Predictors of a high defibrillation threshold test during routine ICD implantation.

BACKGROUND: There is growing evidence that routine defibrillation threshold (DFT) testing during implantable cardioverter defibrillator (ICD) implantation is not necessary. However a small group of patients might be at risk if no DFT testing is performed. METHODS: Patients with a new pectoral ICD implantation in our hospital between 2006 and 2014 were included in a retrospective registry. A clinical high DFT was defined as a safety margin <10 J of the maximal device output. Logistic regression for prediction of high DFT was performed using patient characteristics, clinical, echocardiographic and device-related parameters. RESULTS: DFT testing was performed in 788/864 (91.2%) procedures. In 76 (8.8%) patients no DFT testing was performed mainly due to atrial fibrillation, intra-cardiac thrombus, hemodynamic instability or logistical reasons. A high DFT was present in 44 (5.6%) patients. A QRS duration ≥150 ms, a low left ventricular ejection fraction (LVEF ≤25%), a severely dilated left ventricle ≥60 mm and right sided pre-pectoral implantations were univariate predictors of a high DFT. Independent predictors of a high DFT were a LVEF ≤25% (HR 2.195, 95%CI 1.085-4.443) and right sided pre-pectoral implantations (HR 3.135, 95% CI 1.186-8.287). CONCLUSIONS: A high DFT is still present in about 5% of patients and is more frequent in patients with a severely dilated left ventricle, a very low LVEF, right sided pre-pectoral implantation and wider QRS duration. It might be clinically important to continue DFT testing in these high risk patients.

Inferior and anterior QRS fragmentation have different prognostic value in patients who received an implantable defibrillator in primary prevention of sudden cardiac death.

AIMS: QRS fragmentation (fQRS) has been proposed as a predictor of sudden cardiac death (SCD) and all-cause mortality in ischemic (ICM) and non-ischemic cardiomyopathy patients. However the value of fQRS in patients with a LVEF <35% is a matter of debate. METHODS: All consecutive patients with an indication for an ICD in primary prevention of SCD were included in a retrospective registry from 1996 until 2013. Twelve lead electrocardiograms before implant were analyzed for the presence of fQRS in different regions. Adjusted Cox regression analysis for first appropriate ICD shock (AS) and all-cause mortality was performed. RESULTS: In total 407 patients were included with a mean follow-up of 4.2±3.3y (age 60.6±11.9y, 15.7% female and 52.8% ICM). fQRS was present in 46.7% of patients, predominantly inferior (30.7%) followed by anterior (21.4%) and lateral (11.1%) coronary artery territories. fQRS was significantly more prevalent in ICM (p=0.004). Inferior fQRS was an independent predictor of a first AS within 1y (HR 2.55, 95%CI 1.28-5.07) and 3y (HR 1.90, 95%CI 1.14-3.18) after implantation. Whereas, anterior fQRS was an independent predictor of all-cause mortality within 1y (HR 4.58, 95%CI 1.29-16.19), 3y (HR 3.92, 95%CI 1.77-8.65) and the complete follow-up (HR 2.22, 95%CI 1.33-3.69). Lateral fQRS was only a predictor of late (>3y of follow-up) all-cause mortality (HR 2.04, 95%CI 1.09-3.81). CONCLUSIONS: fQRS in a specific coronary artery territory might be promising to discriminate arrhythmic from mortality risk. Inferior fQRS was a predictor of early arrhythmia, while anterior fQRS was related to mortality.

Attitudes of non-medical staff in hospitals in Spain, Mexico, Cuba and Costa Rica towards organ donation.

