Aims and objectives Heart Failure (HF) and Atrial Fibrillation (AF) are concomitant in many patients. They share common risk factors and can exacerbate or precipitate each other. The aim of this study was to examine the management of patients presenting to Letterkenny University Hospital who were assessed to have tachycardia-induced cardiomyopathy. Methods Patients known to the heart failure support service that had a diagnosis of tachycardia-induced cardiomyopathy were included in this review. Additionally, a HIPE search was undertaken for primary admissions for AF and secondary diagnosis of HF and the medical clinical file reviewed. Patients with known ischaemic heart disease or preserved ejection fraction HF were excluded. Data was analysed using SPSS. Results 48 patients were identified, with a mean age of 67 yrs. The majority had AF and HF diagnosed on the same admission. Hypertension was the most common comorbidity. 96% of patients had an ejection fraction (EF) of <40% at presentation. The majority of patients were appropriately anti-coagulated and had appropriate levels of HF medications (ACE-I/Beta-blockers/MRA). 44% underwent direct current cardioversion with an additional 6% reverting to sinus rhythm chemically or spontaneously. While the total group showed increased EF at one year, those who remained in SR had markedly better improvements with only 12% remaining at EF < 40% compared to 46% of those who were in AF at follow up. Conclusion Tachycardia induced cardiomyopathy is a potentially reversible cause of heart failure and when sinus rhythm is restored it resulted in substantial increases in EF. This group of patients should be identified for early rhythm control in order to improve outcomes.

IntroductionCounty Donegal has traditionally been isolated as a result of its geographical remoteness from 24/7 Primary Percutaneous Intervention (PPCI) enabled centres in the Republic of Ireland. The National Acute Coronary Syndrome (ACS) programme is designed to increase access to PPCI for patients with ST Elevation Myocardial Infarction (STEMI). A cross-border initiative between the SAOLTA Hospitals, HSE, Republic of Ireland and the Western Health and Social Care Trust in Northern Ireland commenced on 5th May 2016 to provide PPCI for Donegal. We sought to evaluate the initial effectiveness of this unique Cross border PPCI pathway.MethodsECG’s from Donegal patients suspected of having a STEMI were transmitted from the National Ambulance Service (NAS) or Letterkenny University Hospital (LUH) ER to Altnagelvin Hospital PPCI service. All data were recorded for continuous audit purposes to assess performance indicators, ECG interpretation and the number of referrals made to the PPCI activator in Altnagelvin. All patients who had an ECG transmitted to Altnagelvin PPCI centre from May 2016 to March 2017 were included.Results139 patients were referred with a suspected STEMI to the Cross Border PPCI pathway with 88/139 patients (63%) referred from the National Ambulance Service (NAS); the rest referred from LUH ER. 95/139 (68%) patients were turned down. Only 44/139 patients were accepted for PPCI with a false activation rate of 32%. Only 30/139 patients actually had a final diagnosis of STEMI. The mean time from STEMI diagnosis on ECG to reestablishing flow in the culprit artery was 117.8 minutes within guidelines. No complications occurred during transfer and 89% were repatriated within 24 hrs. All 95 patients that were turned down were deemed appropriate with only 10/95 (10.5%) actually requiring PCI prior to discharge.ConclusionInitial audit of this unique Cross Border PPCI pathway suggests that it is working effectively. The high referral rate and high rate of turn-downs suggest that diagnostic accuracy of ECG interpretation may need to be evaluated. The high rate of false activations is notable and also requires further investigation. The early success of this unique Cross border service is very encouraging when considering the geographical remoteness of Donegal. Work will continue to further improve this vital service for the people of Donegal.

