Search

Background: The real-world data on the safety profile of ventricular tachycardia (VT) ablation among elderly patients is not well-established. This study aimed to evaluate the procedural outcomes among those aged 18-64 years versus those aged ≥65 years who underwent catheter ablation of VT. Method: Using the Nationwide Readmissions Database, our study included patients aged ≥18 years who underwent VT catheter ablation between 2017 and 2020. We divided the patients into non-elderly (18-64 years old) and elderly age groups (≥65 years old). We then analyzed the in-hospital procedural outcome and 30-day readmission between these two groups. Results: Our study included 2075 (49.1%) non-elderly patients and 2153 (50.9%) elderly patients who underwent VT ablation. Post-procedurally, elderly patients had significantly higher rates of prolonged index hospitalization (≥7 days; 35.5% vs. 29.3%, p < .01), non-home discharge (13.4% vs. 6.0%, p < .01), 30-day readmission (17.0% vs. 11.4%, p < .01), and early mortality (5.5% vs. 2.4%, p < .01). There was no significant difference in the procedural complications between two groups, namely vascular complications, hemopericardium/cardiac tamponade, cerebrovascular accident (CVA), major bleeding requiring blood transfusion, and systemic embolization. Through multivariable analysis, the elderly group was associated with higher odds of early mortality (OR: 7.50; CI 1.86-30.31, p = .01), non-home discharge (OR: 2.41; CI: 1.93-3.00, p < .01) and 30-day readmission (OR: 1.58; CI 1.32-1.89, p < .01). Conclusion: Elderly patients have worse in-hospital outcome, early mortality, nonhome discharge, and 30-day readmission following catheter ablation for VT. There was no significant difference between elderly and non-elderly groups in the procedural complications. [ABSTRACT FROM AUTHOR]

Background: The real‐world data on the safety profile of transvenous lead extraction (TLE) for infected cardiac implantable electronic devices (CIED) among elderly patients is not well‐established. This study aimed to evaluate the hospital outcomes between patients of different age groups who underwent TLE for infected CIED. Method: Using the Nationwide Readmissions Database, our study included patients aged ≥18 years who underwent TLE for infected CIED between 2017 and 2020. We divided the patients into four groups: Group A. Young (<50 years), Group B. Young intermediate (50–69 years old), Group C. Older intermediate (70–79 years old), and Group D. Octogenarian (≥80 years old). We then analyzed the in‐hospital outcome and 30‐day readmission between these age groups. Results: A total of 10,928 patients who were admitted for TLE of infected CIED were included in this study: 982 (9.0%) patients in group A, 4,234 (38.7%) patients in group B, 3,204 (29.3%) patients in group C and 2,508 (23.0%) of patients in group D. Our study demonstrated that the risk of early mortality increased with older age (Group B vs. Group A: OR: 1.92, 95% CI: 1.19‐3.09, p <.01; Group C vs. Group A: OR: 2.47, 95% CI: 1.51‐4.04, p <.01; Group D vs. Group A: OR: 2.82, 95% CI: 1.69‐4.72, p <.01). The risk of non‐home discharge also increased in elderly groups (Group B vs. Group A: OR: 1.89; 95% CI: 1.52‐2.36; p <.01; Group C vs. Group A: OR: 2.82; 95% CI 2.24‐3.56; p <.01; Group D vs. Group A: OR: 4.16; 95% CI: 3.28‐5.28; p <.01). There was no significant difference in hospitalization length and 30‐day readmission between different age groups. Apart from a higher rate of open heart surgery in group A, the procedural complications were comparable between these age groups. Conclusion: Elderly patients had worse in‐hospital outcomes in early mortality and non‐home discharge following the TLE for infected CIED. There was no significant difference between elderly and non‐elderly groups in prolonged hospital stay and 30‐day readmission. Elderly patients did not have a higher risk of procedural complications. [ABSTRACT FROM AUTHOR]

Background: Utilization of catheter ablation of ventricular tachycardia (VT) has steadily increased in recent years. Exploring short‐term outcomes is vital in health care planning and resource allocation. Methods: The Nationwide Readmissions Database from 2010 to 2014 was queried using the ICD‐9 codes for VT (427.1) and catheter ablation (37.34) to identify study population. Incidence, causes of 30‐day readmission, in‐hospital complications as well as predictors of 30‐day readmissions, complications, and cost of care were analyzed. Results: Among 11 725 patients who survived to discharge after index admission for VT ablation, 1911 (16.3%) were readmitted within 30 days. Paroxysmal VT was the most common cause of 30‐day readmission (39.51%). Dyslipidemia, chronic kidney disease (CKD), previous CABG, congestive heart failure (CHF), chronic pulmonary disease, and anemia predicted increased risk of 30‐day readmissions. The overall in‐hospital complication rate was 8.2% with vascular and cardiac complications being the most common. Co‐existing CKD and CHF and the need for mechanical circulatory support (MCS) predicted higher complication rates. Similarly increasing age, CKD, CHF, anemia, in‐hospital use of MCS or left heart catheterization, teaching hospital, and disposition to nursing facilities predicted higher cost. Conclusion: Approximately one in six patients was readmitted after VT ablation, with paroxysmal VT being the most common cause of the readmission. A complication rate of 8.2% was noted. We also identified a predictive model for increased risk of readmission, complication, and factors influencing the cost of care that can be utilized to improve the outcomes related to VT ablation. [ABSTRACT FROM AUTHOR]