INTRODUCTION: Non-medical staff members in hospitals are highly credible at population level, and are a source of opinion even though they do not have sufficient medical training. OBJECTIVES: To analyse the attitudes of non-medical professionals of Spanish and Latin American hospitals towards organ donation and identify the factors that influence these attitudes. MATERIAL AND METHOD: Through the "Proyecto Colaborativo Internacional Donante" (International Collaborative Donor Project), a stratified random sample was selected from non-medical services of eleven hospitals: 3 Spanish (n=277), 5 Mexican (n=632), 2 Cuban (n=42) and 1 Costa Rican (n=101). RESULTS: Of the 1052 professionals surveyed, 72% (n=754) were in favour of donating an organ after death. By country, 98% of Cubans, 80% of Mexicans, 66% of Costa Ricans and 52% of Spanish were in favour (P<.001). The most influential variables were: 1) country, with results being more positive in Mexico (odds ratio [OR]=2.197), 2) believing in the possibility that they will require a transplant (OR=2.202), 3) having discussed the issue with their family (OR=3.23), 4) the positive attitude of their partner towards donation (OR=3.322), 5) not being concerned about possible mutilation of their body after donation (OR=3.378), 6) preferring options other than burial (OR=2.525), 7) accepting an autopsy (OR=2.958). CONCLUSIONS: The attitude of non-medical staff members of hospitals towards the donation of their own organs varies greatly depending on the country of the respondent. Psychosocial factors that influence these attitudes are similar to those described at the population level.

Actitud hacia la donación de órganos del personal no sanitario de hospitales de España, México, Cuba y Costa Rica / Attitudes of non-medical staff in hospitals in Spain, Mexico, Cuba and Costa Rica towards organ donation

Introducción: El personal no sanitario de centros hospitalarios tiene una importante credibilidad a nivel poblacional, siendo un grupo generador de opinión sin formación sanitaria adecuada. Objetivo: Analizar la actitud hacia la donación de los órganos de los profesionales no sanitarios de hospitales españoles y latinoamericanos, y determinar los factores que condicionan dicha actitud. Material y métodos: Del Proyecto Colaborativo Internacional Donante se selecciona una muestra aleatoria y estratificada entre los servicios no sanitarios de once hospitales: 3 españoles (n = 277), 5 mexicanos (n = 632), 2 cubanos (n = 42) y 1 costarricense (n = 101). Resultados: De los 1052 profesionales encuestados, el 72 % (n = 754) está a favor de la donación de órganos tras fallecer. Por país, el 98 % de los cubanos están a favor, el 80 % de los mexicanos, el 66 % de los costarricenses y el 52 % de los españoles (p < 0,001). Las variables con más peso son: 1) país, siendo más favorable en México (odds ratio [OR] = 2,197); 2) creer en la posibilidad de necesitar un trasplante (OR = 2,202); 3) haber comentado el tema con la familia (OR = 3,23); 4) actitud favorable de la pareja hacia la donación (OR = 3,322); 5) no estar preocupado por la posible mutilación del cuerpo tras la donación (OR = 3,378); 6) preferir otras opciones distintas de la inhumación (OR = 2,525); 7) aceptar la realización de una autopsia (OR = 2,958). Conclusiones: La actitud hacia la donación de órganos propios entre el personal no sanitario de centros hospitalarios presenta variaciones importantes según el país del encuestado. Los factores psicosociales que condicionan dicha actitud son similares a los descritos a nivel poblacional (AU)

Introduction: Non-medical staff members in hospitals are highly credible at population level, and are a source of opinion even though they do not have sufficient medical training. Objectives: To analyse the attitudes of non-medical professionals of Spanish and Latin American hospitals towards organ donation and identify the factors that influence these attitudes. Material and method: Through the "Proyecto Colaborativo Internacional Donante" (International Collaborative Donor Project), a stratified random sample was selected from non-medical services of eleven hospitals: 3 Spanish (n=277), 5 Mexican (n=632), 2 Cuban (n=42) and 1 Costa Rican (n=101). Results: Of the 1052 professionals surveyed, 72% (n=754) were in favour of donating an organ after death. By country, 98% of Cubans, 80% of Mexicans, 66% of Costa Ricans and 52% of Spanish were in favour (P<.001). The most influential variables were: 1) country, with results being more positive in Mexico (odds ratio [OR]=2.197), 2) believing in the possibility that they will require a transplant (OR=2.202), 3) having discussed the issue with their family (OR=3.23), 4) the positive attitude of their partner towards donation (OR=3.322), 5) not being concerned about possible mutilation of their body after donation (OR=3.378), 6) preferring options other than burial (OR=2.525), 7) accepting an autopsy (OR=2.958). Conclusions: The attitude of non-medical staff members of hospitals towards the donation of their own organs varies greatly depending on the country of the respondent. Psychosocial factors that influence these attitudes are similar to those described at the population level (AU)

Effective dose analysis of three-dimensional rotational angiography during catheter ablation procedures.

