Heart rate variability during sleep in synucleinopathies: a review.

Synucleinopathies are a group of neurodegenerative diseases characterized by abnormal accumulations of insoluble alpha-synuclein in neurons or glial cells. These consist of Parkinson's disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). Moreover, idiopathic REM sleep behavior disorder (iRBD) is often the first manifestation of synucleinopathies, demonstrating a pathophysiological continuum. While these disorders vary in prevalence, symptom patterns, and severity, they can all include autonomic nervous system (ANS) dysfunction, which significantly reduces quality of life and worsens prognosis. Consequently, identifying abnormalities of the ANS can provide opportunities for improving quality of life through symptomatic treatments that are tailored to the individual's symptoms. An exciting development is using heart rate variability (HRV) as a non-invasive research tool for analyzing how the ANS regulates physiological processes. HRV during sleep, however, may provide a more accurate and reliable measure of ANS activity than during wakefulness, as during awake time, ANS activity is influenced by a variety of factors, including physical activity, stress, and emotions, which may mask or confound the underlying patterns of ANS activity. This review aims to provide an overview of the current knowledge regarding sleep-related HRV in synucleinopathies and to discuss contributing mechanisms. Evidence suggests that iRBD, PD, and MSA are associated with nocturnal ANS dysfunction. Further, comparative studies indicate that the presence of RBD could exacerbate this abnormality. In contrast, no studies have been conducted in patients with DLB. Overall, this review provides new insight into the complex interplay between the ANS and synucleinopathies and underscores the need for further research in this area to develop effective therapies to improve sleep and overall quality of life in patients with synucleinopathies.

Artificial intelligence assisted acute patient journey.

Artificial intelligence is taking the world by storm and soon will be aiding patients in their journey at the hospital. The trials and tribulations of the healthcare system during the COVID-19 pandemic have set the stage for shifting healthcare from a physical to a cyber-physical space. A physician can now remotely monitor a patient, admitting them only if they meet certain thresholds, thereby reducing the total number of admissions at the hospital. Coordination, communication, and resource management have been core issues for any industry. However, it is most accurate in healthcare. Both systems and providers are exhausted under the burden of increasing data and complexity of care delivery, increasing costs, and financial burden. Simultaneously, there is a digital transformation of healthcare in the making. This transformation provides an opportunity to create systems of care that are artificial intelligence-enabled. Healthcare resources can be utilized more justly. The wastage of financial and intellectual resources in an overcrowded healthcare system can be avoided by implementing IoT, telehealth, and AI/ML-based algorithms. It is imperative to consider the design principles of the patient's journey while simultaneously prioritizing a better user experience to alleviate physician concerns. This paper discusses the entire blueprint of the AI/ML-assisted patient journey and its impact on healthcare provision.

Visceral Leishmaniasis (Kala-Azar): A Triumph Against a Trickster Disease.

Leishmaniasis, a protozoan parasitic pathology, is caused by infection with a parasite known as Leishmania donovani, which is transmitted to humans through the bite of a sand fly. The disease has various manifestations, including cutaneous leishmaniasis, visceral leishmaniasis (VL), and disseminated cutaneous leishmaniasis. Visceral leishmaniasis (VL), also known as kala-azar, is mostly seen in the Asian and African regions and can be deadly if left untreated. We present the case of a 10-month-old male infant who was brought to the office with the chief complaints of recurrent fever for the past one month, along with generalized fatigue and poor feeding. A comprehensive history, detailed physical examination, and laboratory testing, including bone marrow aspiration, were performed, and visceral leishmaniasis was diagnosed.

Prevalence of Dyslipidemia in Ischemic Stroke Patients: A Single-Center Prospective Study From Pakistan.

