Low defibrillation threshold in a patient with a dual-coil defibrillator lead implanted through a persistent left superior vena cava.

Several reports have described the successful insertion of implantable cardioverter defibrillator (ICD) in patients with a persistent left superior vena cava (PLSVC). The implanters have used various techniques to achieve appropriate lead placement. In our case, the use of a long sheath, guided by a deflectable catheter, not only facilitated proper implantation of the lead, but also provided a unique position of the dual-coil lead. This resulted in a very low defibrillation threshold (DFT). We describe a case of a patient found to have a PLSVC at implant who after successful insertion of the ICD exhibited DFT ≤ 5 J.

Comparative frequency of angiographic coronary artery disease in African Americans and Hispanics.

BACKGROUND: African Americans and Hispanics are the two largest racial minority groups in the United States. Both groups have a high prevalence of cardiovascular disease risk factors, and African Americans have the highest mortality from cardiovascular disease of any racial group in the United States. Whereas a large body of clinical data compares African Americans and Whites or Hispanics and Whites with regard to coronary artery disease (CAD), limited data are available for such comparison between African Americans and Hispanics. METHODS AND RESULTS: We retrospectively reviewed the angiographic and clinical data of 480 consecutive patients who underwent coronary angiography for suspected CAD in an inner city hospital between January 1997 and December 1998 in order to ascertain the frequency of CAD. One hundred eighty-nine (189) African Americans and 163 Hispanics met the inclusion criteria. The mean ages of African-American and Hispanic patients were similar, 56.3 +/- 10.9 years vs 55.6 +/- 11.4 years, respectively, P=.59. The frequency of angiographic CAD was 56.6% for African Americans and 54.6% for Hispanics, odds ratio [OR] 0.92, 95% confidence interval [CI] 0.60-1.41, P=.71). Coronary artery disease (CAD) involving the left anterior descending coronary artery occurred significantly more in Hispanic compared to African-American patients (44.8% vs 33.7%, OR 1.58, 95% CI 1.03-2.44, P=.04). Coronary artery disease (CAD) risk factors occurred more in Hispanics compared to African Americans. CONCLUSION: The frequency of angiographic CAD was not different for African-American and Hispanic patients (56.6% vs 54.6%, OR 0.92, 95% CI 0.60-1.41, P=.71) even though differences were seen in CAD risk factors.

Disparity in frequency of normal coronary artery in black and white patients undergoing cardiac catheterization.

BACKGROUND: Normal epicardial coronary arteries (NCA) based on angiography have been reported to occur more frequently in Blacks than in Whites, but these studies have suffered from the limitation of being retrospective, reporting on relatively small numbers of subjects, or lacking a systematic angiogram interpretation. METHODS AND RESULTS: Angiograms of 560 consecutive patients (226 Black and 334 White) enrolled in the Harlem-Bassett Study were reviewed. The presence of coronary artery disease risk factors was documented. A coronary artery was defined as normal if no segment contained a luminal diameter stenosis > 24%. Overall, NCA were found in 39.1% of patients (Blacks 42.9% and Whites 36.5%) and were present most frequently in White women (53.7%). Black men were two times more likely than White men to have NCA (odds ratio [OR] 2.09, P < .002). More Blacks than Whites with NCA were hypertensive (OR 3.30, P < .001) and cigarette smokers (OR 5.18, P < .001), whereas more Whites had hypercholesterolemia (OR .29, P < .001). CONCLUSION: Significant racial differences exist between the Black and White populations in regard to the presence of NCA. The traditional risk factors of age, diabetes, cigarette smoking, and hypercholesterolemia are present in both groups. However, a racial disparity exists in the frequency of some risk factors (hypertension, cigarette smoking, hypercholesterolemia) in patients with NCA.