ABSTRACT
Presented here is a case of implantable-cardioverter-defibrillator infection caused by Aspergillus flavus and a review of 14 previously reported Aspergillus infections of pacemakers or implantable cardioverter-defibrillators. Among all 15 cases, fever was the most common presenting feature (11 patients). Three patients presented with generator-pocket inflammation. Transthoracic echocardiography was performed on eight of 13 patients with endocarditis, revealing vegetations in only one. Transesophageal echocardiography demonstrated the presence of vegetations in all eight of the patients on whom it was performed (p < 0.01). Death was due to the Aspergillus infection in five cases. Patients who presented with unexplained fever had a higher mortality rate (60%) than patients with other clinical presentations (20%, p = 0.166).
Subject(s)
Aspergillus flavus/pathogenicity , Defibrillators, Implantable/microbiology , Mycoses/microbiology , Prosthesis-Related Infections/microbiology , Aged , Antifungal Agents/therapeutic use , Aspergillus flavus/drug effects , Female , Humans , Mycoses/drug therapy , Prosthesis-Related Infections/drug therapy , Pyrimidines/therapeutic use , Triazoles/therapeutic use , VoriconazoleABSTRACT
AIMS: The prevent-atrial fibrillation (AF) registry analyses the clinical relevance and usefulness of the four preventive pacing algorithms, available in a family of cardiac stimulators, to prevent atrial fibrillation. METHODS AND RESULTS: This study is a prospective, non-randomized, multicentre registry. Patients are eligible for the registry if they have sick sinus syndrome (SSS) with or without pre-existing atrial fibrillation. The preventive pacing algorithms were programmed for each patient on an individual basis using the diagnostic features of the devices. In the period from April 2000 to April 2001 a total of 68 patients (33 male, 35 female) has been included in the registry in 14 hospitals in Spain. Mean age was 72+/-12 years and the pacemaker indication was SSS in 15 patients (22%) and SSS with paroxysmal AF in 53 patients (78%). The median AF burden for the total group (n=32) was significantly reduced from 3.9 to 1.3% (67%, P=0.034, Wilcoxon signed rank test). The decrease in AF burden was accompanied by a non-significant decrease in the median number of episodes per day from 1.47 to 0.64 (a decrease of 56%). The average atrial pacing % was increased from 72 to 78%. CONCLUSIONS: The prevent-AF registry demonstrated the usefulness of four preventive pacing algorithms in daily clinical practice. During the registry a significant reduction in AF burden and all other endpoints was observed. Dedicated diagnostics were key to adapting the optimal pacing therapy during follow-up.
Subject(s)
Algorithms , Atrial Fibrillation/prevention & control , Cardiac Pacing, Artificial/methods , Pacemaker, Artificial , Sick Sinus Syndrome/therapy , Aged , Aged, 80 and over , Atrial Fibrillation/etiology , Female , Humans , Male , Middle Aged , Prospective Studies , Registries , Sick Sinus Syndrome/complicationsABSTRACT
Hormone replacement therapy is one of the most difficult issues women and their doctors face. Epidemiological studies have consistently found that women using hormone replacement therapy are at a substantially lower risk of developing coronary heart disease. Observational data are supported by findings demonstrating that hormone replacement therapy improves several risk factors o coronary heart disease, specially the favourable changes in lipid profile. However, no study has clearly established hormones help prevent heart disease. In women without heart disease, the benefits of hormone replacement therapy are unclear. However, recent clinical trials have sown that the use of hormone replacement therapy does not provide cardiovascular benefits in women with established heart disease.
