RVoutflow tract pacing versus RV Apical pathophysiologic Effects and prognostic implications

Right ventricular apical pacing has been reported to be associated with adverse haemodynamic effects and alternative sites of pacing have been recommended. On the other hand RV septal pacing was claimed to be more physiological. The present work is intended to compare the classic right ventricular apical DDD pacing to RV outflow tract [RVOT] pacing in both normal and diseased hearts. We studied 30 patients [pts] with complete heart block [CHB]. Fourteen pts [Group I] had no underlying heart disease [8M and 6F with mean age 64.1 +/- 6.4, range 54-76 years] and 16 [Group II] had heart disease [10M, 6F, with mean age 67.5 +/- 8.9, range 58-86 years] including DCM in 12, 1HD in 3 and RHD in Ipt. Right ventricular apical pacing was conducted in 7pts from group I and 8pts from group II. RVA was conducted in 7pts of group I and 8pts of group II. Besides clinical evaluation, all pts were subjected to 2D echo before, and 6 months after pacing. Echo parameters studied included LVEDD, LVESD, EF% and CO with effects expressed in terms of% changes in various parameters. Compared to RVA pacing RVOT pacing in group I [pts with normal heart] induced insignificant% decrease in LVEDD [2.4 +/- 4.8vs 8.6 +/- 9.3, p value =0.146] or LVESD [4.6 +/- 7.8vs 8.3 +/- 6.0,p value =0.113] and insignificant increase in EF [2.4 +/- 4.6vs 0.42.6, p value =0.113] and CO [2.8 +/- 8.0vs 3.3 +/- 3.5, p value =0.08]. However in RVOT pacing in group II [pts with disease heart] induced significantly greater% decrease in LVEDD [3.0 +/- 2.8vs 1.2 +/- 2.3, p=0.005] in LVESD [3.7 +/- 0.9vs 2.5 +/- 2.3, p=0.000], and significantly greater% increase in EF [8.9 +/- 3.3vs I.7 +/- 1.2,p=0.001] and CO [5.8 +/- 9.6vs 10.7 +/- 18.3, p=0.04] in comparison to RVA pacing in group II In the presence of underlying cardiac dysfunction, DDD pacing by RVOT lead is hemodynamically more advantageous to classic RV apical pacing in terms of improving dimensions and enhancing systolic function. We recommend RVOT pacing in the presence of underlying HD to avoid the so called pacing-induced cardiomyopathy.

Chlamydial antibodies among copper T intrauterine contraceptive device users

Approximately 60 million women use the intrauterine contraceptive devices [IUCD] worldwide. IUCD constitutes one of the most accepted and widely used methods of contraception especially in the developing countries. Several studies have demonstrated an increased risk of pelvic inflammatory disease [PID] in women using intrauterine contraceptive devices. The role of chlamydia trachomatis in causing PID among IUCD users is not clear. This prospective study aims to clarify the effect of copper T IUCD on the incidence of chlamydia trachomatis infection in the female genital tract. This was done by measuring anti-chlamydia antibodies in the serum of copper T IUCD users compared to non-users among 100 patients attending Family Planning Clinic in Ain Shams University Maternity Hospital. The results showed that Chlamydia antibodies were significantly higher [P < 0.01] among IUCD users compared to non-users. In addition, on linking diagnostic criteria of chlamydia trachomatis infection to the mean serology of chlamydial antibodies, there was no significant correlation to serology [P > 0.05]. This indicates the silent nature of this infection and the importance of screening of chlamydia trachomatis among women at riskor acquiring this infection