato de salvamento / Luis Souto (pp. 413-430). -- El contrato de remoción de restos / Verónica Meana (pp. 431-446). -- El contrato de clasificación del buque / Jaime Rodrigo de Larrucea (pp. 447-463). -- El seguro de casco y máquina / Carlos Cerdá Donat y Diego de San Simón Palacios (pp. 465-491). -- Los clubes de protección e indemnización (P&I) / Miguel Caballero (pp. 493-504). -- El seguro de protección e indemnización (P&I) / Jaime Albors (pp. 505-524). -- El seguro del acreedor hipotecario / Luis F. Gómez de Mariaca Fernández (pp. 525-540)

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead