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Aims: To describe the incidence and impact of adverse clinical events (ACEs) during first 24 h of bedrest of patients after cardiac implantable electronic device (CIED) implantation., Methods and Results: We conducted a prospective observational study of patients aged over 18 years undergoing elective placement of permanent bicameral pacemaker (PM), cardiac resynchronization therapy (CRT) PM, CRT defibrillator, or implantable cardioverter-defibrillator. Patients were maintained on bedrest post-operatively for 24 h and delirium, post-operative urinary retention, severe post-operative pain, pressure ulcer, and sleep disturbance were recorded using standardized assessments. Of 90 patients, 66 (73.3%) were male and average age was 76 ± 10 years. The median time to first mobilization was 23 (21-24) h. The adverse clinical events occurred in 48/90, with severe pain (38/90), sleep disturbance (12/90), delirium (9/90), and urinary retention requiring urinary catheterization (8/90) most frequent. Patients receiving implantable cardioverter-defibrillator or CRT defibrillator experienced ACEs significantly more frequently than those receiving PM. Adverse clinical event was associated with prolonged hospital stay [odds ratio (OR) 2.5; 95% confidence interval (CI) 1.16-6.17]. Patients with delirium were more dependent for daily living activities on admission (OR 8.0; 95% CI 1.55-41.3)., Conclusion: Adverse clinical events frequently occur post-insertion of a CIED and impact patient clinical course and experience. The progressive increase in ageing and frailty of CIED implant candidates requires special nursing attention to improve patients' satisfaction and to prevent increased healthcare resource use., Competing Interests: Conflict of interest: All authors declare that they have no known competing financial interests or personal relationships with industry that could have influenced the work reported in this paper., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: Some publications have shown good aesthetic results for scars through the early application of fractional CO 2 lasers on elective surgery scars. The aim of this randomized, double-blinded clinical trial was to compare the aesthetic quality of the scar from a group of patients submitted to super-pulsed fractional CO 2 laser applications (10,600 nm fractional CO 2 , set at a density of 20% and an energy of 10 mJ, a scanner of 03 × 03 mm, and a pulse repetition time of 0.3 seconds) in contrast with the other group that used only the silicone gel on the scar after plastic surgery., Method: A prospective study was conducted by analyzing 42 patients with recent scars of up to three weeks in patients with a I-IV Fitz-Patrick skin phototype. The scars were evaluated aesthetically in the second and sixth months by applying the Vancouver scale., Results: At 2 months of treatment, the statistical data showed a discrete superiority in the LASER group's treatment, as compared to that of the SILICONE group, in both percentage and significance concerning flexibility (P = 0.05) and pigmentation (P = 0.01). Laser group presented better results in the sixth month (P = 0,03)., Conclusion: The early use of the fractional CO 2 laser contributed to improving the aesthetic quality of scars from elective surgeries in the second and in the 6th months. Lasers Surg. Med. 49:570-576, 2017. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)

Background: Right ventricular outflow tract (RVOT) pacing has been suggested to improve hemodynamics and to help prevent pacing-induced cardiomyopathy. Pacing from the RVOT is feasible and equivalent in terms of sensing and stimulation threshold. However, physicians have been reluctant to use RVOT pacing because of concerns that defibrillation efficacy might be adversely affected. To date, there have been no randomized-controlled trials published comparing the defibrillation threshold in leads implanted in the RVOT and the right ventricular apex (RVA)., Objective: The purpose of this study was to compare defibrillation thresholds (DFT) in the RVOT and RVA. Ventricular sensing and stimulation thresholds were also compared., Methods: This prospective, randomized, multicenter study included 87 patients (70 males, age 69 +/- 11 years). At implantation, the patient's ventricular implantable cardioverter-defibrillator (ICD) lead position was randomized to either the RVOT or RVA. A four-shock Bayesian up-down method was used to determine the DFT. Patients were followed for 3 months postimplant., Results: DFTs were not significantly different in leads implanted in the RVOT (median 8.8 J [6.28, 12.9] vs. 7.9 J [6.20, 12.6], P = 0.65). Threshold and impedance measurements were stable in both RVOT and RVA groups from implant to follow-up. All ICD leads remained stable chronically at the 3-month follow-up., Conclusion: DFTs in leads placed in the RVOT and RVA are comparable. RVOT ICD lead placement is safe and exhibits similar lead stability, threshold, and impedance measurements as the traditional RVA location.

This article reviews the indications for temporary pacing, describes and illustrates the techniques, discusses the fundamentals of electrical stimulation, and explores special applications, including overdrive and dual-chamber DDD pacing.