The subcutaneous ICD as an alternative to the conventional ICD system: Initial experience in Greece and a review of the literature.

The introduction of an implantable cardioverter defibrillator (ICD) in clinical practice has revolutionized our therapeutic approach for both primary and secondary prevention of sudden cardiac death (SCD), as it has proven to be superior to medical therapy in treating potentially life-threatening ventricular arrhythmias and has resulted in reduced mortality rates. However, implantation of a conventional ICD carries a non-negligible risk of periprocedural and long-term complications associated with the transvenous ICD leads. The entirely subcutaneous implantable cardioverter defibrillator (S-ICD) has recently emerged as a therapeutic alternative to the conventional ICD for patients with various cardiopathies and who are at high risk of SCD. The main advantage is the avoidance of vascular access and thus avoidance of complications associated with transvenous leads. Patients without pacing indications, such as bradycardia, a need for antitachycardia pacing or cardiac resynchronization, as well as those at higher risk of complications from transvenous lead implantation are perfect candidates for this novel technology. The subcutaneous ICD has proven to be equally safe and effective compared to transvenous ICD systems in early clinical trials. Further technical improvements of the system will likely lead to the expansion of indications and widespread use of this technology. In the present review, we discuss the indications for this system, summarize early clinical experiences and highlight the advantages and disadvantages of this novel technology. In addition, we present the first two cases of subcutaneous cardioverter defibrillator system implantation in Greece.

Effect of a special carbohydrate-protein bar and tomato juice supplementation on oxidative stress markers and vascular endothelial dynamics in ultra-marathon runners.

It is well established that exercise induces excessive production of reactive species leading to oxidative stress, which has been implicated in oxidative damage of macromolecules, immune dysfunction, muscle damage and fatigue. The present study examined the effect of supplementation of ultra-marathon runners for a two-months-period with a special whey protein bar containing carbohydrates and protein in a specific ratio (1:1) (N=16), prepared using as starting material the by-products of cheese manufacturing, and supplementation with commercially available tomato juice (N=15). Thiobarbituric-acid reactive substances and protein carbonyls were significantly decreased in both supplementation groups, while a pronounced increased in reduced glutathione was observed in the protein bar group. Total anti-oxidant activity remained unchanged in both groups. Flow-mediated dilatation, used as an estimate of endothelial function, was increased in both groups, with a significant rise observed only in the tomato juice administration group. In conclusion, supplementation of ultra marathon runners for a two-months-period with a special protein bar and tomato juice significantly improved the oxidative status of the subjects, while tomato juice also improved vascular endothelial function in these athletes.