Background Implantable cardioverter defibrillator (ICD) implantation is being performed differently at many hospitals, with some keeping patients overnight after procedure while others discharge patients home same day. In addition, many centers are now performing ICD surgery while on warfarin anticoagulation. There are, however, limited data on outpatient ICD surgery on anticoagulated (AC) patients. Objective We wished to evaluate the safety of performing outpatient ICD surgery with and without warfarin anticoagulation. Methods We evaluated 866 patients who underwent outpatient ICD surgery between April 2010 and September 2014. Patients who were on novel oral anticoagulants, or did not have an international normalized ratio drawn within 24 hours of the procedure were excluded and the remainder were divided into two groups based on whether they were on (n = 230) or off (n = 518) warfarin anticoagulation. We evaluated both procedural and 30-day complications in both groups. Results The complication rate at 30 days in the warfarin AC group was 4.3%, while in the nonanticoagulated (NAC) group was 2.9% and not significantly different (P = 0.31). However, the pocket hematoma rate in the warfarin anticoagulated group was 3.5%, as compared to the NAC group that was 0.4% (P = 0.001). Conclusion Complications from ICD surgery are low in the ambulatory setting on or off warfarin anticoagulation and appear to be comparable. However, warfarin use during ICD surgery is associated with an increased risk of pocket hematoma. [ABSTRACT FROM AUTHOR]

Background Progress in implantable cardiac defibrillator ( ICD) technology has allowed for switching the sensing polarity for the detection of ventricular fibrillation (VF). However, whether one sensing polarity confers additional advantage over the other is not known. Objectives To determine whether one sensing polarity is superior to the other for the detection of VF. Methods Patients were enrolled into a prospective randomized study of sensing of VF and R waves in normal rhythm. Sensing of VF was determined by number of under sensed beats (USB), and time to detection of VF (TDVF). Each patient underwent ICD implantation followed by testing of the ICD. At each induction, patients were randomized to sensing in extended bipolar (EBP) or true bipolar (TBP) configuration. Additionally, R waves were compared at implant and at 1-month follow-up. Results A total of 50 patients were enrolled into the study. When evaluating the primary endpoint, no difference was found between USB in EBP or TBP configuration; 1.1 ± 1.2 beats versus 1.3 ± 1.3 beats; P = NS. Also, no difference was found between TDVF in EBP or TBP configurations; 5.9 ± 0.6 seconds versus 5.9 ± 0.6 seconds; P = NS. With regard to the secondary endpoints, there was no difference between R waves in EBP or TBP configurations at the time of implant 10.9 ± 4.8 mV versus 10.9 ± 4.8 mV P = NS; or at 1-month follow-up 12.4 ± 4.7 mV versus 12.0 ± 5.4 mV P = NS. Conclusions There is no difference in the detection of VF between EBP or TBP configurations in patients undergoing ICD implantation. [ABSTRACT FROM AUTHOR]

The objective of this study was to measure the normal variation of QT dispersion (QTd) with respect to age and gender. The QT interval is a measure of the duration of ventricular depolarization and repolarization, while the QTd is a measure of the variability of the ventricular recovery time. The QTd has been suggested as a means of identifying those patients at risk for sustained ventricular tachyarrythmias and sudden cardiac death (SCD). A total of 250 patients (120 women, 130 men; age range 20-86 years) were recruited for this study. The QT intervals were measured in each of the 12 standard leads of the electrocardiogram. Data are presented as mean (μ) ± SD. The QTd did not vary significantly within the same gender. A significant difference (P < 0.001) was noted in QTd between men (age [μ] = 53.3 ± 15.6 years, QTd = 0.044 ± 0.019 s) and women (age [μ] = 52.1 ± 15.1 years, QTd = 0.034 ± 0.015 s). Overall, men had a greater QTd. while women had a longer QT. In conclusion, we found that men had a longer QTd, which may explain the increased risk of SCD. However, women have a longer QT interval with a smaller QTd. A longer QTmin, as opposed to a longer QTmax, is responsible for the shorter QTd in women. This longer QTmin in women may predispose to an increased risk of drug induced torsades de pointes. [ABSTRACT FROM AUTHOR]

A comparative analysis of the DNA sequences of primary and secondary IgM, fluorescein-specific antibodies was performed. These antibodies were secreted by hybridomas generated following fusion of immunized RALB/c mouse lymphocytes and SP2/0 myeloma cells. Our results show that primary and secondary fluorescein-specific IgM antibodies use a variety of segments from the variable region of the immunoglobulin heavy chain locus (VH), with members of the J558 and 7183 VH gene families predominating in both populations. D regions from the DF116 and DSP2 families were used exclusively in our primary antibody sample and predominated in the secondary response. In the primary antibodies. 15 out of 18 definable D regions were transcribed in reading frame one, but in the secondary antibodies the three reading frames were used stochastically. Secondary IgM antibodies showed a higher frequency of somatic mutation than their primary counterparts, but we could detect no evidence of selection for mutations in the complementarity determining regions as compared with the framework regions. It appears that fusion of secondary cells, 3-6 days after immunization, is able to 'capture' the IgM-producing population of B cells at a stage in their development following mutation but prior to antigenic selection. [ABSTRACT FROM AUTHOR]

We report a case of Peyronie's Disease, for which sonography proved to be a valuable, non-invasive diagnostic procedure. The sonographic findings and some unusual clinical features of our case are discussed. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about dyschromatosis reported in two Indian families.

Mudi-chood is an unusual dermatosis seen in India. It affects the nape of the neck and the exposed part of the upper back in girls and young women. It is characterized by mildly pruritic pigmented papular lesions. It probably represents the comedogenic activity of various oils applied to the hair, which is aggravated by the typical climatic conditions. We present three cases of mudi-chood. [ABSTRACT FROM AUTHOR]