Prevalence of supraventricular arrhythmias from the automated analysis of data stored in the DDD pacemakers of 617 patients: the AIDA study

The confirmation of the occurrence of supraventricular arrhythmias (SVAs) is possible only if a surface electrocardiogram (ECG) is recorded during an episode, or if SVAs occur during 24 h ambulatory monitoring (Holter). The automatic interpretation of memory functions in DDD pacemakers may be useful in this diagnostic task over longer periods of follow up. This hypothesis was tested in 384 men and 233 women (mean age = 70 ± 11 years) who had received Chorus 6034/6035, 6234 or 7034 pacemakers (ELA Medical, Montrouge, France) with fall-back function in case of sustained SVAs. The Automatic Interpretation for Diagnostic Assistance (AIDA) algorithm included in these pacemakers was compared with 24 h Holters recorded simultaneously (DI) and with the clinical history of symptoms consistent with SVAs up to 28 days of follow up (D28). Indications for pacing were atrioventricular block (AVB) in 269 patients, sinus node dysfunction (SND) in 248, and AVB + SND in 100. SVAs were documented before implant in 199 patients (32%). Among the 617 patients included at D1. 76 (12.4%) developed at least one SVA episode, lasting between 1 min and 24 hours, simultaneously recorded on Holter and by AIDA with a 93.8% sensitivity and 94.2% specificity. Data from 354 patients were available for analysis at D28. AIDA diagnosed SVAs in 179 patients (50.6%), 104 of whom (65%) had remained asymptomatic and 117 of whom (65%) had had no SVA documented before implant. Among the 354 patients, AIDA diagnosed SVAs in 76 (21%) asymptomatic patients who had no known SVA before implant. The prevalence of SVA in our AVB population was higher than reported in previous studies: 89 patients (56.3%) with AVB had SVAs versus 90 patients (45.9%) with other diagnoses (p=0.55). Furthermore atrial pacing was associated with fewer SVAs. These first clinical results of the AIDA study demonstrate that the memory functions of Chorus pacemakers and the AIDA software are reliable to analyze the prevalence of SVA at 1 month of follow-up. From a clinical point of view, AIDA is a valuable tool to evaluate the efficacy of antiarrhythmic therapy, particularly as it pertains to the prevention of stroke due to atrial fibrillation.     

Clinical Results with Electrophysiologist-Implanted Cardioverter-Defibrillators

With the advent of nonthoracotomy leads and smaller devices. implantation techniques for implantable cardioverters defibrillators (ICDs) have been simplified. We reviewed the outcome of pectoral ICD implantation by electrophysiologists in 51 consecutive patients, 47 males and 4 females, mean age 60 ± 12 years, presenting with aborted sudden cardiac death (14) and drug refractory hypotensive ventricular tachycardia (37). Patients were implanted with either the PCD Jewel^TM 7219D (37) or 72197C (14) Medtronic pectoral ICDs. The mean operative time was 98 ± 31 minutes. There was no operative mortality. Complications occurred in 2 (4%) patients: right ventricular lead dislodgement requiring lead repositioning occurred in 1 patient, and 1 patient treated with anticoagulants, who had received a subcutaneous patch lead, developed a hematoma not requiring surgical reintervention. The mean defibrillation threshold was 18.6 ± 5.5 J, but was significantly lower for the 7219C(14.1 ± 5.0 J) compared to the 7219D (20.6 ± 4.4J) device, P = 0.0001. A two-lead system consisting of a right ventricular electrode (RVA) and a superior vena caval lead (SVC) was utilized in 29, RVA/SVC-subcutaneous patch in 5 and active can in 17 patients, Patients were discharged after 4.3 ± 3 days. The procedure time was significantly shorter for the 7219C device (79.7 ± 18.9 vs 105.2 ± 32.8 minutes., P = 0.0035]. Over the fallow-up period of 8 ± 5 (range 1–20] months, 26% patients received appropriate therapy (95% antitachycardia pacing, 5% shock). Concomitant antiarrhythmic therapy was utilized in 41% of patients. Ninety-eight percent of patients are alive. One patient died of congestive heart failure. Clinical results with electrophysiologist-implanted pectoral ICDs demonstrate lou morbidity and no operative mortality in this clinical series and lower DFTs and shorter procedure times may be achieved with 7219C (active can) device.     

Thymic Accessory Cells Required for the Increased Responsiveness of Thymocyte Subpopulations to Interleukin 1-Like Monokine in Guinea Pigs

The proliferative response of guinea-pig thymocytes to co-mitogenic stimulation with phytohaemagglutinin and the guinea-pig interleukin 1 (IL-1)-like lymphocyte-activating monokine was lost by removing the cells that adhere to a Sephadex G-10 (G-10) column or the cells of low density in a Ficoll-Conray gradient. The diminished response in the G-10 non-adherent thymocyte or high-density thymocyte fraction was restored by the addition of a macrophage-depleted G-10 adherent thymocyte fraction or a low-density, Ia-positive thymocyte fraction but not by the addition of peritoneal macrophages. These results suggest that the accessory cells which mediate the increased responsiveness of thymocytes to the IL-1-like monokine existed in G-10 adherent cell fractions and the cells with this accessory function were not macrophages. The accessory cells were shown to be of low density, glass-non-adherent, G-10-adherent, Fc receptor-negative, and Ia-positive. These results also suggest that the G-10-non-adherent and high-density thymocyte subpopulation, which is unresponsive or responds very little to the IL-1-like monokine by itself, acquires responsiveness to the monokine and proliferates by stimulation with the IL-1-like monokine and lectin in the presence of the accessory cells.     

