Rate-Adaptive Cardiac Pacing in Children Using a Minute Ventilation Biosensor

YABEK, S.M., ET AL.: Rate-Adaptive Cardiac Pacing in Children Using a Minute Ventilation Biosensor. Chronotropic integrity is required for a normal cardiac output response to exercise. We evaluated a rate-adaptive ventricular demand pacemaker (Telectronics, META-MV) which uses minute ventilation as the sensed physiological variable for adjusting pacing rate, in seven young patients with a mean age of 11.4 years. All patients had clinically significant bradycardia related to complete heart block (n = 4) or sinus node dysfunction (n = 3). For the entire group, paced heart rates increased from 70 ± 10 beats/min to 151 ± 19 beats/min with exercise testing. The onset of rate adaptation took < 30 seconds. Changes in paced rate were linearly related to workload, VO₂ (5.9 to 20.7 mL/min/kg) and minute ventilation (8–65 L/min). The decline in pacing rate after exercise was related directly to the gradual decrease in minute ventilation and VO₂. Our data show that minute ventilation closely and accurately reflects the metabolic demands of varying workloads in children and can be used to achieve physiological, rate-adaptive pacing.     

Echocardiographic Evaluation of Patients with Primary Pulmonary Hypertension Before and After Atrial Septostomy

Objectives: To characterize the early changes in right ventricular [right ventricle (RV)] geometry and function, as assessed by two-dimensional (2-D) and Doppler echocardiography, after balloon-dilation atrial septostomy (BDAS) in patients with severe primary pulmonary hypertension (PPH). Background. Survival in PPH is to a great extent dependent on the functional status of the RV. BDAS recently has been shown to improve functional class and hemodynamics in patients with PPH nonresponsive to conventional vasodilator treatment. Methods: Ten patients with severe PPH who underwent BDAS were studied with transthoracic and transesophageal 2-D and Doppler echocardiography. RV dimensions were measured in the apical four-chamber view. Continuous-wave Doppler echocardiography was used to obtain peak velocity of tricuspid regurgitation. Transesophageal echocardiography (TEE) primarily was used for the follow-up of the atrial septal defects (ASDs). Results: In the early post-BDAS studies, right atrial and ventricular dimensions significantly decreased in all patients (P < 0.05). Global right ventricular wall motion (RVWM) also improved. RV percent change in area after septostomy inversely correlated with the changes in RV systolic area (r =–0.75; P < 0.05) and also with the baseline (preprocedure) values of RV percent change in area (r =–0.77; P < 0.05). Neither RV wall thickness nor the degree of tricuspid regurgitation were modified significantly after the procedure. Conclusions: BDAS in the setting of severe PPH results in moderate and salutary changes in geometry and function of the RV as assessed by 2-D echocardiography. These changes mainly appear to be the result of the decompression effect of atrial septostomy.     

A Multicenter, Randomized Trial Comparing Calcium Hydroxylapatite to Two Hyaluronic Acids for Treatment of Nasolabial Folds

INTRODUCTION In this study, we examined Radiesse (calcium hydroxylapatite; CaHA), Juvederm 24 (hyaluronic acid; HA-1A), Juvederm 24HV (HA-1B), and Perlane (HA-2) for patient satisfaction, likelihood to return, immediate efficacy, and duration of correction.
OBJECTIVE This multicenter, blinded, randomized study compares patient satisfaction variables, efficacy, and durability of CaHA gel and HA for correction of nasolabial folds (NLFs) through 12 months after 4-month touch-up.
METHODOLOGY A total of 205 randomized patients received either CaHA gel or HA for NLF treatment at initial visit and 4-month touch-up. Patients returned at 4, 8, and 12 months after the second injection for evaluation. Surveys measured patient satisfaction; effectiveness measures included the Global Aesthetic Improvement Scale (GAIS).
RESULTS More CaHA gel patients were satisfied or extremely satisfied than each HA tested. At 8 months, significantly more CaHA gel–treated NLFs were improved on the GAIS than any HA. The volumes of CaHA gel and three HA materials injected through 4 months were 2.2, 2.9, 4.8, and 2.9 mL, respectively ( p <.005). No serious adverse events were observed.
CONCLUSIONS In this controlled study, CaHA gel ranked highest in patient satisfaction and likelihood to return. The material was more effective and longer lasting than each HA in maintaining NLF augmentation.     

Real‐World Safety and Effectiveness Outcomes of a Zotarolimus‐Eluting Stent: Final 3‐Year Report of the RESOLUTE International Study

Objectives

We evaluated the safety and effectiveness of the Resolute? zotarolimus‐eluting stent (R‐ZES) in real‐world clinical practice through 3 years.

Background

A randomized comparison of the R‐ZES and the XIENCE V? everolimus‐eluting stent showed no difference in any outcomes through 3‐year follow‐up in high‐volume academic centers. RESOLUTE International is a confirmatory trial designed to evaluate the R‐ZES in real‐world clinical practice.

Methods

RESOLUTE International is a single arm, observational trial that enrolled 2,349 patients from 88 centers with only a few inclusion and exclusion criteria. The primary end‐point was the composite of cardiac death and target vessel myocardial infarction (TV‐MI) at 1 year. Secondary end‐points include target lesion failure (TLF), target vessel revascularization (TVR), and their components, and stent thrombosis (ST).