Background Stroke is a debilitating condition that adds morbidity to the patient and is an economic burden to society. Several modifiable risk factors can be identified and controlled, and dyslipidemia is one such under-diagnosed and least reported risk factor in Pakistan. We aimed to conduct this study to determine the frequency of dyslipidemia in ischemic stroke patients. Methodology We conducted a prospective cross-sectional study for seven months at Shalamar Hospital, Lahore, from November 2020 to May 2021. One hundred four patients were enrolled as per inclusion and exclusion criteria. After informed consent, a blood sample was taken from the patients and sent to a laboratory to determine dyslipidemia. Demographic details, history, and co-morbidities were also noted on a performa. All the collected data were analyzed in SPSS 20.0. Results The mean age was 53.09 ± 12.51 years. Of 104 patients, 60 (57.69%) were male, and 44 (42.31%) were females, with a male-to-female ratio of 1.4:1. The mean duration of disease in our study was 5.77 ± 3.33 hours. The mean BMI was 27.54 ± 3.03 kg/m2. In our study, the frequency of dyslipidemia in ischemic stroke patients was 39.42% (41 patients).  Conclusion This study concluded that dyslipidemia in ischemic stroke patients is very high in the Pakistani population. This highlighted the need to control this modifiable risk factor in the population. Strategic measures, including pharmacological therapy and diet modification, should be adopted, and awareness about the disease burden, control, and importance should be spread.

Durability of left bundle branch area pacing.

BACKGROUND: Left bundle branch area pacing (LBBAP) is a form of conduction system pacing. Long-term data on the safety and performance of LBBAP 1 year postdevice implantation has not been well described. METHODS AND RESULTS: Sixty-five patients (49% females) who received LBBAP for bradycardia indications using the SelectSecure 3830 lead (Medtronic) were retrospectively evaluated. Clinical variables were examined. Lead parameters were obtained at implant and during regular follow-up. Mean age of patients was 75.7 ± 10.1 years with left ventricular ejection fraction 59.8 ± 10.4%. Indications for pacing were atrioventricular block 55%, sinus node dysfunction 19%, tachy-brady syndrome 15%, atrioventricular node ablation 8%, and bail out cardiac resynchronization therapy 3%. Mean baseline QRS measured 120 ± 38 ms, paced QRS duration was 138 ± 22ms. Paced QRS narrowed by 24 ms in those with pre-existing left bundle branch block (BBB), increased by 1 ms in those with pre-existing right BBB, and increased by 42 ms in those with no BBB. LBBAP threshold at implant was 0.521 ± 0.153 V at 0.4 ms, and increased to 0.654 ± 0.186 V at 3 months (+26%), 0.707 ± 0.186 V at 6 months (+36%), and 0.772 ± 0.220 V at 12 months (+48%). Patients with left BBB showed the maximum benefit with QRS narrowing 24 ms. Pacing impedance remained unchanged with no procedure-related complications. CONCLUSION: LBBAP is a durable form of conduction system pacing with pacing thresholds remaining relatively stable over 12 months post device implantation. Patients with left BBB display the narrowest paced QRS.

Diet impacts on the biological aspects of pink bollworm, Pectinophora gossypiella (Lepidoptera: Gelechiidae) under controlled laboratory conditions.

BACKGROUND: Pink bollworm, Pectinophora gossypiella (Lepidoptera: Gelechiidae) is a native pest of Asia and preferably invasion on cotton (Gossypium hirsutum L.) crop as a commendatory host plant. Commercially, G. hirsutum is known as white gold and is an important cash crop all over the globe. Limited studies were published to focus on certain dietary compositions against different cotton pests. Therefore, the present study was undertaken in the laboratory under controlled conditions (temperature: 27 ± 2°C and relative humidity: 60 ± 10%) to determine the impact of three different treatment diets (wheat germ meal, okra, and chickpea) on the biological aspects (lifetime, developmental period) of P. gossypiella. RESULTS: Results revealed that the shortest larval time of P. gossypiella was observed on the okra feed diet while the longest period was recorded on the wheat germ diet. Meanwhile, the pupation delay was noted on the wheat germ diet. The dietary influence was also observed on adult stages of female and male P. gossypiella (43.00 and 37.50 days respectively) and compared with a standard diet (56.50 and 52.50 days respectively). Furthermore, larval weighed more on the okra and chickpea diet followed by the wheat germ diet, whereas highest pupal weight was observed on the standard diet followed by the chickpea diet and okra diet. CONCLUSION: Developmental parameters were significantly variant across all treatment diets, whereas the higher significant difference was reported on the okra diet. Therefore, the existing data of this study offers fruitful interventions for the future as a modified diet for large-scale and rapid mass production of P. gossypiella larvae.