Purification and characterization of gonadotropin I and II from pituitary glands of tuna (Thunnus obesus)

The duality of teleost pituitary gonadotropins was established in an advanced marine fish, the tuna (Thunnus obesus). Two different molecular forms of gonadotropins, designated tGTH I and tGTH II, were isolated from an alcoholic extract of pituitary glands following ion-exchange chromatography and reversed-phase HPLC. Both tGTH I and tGTH II stimulated estradiol-17β and testosterone production in tuna ovarian follicles in vitro, although responses to tGTH II were significantly greater than those to tGTH I. Each gonadotropin consisted of α- and β-subunits. tGTH I was stable in acidic conditions, whereas tGTH II dissociated into two subunits after acid treatment. Alpha subunits of tGTH I and tGTH II had identical amino acid sequences of 94 amino acid residues. The tGTH Iβ and tGTH IIβ consisted of 102 and 115 amino acid residues, respectively, and showed 35% sequence identity. tGTH Iβ is structurally more similar to salmon GTH Iβ than to salmon GTH IIβ, whereas tGTH IIβ is more similar to salmon GTH IIβ. Thus it is evident that the tuna pituitary gland produces two chemically distinct gonadotropins.     

Multimodality Neuromonitoring for Neurocardiology

Neurophysiologic monitoring, including quantitative EEG, transcranial Doppler (TCD) ultrasound and transcranial near-infrared spectroscopy (NIRS), can be of diagnostic value in neurocardiology—the study of dysfunctional brain-heart relationships. A new multivariate EEG technique bispectral analysis, enables the cardiologist to objectively and precisely document transient episodes of syncope and seizure. TCD permits precise determination of the nature and extent of cerebral hemodynamic irregularities, while NIRS detects frontal lobe imbalance in the delivery and consumption of oxygen. These powerful new neurophysiologic tools, coupled with traditional systemic hemodynamic and electrocardiographic measures, will undoubtedly improve the diagnostic yield in the complex determination of the causes of syncope and cardiac-based confusional states.     

Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography

BACKGROUND: The incidence of postsurgical venous thromboembolism is thought to be low in Asian ethnic populations. OBJECTIVE: We studied the incidence of deep-vein thrombosis (DVT) in Asian patients undergoing major orthopedic surgery of the lower limbs. PATIENTS/METHODS: We performed a prospective epidemiological study in 19 centers across Asia (China, Indonesia, South Korea, Malaysia, Philippines, Taiwan, and Thailand) in patients undergoing elective total hip replacement (THR), total knee replacement (TKR) or hip fracture surgery (HFS) without pharmacological thromboprophylaxis. The primary endpoint was the rate of DVT of the lower limbs documented objectively with bilateral ascending venography performed 6-10 days after surgery using a standardized technique and evaluated by a central adjudication committee unaware of local interpretation. RESULTS: Overall, of 837 Asian patients screened for this survey, 407 (48.6%, aged 20-99 years) undergoing THR (n = 175), TKR (n = 136) or HFS (n = 96) were recruited in 19 centers. DVT was diagnosed in 121 of 295 evaluable patients [41.0%, (95% confidence interval (CI): 35.4-46.7)]. Proximal DVT was found in 30 patients [10.2% (7.0-14.2)]. Total DVT and proximal DVT rates were highest in TKR patients (58.1% and 17.1%, respectively), followed by HFS patients (42.0% and 7.2%, respectively), then THR patients (25.6% and 5.8%, respectively). DVT was more frequent in female patients aged at least 65 years. Pulmonary embolism was clinically suspected in 10 of 407 patients (2.5%) and objectively confirmed in two (0.5%). CONCLUSIONS: The rate of venographic thrombosis in the absence of thromboprophylaxis after major joint surgery in Asian patients is similar to that previously reported in patients in Western countries.     

Agminated Spitz Nevi Arising on a Nevus Spilus after Chemotherapy

Abstract: Agminated Spitz nevus arising on a background of nevus spilus (NS) is a rare condition. We report here a further case in a child that is original because it is induced by chemotherapy. A 3‐year‐old boy presented 3 months after the onset of a chemotherapy for a vesico‐prostatic rhabdomyosarcoma, multiple pigmented papulo‐nodules located on the face, neck, chest wall, and the higher back. These lesions have arose on a pre‐existent large congenital histologically confirmed nevus spilus extending along the face, neck, the left shoulder and the left chest wall. Histological examination of three excised nodules led to the diagnosis of Spitz nevus. Our patient may have a high risk for melanoma since he has many criteria predisposing to this risk. Some of these criteria are related to NS but we should also take into account the chemotherapy induction and the high number of Spitz nevi.