Defibrillation thresholds with right pectoral implantable cardioverter defibrillators and impact of waveform tuning (the Tilt and Tune trial).

Aims: Assess defibrillation thresholds (DFTs) with right active pectoral implantable cardioverter defibrillator (RICDs). Defibrillation thresholds in patients receiving RICDs are regarded as \u27high\u27 and potentially improved by waveform optimization (tuning). However, this has not been systematically tested. Methods and results: Patients receiving RICDs [Single chamber (VVI) = 16, DDD = 32, cardiac resynchronization therapy (CRT) = 43] were randomized to either 50/50% fixed tilt (FT) or tuned waveform (3.5 ms time constant based). Defibrillation threshold was tested with a binary search protocol in single coil anodal configuration. Then RICDs were compared with left-sided placements. Baseline patient characteristics in FT (n = 54) and tuned (n = 37) were similar (65 ± 14 years, 71% male, Left ventricular ejection fraction 31 ± 13%; and proportions VVI/DDD/Cardiac resynchronization therapy defibrillator). Tuning reduced Phase 1 by 15% and Phase 2 by 45%. For FT vs. tuned: high voltage impedance was 61.9 ± 13.2 vs. 64.5 ± 12.7 Ω (P = 0.33) and mean DFT 14.2 ± 8.8 vs. 14.9 ± 9.2 J (P = 0.8). When high voltage impedance was \u3e62 Ω (mean 73.6 ± 8.6 Ω), DFT was identical [FT 13.0 ± 7.9 J vs. tuned 12.0 ± 5.9 J (P= 0.7)]. Defibrillation thresholds exceeded 20 J (600 V) in \u3e20% of patients [FT 11/54 (20.4%) vs. tuned 12/37 (32%) patients]. Defibrillation threshold with RICD was greater and exhibited wider dispersion compared with left ICDs (n = 54) under similar conditions. Conclusion: This first randomized trial investigating DFTs with right ICDs confirms relatively higher DFTs with RICDs than reported for left pectoral ICDs. However, DFTs were generally unaffected by 3.5 ms time constant-based waveform tuning compared with a 50% tilt waveform. Implant testing may be preferred with RICDs. Clinical trial number: NCT00873691

Ventricular Arrhythmia in Cancer Patients: Mechanisms, Treatment Strategies and Future Avenues.

Cardiovascular disease and cancer are the leading causes of morbidity and mortality in the US. Despite the significant progress made in cancer treatment leading to improved prognosis and survival, ventricular arrhythmias (VA) remain a known cardiovascular complication either exacerbated or induced by the direct and indirect effects of both traditional and novel cancer treatments. Although interruption of cancer treatment because of VA is rarely required, knowledge surrounding this issue is essential for optimising the overall care of patients with cancer. The mechanisms of cancer-therapeutic-induced VA are poorly understood. This review will discuss the ventricular conduction (QRS) and repolarisation abnormalities (QTc prolongation), and VAs associated with cancer therapies, as well as existing strategies for the identification, prevention and management of cancer-treatment-induced VAs

Role of yoga as an adjunctive therapy in patients with neurocardiogenic syncope: a pilot study

Neurocardiogenic syncope (NCS) is a common clinical condition characterized by abrupt cardiovascular autonomic changes resulting in syncope. This is a recurring condition with mixed results from current strategies of treatment

Perioperative hematoma with subcutaneous ICD implantation: Impact of anticoagulation and antiplatelet therapies

BackgroundThe safety of perioperative anticoagulation (AC) and antiplatelet (AP) therapy with subcutaneous implantable cardioverter‐defibrillator (S‐ICD) implantation is unknown. The purpose of this study was to identify the risk factors associated with hematoma complicating S‐ICD implantation.MethodsRecords were retrospectively reviewed from 200 consecutive patients undergoing S‐ICD implantation at two academic medical centers. A hematoma was defined as a device site blood accumulation requiring surgical evacuation, extended hospital stay, or transfusion.ResultsAmong 200 patients undergoing S‐ICD implantation (age 49 ± 17 years, 67% men), 10 patients (5%) had a hematoma, which required evacuation in six patients (3%). Warfarin was bridged or uninterrupted in 12 and 13 patients, respectively (6% and 6.5%). Four of 12 patients with warfarin and bridging AC (33%) and two of 13 patients with uninterrupted warfarin (15%) developed a hematoma. Neither of the two patients with uninterrupted DOAC had a hematoma. No patients on interrupted AC without bridging (n = 26, 13 with warfarin, 13 with DOAC) developed a hematoma. A hematoma was also more likely with the use of clopidogrel (n = 4/10 vs 10/190, 40% vs 5.3%, P < 0.0001) in combination with aspirin in 12/14 patients. Any bridging AC (odds ratio [OR] 10.3, 1.8–60.8, P = 0.01), clopidogrel (OR 10.0, 1.7–57.7, P = 0.01), and uninterrupted warfarin without bridging (OR 11.1, 1.7–74.3, P = 0.013) were independently associated with hematoma formation.ConclusionAC and/or AP therapy with clopidogrel appears to increase the risk for hematoma following S‐ICD implantation. Interruption of AC without bridging should be considered when it is an acceptable risk to hold AC.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145383/1/pace13349_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145383/2/pace13349.pd

