Transtelephonic Monitoring and Transmission of Stored Arrhythmia Detection and Therapy Data From an Implantable Cardioverter Defibrillator

A new transtelephonic monitoring device designed for use with implantable Cardioverter defibrillators (ICDs) was evaluated. It is capable of interrogating ICDs and transmitting the following data via telephone: programmed parameters (e.g., ventricular tachycardia [VT] and ventricular fibrillation [VF] detection, therapies), number of VT and VF episodes, identification of successful therapies, the 20 cycle lengths preceding the last episode detected, the 10 cycle lengths after the last delivered therapy, battery voltage, and real-time transmission of the patient's rhythm. Eighteen patients (mean age 64 ± 17years; 15 males) were implanted with an ICD and epicardial lead system. The patients who did not live near the primary hospital were provided with this transmitter and instructed to transmit monthly and whenever presyncope, syncope, or a shock were experienced. Five hundred ten episodes of spontaneous arrhythmia (495 VT, 15 VF) were detected in 14 of 18 patients in a 24-month period and the success of each therapy (antitachycardia pacing, cardioversion 0.4-34 J, defibrillation 34 J) was analyzed. The number of therapies delivered and their success (%) in terminating the arrhythmia were: 380 ramp/86%, 116 burst/84%, 119 cardioversion/57%, and 15 defibrillations/ 100%. Sixty-three (42%) of the 152 transmissions indicated an arrhythmia. Twenty-five (16%) of the 152 were transmitted because of symptoms. Sixteen (9.7%) of 165 VT episodes could not be terminated by the full set of programmed VT therapies. Analysis of the pre- and post-episode intervals along with the patient's transmitted rhythm indicated that sinus tachycardia or atrial fibrillation were likely responsible for these episodes. The transmitted data included the real-time ECG, which provided acute rhythm status plus stored data from the ICDs memory identifying the chronic arrhythmias detected, the therapies delivered, and the number and type of successful and ineffective therapies. This information provided the clinical data to the primary physician in order to determine the effectiveness of the programmed detection and therapy parameters and in some cases recommend to the home physician modifications to the device parameters or medication adjustments for enhanced arrhythmia control. We conclude that telephone transmission of stored ICD data is feasible and useful for patient management. It may obviate the need for patients experiencing symptoms to return to a site capable of device interrogation.     

EPIDEMIOLOGY OF ALCOHOLIC CIRRHOSIS

Seventy-seven alcoholic patients, 54 men and 23 women, had cirrhosis of the liver when they first attended the Alcoholism Clinic at St Vincent's Hospital, Melbourne, between July, 1964, and June, 1968. During this period 800 chronic alcoholics, 663 men and 137 women, attended the clinic. Cirrhosis was thus diagnosed twice as often in women as in men. The case histories of the 77 cirrhotic patients were reviewed, and information was collected about socio-economic status and drinking habits. This information was compared with that obtained from a sample of 220 patients--all those who attended the Alcoholism Clinic between July, 1966, and June, 1967. Most of the cirrhotic patients were beer drinkers, as are the majority of Australian alcoholics. Relatively more cirrhotics were habitual excessive drinkers. The cirrhotic patients did not drink more heavily, but they had drunk excessively for longer when their cirrhosis was diagnosed. Cirrhotic women, however, had drunk excessively for a significantly shorter time than cirrhotic men. No difference was found in the incidence of either social isolation or clinical peripheral neuropathy between cirrhotic and alcoholic patients, or between male and female cirrhotics. Cirrhosis was not commoner among the lower socio-economic groups. These findings were interpreted as suggesting that nutrition did not play an important part in the causation of the liver disease. Women appear to be more susceptible than men to cirrhosis of the alcoholic, and unremitting habitual excess more damaging than intermittent alcohol abuse. Some undetermined predisposition must also exist, since the disease is still sporadic even when these factors operate.     

Effect of antibody preparations on glucose uptake by a cariogenic streptococcus

The effect of antisera to whole cells or cell wall components on glucose uptake by S. mutans 6715 was examined. Early stationary phase 6715 cells were treated with test scrum and incubated at 37°C in the presence of ¹⁴C-glucose. Samples were removed at timed intervals and measured in a liquid scintillation counter for radioactive uptake. Antisera to both whole cells and components known to be present on the surface of the cells reduced glucose uptake relative to normal serum. It is suggested that inhibition of glucose uptake may be one mechanism by which a caries vaccine may operate.     

Unusual Presentation of Pulmonary Inflammatory Pseudotumor (Plasma Cell Granuloma) as Esophageal Obstruction

A 12-year old boy had a five-year course of dysphagia secondary to lower esophageal obstruction by a posterior mediastinal extension of an inflammatory pseudotumor of the lung. The case illustrates the capacity of pseudotumor to behave in a locally aggressive manner and to present in extrapulmonic sites.     

THE ESTABLISHMENT AND MANAGEMENT OF A RECOVERY AND RESUSCITATION WARD

The establishment and management of a recovery and resuscitationward with its aims, advantages and disadvantages, structure,composition and equipment have been discussed. The ward, whichhas been maintained at Sydney Hospital over the past six yearswith great benefit to patients, surgeon and anaesthetist, hasbeen described as an example of this type of unit.