Coronary Artery Calcium Score: Assessment of SYNTAX Score and Prediction of Coronary Artery Disease.

Background With the advent of modern imaging technologies, non-invasive assessment of the coronary system is not only possible but its complexity and plaque burden can be quantified. This study aims to determine whether calcium score on computed tomography coronary angiography (CTCA) can be associated with the complexity of coronary artery disease (CAD), which is determined by the SYNTAX score on coronary angiography, as well as to determine which cut-off value of coronary artery calcium (CAC) score can predict severe CAD in our population. Methodology This was a cross-sectional study conducted at the Rawalpindi Institute of Cardiology, Pakistan from January 2019 to March 2020. The calcium score of all patients with low-to-intermediate pretest probability of CAD was calculated on CTCA. All patients who had significant disease on CTCA were subjected to conventional coronary angiography and SYNTAX score was calculated, which was later used to determine the association between calcium and SYNTAX score. Results A total of 90 patients were included in the study. CAC and SYNTAX score were found to be positively correlated (Pearson coefficient [r] = 0.354; p = 0.001). The total CAC score with a cut-off value of 212 recognized patients with the SYNTAX score of >27. The sensitivity was 66.7% and specificity was 70.5% with an area under the curve of 0.743. The mean calcium score of patients in our study group was 223, with the maximum score of 1,216 and the minimum score of zero. Conclusion A CAC score greater than 212 is associated with a high SYNTAX score indicating complex disease. Only age is an independent predictor of calcium score.

RNA-Seq profiling reveals the plant hormones and molecular mechanisms stimulating the early ripening in apple.

Fruit development and ripening are essential components of human and animal diets. Fruit ripening is also a vital plant trait for plant shelf life at the commercial level. In the present study, two apple cultivars, Hanfu wild (HC) and Hanfu mutant (HM), were employed for RNA-Sequencing (RNA-Seq) to explore the genes involved in fruit ripening. We retrieved 2642 genes, differentially expressed in HC and HM apple cultivars. Gene ontology (GO) analysis revealed the 569 categories, significantly enriched in biological process, cellular component, and molecular function. KEGG analysis exhibited the plant hormone transduction and flavonoid-anthocyanin biosynthesis pathways, might be involved in the fruit ripening and anthocyanin biosynthesis mechanism. A cluster of 13 and 26 DEGs was retrieved, representing the plant hormones and transcription factors, respectively, that may be important for early ripening in HM genotype. This transcriptome study would be useful for researchers to functionally characterize the DEGs responsible for early ripening.

Sub-Lethal Effects of Partially Purified Protein Extracted from Beauveria bassiana (Balsamo) and Its Presumptive Role in Tomato (Lycopersicon esculentum L.) Defense against Whitefly (Bemisia tabaci Genn.).

Plants rely on various physiological and molecular defense mechanisms against biotic stresses such as herbivore insects. Many entomopathogenic fungi synthesize protein molecules that can trigger these plant defenses. This laboratory study characterized the bioactivity of a partially purified protein derived from Beauveria bassiana (ARSEF 2860) against whitefly, Bemisia tabaci (Hemiptera: Aleyrodidae), which is an economically important pest of agricultural and horticultural crops worldwide. Different concentrations (i.e., 0.021, 0.042 and 0.063 µM) of fungal protein were bioassayed to determine their sub-lethal effect on the survival percentage and fecundity rate of B. tabaci on tomato (Lycopersicon esculentum) plants. In addition, the putative role of this partially purified B. bassiana protein in the defense mechanisms of plant was assessed through the expression analyses of important genes related to salicylic acid (SA)-and jasmonic acid (JA)-associated pathways using RT-qPCR. Results revealed a significant suppression of the survival percentage and fecundity rate of B. tabaci by the fungal protein. Lowest survival (41%) was recorded for the highest concentration of protein (0.063 µM), whereas mean survival for the other two protein concentrations (0.042 and 0.021 µM) were 62 and 71%, respectively. Likewise, the highest and lowest mean fecundity rates were observed for the control and the highest protein concentration (i.e., 3.3 and 1.8 eggs day-1 female-1, respectively). Furthermore, the exogenous application of B. bassiana-derived protein on tomato plants strongly up-regulated the SA-related genes (PAL, PR1, BGL2 and EDS1) and slightly up-regulated the JA-related genes (AOC, AOS, OPR3 and LOX) as compared to the control plants. These findings demonstrate the putative role of this partially purified B. bassiana protein fraction in inducing systemic resistance in the tomato plants against B. tabaci, suggesting its further purification and characterization to be used as novel biological pest control tool against B. tabaci and other sap-sucking insect pests.

