Effects of canola-wheat intercrops on Delia spp. (Diptera: Anthomyiidae) oviposition, larval feeding damage, and adult abundance.

Reductions in oviposition and subsequent damage by root maggots (Diptera: Anthomyiidae, Delia spp.) to brassicaceous crops in the presence of nonhost plants has been demonstrated, but such investigations have not been conducted using intercrops of species commonly grown in the large-scale agricultural production systems of western Canada. A field experiment was conducted at three sites in Alberta, Canada, in 2005 and 2006 to determine interactions between root maggots and the various proportions of canola (Brassica napus L.) making up the total crop plant populations in intercrops with wheat (Triticum aestivum L.). The effect of a neonicotinoid seed treatment also was investigated. Root maggot damage to canola taproots decreased with increasing proportions of wheat in the intercrops. The presence of wheat in the intercrops had little effect on root maggot adult abundance in any single site-by-year combination or when data were combined over all sites and years, with different Delia species and sexes responding differently. Similarly, per plant root maggot egg populations were unaffected by intercropping, although egg populations were reduced on a per unit land area basis in intercrops compared with monocultures. Insecticidal seed treatment did not affect root maggot egg populations or canola root damage. Variable abundances and phenologies of the principal root maggot species infesting canola at different sites and years may influence their responses to canola-wheat intercrops. Intercropping canola and wheat may provide an opportunity for reducing crop damage from root maggot attack without compromising environmental sustainability.

Effect of first-phase polarity of biphasic shocks on defibrillation threshold with a single transvenous lead system.

OBJECTIVES: The purpose of this study was to determine whether the polarity of the first phase of a biphasic shock affects the defibrillation threshold. BACKGROUND: The polarity of a monophasic shock has been shown to affect the defibrillation threshold. METHODS: A transvenous defibrillation lead with distal and proximal shocking electrodes was used in this study. In 15 consecutive patients, the defibrillation threshold was determined twice using a step-down protocol, in random order: with the distal coil as the anode for the initial phase (anodal biphasic shock) and with the polarity reversed (cathodal biphasic shock). The power to detect a 5.0-J difference in this study is 0.96. These patients were 61 +/- 11 years old (mean +/- SD), and the mean left ventricular ejection fraction was 0.32 +/- 0.10. RESULTS: Mean defibrillation threshold using anodal biphasic shocks was 9.9 +/- 4.8 J, compared with 9.5 +/- 4.2 J using cathodal biphasic shocks (p = 0.8). In three patients the defibrillation threshold was lower by a mean of 6.3 +/- 2.9 J with the former configuration; in three patients the defibrillation threshold was lower by a mean of 6.7 +/- 2.5 J with the latter configuration; and in nine patients it was the same. Using the standard cathodal configuration, a defibrillation threshold < or = 10 J was obtained in approximately 70% of patients, and a subcutaneous patch was not required in any patient. CONCLUSIONS: The polarity of the first phase of a biphasic shock used with a single transvenous lead does not affect the defibrillation threshold.

Randomized comparison of anatomic and electrogram mapping approaches to ablation of the slow pathway of atrioventricular node reentrant tachycardia.