Results

At 3 years 97.2% of patients completed clinical follow‐up. The mean age was 63.4 ± 11.2 years, 77.8% were male, and 30.4% had diabetes. The average number of stents per patient was 1.6 ± 1.0; and mean stent length was 30.9 ± 20.5 mm. Dual antiplatelet therapy was used in 91.1% of patients at 1 year, 43.0% at 2 years, and 34.6% at 3 years. Cardiac death and TV‐MI occurred in 161 patients (7.0%). There were 6 (0.3%) very late ST events for a total ST rate of 1.1% through 3 years. The rates of clinically driven target lesion revascularization (TLR), TVR, and TLF were 5.7%, 7.4%, and 11.4%, respectively.

Conclusions

The safety and effectiveness of the R‐ZES through 3 years in this real‐world all‐comer study was consistent with previously reported all‐comer trials. (J Interven Cardiol 2013;26:515‐523)

     

Use of Single Lead VDD Pacing in Children

The development of transvenous ventricular pacing leads with proximal electrodes capable of atrial sensing and the recent availability of smaller generators has created the opportunity to treat children with complete AV block and normal sinus node function with a transvenous single lead VDD pacing system. Studies in adults have demonstrated this system to be efficacious with low complication rates. Transvenous single lead VDD pacemakers were implanted in ten children, aged 5–15 years, between December 1993 and April 1996, in our institution. The indications were complete AV block with severe bradycardia in 5 patients, second-degree or complete A V block following congenital heart surgery in 3, complete A V block with long QT syndrome in 1, and second-degree AV block and syncope in 1. There were no complications related to the procedure in any case. P and R wave amplitudes were measured and thresholds were determined intraoperatively on all patients. Amplitudes and thresholds were remeasured on seven patients with a mean follow-up of 17 months; Holter monitors were performed on seven patients with a mean follow-up of 16 months. P and H wave amplitudes were generally diminished at follow-up compared to initial values but remained within an acceptable range for all patients. Four patients required reprogramming after pacemaker insertion, 1 received an atrial lead for dual chamber pacing, 1 required repositioning for lead dislodgment. and 1 patient required a new lead for an inadequate ventricular pacing threshold. No patient had evidence of failure to sense or capture as evaluated by Halter monitoring at last follow-up. Single lead VDD pacing systems can be successfully used in properly selected children with high degree or complete AV block with normal sinus node function.     

Monoclonal antibodies to HLA recognize monomorphic and polymorphic epitopes on BoLA

Fourteen monoclonal antibodies recognizing monomorphic and polymorphic epitopes on class I and class II antigens of the human MHC have been assayed on lymphocytes of a panel of 20–150 BoLA typed bovine animals from 12 different breeds. Some monomorphic antibodies cross-reacted and others did not. Two polymorphic monoclonal antibodies in man recognize a polymorphism in cows that follows allospecificities (BoLA-w3, w9) already described. Immunoprecipitation experiments with monomorphic anti-B2m and anti-HLA-DR monoclonal antibodies have shown that these cross-reactions concern BoLA antigens. They also revealed that Ia-like antigens in cattle present the same two chain features characterized in other species.     

Thrombus apposition on catheter ablation injuries

64 ablation catheter-induced injuries were studied macroscopicallyand microscopically to determine the incidence of endocardialthrombus formation. Ablation was performed in 16 mongrel dogs,7 days before necropsy, 16 endocardial necroses were locatedin the right atrioventricular (AV) junction, 16 in the non-coronarycusp of the aortic valve or the subaortic valve area, 16 inthe right and 16 in the left ventricle. Cathodal discharge at the distal electrode was employed againstan external anodal plate for ventricular ablation. Necrosesin the right AV junction and in the aortic area where the resultof transseptal His bundle ablation. Energies ranged from 100–360J. Pathologic examination was performed 1 week after ablation.13 thrombi were observed attached to the endocardial necrosisarea, of sizes ranging from 1–25 mm diameter (mean 6.9mm). Six thrombi were found in the septal valve of the tricuspidvalve, two in the aortic valve, two in the subaortic region,and three related to ventricular necroses. We conclude that the incidence of thrombosis is 20% in ablationinjuries, the majority, 77%, having a diameter 10 mm. No correlationwas found between thrombus formation and delivered energy orcatheter polarity.     

MILKING ACTION: A NEW FUNCTIONAL CONCEPT OF A DIFFERENT ORTHOTOPIC NEOBLADDER: 4-YEAR FOLLOWUP

Purpose

We demonstrate how the combined use of detubularized and remodeled intestine with intact cecum in the construction of an orthotopic colonic neobladder determines different functioning.

Materials and Methods

Since February 1993, 11 men who underwent radical cystectomy due to invasive bladder carcinoma have received a new bladder substitute consisting of an upper component of ascending colon and a detubularized and remodeled right half of transverse colon, and a lower component with intact cecum. During postoperative years 1 and 4 all patients were evaluated with urodynamics and cystography.

Results

The detubularized upper component of the neobladder acts as a large capacity, low pressure filling reservoir, while the intact cecum with its haustral contractions (inverted milking action) contributes as an additional continence mechanism. The mass contractions (milking action) with abdominal wall tension actively collaborate to evacuate the reservoir completely.

Conclusions

This new structural concept of a neobladder constructed from detubularized and intact intestine has a different functional behavior than neobladders described in literature. This neobladder enables complete evacuation and total continence in the immediate postoperative period.