Putative Role of a Yet Uncharacterized Protein Elicitor PeBb1 Derived from Beauveria bassiana ARSEF 2860 Strain against Myzus persicae (Homoptera: Aphididae) in Brassica rapa ssp. pekinensis.

This study reports the characterization of protein elicitor PeBb1 derived from entomopathogenic fungus Beauveria bassiana ARSEF-2860 strain and its putative role in induced systemic resistance in Brassica rapa ssp. pekinensis against green peach aphid Myzus persicae. The sequence of purified elicitor protein was matched with the genomic sequence of a hypothetical protein BBA_10269 from B. bassiana ARSEF-2860 (GenBank Accession No. XP_008603588.1). The protein-encoding gene PeBb1 contained 534 bp cDNA encoding a polypeptide of 177 amino acids with a molecular mass of 19 kDa. The recombinant elicitor protein was expressed in Escherichia coli using pET-28a (+) expression vector and induced necrosis in the leaves of tobacco. The effects of elicitor protein on aphid M. persicae was determined by applying three different concentrations of PeBb1 (i.e., 26, 35, 53 µM) on B. rapa plants at 4-leaf stage and the treated plants were exposed to newly emerged (0-6 h old) apterous adult aphids. Bioassay results showed significant (p < 0.05) sub-lethal effects of the exogenous application of PeBb1 elicitor on M. persicae. Moreover, the RT-qPCR gene expression analyses showed a significant up-regulation of most of the key genes linked to ethylene (ET)- and jasmonic acid (JA)-associated plant defense pathways in elicitor-treated plants. These results not only recommend the putative utilization of PeBb1 elicitor protein in future biological pest control strategies against phloem-feeding insect pests such as M. persicae, but also help in better comprehension of the mechanisms through which beneficial fungi trigger the induced plant resistance.

Anti-insect activity of a partially purified protein derived from the entomopathogenic fungus Lecanicillium lecanii (Zimmermann) and its putative role in a tomato defense mechanism against green peach aphid.

Many biotrophic and necrotrophic fungi synthesize proteins that may elicit induced plant resistance against different herbivore pests. This in-vitro study elucidates the sub-lethal effect of a partially-purified protein derived from the entomopathogenic fungus Lecanicillium lecanii (Zimmerman) (Hypocreales: Clavicipitaceae) against green peach aphid Myzus persicae (Sulzer) (Hemiptera: Aphididae), an economically important pest of many solanaceous crops including tomato. Bioassays were conducted to determine the impact of different concentrations of protein (i.e. 0.018, 0.036 and 0.054 µM) on the survival and fecundity of M. persicae on tomato (Lycopersicon esculentum) plants. Moreover, the potential role of this exogenous protein in the plant defense mechanism was assessed by expression analyses of key genes associated with salicylic acid (SA) and jasmonic acid (JA) pathways using RT-qPCR. The results indicated a significant negative effect of all protein concentrations on the survivorship and fecundity of M. persicae. The highest concentration (0.054 µM) resulted in lowest survival (46%) of aphids at 7th day post-treatment, while two other concentrations (0.036 and 0.018 µM) resulted in 61 and 71% survival rate, respectively. Similarly, lowest and highest mean fecundity rates were recorded for the highest protein concentration and the control (1.5 and 2.4 nymphs day-1 female-1), respectively. Moreover, L. lecanii-derived protein strongly upregulated the SA associated genes PR1, BGL2 and PAL, and moderately upregulated the JA associated genes LOX, AOS and AOC in protein-treated tomato plants compared to the control plants. These findings demonstrate the systemic resistance induced in tomato plants against M. persicae by the exogenous application of partially-purified protein extracted from L. lecanii, suggesting its further purification and characterization as a novel biological pest management tool against aphids and other phloem-feeding insect pests.