Background Coronary artery ectasia (CAE) is a common coronary artery disorder associated with adverse outcome but with determined pathophysiology. In the present study we sought to examine the systemic chronic inflammatory response that might associate CAE with respect to normal. Methods Plasma samples from 16 patients with coronary artery ectasia (median age 64.9 ± 7.3 years, 12 male) and 71 matched controls (64.8 ± 8.6 years, 31 males) with normal coronary arteries. Samples were analysed at Umea university Biochemistry Laboratory, Sweden, using the V-PLEX Proinflammatory Panel 1 (human) Kit. Statistically significant differences (p<0.05) between patients and controls were determined using Mann-Whitney U-tests. Results The CAE patients had significantly higher systemic levels of INF and TNF IL-1 and IL-8 (p = 0.007, 0.01, 0.001 and 0.002 respectively), while the levels of IL-2 and IL-4 were lower (P < 0.001 for both). The systemic levels of IL-10, IL-12 p and IL-13 did not differ significantly between patients and controls. None of these markers was significantly different between patients with Pure (n=6) and mixed (n=10) CAE with minimal atherosclerosis. Conclusion These results indicate an enhanced systemic pro-inflammatory response in CAE, irrespective of additional atherosclerosis. The profile of this response indicates activation of macrophages, as well as possible involvement of a viral factor. The raised IL-8 levels may suggest additional evidence for angiogenesis.

Les nouvelles techniques de planification de radiothérapie et les soins de support ont permis de diminuer la survenue de toxicité aiguë radio-induite. La mucite reste cependant un effet secondaire majeur pouvant compromettre l’observance du traitement chez les patients irradiés dans la sphère ORL. L’objectif de cette étude était de documenter l’efficacité du laser basse énergie dans la prévention de la mucite radio-induite. Quarante patients pris en charge par arcthérapie volumétrique modulée exclusive (n = 23) ou adjuvante (n = 17) entre août 2014 et octobre 2015 pour un carcinome épidermoïde de la sphère ORL ont été inclus. Ils ont tous bénéficié de laser basse énergie transcutané Heltschl® type FL 3500, 350 mW, trois fois par semaine à visée préventive et à vise curative. Le grade de mucite (score Common Terminology Criteria for Adverse Events [CTCAE] version 3.0.) a été recueilli de la semaine 1 à la semaine 7 puis à 1 mois de la fin du traitement. La dose reçue à la muqueuse buccale a été documentée. Les localisations tumorales étaient la cavité buccale pour sept patients, l’oropharynx pour 19, l’hypopharynx pour huit, et des atteintes synchrones pour six. La dose totale médiane délivrée était de 70 Gy [64–70 Gy]. Une chimiothérapie concomitante a été administrée chez 29 patients : cisplatine pour 25, cétuximab pour trois et 5-fluoro-uracile-ciplatine pour un. Une mucite de grade 0, 1, 2 et 3 a été observée chez neuf (22 %), neuf (22 %), 17 (41 %) et six (14 %) patients respectivement à la semaine 7 et chez 33 (80,5 %), deux (5 %), 3 (7 %) et 3 (7 %) patients à 1 mois du traitement. Il n’y a eu aucune mucite de grade 4. Pour ce qui concerne la muqueuse buccale, les doses moyennes et maximales médianes reçues étaient de 42,5 Gy [12,9–66,3 Gy] et 67 Gy [39–76 Gy]. Malgré des doses conséquentes délivrées à la muqueuse buccale, le taux de mucite radio-induite aiguë de grade 3 ou plus a été faible chez les patients qui ont bénéficié de laser de basse énergie durant leur radiothérapie.

