The Subcutaneous Defibrillator

OPINION STATEMENT: Prevention of sudden cardiac death (SCD) remains an important clinical problem. Currently, therapeutic goals for SCD prevention include identification of high risk patients and aggressively treating comorbidities underlying. However, many patients remain at increased risk despite optimal medical management (eg, coronary artery disease and cardiomyopathy) whereas others have nonmodifiable risk for sudden death (eg, arrhythmogenic right ventricular dysplasia/cardiomyopathy, Brugada syndrome, long QT syndrome, and hypertrophic cardiomyopathy). In such patients, device therapy with an implantable defibrillator remains the most effective therapy for SCD prevention. However, implantable cardioverter defibrillators (ICDs), which are typically implanted with at least 1 lead placed within the heart, are associated with risks related to device implantation, as well as the presence of chronic endovascular leads. The durability of chronic leads is variable and can require either new leads to be placed or require lead extraction, which is associated with significant morbidity and mortality. The recently developed subcutaneous ICD (S-ICD) does not rely on any component to be placed within the heart or vasculature and therefore may mitigate the risks associated with endovascular leads. Therefore, it may be preferred for patients who are young, have inherited channelopathies, are immunocompromised, have indwelling catheters, or in whom venous access is obstructed or unfavorable due to congenital heart disease. Though long-term data regarding S-ICD performance are not yet available it may prove to be an effective therapeutic option for prevention of SCD.     

The Development of the Transvenous Automatic Defibrillator

The transvenous automatic defibrillator is a device which automatically recognizes and treats ventricular fibrillation. The initial clinical prototype resembles an external pacemaker: the electronic components and power supply are external to the body, the sensing and defibrillating elements being contained in a transvenous catheter. The sensors monitor intracardiac R waves and cardiac contraction. Absence of both signals identifies the arrhythmia and triggers the defibrillatory shock, delivered through the right ventricular electrode and another more proximal on the catheter. If needed, the device recycles automatically. It is also adaptable for pacing and for elective intraatrial cardioversion. Results of animal experiments were successful, and tests are currently being done on patients requiring defl‐brillation during open heart surgery. The clinical indications for the device are numerous and it is hoped that this approach will decrease the present prohibitive mortality from coronary heart disease.     

The Effect of Medazepam in Relieving Symptoms of Functional Gastrointestinal Distress**

Summary: In a double-blind cross-over clinical trial conducted on 30 out-patients, a significant preference emerged for medazepam against a placebo preparation when patients compared the efficacy of the two agents in relieving several major symptom complexes associated with functional bowel disease. The results suggest that medazepam can rationally be used in the treatment of aerophagy, nervous dyspepsia and functional gastro-intestinal pain. No significant side effects emerged during the study.     

恶性快速室性心律失常的AICD治疗

1例持续性室性心动过速(VT)反复发作,伴心源性晕厥患者,心电图、超声心动图、X线心脏摄片均提示心脏扩大。心肌断层显像呈不可逆性、节段性、花斑样稀琉区。心脏电生理检查可见心室晚电位,心室程序刺激可诱发持续性临床型VT。诊断扩张型心肌病,VT。于1991年4月13日安置埋藏式自动复律除颤器,术后3个月自动除颤4次,有效地防止了晕厥。     

The Real Code of Leonardo da Vinci

Leonardo da Vinci was born in Italy. Among the researchers and scientists, he is favourably known for his remarkable efforts in scientific work. His investigations of atherosclerosis judiciously combine three separate fields of research. In 1506, he finished his masterpiece, painting of Mona Lisa. A careful clinical examination of the famous painting reveals a yellow irregular leather-like spot at the inner end of the left upper eyelid and a soft bumpy well-defined swelling of the dorsum of the right hand beneath the index finger about 3 cm long. This is probably the first case of familial hypercholesterolemia (FH). The FH code of Leonardo da Vinci was given immense consideration by scientists like Carl Muller, who described the xanthomas tuberosum and angina pectoris. On the contrary, Akira Endo searched for microbial metabolites that would inhibit HMG-CoA reductase, the rate-limiting enzyme in the synthesis of cholesterol and finally, Michael Brown and Joseph Goldstein published a remarkable series of elegant and insightful papers in the 70s and 80s. They established that the cellular uptake of low-density lipoprotein (LDL) essentially requires the LDL receptor. In conclusion: this was the real Code of Leonardo da Vinci.Key Words: Familial hypercholesterolemia; Leonardo da Vinci.     

心力衰竭患者心脏再同步治疗时后备除颤功能的必要性

充血性心力衰竭是心内科治疗学上的难题,是使患者丧失工作能力,具有较高患病率和死亡率的严重疾患。随着人口老龄化速度的加快以及心脏疾病尤其是心肌梗死治疗的进展,心力衰竭患者日趋增多。流行病学资料显示:我国成人心力衰竭患者约有400万,全球心力衰竭患病人数高达2250万,且每年新增病例数约200万。尽管近年来药物治疗取得了很大的进展,但仍有相当数量患者疗效不佳。在药物治疗基础上,器械治疗,包括心脏再同步治疗(CRT)和埋藏式心律转复除颤器(implantable cardioverter defibrillator,ICD)以其卓越的疗效已成为心力衰竭的重要治疗手…     

埋藏式心律转复除颤器的除颤电极植入部位对三尖瓣反流的影响

目的:探讨埋藏式心律转复除颤器(ICD)的除颤电极在右心室不同植入位置与三尖瓣反流进展的相关性.方法:回顾性纳入2016年1月至2019年12月于中国医学科学院阜外医院心律失常中心植入ICD或心脏再同步治疗除颤器(CRT-D)患者198例.所有患者在术前及术后均完善超声心动图,根据三尖瓣反流面积分为无、轻、中、重度四级...     

The Clinical Synopsis*

Summary: We have devised the problem oriented clinical synopsis to provide a continuously updated and formalised record of patient management in a teaching hospital. The synopsis is de-signed for explicit recording of evidence used in making decisions on diagnosis, investigation or treatment and so facilitates communication and quality control in the ward environment. When the patient is ready for discharge the synopsis automatically provides a final case summary for despatch to the referring doctor. For 554 patients admitted to a medical ward over a twelve month period, the synopsis was compiled on a pre-printed form** divided into eleven columns. A list of provisional diagnoses (or unexplained problems) was entered in a column down the left of the synopsis form. Contributory history, signs and investigations and decisions on treatment were recorded in appropriate columns across the page. Subsequently the synopsis Before discharge, a recommended management was recorded against each diagnosis and a final discharge opinion added. The synopsis data were entered at a computer terminal and processed by a programme which printed out a formalised case summary.