Role of Prophylactic Magnesium Supplementation in Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: a Systematic Review and Meta-Analysis of 20 Randomized Controlled Trials.

BACKGROUND: Several randomized trials have evaluated the efficacy of prophylactic magnesium (Mg) supplementation in prevention of post-operative atrial fibrillation (POAF) in patients undergoing cardiac artery bypass grafting (CABG). We aimed to determine the role of prophylactic Mg in 3 different settings (intraoperative, postoperative, intraoperative plus postoperative) in prevention of POAF. METHODS: A systemic literature search was performed (until January 19, 2019) using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify trials evaluating Mg supplementation post CABG. Primary outcome of our study was reduction in POAF post CABG. RESULTS: We included a total of 2,430 participants (1,196 in the Mg group and 1,234 in the placebo group) enrolled in 20 randomized controlled trials. Pooled analysis demonstrated no reduction in POAF between the two groups (RR 0.90; 95% CI, 0.79-1.03; p=0.13; I2=42.9%). In subgroup analysis, significant reduction in POAF was observed with postoperative Mg supplementation (RR 0.76; 95% CI, 0.58-0.99; p=0.04; I2=17.6%) but not with intraoperative or intraoperative plus postoperative Mg supplementation (RR 0.77; 95% CI, 0.49-1.22; p = 0.27; I2=49% and RR 0.92; 95% CI, 0.68-1.24; p = 0.58; I2=51.8%, respectively). CONCLUSIONS: Magnesium supplementation, especially in the postoperative period, is an effective strategy in reducing POAF following CABG.

Molecular and Functional Characterization of Elicitor PeBC1 Extracted from Botrytis cinerea Involved in the Induction of Resistance against Green Peach Aphid (Myzus persicae) in Common Beans (Phaseolus vulgaris L.).

Elicitors are biofactors that induce resistance in plants against different insect pests. This in vitro study evaluated the impact of a novel elicitor protein PeBC1, extracted from a necrotrophic fungus Botrytis cinerea, on the development and fecundity parameters of green peach aphid (Myzus persicae) on common beans (Phaseolus vulgaris L.). Three different concentrations of PeBC1 elicitor (i.e., 33.56, 25.43, 19.33 µg mL-1) were applied at three different temperature regimes (i.e., 18, 21, and 25 °C). Elicitor treatments were applied topically on the bean plants at 3-leaf stage and newly emerged (0⁻6 h old) apterous adult aphids were exposed to these treated leaves. In addition to the biological parameters of aphids, the relative expression levels of key genes associated with jasmonic acid (JA) and salicylic acid (SA) plant defense pathways were also determined through RT-qPCR. Results of bioassays revealed that the application of PeBC1 elicitor protein exhibited pronounced and significant (p < 0.05) sub-lethal effects on green peach aphids. The fecundity was reduced and the nymphal development time was prolonged by different concentrations of PeBC1 elicitor and temperature regimes. Gene expression studies showed that the exogenous application of PeBC1 induced a significant upregulation of the expression levels of JA and SA pathway-associated genes in bean plants. As compared to control, elicitor-treated plants exhibited an induced resistance against aphids. Our findings suggest the potential use of PeBC1 elicitor protein in future bio-intensive management strategies against sap-sucking insect pests such as green peach aphids.

Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical impact, and management.

Hypertrophic cardiomyopathy (HCM) is the most common hereditary cardiomyopathy characterized by left ventricular hypertrophy and spectrum of clinical manifestation. Atrial fibrillation (AF) is a common sustained arrhythmia in HCM patients and is primarily related to left atrial dilatation and remodeling. There are several clinical, electrocardiographic (ECG), and echocardiographic (ECHO) features that have been associated with development of AF in HCM patients; strongest predictors are left atrial size, age, and heart failure class. AF can lead to progressive functional decline, worsening heart failure and increased risk for systemic thromboembolism. The management of AF in HCM patient focuses on symptom alleviation (managed with rate and/or rhythm control methods) and prevention of complications such as thromboembolism (prevented with anticoagulation). Finally, recent evidence suggests that early rhythm control strategy may result in more favorable short- and long-term outcomes.

