Reliability of Atrial Screw-in Leads

The aim of this study was to investigate long-term performance of a carbon coated atrial screw-in lead. During implantation of 247 leads of this type we measured an average stimulation threshold of 0.74 V(range: 0.2–1.6 V) at 1 ms pulse width. Mean lead impedance came to 446 ohms (range: 263–1000 ohms) resulting in an arithmetical energy consumption of 1.51 μJ(range: 0.1–7.21 μJ). Average P wave amplitude was 3.9 mV (range: 1.3–11 mV). After a mean follow-up of 16.4 months (range; 3–60 months) we found excellent threshold results in 76% of the patients permitting a safety programming al half of nominal value. An additional 14% nominal settings could be retained. With regard to chronic lead impedance of 488 ohms (range: 315–1327 ohms) we calculated an average chronic energy consumption of 10.83 μJ (range: 1.62–22.78 μJ) during safety programming. This made up 34.6% of the corresponding energy consumption during nominal programming. Eighty percent of the patients showed chronic P waves above 2 mV; nearly half of them (n - 94 = 38%) showed a proper sensing function even when programmed to minimal sensitivity settings or above 4 mV. In 19 leads (8%) we observed unsatisfying threshold results requiring high output programmings. All threshold increases occurred within the first year, 84% (n = 16/19) within the first 3 postoperative months. An additional five leads (2%) were found to have a loss of capture, and one (0.5%) a loss of sensing. These complications required reoperation as well as one dislocation (0.5%) resulting in a low complication rate of 3% as compared to the total complication rate of all implanted atrial leads which was substantially higher (n = 48/652 = 7.5%). With regard to our results we consider the carbon coated atrial screw-in lead to have proven long-term reliability.     

Mature liver stages of cloned Plasmodium falciparum share epitopes with proteins from sporozoites and asexual blood stages

The liver merozoites of malaria parasites are of paramount importance, as they initiate the parasite invasion of red blood cells and start the cycle associated with the clinical features of malaria. Investigating liver merozoite antigen is difficult because of the lack of a rodent model of human malaria. In addition, only a low proportion of cells are obtained in vivo, the parasites from Cebus and Aotus monkeys are immature, and in-vitro experiments with liver cells are often confounded by contamination with the natural mosquito flora copurified with the sporozoites used for seeding the liver cultures. In our study, mature liver schizonts were shown to possess many of the antigenic determinants recognized by MoAbs and sera specific for defined sporozoite and blood-stage antigens. We employed an immunofluorescence procedure based on evaluating parasites in cryosections prepared from infected chimpanzee liver. Sufficient numbers of sectioned parasites were evaluated with each antibody to assure the reproducibility of the results, and the fixation procedure used was sufficiently non-destructive to parasite antigens so that clear differences between reactions of specific antibodies and negative controls were observed. Our evidence for sharing of epitopes by liver merozoites and sporozoites or by liver merozoites and asexual blood-stage parasites raises the possibility that immune responses elicited against sporozoites or asexual stage antigens being considered as vaccine candidates may also act against this important, little-studied stage of the parasite.     

Cardioverter Discharges Following Sensing of Electrical Artifact Due to Fluid Penetration in the Connector Port

We report a unique case of fluid penetration, 3 months after implantation, in the connector port of an automatic implantable Cardioverter defibrillator (ICD) with transvenous subcutaneous lead system. The patient had coronary artery disease and recurrent episodes of ventricular fibrillation, the fluid caused electrical signals interpreted as ventricular fibrillation by the device, which triggered shock delivery .     

