Safety and Effectiveness of Transvenous Lead Extraction in Octogenarians

Transvenous Lead Extraction . Introduction: As the population ages, the number of elderly patients with implantable cardiac devices referred for transvenous lead extraction will dramatically increase in Western countries. The safety and effectiveness of lead extraction in elderly patients has not been well evaluated. We report the safety and effectiveness of transvenous lead extraction in octogenarians. Methods and Results: From January 2005 to January 2011, we reviewed data from consecutive patients ≥ 80 years referred to our institutions for transvenous lead extraction because of cardiac device infection or lead malfunction. Clinical characteristics, procedural features, and periprocedural major and minor complications were compared between octogenarians and younger patients. Out of 849 patients undergoing lead extraction in the participating institutions during the study period, 150 (18%) patients were octogenarians (mean age 84 years; range 80–96; 64% males). A significantly higher percentage of octogenarians presented with chronic renal failure (55% vs 26%; P < 0.001), history of malignancy (22% vs 6%; P < 0.001), and chronic obstructive pulmonary disease (46% vs 19%; P < 0.001). Complete lead extraction rates were similar in the 2 age groups (97% in octogenarians vs 96% in patients <80 years; P = 0.39). Periprocedural death occurred in 2 (1.3%) patients ≥80 years and in 5 (0.72%) patients <80 years (P = 0.45 for comparison). No differences in terms of other periprocedural major and minor complications were found between the 2 age groups. Conclusion: Despite presenting with a significantly higher rate of comorbidities, transvenous lead extraction can be performed safely and successfully in octogenarians. (J Cardiovasc Electrophysiol, Vol. 23 pp. 1103‐1108, October 2012)     

AN OPEN MULTICENTRIC STUDY EVALUATING 4-HYDROXYBUTYRIC ACID SODIUM SALT IN THE MEDIUM-TERM TREATMENT OF 179 ALCOHOL DEPENDENT SUBJECTS

We report the results of an ‘open’ multicentre studyevaluating the use, tolerability and therapeutic efficacy ofthe sodium salt of 4-hydroxybutyric acid (GHB) for the medium-termtreatment of withdrawal symptoms in 179 patients with alcoholdependence followed up as outpatients. The follow-up of patientswas 6 and 12 months after drug discontinuation. Following adaily oral administration of 50mg/kg for approximately 6 months,no serious systemic or single-organ consequences leading todrug discontinuation were reported, and tolerability was fairin all patients. Eleven subjects (10.1%) snowed craving forthe drug and voluntarily increased their doses (6–7 timesthe recommended levels). GHB led to complete abstinence duringdrug administration in 78.0% of the patients. A significantreduction of compulsive desire (‘craving’) was observedin parallel, as deduced from evaluation of a specific questionnaire,the Alcohol Craving Scale. At follow-up examination, 43 of thetreated subjects remained abstinent at 6 months, and 30 subjectswere abstinent for 1 year after drug discontinuation.     

When Water Hurts

Deglutition syncope refers to an uncommon cause of neurally mediated syncope induced by swallowing. We briefly review a case of a 66-year-old man who experienced recurrent syncope episodes during ingestion of beverages, mainly water. Our investigations documented several short asymptomatic episodes of asystole and one prolonged complete atrioventricular block of around 15 seconds associated with the syncopal events, during swallowing. Barium x-ray and manometry evaluations revealed only a nonspecific esophageal dysmotility. An underlying sick-sinus syndrome was found on electrophysiologic study. A DDD pacemaker implantation was performed leading to total disappearance of patient's symptoms.