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Spatial and also temporary habits regarding innate selection in Bombus terrestris numbers from the Iberian Peninsula in addition to their conservation ramifications.
OBJECTIVES The aim of this study was to compare the safety and hospital charges between intracardiac echocardiography (ICE)- and transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO). BACKGROUND TEE has been the gold standard imaging modality to guide LAAO. Although ICE has emerged as an alternative to guide LAAO, data on the safety, and cost effectiveness of its routine remain limited. METHODS Consecutive patients who underwent LAAO with ICE or TEE guidance at the West Virginia University Clinic were compared for the following endpoints 1) technical success; 2) procedure-related events; 3) hospital charges; and 4) peri-device leak, device embolization, or device thrombus at 45 days. RESULTS After excluding patients who underwent a concomitant non-LAAO intervention, 286 patients (n = 196 TEE, n = 90 ICE) were enrolled. Baseline characteristics were similar. Technical success was achieved in 97.8% and 97.4% of the patients in the ICE and TEE groups, respectively (p = 0.88). No patients in the ICE group required conversion to TEE or general anesthesia. Major procedure-related events occurred in 3.3% and 4.1% of the patients in the ICE and TEE groups, respectively (p = 0.76). Procedural and fluoroscopy times were similar (35.2 ± 11.3 min vs. SKF38393 concentration 36.6 ± 15.6 min; p = 0.42 and 14.2 ± 3.6 min vs. 13.8 ± 8.9 min; p = 0.67, respectively). However, in-room time was shorter with ICE (78.7 ± 19.5 min vs. 113.6 ± 18.1 min; p less then 0.001). Hospital charges were higher with ICE ($76,366 ± $8,028 vs. $71,114 ± $10,802; p less then 0.001), whereas professional fees were higher with TEE ($6,033 ± $1,081 vs. $2,654 ± $395; p less then 0.001). However, global charges were similar with ICE and TEE ($79,020 ± $8,241 vs. $77,147 ± $10,941; p = 0.15). Follow-up imaging at 45 ± 15 days showed similar rates of peri-device leaks, device thrombi, and iatrogenic atrial septal defects. CONCLUSIONS ICE-guided LAAO is associated with similar outcomes and hospital charges compared with TEE-guided LAAO. OBJECTIVES This study aimed to determine how CIED-related complications affect all-cause and cardiovascular mortality over a long-term follow-up. BACKGROUND Although complications related to implantable electronic device (CIED) implantation are steadily increasing in Europe, little is known about the impact of complications other than device infection on mortality. METHODS The POINTED (Impact on Patient Outcome and health care utilization of cardiac ImplaNTable Electronic Device complications) registry was a prospective, multicenter, observational study designed to collect data on complications in patients undergoing de novo CIED implantation (NCT03612635). All consecutive patients were enrolled in 6 high-volume centers between January 2010 and December 2012 and followed up for at least 3 years. A complication was defined as any CIED-related adverse event requiring surgical revision after implantation. RESULTS During follow-up (median 56.9 months), we observed 283 complications in 263 of 2811 consecutive patients (71 ± 14 years of age, 66.7% men). Early complications (≤30 days) were associated with significantly lower cumulative survival from cardiovascular death in comparison with late complications and with freedom from complications. On multivariate analysis, early complication, pneumothorax, and pocket hematoma were significantly associated with a higher risk of all-cause death, while device infection remained the only complication significantly associated with a higher risk of cardiovascular death. CONCLUSIONS All CIED-related complications are associated with an increased risk of cardiovascular mortality, and early complications are associated with an increased risk of all-cause mortality. These data underline the importance of specific measures aimed at reducing CIED complications and improving their management. OBJECTIVES This study sought to describe, in detail, the angiographic, gross macroscopy, and histological dissection of the conduction axis in humans. BACKGROUND The recent upsurge of interest in specific pacing of the atrioventricular conduction axis has emphasized the need for precise knowledge of the location of the atrial and penetrating components of the atrioventricular conduction axis. METHODS A total of 41 human hearts were studied by serial histological sectioning and an additional 3 hearts by gross dissection. One of the hearts studied histologically was also dissected to show the location of the conduction axis prior to serial sectioning. The anatomical findings were then compared with the results of angiography undertaken in the catheter laboratory in 60 patients undergoing electrophysiological studies. RESULTS Marked variation of the location of the transition from atrioventricular conduction axis to the penetrating atrioventricular bundle, or the bundle of His, relative to the landmarks of the triangle of Koch was observed. In just over one-half of both the specimens and the patients, the site of penetration was on the atrial aspect of the hinge of the septal leaflet of the tricuspid valve, with further variation noted relative to the apex of the triangle of Koch. Based on measurements of the histological sections, marked variation in the dimensions of the axis and its adjacency to the right-sided endocardium were also found. In almost three-fifths of hearts, an interventricular component of the fibrous membranous septum was not able to be identified. The significance of these findings to those who seek to perform selective pacing of the atrioventricular conduction axis are discussed. CONCLUSIONS Marked variability of the location of the conduction axis within the triangle of Koch is reported. In three-fifths of hearts, the interventricular component of the fibrous membranous septum is nonexistent. Cardiac amyloidosis is characterized by extracellular protein fibril deposition in the myocardium leading to restrictive heart failure. Both atrial and ventricular arrhythmias, along with conduction disease, are common in cardiac amyloidosis, and are often highly symptomatic and poorly tolerated. Many commonly used therapeutics such as beta-blockers, calcium-channel blockers, and digoxin may be poorly tolerated and lead to clinical decompensation in this population, adding complexity to the co-management of these conditions. In addition, studies have shown that atrial fibrillation with cardiac amyloidosis carries a high risk of stroke and systemic embolism, making anticoagulation indicated in all patients regardless of CHA2DS2-VASc score. Ventricular arrhythmias are common, whereas an implantable cardioverter-defibrillator has not been shown to improve survival. Conduction disease is also common and permanent pacemaker placement is often needed. High-quality evidence and guideline recommendations are limited with regard to the management of arrhythmias in cardiac amyloidosis.
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