Increased Incidence of Noise in the Tendril Pacemaker Lead Detected via Remote Monitoring

BackgroundPrior studies suggest increased rates of noise on the Tendril (St Jude Medical/Abbott, St. Paul, MN, USA) pacemaker lead. We aim to assess the incidence of lead noise in the Tendril and 5076 (Medtronic PLC, Minneapolis, MN, USA) pacemaker leads in our cohort and in the process assess the utility of remote monitoring for identifying lead malfunction.MethodsDeidentified, multi-centre, prospectively collected observational cohort data was obtained to assess the incidence of noise on the Tendril and 5076 pacemaker leads.Results148 Tendril and 737 CapSureFix Novus 5076 (Medtronic, MN, USA) pacemaker leads were remotely monitored. Incidence of noise on the Tendril was 8% and 0.27% on the CapSureFix Novus.ConclusionRates of noise in the Tendril lead are higher than a market competitor. Remote monitoring is useful in detecting this concerning anomaly.     

双心室起搏治疗慢性心力衰竭患者的护理与生活质量评价

目的 观察双心室起搏对慢性心力衰竭患者生活质量的影响，定量反应该治疗的效果。方法 慢性心力衰竭伴室内传导阻滞患者9例，全部植入三腔双心室起搏器，比较双心室起搏前后患者超声心动图和生活质量的变化。结果 双心室同步起搏后，患者左室射血分数，6min步行距离（m），生活质量评分比治疗前有显著性差异（P〈0．05）。结论 双心室起搏能有效改善慢性心衰患者心肺功能，提高生活质量。     

Body surface potential mapping investigating the ventricular activation patterns in the cardiac resynchronization of patients with left bundle-branch block and heart failure

Body surface potential mapping assessed mean cardiac electrical activation times displayed by isochronal maps in the right ventricle (RV; right ventricle mean activation time [mRV]), anterior septal area (anterior septal area mean activation time [mAS]), and left ventricle (left ventricle mean activation time [mLV]) of 28 patients (mean, 61.07 years; congestive heart failure class III-IV; ejection fraction, < or =40%; left bundle-branch block [LBBB] QRS, 180.17 milliseconds), before and after biventricular pacemaker implantation, comparing them, using reference values from a control group of healthy individuals with normal hearts (GNL), in (1) baseline native LBBB, where mRV and mAS values were similar (40.99 vs 43.62 milliseconds), with mLV delayed (80.99 milliseconds, P < .01) and dyssynchronous with RV/anterior septal area; (2) single-site RV pacing, where mRV was greater than in GNL (86.82 milliseconds, P < .001), with greater mAS/mLV difference (63.41 vs 102.7 milliseconds; P < .001); and (3) biventricular pacing (BIV-PM), where mLV and mRV were similar (71.99 vs 71.58 milliseconds), mRV was greater than in GNL and native LBBB (71.58 vs 35.1 and 40.99 milliseconds; P < .001), and mAS approached values in GNL and native LBBB (51.28 vs 50.14 and 43.62 milliseconds). Body surface potential mapping showed that similar RV/left ventricle activation times during biventricular pacing, nearing mAS, indicate synchronized ventricular activation pattern in patients with congestive heart failure/LBBB.     

Cambridge Breathlessness Intervention Service (CBIS)

Abstract

Breathlessness is a common disabling symptom of advanced cardiorespiratory disease both malignant and non-malignant in nature. It is profoundly distressing for both patient and those who care for them, and often leads to disability, social isolation, and depression. It is extremely difficult to palliate successfully and interventions that help breathlessness are still poorly understood. Breathlessness occurs in 90% of patients with advanced chronic obstructive pulmonary disease and lung cancer and is also common in heart failure. The Cambridge Breathlessness Intervention Service was set up to deliver an evidence-based complex intervention for breathlessness and to carry out research to improve its management. The team consists of a palliative care consultant, specialist physiotherapists, a lead occupational therapist: it is part of a palliative care department at an acute hospital but sees patients in the community and carries out ward consultations. The evaluation and modelling of the service (using the Medical Research Council (MRC) methodology for research in complex interventions) has taken 10 years and has shown the value of the fan, using pacing techniques, an individualized exercise programme, breathing exercises, learning anxiety reduction techniques, and support for carers delivered with a rehabilitative approach. Recently, the Phase III evaluation of the service has demonstrated its effectiveness in reducing distress due to breathlessness in patients with lung cancer. The qualitative data also demonstrated the importance not only of the interventions themselves but also the manner in which they were delivered, i.e. that empathy; kindness and active listening were central to effective management.