His Bundle Pacing: Hemodynamics and Clinical Outcomes.

From 1993 to 2009, nearly 2.9 million pacemakers were implanted in the United States; the majority of which were dual-chamber pacemakers. One of the major physiologic advantages of dual-chamber pacing over single-chamber ventricular pacing is atrioventricular synchrony, which prevents the pacemaker syndrome. However, patients who are pacemaker dependent or use right ventricle (RV) apical pacing more than 40% of the time are at a risk of developing heart failure from electromechanical dyssynchrony. Studies have also shown that RV pacing results in nonphysiological activation of the left ventricle, leading to adverse clinical outcomes. Hence, alternative pacing sites, including the RV outflow tract, the high-RV septal region, bi-ventricular pacing, or His bundle pacing, have been explored for a better physiological electromechanical coupling of the ventricles. Although His bundle pacing has gained attention due to favorable data and clinical outcomes, it has not gained widespread acceptance into clinical practice. Hence, we aim to review the current experience with His bundle pacing and its clinical implications in this article.

Thirty-day readmissions after cardiac implantable electronic devices in the United States: Insights from the Nationwide Readmissions Database.

BACKGROUND: Limited data are available regarding true estimates of individual complications contributing to readmissions after cardiac implantable electronic device (CIED) implantation. OBJECTIVE: The purpose of this study was to identify predictors of 30-day readmission in patients admitted for CIED implantation. METHODS: The study cohort consisted of patients who underwent CIED implantation in 2014, identified from the National Readmission Database. Readmission was defined as a subsequent hospital admission within 30 days after the discharge day of index admission. If patients had more than 1 readmission within 30 days, only the first readmission was included. RESULTS: Our final cohort consisted of 70,223 cases, 61,738 (88%) in the no-readmission group and 8485 patients (12%) in the readmission group. Female gender (odds ratio [OR] 1.09; 95% confidence interval [CI] 1.04-1.14; P = .001), atrial fibrillation/flutter (OR 1.23; 95% CI 1.17-1.29, P <.001), acute renal failure (OR 1.65; 95% CI 1.56-1.74; P <.001), coronary artery disease (OR 1.09; 95% CI 1.03-1.14; P = .002), length of stay (OR 1.70; 95% CI 1.51-1.89; P <.001), device placement on the day of admission (OR 0.87; 95% CI 0.80-0.95, P = .001), and fourth quartile of hospital procedure volume (OR 0.91; 95% CI 0.84-0.99; P = .03; first quartile of hospital procedure volume as reference) were independent predictors of 30-day readmissions. The 30-day readmission resulted in additional median charges of $30,692 per patient. Device-related complications were seen in 10.7% of readmitted patients. The most common complications were mechanical (2.8%) and infectious (2.6%). CONCLUSION: Several patient and hospital-related factors were identified to be independent predictors of 30-day readmission, accounting for increased health care cost.

Role of implantable cardioverter defibrillator in non-ischemic cardiomyopathy: a systematic review and meta-analysis of prospective randomized clinical trials.

INTRODUCTION: A mortality benefit in patients with implantable cardioverter defibrillator (ICD) in ischemic cardiomyopathy is well established. However, the benefit of ICD implantation in non-ischemic cardiomyopathy (NICM) on total mortality remains uncertain. We performed a systematic review and meta-analysis of randomized controlled trials (RCT) evaluating the role of primary prevention ICD in NICM patients. METHODS: We performed a systematic review on PubMed, The Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases from the inception through February 2017 to identify RCT evaluating the role of ICD in NICM patients. Mantel-Haenszel risk ratio (RR) fixed effects model was used to summarize data across treatment arms. If heterogeneity (I 2) ≥25, random effects model was used instead. RESULTS: We analyzed a total of 2573 patients from five RCTs comparing ICD with medical therapy in patients with NICM. The mean follow up for the trials was 48 ± 22 months. There was a significant reduction in (a) all-cause mortality (RR 0.84, 95% CI 0.71-0.99, p = 0.03) and (b) sudden cardiac death (RR 0.47, 95% CI 0.30-0.73, p < 0.001) in ICD group versus medical therapy. CONCLUSION: Our analysis demonstrates that the use of ICD for primary prevention is associated with a reduction in all-cause mortality and SCD in patients with NICM.

