Peter Henry Waddingham, Jonathan M Behar, Neil Roberts, Gurpreet Dhillon, Adam J Graham, Ross J Hunter, Carl Hayward, Mehul Dhinoja, Amal Muthumala, Rakesh Uppal, Edward Rowland, Mark J Earley, Richard J Schilling, Simon Sporton, Martin Lowe, Amer Harky, Oliver R Segal, Pier D Lambiase, Anthony W C Chow
AIMS: Optimum timing of pacemaker implantation following cardiac surgery is a clinical challenge. European and American guidelines recommend observation, to assess recovery of atrioventricular block (AVB) (up to 7 days) and sinus node (5 days to weeks) after cardiac surgery. This study aims to determine rates of cardiac implantable electronic devices (CIEDs) implants post-surgery at a high-volume tertiary centre over 3 years. Implant timing, patient characteristics and outcomes at 6 months including pacemaker utilization were assessed...
October 21, 2020: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Michele Brignole, Federica Kessisoglu, Francesco Croci, Alberto Solano, Paolo Donateo, Roberto Maggi, Diana Solari, Cristina Bertolone, Daniele Fontana, Daniele Oddone, Giulia Rivasi, Martina Rafanelli, Niccolò Casini, Andrea Ungar
AIMS: Indications, methodology, and diagnostic criteria for carotid sinus massage (CSM) and tilt testing (TT) have been standardized by the 2018 Guidelines on Syncope of the European Society of Cardiology. Aim of this study was to assess their effectiveness in a large cohort which reflects the performance under 'real-world' conditions. METHODS AND RESULTS: We analysed all patients who had undergone CSM and TT in the years 2003-2019 for suspected reflex syncope. Carotid sinus massage was performed according to the 'Method of Symptoms'...
October 20, 2020: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
A R Absalom, A E Rigby-Jones, A R Rushton, J R Sneyd
Total intravenous anesthesia (TIVA) using a mixture of propofol and remifentanil in the same syringe has become an accepted technique in Pediatric Anesthesia. A survey by a group of respected UK anesthetists demonstrated a low incidence of serious complications, related to the pharmacology and dose of the drugs. However, a current guideline for the safe use of TIVA recommends against this practice. Pharmaceutical concerns include the physical stability of the emulsion when remifentanil is mixed with propofol; changes in drug concentration over time; non-uniform mixing of propofol and remifentanil; the risk of bacterial contamination; and the potential for drug administration errors...
October 13, 2020: Paediatric Anaesthesia
Mathias Maagaard, Emil Eik Nielsen, Naqash Javaid Sethi, Liang Ning, Si-Hong Yang, Christian Gluud, Janus Christian Jakobsen
OBJECTIVE: To determine the impact of ivabradine on outcomes important to patients with angina pectoris caused by coronary artery disease. METHODS: We conducted a systematic review. We included randomised clinical trials comparing ivabradine versus placebo or no intervention for patients with angina pectoris due to coronary artery disease published prior to June 2020. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Cochrane methodology, Trial Sequential Analysis, Grading of Recommendations Assessment, Development, and Evaluation, and our eight-step procedure...
October 2020: Open Heart
Ajit Mullasari
INTRODUCTION: Dosing frequency is an important factor influencing medication compliance in patients with heart failure (HF), which in turn is imperative in achieving the desired therapeutic outcome. Here we assessed the efficacy and safety of ivabradine prolonged-release (PR) once-daily (test) vs. ivabradine immediate-release (IR) twice-daily (reference) formulations in patients with stable chronic HF with systolic dysfunction. METHODS: Patients with sinus rhythm and heart rate (HR) ≥ 50 bpm, left ventricular ejection fraction ≤ 40% (HF with reduced ejection fraction), on guideline-based standard care, receiving a stable dose of ivabradine IR 5/7...
October 1, 2020: Cardiology and Therapy
Chintan Shah, Govindan Vijayaraghavan, Chandrasekharan C Kartha
BACKGROUND: Dengue fever (DF) is an infectious disease of viral origin common in the tropics. Studies on a large number of patients with dengue infection to assess associated cardiac involvement are rare. METHODS: We analyzed the incidence and spectrum of cardiac abnormalities in 320 patients with dengue fever admitted to our hospital located in an endemic area for dengue infection. All patients were evaluated following the WHO guidelines. Those confirmed to have dengue infection by serology had detailed clinical evaluation, 12‑lead electrocardiography (ECG), assay for cardiac markers (troponin T, CK-MB, NT Pro BNP) and 2-D echocardiography...