There is increasing use of three-dimensional rotational angiography (3DRA) during cardiac ablation procedures. As compared with 2D angiography, a large series of images are acquired, creating the potential for high radiation doses. The aim of the present study was to quantify patient-specific effective doses. In this study, we developed a computer model to accurately calculate organ doses and the effective dose incurred during 3DRA image acquisition. The computer model simulates the exposure geometry and uses the actual exposure parameters, including the variation in tube voltage and current that is realized through the automatic exposure control (AEC). We performed 3DRA dose calculations in 42 patients referred for ablation on the Siemens Axiom Artis DynaCT system (Erlangen, Germany). Organ doses and effective dose were calculated separately for all projections in the course of the C-arm rotation. The influence of patient body mass index (BMI), dose-area product (DAP), collimation and dose per frame (DPF) rate setting on the calculated doses was also analysed. The effective dose was found to be 5.5 +/- 1.4 mSv according to ICRP 60 and 6.6 +/- 1.8 mSv according to ICRP 103. Effective dose showed an inversely proportional relationship to BMI, while DAP was nearly BMI independent. No simple conversion coefficient between DAP and effective dose could be derived. DPF reduction did not result in a proportional effective dose decrease. These paradoxical findings were explained by the settings of the AEC and the limitations of the x-ray tube. Collimation reduced the effective dose by more than 20%. Three-dimensional rotational angiography is associated with a definite but acceptable radiation dose that can be calculated for all patients separately. Their BMI is a predictor of the effective dose. The dose reduction achieved with collimation suggests that its use is imperative during the 3DRA procedure.

Diagnóstico y tratamiento oportunos de la infección por Helicobacter pylori: solución a un problemas de salud / Diagnosis and opportune treatments for Helicobacter pylori infection: a solution for a health problems

Introducción. Helicobacter pylori (Hp) es una de las bacterias más estudiadas actualmente. Está asociada con gastritis y úlcera péptica; en 95 por ciento de las úlceras duodenales, 75 por ciento de las gástricas, con cáncer gástrico en 65 por ciento de los casos. No se conocen datos específicos en nuestra región, por lo que se pretende demostrar cuál es la utilidad, especificidad y sensibilidad de las pruebas diangósticas. Material y métodos. Se condujo un estudio clínico, observacional y descriptivo en 50 adultos; 30 mujeres y 20 varones. Se les practicaron biopsias gástricas por endoscopia, prueba de CLOtest, prueba del aliento con urea radiactiva (PA-C14), cultivo y sensibilidad antibacteriana mediante Epsilometría (î-test), laboratorio de rutina y determinación de anticuerpos vs Hp en suero (Acs vs Hp). Resultados. Todos presentaron positiva la prueba de CLOtest (100 por ciento). La PA-C14 fue positiva en 98 por ciento. Se encontró una resistencia de 34 por ciento in vitro al metronidazol. Los niveles promedio de los Acs vs Hp fueron de 75 U/mL; dos casos negativos. Conclusión. Por primera vez en nuestra región es conducido un estudio de carácter multidisciplinario, dirigido a comparar y determinar frecuencia de positividad de diferentes pruebas diagnósticas. Resalta la utilidad del antibiograma para Hp por epsilometría, en virtud de la existencia de cepas resistentes. La determinación de Acs vs Hp se manifestó como una prueba, no invasiva, con aceptable sensibilidad y especificidad (96 por ciento y 94 por ciento). Un diagnóstico y tratamiento oportunos para infección por Helicobacter pylori propiciará disminución de uno de los principales motivos de consulta por síndrome dispépsico, con el consecuente balance positivo para la salud, e indudablemente una positiva relación costo-beneficio