Perioperative hematoma with subcutaneous ICD implantation: Impact of anticoagulation and antiplatelet therapies

BackgroundThe safety of perioperative anticoagulation (AC) and antiplatelet (AP) therapy with subcutaneous implantable cardioverter‐defibrillator (S‐ICD) implantation is unknown. The purpose of this study was to identify the risk factors associated with hematoma complicating S‐ICD implantation.MethodsRecords were retrospectively reviewed from 200 consecutive patients undergoing S‐ICD implantation at two academic medical centers. A hematoma was defined as a device site blood accumulation requiring surgical evacuation, extended hospital stay, or transfusion.ResultsAmong 200 patients undergoing S‐ICD implantation (age 49 ± 17 years, 67% men), 10 patients (5%) had a hematoma, which required evacuation in six patients (3%). Warfarin was bridged or uninterrupted in 12 and 13 patients, respectively (6% and 6.5%). Four of 12 patients with warfarin and bridging AC (33%) and two of 13 patients with uninterrupted warfarin (15%) developed a hematoma. Neither of the two patients with uninterrupted DOAC had a hematoma. No patients on interrupted AC without bridging (n = 26, 13 with warfarin, 13 with DOAC) developed a hematoma. A hematoma was also more likely with the use of clopidogrel (n = 4/10 vs 10/190, 40% vs 5.3%, P < 0.0001) in combination with aspirin in 12/14 patients. Any bridging AC (odds ratio [OR] 10.3, 1.8–60.8, P = 0.01), clopidogrel (OR 10.0, 1.7–57.7, P = 0.01), and uninterrupted warfarin without bridging (OR 11.1, 1.7–74.3, P = 0.013) were independently associated with hematoma formation.ConclusionAC and/or AP therapy with clopidogrel appears to increase the risk for hematoma following S‐ICD implantation. Interruption of AC without bridging should be considered when it is an acceptable risk to hold AC.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145383/1/pace13349_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145383/2/pace13349.pd

Quality of public school toilets and the frequency of changing sanitary napkins among students in public secondary schools in the City of Manila, Philippines

Abstract Background In sub-tropical countries, poor menstrual hygiene management has been reported. One cause of poor menstrual hygiene management can be poor quality toilets. However, associations between poor quality toilets and menstrual-related behaviors have been poorly understood. The present study aimed to assess the association between the quality of school toilets and the frequency of changing sanitary napkins in school toilet among Filipino students. Methods A cross-sectional study was conducted in six secondary schools of the City of Manila, Philippines, in 2017. A self-administered survey questionnaire with female students collected data on the outcome variable, self-reported daily frequency of changing sanitary napkins in school toilet, and other predictor variables. An observational survey collected data on the main predictor variable, surveyor-rated toilet quality variables. A total of 526 students were included in the analyses. Logistic regression with generalized estimating equation model was used to assess the association between the outcome and predictor variables. Results No significant association was found both between toilet quality and the outcome. Although the association was not significant, the odds ratio (OR) of “sanitary bin is available in toilet” was 2.54 compared to “sanitary bin is not available in toilet.” The results of multivariate analysis showed that participants who reported stronger perceived behavioral control or stronger subjective norm were significantly more likely to change sanitary napkins, compared to those with lower perceived control score or lower subjective norm score, respectively (adjusted OR 2.29, 95% confidence interval 1.24 to 4.25; adjusted OR 2.63, 95% confidence interval 1.45 to 4.76). Conclusions The present study showed that the quality of school toilets was not associated with the frequency of changing sanitary napkins among the studied population. However, it does not mean that the cause-effect relationship was rejected. Further studies involving more schools are necessary to confirm this relationship. Improving subjective norm and perceived behavior control might improve menstrual hygiene behavior

Initial real world experience with a novel insertable (Reveal LinQ(@Medtronic)) compared to the conventional (Reveal XT(@Medtronic)) implantable loop recorder at a tertiary care center - Points to ponder!

Limited data is available regarding the novel Reveal LinQ (LinQ) which is a new generation implantable loop recorders (ILRs)