September 12, 2020: International Journal of Cardiology
John Alexander Lata Guacho, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Alberto Machado da Ponte Neto, Shailendra Singh, Marina Gammaro Baldavira Tucci, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
BACKGROUND: Patients with cirrhosis frequently require sedation for elective endoscopic procedures. Several sedation protocols are available, but choosing an appropriate sedative in patients with cirrhosis is challenging. AIM: To conduct a systematic review and meta-analysis to compare propofol and midazolam for sedation in patients with cirrhosis during elective endoscopic procedures in an attempt to understand the best approach. METHODS: This systematic review and meta-analysis was conducted using the PRISMA guidelines...
August 16, 2020: World Journal of Gastrointestinal Endoscopy
Karen M Marzlin
No abstract text is available yet for this article.
September 15, 2020: AACN Advanced Critical Care
Kent A Owusu, Lisa Kurczewski, Michael J Armahizer, Albert Zichichi, Carolina B Maciel, Mojdeh S Heavner
PURPOSE: Although guidelines recommend dexmedetomidine (DEX) or propofol (PRO) as preferred sedatives in critically ill adults, comparisons in neurocritical care (NCC) are limited. We aimed to evaluate the clinical utility and safety of DEX compared with PRO in NCC setting. MATERIALS AND METHODS: This retrospective, multicenter, observational cohort study conducted at three tertiary academic hospitals with Level 1 Trauma Center and Comprehensive Stroke Center designations, compared the clinical indication and safety of DEX vs PRO in patients in NCC setting...
July 24, 2020: Journal of Critical Care
Oriana Nanni, Pierluigi Viale, Bernadette Vertogen, Claudia Lilli, Chiara Zingaretti, Caterina Donati, Carla Masini, Manuela Monti, Patrizia Serra, Roberto Vespignani, Veruska Grossi, Annibale Biggeri, Emanuela Scarpi, Francesca Galardi, Lucia Bertoni, Americo Colamartini, Fabio Falcini, Mattia Altini, Ilaria Massa, Raffaella Gaggeri, Giovanni Martinelli
OBJECTIVES: Hydroxychloroquine has shown to have antiviral activity in vitro against coronaviruses, specifically SARS-CoV-2. It is believed to block virus infection by increasing endosomal pH required for virus cell fusion and glycosylation of viral surface proteins. In addition to its antiviral activity, hydroxychloroquine has an immune-modulating activity that may synergistically enhance its antiviral effect in vivo, making it a potentially promising drug for the prevention and the cure of SARS-CoV-19...
July 31, 2020: Trials
Nasreen Hassoun-Kheir, Oryan Henig, Tomer Avni, Leonard Leibovici, Mical Paul
OBJECTIVES: To assess the effects and safety of β-blockers in hospitalized patients with burns. METHODS: A systematic review and meta-analysis of the literature. A broad search was conducted to identify all randomized controlled trials (RCTs) comparing β-blockers to control in hospitalized patients with burns. The primary outcome was 3-month all-cause mortality. Secondary outcomes were clinical patient-relevant end points. We subgrouped results by children/adults and burn severity...
July 20, 2020: Journal of Intensive Care Medicine
Mikayla Muzzey, Katie B Tellor, Karthik Ramaswamy, Martin Schwarze, Anastasia L Armbruster
INTRODUCTION: Current atrial fibrillation (AF) guidelines recommend flecainide as a first-line rhythm control option in patients without structural heart disease. While there is proven efficacy in clinical trials and guideline support, it is hypothesized that flecainide may be underutilized due to negative outcomes in the CAST trial and that adverse effects are less common than previously perceived. METHODS: This retrospective chart review evaluated patients ⩾18 years initiated on flecainide for AF from August 2011 to October 2016 by a cardiology provider at the study site...
January 2020: Therapeutic Advances in Cardiovascular Disease
Chantal Lau
The increase in preterm infants' survival over the last 30 years has shed light over their inability to feed by mouth safely and efficiently. With adverse events such as increased risks for oxygen desaturation, bradycardia, penetration/aspiration, infants' hospitalization in neonatal intensive care units (NICUs) are understandably prolonged. Unfortunately, this leads to delayed mother-infant reunion, maternal stress, breastfeeding obstacles, and increased medical costs. Such impediments have stimulated clinicians and researchers to better understand the underlying causes and develop evidence-based solutions to assist these infants...
2020: Frontiers in Pediatrics
Nils T Songstad, Claus Klingenberg, Erin V McGillick, Graeme R Polglase, Valerie Zahra, Georg M Schmölzer, Peter G Davis, Stuart B Hooper, Kelly J Crossley
Objectives: Neonatal resuscitation guidelines recommend administering intravenous (IV) adrenaline if bradycardia persists despite adequate ventilation and chest compressions (CC). Rapid IV access is challenging, but little evidence exists for other routes of administration. We compared IV, endotracheal (ET), and intranasal routes for adrenaline administration during resuscitation of asphyxiated newborn lambs. Study design: Near-term lambs ( n = 22) were delivered by caesarean section. Severe asphyxia was induced by clamping the umbilical cord while delaying ET ventilation until blood flow in the carotid artery ceased...