Background. Survivors ofout-of-hospital cardiac arrest notassociated withacutemyocardial infarction areathighrisk forrecurrent cardiac arrest andsuddencardiac death. Theimpact oftheimplantable cardioverter-defibrillator on long-term prognosis inthese patients isuncertain. Methods andResults. Threehundred thirty-one survivors ofout-of-hospital cardiac arrest (age, 56±13.7 years) underwent electrophysiologically guided therapy. Implantable defibrillators wereplaced in150patients (453%o), and181patients (54.7%o) received pharmacological and/or surgical therapy alone. Left ventricular ejection fraction was 35.2±16.6% indefibrillator recipients and453±18.2% innondefibrillator patients. Medianpatient follow-up was 24months inthedefibrillator groupand46months inthenondefibrillator group.Ina proportional hazards model, theindependent predictors oftotal cardiac mortality were left ventricular ejection fraction ofless than0.40(relative risk, 4.55; 95%confidence interval, 2.44to8.33; P=.0001), absence ofan implantable defibrillator (relative risk, 2.70; confidence interval, 1.41to5.00, P=.017), andpersistence ofinducible sustained ventricular tachycardia (relative risk, 1.84; 95%confidence interval, 0.97 to3.49; P=.045). The1-and5-year probabilities ofsurvival free ofcardiac mortality inpatients withleft ventricular ejection fraction ofless than0.40 were943%and69.6%o with adefibrillator and82.1% and 453%without adefibrillator, respectively. Forpatients withleft ventricular ejection fraction of0.40 ormore, the 1- and5-year probabilities ofsurvival free ofcardiac mortality were97.7% and94.61% with adefibrillator and95.4% and86.9%,o without adefibrillator, respectively. Conclusions. Insurvivors ofout-of-hospital cardiac arrest, theimplantable defibrillator isassociated witha reduction incardiac mortality, particularly inpatients withimpaired left ventricular function. (Circulation. 1993;88:1083-1092.)

HAUSER, R.G., et al. : Long‐Term Structural Failure of Coaxial Polyurethane Implantable Cardioverter Defibrillator Leads. Transvene models 6936/6966, a coaxial polyurethane ICD lead, may be prone to structural failure. These models comprise 54% of ICD lead failures in the authors' Multicenter Registry database. Because ICD leads perform a vital function, the clinical features, causes, and probability of Transvene 6936/6966 lead failure were determined. The Registry and United States Food and Drug Administration databases were queried for the clinical features and structural causes of the Transvene 6936/6966 lead failure, and a five‐center substudy estimated the survival probability for 521 Transvene 6936/6966 implants. The mean time to failure was 4.8 ± 2.1 years, and the estimated survival at 60 and 84 months after implant were 92% and 84%, respectively. Oversensing was the most common sign of failure (76%), and 24 patients experienced inappropriate shocks. The manufacturer's reports indicated that high voltage coil fracture and 80A polyurethane defects were the predominant causes of lead failure. Transvene models 6936 and 6966 coaxial polyurethane ICD leads are prone to failure over time. Patients who have these leads should be evaluated frequently. Additional studies are needed to identify safe management strategies.

IntroductionAtrial fibrillation (AF), the most common sustained cardiac rhythm disturbance, is increasing in prevalence as the popu-lation ages.Although it is often associated with heart disease, AF occurs in many patients with no detectable disease.Hemodynamic impairment and thromboembolic events result This document was

