Causes of death and heart pathology in pacemaker or implantable cardioverter-def ibrillator patients who died in hospital.

UNLABELLED: 83 pacemaker (PM)/14 implantable cardioverter-defibrillator (ICD) autopsied patients, predominantly males, deceased 4.0±3.0/2.8±2.5 years after implantation in hospital. Coronary artery disease was most frequent. Its consequences were more severe in ICD patients. Sclerotic and rheumatic heart changes were present in older PM patients group only. The immediate cause of death was mostly of cardiac etiology. Relatively short implant-death interval should be explained by rather great part of non-cardiac causes of death in hospitalised patients. KEYWORDS: pacemakers - implantable cardioverter - defibrillators-causes of death - heart pathology - autopsy.

The role of voxel-based morphometry in the detection of cortical dysplasia within the temporal pole in patients with intractable mesial temporal lobe epilepsy.

PURPOSE: To determine whether voxel-based morphometry (VBM) might contribute to the detection of cortical dysplasia within the temporal pole in patients with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE/HS). METHODS: Eighteen patients with intractable MTLE/HS and 30 sex- and age-matched healthy controls were included in the study. All of the patients fulfilled the diagnostic criteria for MTLE/HS and underwent anteromedial temporal resection. VBM without a modulation step was applied to the magnetic resonance (MR) images of the brain. Statistical parametric maps were used to compare structural characteristics such as gray matter concentration (GMC) within the temporal pole among patients and controls separately. The acquired data were then statistically analyzed to determine the congruency between visually inspected MR imaging (MRI) scans and VBM results in the detection of morphologic abnormalities in the temporal pole compared to postoperative histopathologic findings of cortical dysplasia. KEY FINDINGS: Histopathologic examination revealed cortical dysplasia within the temporal pole in 11 patients. In detail, according to Palmini's classification, mild malformations of cortical development (mMCDs) were disclosed in three patients, focal cortical dysplasia (FCD) type Ia in three patients, and FCD type Ib in five patients. Some type of structural temporal pole abnormality was suggested by VBM in 14 patients and by visually inspected MRI scans in 11 patients. The results of VBM were in agreement with the presence/absence of cortical dysplasia in 13 patients (72.2%); this correspondence was significant (p = 0.047). In one case, VBM was false negative and in four cases it was false positive. There was congruence between the results of visual analysis and histologic proof in 55.6% of examined patients, which was not significant. SIGNIFICANCE: We found that VBM made a superior contribution to the detection of temporopolar structural malformations (cortical dysplasia) compared to visual inspection. The agreement with postoperative histopathologic proof was clearly significant for VBM results and nonsignificant for visual inspection.

Histological findings around electrodes in pacemaker and implantable cardioverter-defibrillator patients: comparison of steroid-eluting and non-steroid-eluting electrodes.

AIMS: To analyse histological findings surrounding the electrodes in pacemaker/implantable cardioverter-defibrillator (PM/ICD) patients. To compare histology around steroid-eluting and non-steroid ventricular pacing electrodes. METHODS AND RESULTS: In autopsied PM/ICD patients histopathological findings around the electrodes were determined. Seventy patients were studied, PM(58), ICD(12), mean age 75.1 ± 9.3 years. The implantation-death interval was 4.0 ± 3.3 years. Most causes of death were cardiac (PM 52%, ICD 58%). The majority of atrial electrodes were attached to the endocardium and most ventricular electrodes were found in the myocardium (P ≤ 0.001). The maximum thickness of the fibrous electrode sheath was greatest for the ICD ventricular electrodes. Some electrodes were covered with fibrin thrombi and granulation tissue, most frequently in the ICD ventricular electrodes. The fibrous sheath usually contained chronic inflammatory cells and in some cases particles of foreign material, foreign body giant cells, and haematogenous pigment. The tissue around steroid-eluting ventricle PM electrodes was compared with the tissue around the non-steroid-eluting ventricle PM electrodes; granulation tissue, foreign material, giant cells being found more frequently around the steroid-eluting electrodes. The fibrous sheath was slightly thinner in the steroid-eluting electrodes. The histology around four coronary sinus electrodes was described. CONCLUSIONS: Atrial electrodes were attached more superficially to the endocardium while PM and ICD ventricular electrodes were more frequently embedded in the myocardium. The electrodes were covered by a connective tissue sheath as a result of thrombus organization. This process persisted most frequently around ICD ventricular electrodes. Only borderline differences were found between the histological findings around steroid-eluting and non-steroid-eluting PM ventricular electrodes.

"MRI-negative PET-positive" temporal lobe epilepsy: invasive EEG findings, histopathology, and postoperative outcomes.

The aim of this retrospective study was to analyze invasive EEG findings, histopathology, and postoperative outcomes in patients with MRI-negative, PET-positive temporal lobe epilepsy (TLE) (MRI-/PET+TLE) who had undergone epilepsy surgery. We identified 20 patients with MRI-/PET+TLE (8.4% of all patients with TLE who had undergone surgery; 11 men, 9 women). Of the 20 patients, 16 underwent invasive EEG. The temporal pole and hippocampus were involved in the seizure onset zone in 62.5% of the patients. We did not identify a lateral temporal or extratemporal seizure onset in any patient. Of the 20 patients, 17 had follow-up periods >1 year (mean follow-up=3.3 years). At the final follow-up, 70.6% patients were classified as Engel I, 5.8% of patients as Engel II, and 11.8% of patients as Engel III and IV (11.8%). Histopathological evaluation showed no structural pathology in any resected hippocampus in 58% of all evaluated temporal poles. The most common pathology of the temporal pole was focal cortical dysplasia type IA or IB. MRI-/PET+TLE should be delineated from other "nonlesional TLE." The ictal onset in these patients was in each case in the temporal pole or hippocampus, rather than in the lateral temporal neocortex. Standard surgery produced a good postoperative outcome, comparable to that for patients with lesional TLE. Histopathological findings were limited: the most common pathology was focal cortical dysplasia type I.

Autopsy and clinical context in deceased patients with implanted pacemakers and defibrillators: intracardiac findings near their leads and electrodes.

AIMS: To evaluate intracardiac findings near leads and causes of death in pacemaker/defibrillator patients. METHODS AND RESULTS: Special autopsy was performed on 78 patients deceased in a hospital. Age at death was 77.9 +/- 10.0, implantation-death interval 4.0 +/- 3.3 years, ventricular leads n = 78, and atrial leads n = 21. Thrombi along leads in brachiocephalic vein/upper caval vein (BV/UCV) were found in 22 (7), in right atrium (RA) in 11 (8), and in right ventricle (RV) in 11 cases. Bipolar lead rings were fixed by fibrous tissue in 43 (4) cases. Connective tissue bridges and tunnels were found in BV/UCV in 44 (13), in RA in 17 (15), and in RV in 68 cases, with a length of 0.2-12.0 cm. Right ventricular leads in tricuspidal orifice were fixed by fibrous tissue in 11 and penetrating chordae in 25 cases. Main causes of death were: heart failure in 35, pulmonary embolism in 9, and myocardial infarction in 11 cases. CONCLUSION: We have found (i) thrombi on ventricular/atrial leads in 33/48%, (ii) bipolar lead rings fixed by fibrous tissue in 68/22%, (iii) connective tissue bridges or tunnels in ventricle/atrium in 87/71%, and (iv) ventricular leads fixed to valve or penetrating chordae in 46% of patients. We do recommend caution when extracting leads.