Subcutaneous or Transvenous Defibrillator Therapy.

BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (ICD) was designed to avoid complications related to the transvenous ICD lead by using an entirely extrathoracic placement. Evidence comparing these systems has been based primarily on observational studies. METHODS: We conducted a noninferiority trial in which patients with an indication for an ICD but no indication for pacing were assigned to receive a subcutaneous ICD or transvenous ICD. The primary end point was the composite of device-related complications and inappropriate shocks; the noninferiority margin for the upper boundary of the 95% confidence interval for the hazard ratio (subcutaneous ICD vs. transvenous ICD) was 1.45. A superiority analysis was prespecified if noninferiority was established. Secondary end points included death and appropriate shocks. RESULTS: A total of 849 patients (426 in the subcutaneous ICD group and 423 in the transvenous ICD group) were included in the analyses. At a median follow-up of 49.1 months, a primary end-point event occurred in 68 patients in the subcutaneous ICD group and in 68 patients in the transvenous ICD group (48-month Kaplan-Meier estimated cumulative incidence, 15.1% and 15.7%, respectively; hazard ratio, 0.99; 95% confidence interval [CI], 0.71 to 1.39; P = 0.01 for noninferiority; P = 0.95 for superiority). Device-related complications occurred in 31 patients in the subcutaneous ICD group and in 44 in the transvenous ICD group (hazard ratio, 0.69; 95% CI, 0.44 to 1.09); inappropriate shocks occurred in 41 and 29 patients, respectively (hazard ratio, 1.43; 95% CI, 0.89 to 2.30). Death occurred in 83 patients in the subcutaneous ICD group and in 68 in the transvenous ICD group (hazard ratio, 1.23; 95% CI, 0.89 to 1.70); appropriate shocks occurred in 83 and 57 patients, respectively (hazard ratio, 1.52; 95% CI, 1.08 to 2.12). CONCLUSIONS: In patients with an indication for an ICD but no indication for pacing, the subcutaneous ICD was noninferior to the transvenous ICD with respect to device-related complications and inappropriate shocks. (Funded by Boston Scientific; PRAETORIAN ClinicalTrials.gov number, NCT01296022.)

Rapid left ventricular recovery after cabergoline treatment in a patient with peripartum cardiomyopathy

The aetiology of peripartum cardiomyopathy (PPCM) is still largely unknown. Recent evidence suggests that the breakdown products from prolactin can induce cardiomyopathy. Prolactin secretion can be reduced with bromocriptine which had beneficial effects in a small study. We present a case of a patient with PPCM who received cabergoline, a strong and long lasting antagonist of prolactin secretion. Following treatment, her prolactin levels dropped swiftly. N-terminal pro-BNP levels, which had remained high up to that point, dropped within 1 day (7006 to 4408 pg/mL). Echocardiographic left ventricular ejection fraction recovered from 26% on Day 4 postpartum to 32% and later 47% on Days 2 and 5 after cabergoline treatment. To our knowledge, this is the first description of a case of PPCM in which cabergoline was administered

Baseline characteristics of the AGNES case-control set.

<p>CK-MB, creatine kinase-MB; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery. *In case of missing values, the sample sizes of the total, case and control sets (total, case, control) for which information was available are given. ^† Normally distributed continuous variables are presented as mean ± SD or as Median [interquartile range] otherwise. Categorical variables data are presented as number (%). ‡ <i>P</i> value for comparison of cases and controls using independent t-test, Mann-Whitney test, or chi-square test where appropriate.</p

Association analysis of SNPs with VF in AGNES cases versus AGNES controls.

*<p>effect estimate is given per copy of the coded allele adjusted for age, sex and culprit artery. † <i>P</i> values for interaction between SNPs and culprit artery on risk of VF</p

ECG characteristics of AGNES cases and controls according to the artery harbouring the stenotic lesion.

<p>LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery</p>*<p><i>P</i> value of comparison between cases and controls using a logistic regression model adjusted for age and sex. (All patients with AV block or PR≥200 ms or QRS≥120 ms & AF are excluded)</p

Association analysis of SNPs with ECG indices of conduction and repolarization during myocardial ischemia.

<p>SE, Standard Error * Direction of effect estimate per copy coded allele; Inc, Increasing effect; Dec, Decreasing effect; data from previous GWA studies † Effect estimate is given per copy of the coded allele adjusted for age, sex and culprit artery (all patients with AV block or PR ≥ 200 ms or QRS ≥ 120 ms are excluded).</p