Failure of Defibrillator Paddle as Mimic for Subcutaneous Patch Lead During Nonthoracotomy Implantable Cardioverter Defibrillator Lead Configuration Assessment

It is a common, although virtually unsubstantiated, practice to assess the efficacy of nonthoracotomy lead systems for implantable cardioverter defibrillators using a defibrillator paddle as mimic for the subcutaneous patch lead. We report a case in which an adequate defibrillation threshold was documented with the nonthoracotomy lead system using a defibrillator paddle but not following implantation of the true subcutaneous patch lead. This case suggests that the substitution of a defibrillator paddle for the subcutaneous patch lead during nonthoracotomy lead system evaluation may have significant limitations in assessing lead configuration efficacy.     

Australian consumer perspectives on dialysis: First national census

Aim: The percentage of people in Australia who undertake home dialysis has steadily decreased over the past 40 years and varies within Australia. Consumer factors related to this decline have not previously been determined. Methods: A 78‐question survey was developed and piloted in 2008 and 2009. Survey forms were distributed to all adult routine dialysis patients in all Australian states and territories (except Northern Territory) between 2009 and 2010. Of 9223 distributed surveys, 3250 were completed and returned. Results: 49% of respondents indicated they had no choice in the type of dialysis and 48% had no choice in dialysis location. Respondents were twice as likely to receive information about haemodialysis (85%) than APD (39%) or CAPD (41%). The provision of education regarding home modalities differed significantly between states, and decreased with increasing patient age. Additional nursing support and reimbursement of expenses increased the proportion of those willing to commence dialysis at home, from 13% to 34%. State differences in the willingness to consider home dialysis, the degree of choice in dialysis location, the desire to change current dialysis type and/or location, and the provision of information about dialysis were identified. Conclusion: The delivery of pre‐dialysis education is variable, and does not support all options of dialysis for all individuals. State variances indicate that local policy and health professional teams significantly influence the operation of dialysis programs.     

Relationship between Cycle Length of Typical Atrial Flutter and Double Potential Interval after Achievement of Complete Isthmus Block

Background: There is some disagreement concerning the minimal value of the interval between components of double potentials (DPs interval) that allows distinguishing complete and incomplete block in the cavotricuspid isthmus (CTI). Objectives: To assess clinical utility of the relationship between atrial flutter cycle length (AFL CL) and the DPs interval. Methods: Ablation of the CTI was performed in 87 patients during AFL (245 ± 40 ms). Subsequently, DPs were recorded during proximal coronary sinus pacing at sites close to a gap in the ablation line and after achievement of complete isthmus block. Results: We noted strong correlation between AFL CL and the DPs interval after achievement of isthmus block (r = 0.73). The mean DPs interval was 95.3 ± 18.3 ms (range 60–136 ms) and 123.3 ± 24.3 ms (range 87–211 ms) during incomplete and complete isthmus block, respectively (P < 0.001). When expressed as a percentage of AFL CL, this interval was 35.7 ± 3.5% AFL CL (range 28–40.2%) and 50.4 ± 6.9% AFL CL (range 39–72%) during incomplete and complete isthmus block, respectively (P < 0.001). A cutoff value of 40% of AFL CL identified CTI block with 96.7% sensitivity and 100% specificity. Conclusions: The interval between DPs after achievement of block in the CTI correlates with AFL CL. The DPs interval expressed as a percentage of AFL CL allows better distinguishing between complete and incomplete isthmus block compared to standard method based on milliseconds. The DPs interval below 40% of AFL CL indicates sites close to a gap in the ablation line. (PACE 2010; 33:1518–1527)     

CAUSES OF BLINDNESS IN AUSTRALIA: ANALYSIS OF PENSIONS GRANTED BY THE DEPARTMENT OF SOCIAL SECURITY ON THE GROUND OF BLINDNESS FOR THE YEAR ENDING 30 JUNE 1984

The principal and contributing causes of blindness for all pensions granted by the Department of Social Security on account of blindness in Australia during the year ending 30 June 1984 have been coded according to the lnternational Classification of Diseases, 7975 (lCD9). The results are presented in tables which show the major diagnosis for symmetrical and asymmetrical cases according to frequency and age, and the combination of major and contributing diagnosis according to age, sex and prevalence per 100 persons.