Long-Term Follow-Up of Endocardial Pacing Leads Implanted with Extrathoracic Subclavian Venous Approach

The extrathoracic subclavian venous approach is a new approach with the aim to exclude the disadvantages of the conventional subclavian venous approach that carries a risk of pneumothorax and may result in lead damage. We investigated long-term survival of the leads implanted by this new approach between May 1995 and June 2005. A total of 482 leads implanted in 309 patients were analyzed. In cases of patient death, meeting criteria for lead failure or difficulty of continuing follow-up for other reasons, the follow-up was terminated at that time. Therefore, the follow-up was complete for 358 leads (74.3%) and the mean followup time was 55.0 ± 32.1 months (range 1–122 months). The overall lead survival rate was 100% at 5 years and 98.3% at 7 years. This finding suggested that this approach might reduce the incidence of lead failure

Right Bundle Branch Block Like Pattern Recorded in Right Ventricular Endocardial Pacing

Right bundle branch block (RBBB) pattern recorded during right ventricular (RV) endocardial pacing should be given special attention in terms of safe RV pacing or lead malposition, e.g. left ventricular pacing or coronary venous pacing, even for patients with no symptoms. Paced electrocardiograms from 47 consecutive patients with a pacemaker implanted were studied. Four patients (8.5%) were found to have RBBB pattern recorded in precordial V1 and V2 leads in the usual 4th intercostal space. All of these patients showed left bundle branch block (LBBB) pattern in limb leads. When precordial V1 and V2 leads in the 5th space were recorded, RBBB pattern changed to LBBB pattern. Biplane chest X-ray film and echocardiogram, especially 3D echo mode, confirmed that tips of pacing leads of the 4 patients were located in the distal RV septum or the apex. RBBB pattern observed during RV endocardial pacing usually represents safe RV endocardial pacing rather than perforation or malposition of pacing leads

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo