[Pacemakers and defibrillators: what the non-specialist needs to know]. / Pacemakers et défibrillateurs: ce que le non-spécialiste doit savoir.

Cardiologists are in charge of the follow-up of patients equipped with pacemakers and defibrillators. In many situations, however, the non-specialist will have to take care of these patients. It is therefore essential that the practitioner understands the basics of how these devices work, the potential complications and the situations in which the cardiologist's intervention is necessary. This article summarizes implantation techniques, post-operative follow-up and potential complications of implantable devices. It recapitulates the differences between pacemaker, defibrillator and resynchronization therapy. It explains the stimulation modes and reminds the reader how the magnet works and the precautions to be taken in the operating theatre, during magnetic resonance imaging or in situations of emergency.

Le suivi des patients porteurs de pacemakers et de défibrillateurs incombe au cardiologue. Dans de nombreuses situations néanmoins, le non-spécialiste devra prendre en charge ces patients. Il demeure donc essentiel que le praticien soit familier avec les bases du fonctionnement de ces dispositifs, les potentielles complications et les situations pour lesquelles l'intervention du cardiologue s'avère nécessaire. Cet article résume les techniques d'implantation, le suivi postopératoire et les complications potentielles de ces dispositifs médicaux; il rappelle également les différences entre pacemaker, défibrillateur et thérapie de resynchronisation. Il revient finalement sur les modes de stimulation, le fonctionnement de l'aimant ainsi que sur les précautions à prendre au bloc opératoire, lors d'examens par résonance magnétique ou en situation d'urgence.

Hospital revascularisation capability and quality of care after an acute coronary syndrome in Switzerland.

BACKGROUND: Patients with acute coronary syndrome (ACS) transferred to regional nonacademic hospitals after percutaneous coronary intervention (PCI) may receive fewer preventive interventions than patients who remain in university hospitals. We aimed at comparing hospitals with and without PCI facilities regarding guidelines-recommended secondary prevention interventions after an ACS. METHODS: We studied patients with ACS admitted to a university hospital with PCI facilities in Switzerland, and either transferred within 48 hours to regional nonacademic hospitals without PCI facilities or directly discharged from the university hospital. We measured prescription rates of evidence-based recommended therapies after ACS including reasons for nonprescription of aspirin, statins, ß-blockers, angiotensin converting-enzyme inhibitors (ACEI) / angiotensin II receptor blockers (ARB), along with cardiac rehabilitation attendance and delivery of a smoking cessation intervention. RESULTS: Overall, 720 patients with ACS were enrolled; 541 (75.1%) were discharged from the hospital with PCI facilities, 179 (24.9%) were transferred to hospitals without PCI facilities. Concomitant prescription of aspirin, ß-blockers, ACEI/ARB and statins at discharge was similar in hospitals with and without PCI facilities, reaching 83.9% and 85.5%, respectively (p = 0.62). Attendance at cardiac rehabilitation reached 55.5% for the hospital with PCI facilities and 65.7% for hospitals without PCI facilities (p = 0.02). In-hospital smoking cessation interventions were delivered to 70.8% patients exclusively at the hospital with PCI facilities. CONCLUSION: Quality of care for patients with ACS discharged from hospitals without PCI facilities was similar to that of patients directly discharged from the hospital with PCI facilities, except for in-hospital smoking cessation counselling and cardiac rehabilitation attendance.

Electric bicycles as a new active transportation modality to promote health.

UNLABELLED: Electrically assisted bicycles (EAB) are an emerging transportation modality favored for environmental reasons. Some physical effort is required to activate the supporting engine, making it a potential active commuting option. PURPOSE: We hypothesized that using an EAB in a hilly city allows sedentary subjects to commute comfortably, while providing a sufficient effort for health-enhancing purposes. METHODS: Sedentary subjects performed four different trips at a self-selected pace: walking 1.7 km uphill from the train station to the hospital (WALK), biking 5.1 km from the lower part of town to the hospital with a regular bike (BIKE), or EAB at two different power assistance settings (EAB high, EAB std). HR, oxygen consumption, and need to shower were recorded. RESULTS: Eighteen sedentary subjects (12 female, 6 male) age 36 ± 10 yr were included, with V·O 2max of 39.4 ± 5.4 mL·min(-1)·kg(-1). Time to complete the course was 22 (WALK), 19 (EAB high), 21 (EAB std), and 30 (BIKE) min. Mean %V·O 2max was 59.0%, 54.9%, 65.7%, and 72.8%. Mean %HRmax was 71.5%, 74.5%, 80.3%, and 84.0%. There was no significant difference between WALK and EAB high, but all other comparisons were different (P < 0.05). Two subjects needed to shower after EAB high, 3 needed to shower after WALK, 8 needed to shower after EAB std, and all 18 needed to shower after BIKE. WALK and EAB high elicited 6.5 and 6.1 METs (no difference), whereas it was 7.3 and 8.2 for EAB std and BIKE. CONCLUSIONS: EAB is a comfortable and ecological transportation modality, helping sedentary people commute to work and meet physical activity guidelines. Subjects appreciated ease of use and mild effort needed to activate the engine support climbing hills, without the need to shower at work. EAB can be promoted in a challenging urban environment to promote physical activity and mitigate pollution issues.