Regulation of blood volume—implications for cardiovascular pathophysiology in sleep apnoea

SUMMARY  Volume homeostasis plays an important role in the regulation of the cardiovascular system and maintenance of haemodynamics. The heart-kidney axis represents the central part of the volume regulating system: the heart senses changes in the volume status and influences renal function via neural and humoral pathways in order to compensate for disturbances in volume homeostasis and prevent under- or overfilling of the heart. An undisturbed circadian rhythmicity of volume homeostasis, renal function and secretory pattern of volume regulating hormones may be of physiological importance. Disturbances in volume regulation are involved in the pathogenesis of cardiovascular diseases, e.g. arterial hypertension and heart failure. Nocturia in sleep apnoea (suggesting heart failure) may be explained by changes in volume-regulating hormones indicating hypervolaemia of the central part of the cardiovascular system ('central hypervolaemia') caused by exaggerated venous return during repetitive Muller manoeuvres. Treatment of sleep apnoea abolishes nocturia and restores normal circadian rhythm of volume homeostasis and secretion of volume-regulating hormones. Chronic cardiac volume overload during sleep may be implicated in the pathogenesis of cardiovascular sequelae in sleep apnoea: cardiac hypertrophy and heart failure. Central hypervolaemia during sleep can cause long-term disturbances in blood pressure control by different mechanisms and may be in part responsible for the development of daytime hypertension in sleep apnoea. In summary, volume homeostasis is controlled by a complex interaction of heart and kidney. Disturbances may reflect cardiovascular diseases or may even be the cause. In sleep apnoea disturbances in volume regulation may be important for the development of cardiovascular sequelae.     

Differences Between Atrial Single Chamber Pacing (AAI) and Ventricular Single Chamber Pacing (VVI) with Respect to Prognosis and Antiarrhythmic Effect in Patients with Sick Sinus Syndrome

STANGL, K., ET AL.: Differences Between Atrial Single Chamber Pacing (AAI) and Ventricular Single Chamber Pacing (VVI) with Respect to Prognosis and Antiarrhythmic Effect in Patients with Sick Sinus Syndrome. Several studies suggest different effects of atrial (AAI) and ventricular single chamber pacing (VVI) for sick sinus syndrome with respect to the suppression of atrial tachycardias and to the prognosis. With this aspect in mind, we studied 222 patients with sick sinus syndrome, 110 of whom had been supplied with AAI systems, and 112 with VVI systems, in the period from January 1978to December 1986. The mean observation period was 53 ± 28 months. The cumulative 5-year survival rate was not significantly different in the two groups. After subgroups with comparable underlying diseases had been differentiated, patients with coronary heart disease showed a significantly higher survival rate (p < 0.05) under AAI pacing, and the same was shown for patients with no underlying heart disease (p < 0.02). The incidence of chronic atrial fibrillation was 6% in the AAI group and 19% in the VVI group. Patients with preexisting atrial tachyarrhythmias showed the lowest incidence of chronic atrial fibrillation under AAI pacing. Under VVI pacing this incidence was a function of the basic rate of the pacemaker systems. In conclusion, the pacing mode seems to have a prognostic importance in spite of all methodological difficulties. A suppressive effect of AAI pacing on atrial dysrhythmias can also be assumed.     

The guinea-pig: an animal model for human skin absorption of hydrocortisone,testosterone and benzoic acid?

¹⁴C ring-labelled hydrocortisone, testosterone and benzoic acid dissolved in acetone were applied to the backs of guinea-pigs (4 μg/cm²). Percutaneous absorption was quantified by following the excretion of tracer in urine and faeces for 5 days. Absorption of hydrocortisone and benzoic acid was 2.4% (s. d. = 0.5; n = 3) and 31.4% (s. d. = 9.1; n = 3) of the applied dose respectively, similar to published human absorption data. Testosterone was absorbed to a greater extent in guinea-pigs (34.9%± 5.4; n = 5) than man. A thioglycollate based depilatory cream significantly increased the skin absorption of testosterone, while the absorption velocity was unaltered. Two analytical methods were compared, direct counting versus wet ashing; results were in the, same range for the three compounds. Two methods of quantifying skin absorption were compared; urine recovery corrected for incomplete urinary excretion after parenteral administration versus the addition of urine and faecal recovery. For benzoic acid, excreted mainly in the urine (88.1 %), the two methods gave similar results; for testosterone, excreted in the urine to a lesser extent (46.8%), the method of addition of urine and faecal recovery appeared to be more correct.