2020: Frontiers in Pediatrics
Kayla L Myers, Christopher R Leong, Ahmed A Mahmoud
BACKGROUND: Medical management for type B aortic dissections (TBADs) require aggressive blood pressure and heart rate control to minimize further dissection extension and to restore perfusion to vital organs. Current guidelines recommend β-blockers (BB) as first-line therapy, however do not differentiate an ideal agent for use. OBJECTIVE: This study evaluated the hemodynamic safety of continuous infusion labetalol compared to esmolol combination (EC) therapies for TBADs...
June 17, 2020: Journal of Pharmacy Practice
Idris Harding, Amit Kaura, Arthur Yue, Paul Roberts, Francis Murgatroyd, Paul A Scott
BACKGROUND: Patients with existing or anticipated indications for cardiac resynchronisation therapy (CRT), bradycardia or anti-tachy pacing should not be offered subcutaneous defibrillators (SQIDs) but it remains unclear how clinicians should predict future need for these therapies. METHODS: We applied three SQID selection policies to data collected retrospectively from TV-ICD implants: •Approach A: SQID used in inherited channelopathies and idiopathic ventricular fibrillation only; •Approach B: as above, plus all hypertrophic cardiomyopathy and grown-up congenital heart disease patients; •Approach C: as above, plus primary and secondary prevention (for ventricular fibrillation only) of SCD in patients with QRS<150ms...
May 8, 2020: Pacing and Clinical Electrophysiology: PACE
Christina Massoth, Lisa Töpel, Manuel Wenk
PURPOSE OF REVIEW: Hypotension during cesarean section remains a frequent complication of spinal anesthesia and is associated with adverse maternal and fetal events. RECENT FINDINGS: Despite ongoing research, no single measure for sufficient treatment of spinal-induced hypotension was identified so far. Current literature discusses the efficacy of low-dose spinal anesthesia, timing and solutions for adequate fluid therapy and various vasopressor regimens. Present guidelines favor the use of phenylephrine over ephedrine because of decreased umbilical cord pH values, while norepinephrine is discussed as a probable superior alternative with regard to maternal bradycardia, although supporting data is limited...
June 2020: Current Opinion in Anaesthesiology
Michele Brignole, Francesco Croci, Alberto Solano, Paolo Donateo, Roberto Maggi, Diana Solari, Cristina Bertolone, Daniele Fontana, Daniele Oddone
AIMS: The reproducibility of carotid sinus massage (CSM) is debated. Aim of this study was to assess the reproducibility according to the methodology and diagnostic criteria defined by the guidelines on syncope of the European Society of Cardiology. METHOD: Among 2800 patients with syncope who underwent CSM in the years 2005-2019, 109 patients (62 males; mean age 76±10 years), had performed a second CSM after a median of 28 months. Carotid sinus hypersensitivity (CSH) was diagnosed when CSM elicited a pause of >3s and/or a fall in systolic blood pressure >50 mmHg without reproduction of spontaneous symptoms...
May 4, 2020: Pacing and Clinical Electrophysiology: PACE
Azam Pourahmadiyan, Morteza Heidari, Hossein Shojaaldini Ardakani, Shahab Noorian, Shahram Savad
Introduction: Lethal neonatal rigidity and multifocal seizure syndrome (RMFSL) is a severe autosomal recessive epileptic encephalopathy characterized by microcephaly, rigidity, intractable focal seizures, apnea, and bradycardia at or soon after birth. RMFSL is related to BRCA1-associated ATM activator 1 ( BRAT1 ) gene mutations. Methods: An Iranian couple with history of infant death due to RMFSL was referred to our genetics lab for specialized genetic counseling and testing. Whole Exome Sequencing (WES) was applied...
April 29, 2020: International Journal of Neuroscience
Igor Diemberger, Giulia Massaro, Antonio Rossillo, Enrico Chieffo, Daniela Dugo, Fabrizio Guarracini, Pier Luigi Pellegrino, Francesco Perna, Maurizio Landolina, Roberto De Ponti, Massimo Zoni Berisso, Renato Pietro Ricci, Giuseppe Boriani
BACKGROUND: Temporary transvenous cardiac pacing (TTCP) is a standard procedure in current practice, despite limited coverage in consensus guidelines. However, many authors reported several complications associated with TTCP, especially development of infections of cardiac implantable electronic devices (CIED). The aim of this survey was to provide a country-wide picture of current practice regarding TTCP. METHODS: Data were collected using an online survey that was administered to members of the Italian Association of Arrhythmology and Cardiac Pacing...
June 2020: Journal of Cardiovascular Medicine
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