Quantitative Correlates of Resting Potassium-43 Perfusion Following Myocardial Infarction in Man

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A Case of Distal Embolization of Left Ventricular Thrombus due to Blunt Chest Trauma-Induced Coronary Artery Occlusion

Chest trauma can lead to various cardiac complications ranging from simple arrhythmias to myocardial rupture. A variety of injuries to the coronary arteries, including laceration, thrombosis, intimal dissection, arteriovenous fistula and pseudoaneurysm formation following blunt trauma have been rarely reported. We report a very unusual case of distal embolization of left ventricular thrombus due to blunt chest trauma-induced coronary artery occlusion

Worldwide pacemaker and defibrillator reuse: Systematic review and metaâ analysis of contemporary trials

BackgroundPatients go without pacemaker, defibrillator, and cardiac resynchronization therapies (devices) each year due to the prohibitive costs of devices.ObjectiveWe sought to examine data available from studies regarding contemporary risks of reused devices in comparison with new devices.MethodsWe searched online indexing sites to identify recent studies. Peerâ reviewed manuscripts reporting infection, malfunction, premature battery depletion, and deviceâ related death with reused devices were included. The primary study outcome was the composite risk of infection, malfunction, premature battery depletion, and death. Secondary outcomes were the individual risks.ResultsNine observational studies (published 2009â 2017) were identified totaling 2,302 devices (2,017 pacemakers, 285 defibrillators). Five controlled trials were included in metaâ analysis (2,114 devices; 1,258 new vs 856 reused). All device reuse protocols employed interrogation to confirm longevity and functionality, disinfectant therapy, and, usually, additional biocidal agents, packaging, and ethylene oxide gas sterilization. Demographic characteristics, indications for pacing, and median followâ up were similar. There were no deviceâ related deaths reported and no statistically significant difference in risk between new versus reused devices for the primary outcome (2.23% vs 3.86% respectively, P = 0.807, odds ratio = 0.76). There were no significant differences seen in the secondary outcomes for the individual risks of infection, malfunction, and premature battery depletion.ConclusionsDevice reuse utilizing modern protocols did not significantly increase risk of infection, malfunction, premature battery depletion, or deviceâ related death in observational studies. These data provide rationale for proceeding with a prospective multicenter noninferiority randomized control trial.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146585/1/pace13488_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146585/2/pace13488.pd

Establishment of a canine model of cardiac memory using endocardial pacing via internal jugular vein

<p>Abstract</p> <p>Background</p> <p>Development of experimental animal models has played an important role in understanding the mechanisms of cardiac memory. The purpose of this study was to evaluate a new canine model of cardiac memory using endocardial ventricular pacing via internal jugular vein.</p> <p>Methods</p> <p>Twelve Beagle dogs underwent placement of a permanent ventricular pacemaker mimicking the use of pacemakers in humans and induction of cardiac memory by endocardial ventricular pacing.</p> <p>Results</p> <p>Cardiac memory was achieved in 11 of 12 attempts overall. Procedural mortality due to cardiac tamponade (n = 1) occurred in the first attempt. The T-wave memory persisted for 96 ± 17 minutes and 31 ± 6 days in the short-term and long-term cardiac memory groups, respectively. There were no significant differences in the heart rate, blood pressure and echocardiographic parameters in the animals between before and after ventricular pacing in the short-term and long-term cardiac memory groups. No significant pathologic changes with the light microscopy were found in the present study in all dogs.</p> <p>Conclusion</p> <p>The model does require surgery but is not as invasive as an open-chest model. This canine model can serve as a useful tool for studying mechanisms of cardiac memory.</p

Remote versus face-to-face monitoring for implantable cardiac devices : rationale and design of the PORTLink (PORTuguese Research on Telemonitoring with CareLink) trial