Pacing and Clinical ElectrophysiologyVolume 24, Issue 2 p. 262-269 Consensus Statement on Indications, Guidelines for Use, and Recommendations for Follow-up of Implantable Cardioverter Defibrillators STEPHEN L. WINTERS, STEPHEN L. WINTERS Morristown Memorial Hospital, Morristown, New JerseySearch for more papers by this authorDOUGLAS L. PACKER, DOUGLAS L. PACKER St. Mary's Hospital Complex, Mayo Foundation, Rochester, MinnesotaSearch for more papers by this authorFRANCIS E. MARCHLINSKI, FRANCIS E. MARCHLINSKI University of Pennsylvania Medical Center, Philadelphia, PennsylvaniaSearch for more papers by this authorRALPH LAZZARA, RALPH LAZZARA University of Oklahoma Health Science Center, Oklahoma City, OklahomaSearch for more papers by this authorDAVID S. CANNOM, DAVID S. CANNOM The Hospital of the Good Samaritan, Los Angeles, CaliforniaSearch for more papers by this authorGÜNTER E. BREITHARDT, GÜNTER E. BREITHARDT Universität Münster, Münster, GermanySearch for more papers by this authorDAVID A. WILBER, DAVID A. WILBER University of Chicago Medical Center, Chicago, IllinoisSearch for more papers by this authorA. JOHN CAMM, A. JOHN CAMM St. George's Medical School, London, EnglandSearch for more papers by this authorJEREMY N. RUSKIN, JEREMY N. RUSKIN Massachusetts General Hospital, Boston, MassachusettsSearch for more papers by this author STEPHEN L. WINTERS, STEPHEN L. WINTERS Morristown Memorial Hospital, Morristown, New JerseySearch for more papers by this authorDOUGLAS L. PACKER, DOUGLAS L. PACKER St. Mary's Hospital Complex, Mayo Foundation, Rochester, MinnesotaSearch for more papers by this authorFRANCIS E. MARCHLINSKI, FRANCIS E. MARCHLINSKI University of Pennsylvania Medical Center, Philadelphia, PennsylvaniaSearch for more papers by this authorRALPH LAZZARA, RALPH LAZZARA University of Oklahoma Health Science Center, Oklahoma City, OklahomaSearch for more papers by this authorDAVID S. CANNOM, DAVID S. CANNOM The Hospital of the Good Samaritan, Los Angeles, CaliforniaSearch for more papers by this authorGÜNTER E. BREITHARDT, GÜNTER E. BREITHARDT Universität Münster, Münster, GermanySearch for more papers by this authorDAVID A. WILBER, DAVID A. WILBER University of Chicago Medical Center, Chicago, IllinoisSearch for more papers by this authorA. JOHN CAMM, A. JOHN CAMM St. George's Medical School, London, EnglandSearch for more papers by this authorJEREMY N. RUSKIN, JEREMY N. RUSKIN Massachusetts General Hospital, Boston, MassachusettsSearch for more papers by this author First published: 22 July 2003 https://doi.org/10.1046/j.1460-9592.2001.00262.xCitations: 50 Address for reprints: NASPE c/o Ms. Marilyn Bishop, Six Strathmore Road, Natick, MA 01760-2499. Fax: (508) 647-0124. *Conference participants: Gust H. Bardy, David G. Benditt, Günter E. Breithardt, A. John Camm, David S. Cannom, Debra S. Echt, George J. Klein, Ralph Lazzara, Francis E. Marchlinski, Daniel B. Mark, L. Brent Mitchell, Douglas L. Packer, Jeanne E. Poole, Jeremy N. Ruskin, Arjun D. Sharma, David J. Wilber, Stephen L. Winters, and Raymond Yee. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume24, Issue2February 2001Pages 262-269 RelatedInformation

HAUSER, R., et al.: Feasibility and Initial Results of an Internet‐Based Pacemaker and ICD Pulse Generator and Lead Registry. The medical community has no independent source of timely information regarding the performance of pacemaker and ICD pulse generators and leads. Accordingly, the authors established an Internet‐based registry of pacemaker and ICD pulse generator and lead failures (www.pacerandicregistry.com). During the first year, they found three previously unreported device problems that were promptly communicated to the participants. Of the failures reported, 11% of ICD and 10% of pacemaker pulse generator failures were heralded by signs other than the expected elective replacement indicator (ERI). Average ICD battery longevity was 4.0 ± 0.7 years, and average dual chamber pacemaker battery longevity was 6.8 ± 2.6 years. Disrupted insulation accounted for 54% of pacemaker and 29% of ICD lead failures. Compared to pacemaker pulse generator and lead failure, ICD device failures were more likely to cause severe clinical consequences. In conclusion, an Internet‐based registry is feasible and capable of providing timely data regarding the signs, causes, and clinical consequences of pacemaker and ICD failures.

The electrophysiology community in the United States should be con~dent of its future; we have revolutionary new procedures, devices and clinical trials. Instead, there is a pervasive uncertainty and even fear about what even the short term holds. The reason for this is simple. Electrophysiology is costly and the changes in the economics of reimbursement are a threat to an expensive subspecialty. Current changes will see some electrophysiologists thriving, while others will fail and, in turn, relocate or retrain.