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Introduction: Epicardial pacemakers are known as an alternative for endocardial pacemakers in some cases such as heart block, and complex congenital heart diseases. Considering recent advances and improvement of epicardial lead subtypes, it is essential to investigate the long‐term function of them. In this study, we aimed to assess the sensing and pacing characteristics, and survival of bipolar steroid‐eluting and unipolar nonsteroid‐eluting epicardial pacemakers. Methods: We conducted an entirely concentrated search on the documents of all patients who had undergone epicardial lead implantation in the Shaheed Rajaie Cardiovascular, Medical & Research Center during 2015–2018. Implant, and follow‐up data were extracted. Kaplan–Meier analysis and Weibull regression hazards model were applied for the survival analysis. Results: Eighty‐nine leads were implanted for 77 patients. Of the total leads, 52.81%, 53.93%, and 47.19% were implanted in children (under 18‐year‐old), females, and patients with congenital heart diseases, respectively. Bipolar steroid‐eluting leads comprised 33.71% of 89 leads. The pacing threshold of unipolar nonsteroid‐eluting leads that were implanted on the left ventricle and right atrium increased significantly during the follow‐up to greater records than bipolar steroid‐eluting leads. Survival analysis also revealed that bipolar steroid‐eluting leads are significantly better in 48‐month survival (Weibull hazard ratio [HR]: 0.13 (95% confidence interval [CI]: 0.02–0.99), p =.049). Age, ventricular location of the lead, and acute pacing characteristics were not associated with survival. Conclusions: Bipolar steroid‐eluting epicardial leads have an acceptable survival compared with unipolar nonsteroid‐eluting, without a significant difference regarding patients age. Therefore, they could be an excellent alternative for endocardial ones. [ABSTRACT FROM AUTHOR]

Objective: Although the role of oxidative stresses has been confirmed in the pathophysiology of allergic rhinitis and the protective effect of silymarin against oxidative stresses has been proven in different organs, no study has yet been conducted on the impact of silymarin on allergic rhinitis treatment., Study Design: A randomized clinical trial study., Setting: Two tertiary referral centers with otorhinolaryngology-head and neck surgery and allergy and immunology departments., Patients and Methods: In a randomized clinical trial, 94 patients with the signs and symptoms of allergic rhinitis and a positive skin prick test were selected and randomly divided into 2 groups. Their signs and symptoms, eosinophil percentage on nasal smear, serum IgE, and interleukin (IL-4, IL-5, interferon-γ) levels were recorded. The study group was treated with silymarin, whereas the control group received placebo, both for 1 month, along with routine antihistamine treatment. At the end of the treatment course, clinical and laboratory findings were statistically analyzed., Results: Sixty patients completed the trial. Based on the Sino-Nasal Outcome Test 20 (SNOT-20), a significant improvement in clinical symptom severity was observed in both groups (9.23 ± 5.14 vs 2.20 ± 2.69; P < .001), which was statistically significantly higher in the study group (P < .001). Posttreatment percentage of nasal eosinophils and cytokine levels showed no significant difference (P > .05). Rise in serum IgE level was seen after treatment with silymarin (P = .003)., Conclusion: Considering the statistically effective role of silymarin in alleviating the severity of allergic rhinitis symptoms, applying this herbal antioxidant along with other medications may result in better management.