© 2012 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L. Todos os direitos reservados.With expanding indications for cardiac implantable electronic devices (CIEDs) capable of treating bradycardias, complex cardiac tachyarrhythmias and heart failure, the number of patients requiring regular long-term specialized care is growing rapidly. Currently, routine face-to-face follow-up consultations for patients with CIEDs are a significant burden on hospital services. Remote telemonitoring appears to offer a safe and effective alternative to conventional follow-up in this area. The Medtronic CareLink Network enables remote monitoring of CIED patients, and thus has the potential to improve the efficiency of medical care in this population. The objective of the PORTLink (PORTuguese Research on Telemonitoring with CareLink) multicenter randomized trial is to assess the safety, efficacy and costs of remote CIED monitoring compared to traditional face-to-face follow-up. It will evaluate aspects such as physicians’ and patients’ acceptance of and satisfaction with reviewing device data via the website, the complexity for troubleshooting calls to the support center, the use of emergency resources by symptomatic patients, the incidence of unscheduled consultations after remote interrogations, levels of anxiety, depression and quality of life, and the main resources used by the CareLink system. Approximately 200 patients will be randomized in up to five centers, with clinical follow-up of 12 months. Enrollment began in 2012 and is expected to be completed in early 2014.Com a expansão das indicações para terapêutica com dispositivos cardíacos implantáveis (DCI), capazes de tratar bradiarritmias, taquidisritmias entriculares e insuficiência cardíaca, o número de doentes que necessitam de seguimento especializado regular a longo prazo tem vindo a aumentar rapidamente. Atualmente, as consultas de rotina com portadores de DCI envolvendo equipas multidisciplinares representam uma sobrecarga significativa na atividade hospitalar. Neste contexto, a monitorização à distância tem sido sugerida como uma opção segura e eficaz, com grande potencial como alternativa ao seguimento convencional. O sistema Medtronic CareLink tem sido largamente implementado na monitorização à distância, podendo associar-se a melhoria na eficiência dos programas de seguimento desta população. O objetivo do PORTuguese Research on Telemonitoring with CareLink (PORTLink), um estudo multicêntrico aleatorizado, é avaliar a segurança, a eficácia e os custos da monitorização à distância de DCI, quando comparados com o seguimento hospitalar convencional. O estudo pretende avaliar aspetos como a aceitação e satisfação da equipa médica e dos doentes com os dados do funcionamento do dispositivo obtidos via website, a complexidade referida pelos vários centros na deteção e resolução de problemas, a utilização dos recursos de urgência por doentes sintomáticos, a incidência de consultas não programadas, os níveis de ansiedade, depressão e qualidade de vida, e o consumo de recursos associados ao funcionamento do sistema CareLink

Implantable or External Defibrillators for Individuals at Increased Risk of Cardiac Arrest: Where Cost-Effectiveness Hits Fiscal Reality

Objcetives:  Implantable cardioverter defibrillators (ICDs) are highly effective at preventing cardiac arrest, but their availability is limited by high cost. Automated external defibrillators (AEDs) are likely to be less effective, but also less expensive. We used decision analysis to evaluate the clinical and economic trade-offs of AEDs, ICDs, and emergency medical services equipped with defibrillators (EMS-D) for reducing cardiac arrest mortality. Methods:  A Markov model was developed to compare the cost-effectiveness of three strategies in adults meeting entry criteria for the MADIT II Trial: strategy 1, individuals experiencing cardiac arrest are treated by EMS-D; strategy 2, individuals experiencing cardiac arrest are treated with an in-home AED; and strategy 3, individuals receive a prophylactic ICD. The model was then used to quantify the aggregate societal benefit of these three strategies under the conditions of a constrained federal budget. Results:  Compared with EMS-D, in-home AEDs produced a gain of 0.05 quality-adjusted life-years (QALYs) at an incremental cost of $5225 ($104,500 per QALY), while ICDs produced a gain of 0.90 QALYs at a cost of $114,660 ($127,400 per QALY). For every $1 million spent on defibrillators, 1.7 additional QALYs are produced by purchasing AEDs (9.6 QALYs/$million) instead of ICDs (7.9 QALYs/$million). Results were most sensitive to defibrillator complication rates and effectiveness, defibrillator cost, and adults’ risk of cardiac arrest. Conclusions:  Both AEDs and ICDs reduce cardiac arrest mortality, but AEDs are significantly less expensive and less effective. If financial constraints were to lead to rationing of defibrillators, it might be preferable to provide more people with a less effective and less expensive intervention (in-home AEDs) instead of providing fewer people with a more effective and more costly intervention (ICDs).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74790/1/j.1524-4733.2006.00118.x.pd