Right ventricular apical versus non-apical implantable cardioverter defibrillator lead: A systematic review and meta-analysis.

INTRODUCTION: We aimed to study the effect of right ventricular implantable cardioverter defibrillator (ICD) lead positioning on clinical outcomes in patients undergoing ICD placement. METHODS: A systematic literature search was performed using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify clinical trials comparing outcomes in patients with ICD leads in apical and non-apical positions. The primary outcome of our study was death at 1-year follow-up. Secondary outcomes studied were "death at 3years", "total number of shocks", "appropriate shocks", "inappropriate shocks" and "cut-to-suture time". RESULTS: We analyzed a total of 3731 patients (2852 in apical and 879 in non-apical ICD groups) enrolled in 4 clinical trials. No significant difference was observed between the apical and non-apical ICD groups in all-cause mortality at 1year (OR 0.88; 95% CI 0.51-1.49, p=0.63; I2=5.32%). Similarly, no differences were seen between the two groups in death at 3years (OR=0.76; 95% CI 0.56-1.04, p=0.08; I2=0%), total number of shocks (OR 0.99; 95% CI 0.81-1.22, p=0.95; I2=0%), appropriate shocks (OR 1.00; 95% CI 0.79-1.27, p=0.99; I2=0%), inappropriate shocks (OR 0.98; 95% CI 0.70-1.37, p=0.91; I2=0%) and cut-to-suture time (Standard mean difference=-0.03; 95% CI -0.20 to 0.14, p=0.73; I2=0%). No publication bias was seen. CONCLUSION: Non-apical RV ICD lead implantation is non-inferior to traditional RV apical position with no significant differences in mortality, total number of shocks, appropriate shocks, inappropriate shocks and procedural time.

Right Ventricular and Chest Wall Perforation with Implantable Cardioverter-Defibrillator Lead with Lodgment into the Cutaneous Tissue of the Chest Wall.

Implantable cardioverter-defibrillator (ICD) lead perforation is a rare but serious complication of cardiac device implantation. Subacute (24 h to one month) and delayed (>1 month) presentations of rupture are also rare. Here we report a case of right ventricular perforation by a ventricular ICD lead in a 61-year-old man that was detected four months' postimplantation. The lead was present out from his chest wall and was palpable beneath the skin.

Speckle tracking echocardiography-determined measures of global and regional left ventricular function correlate with functional capacity in patients with and without preserved ejection fraction.

BACKGROUND: Standard measures of left ventricular systolic and diastolic function often fail to identify left ventricular dysfunction in patients with heart failure and do not correlate with measures of functional capacity. AIM: To determine if speckle tracking echocardiography (STE)-determined measures of global and regional myocardial contractility have a linear association with functional capacity in patients with and without preserved ejection fraction. METHODS: In 68 adult patients, functional status was estimated with the Duke Activity Status Index (DASI), left ventricular ejection fraction was determined with Simpson's biplane method, and QLAB advanced quantification software (Philips, The Netherlands) was used to determine peak measures of strain. RESULTS: Global and regional measures of longitudinal, circumferential, and radial strain had a strong linear association with the DASI score. Longitudinal strain in the inferolateral segments had the strongest correlation with DASI (r = -0.72, P < 0.001). In patients with an ejection fraction ≥45%, ejection fraction and E/e' had no correlation with DASI, whereas longitudinal strain in the inferolateral segments had significant correlation with DASI (r = -0.53, P = 0.03, n = 16). CONCLUSIONS: STE-determined measures of global and regional left ventricular function have a strong linear association with estimates of functional capacity in patients with and without preserved ejection fraction. STE-determined measures of strain, especially longitudinal strain, are likely to be important targets for therapy and should be considered in future studies aimed at improving our diagnosis of left ventricular inadequacy in patients with heart failure, especially those with preserved ejection fraction.