OBJECTIVES: The purpose of this study was to prospectively compare in random fashion an anatomic and an electrogram mapping approach for ablation of the slow pathway of atrioventricular (AV) node reentrant tachycardia. BACKGROUND: Ablation of the slow pathway in patients with AV node reentrant tachycardia can be performed by using either an anatomic or an electrogram mapping approach to identify target sites for ablation. These two approaches have never been compared prospectively. METHODS: Fifty consecutive patients with typical AV node reentrant tachycardia were randomly assigned to undergo either an anatomic or an electrogram mapping approach for ablation of the slow AV node pathway. In 25 patients randomly assigned to the anatomic approach, sequential radiofrequency energy applications were delivered along the tricuspid annulus from the level of the coronary sinus ostium to the His bundle position. In 25 patients assigned to the electrogram mapping approach, target sites along the posteromedial tricuspid annulus near the coronary sinus ostium were sought where there was a multicomponent atrial electrogram or evidence of a possible slow pathway potential. If the initial approach was ineffective after 12 radiofrequency energy applications, the alternative approach was then used. RESULTS: The anatomic approach was effective in 21 (84%) of 25 patients, and the electrogram mapping approach was effective in all 25 patients (100%) randomly assigned to this technique (p = 0.1). The four patients with an ineffective anatomic approach had a successful outcome with the electrogram mapping approach. On the basis of intention to treat analysis, there were no significant differences between the electrogram mapping approach and the anatomic approach with respect to the time required for ablation (28 +/- 21 and 31 +/- 31 min, respectively, mean +/- SD, p = 0.7) duration of fluoroscopic exposure (27 +/- 20 and 27 +/- 18 min, respectively, p = 0.9) or mean number of radiofrequency applications delivered (6.3 +/- 3.9 vs. 7.2 +/- 8.0, p = 0.6). With both the anatomic and electrogram mapping approaches, the atrial electrogram duration and number of peaks in the atrial electrogram were significantly greater at successful target sites than at unsuccessful target sites. CONCLUSIONS: The anatomic and electrogram mapping approaches for ablation of the slow AV nodal pathway are comparable in efficacy and duration. If the anatomic approach is initially attempted and fails, the electrogram mapping approach may be successful at sites outside the areas targeted in the anatomic approach. With both the anatomic and electrogram mapping approaches, there are significant differences in the atrial electrogram configuration between successful and unsuccessful target sites.

Recognition and catheter ablation of subepicardial accessory pathways.

OBJECTIVES: The purpose of this study was to characterize left-sided accessory pathways that traverse the atrioventricular (AV) groove subepicardially and to describe results of radiofrequency catheter ablation within the coronary sinus in the patients studied. BACKGROUND: Radiofrequency catheter ablation has proved to be a safe and effective method for treatment of accessory pathways; however, subepicardial accessory pathways may account for some of the failures encountered during endocardial ablation. METHODS: The study group comprised 51 consecutive patients with a left-sided accessory pathway who were undergoing radio-frequency catheter ablation. Initially, the ablation catheter was introduced into a femoral artery and positioned on the ventricular aspect of the mitral annulus. If this endocardial approach was unsuccessful, the ablation catheter was introduced into the coronary sinus and energy applied at sites with shorter activation times than those recorded from the endocardium. RESULTS: Five (10%) of 51 patients with a left-sided accessory pathway could not have accessory pathway conduction interrupted with a median of 18 endocardial radiofrequency energy applications. Accessory pathway potentials were less frequent during endocardial mapping in these 5 patients than in the 46 patients whose accessory pathway was successfully ablated from the endocardial surface. All five of these patients later had successful ablation using one or two applications of radiofrequency energy from within the coronary sinus. Effective target site electrograms in the coronary sinus were characterized by an accessory pathway potential that was larger than the corresponding atrial or ventricular electrogram. There were no complications or recurrences after ablation within the coronary sinus. CONCLUSIONS: Some left-sided accessory pathways may be difficult to ablate from the endocardial surface because they traverse the AV groove subepicardially. The absence of an accessory pathway potential during endocardial mapping in combination with a relatively large accessory pathway potential within the coronary sinus may be a useful marker of a subepicardial pathway. In this select group of patients, radiofrequency catheter ablation from within the coronary sinus appears to enhance efficacy.

Prospective, randomized comparison of conventional and high dose loading regimens of amiodarone in the treatment of ventricular tachycardia.

OBJECTIVES: The purpose of this prospective randomized study was to compare the electrophysiologic effects of conventional and high dose loading regimens of amiodarone in patients with sustained ventricular tachycardia. BACKGROUND: Uncontrolled studies in which patients have been treated with an oral loading dose of 2 to 4 g/day of amiodarone have suggested that, compared with a conventional loading dose, this dosing regimen results in more rapid control of spontaneous ventricular tachycardia and ventricular tachycardia induced by programmed stimulation. METHODS: Patients in whom sustained monomorphic ventricular tachycardia was inducible by programmed stimulation and who were refractory to class I antiarrhythmic medications were randomly assigned to receive either a conventional (n = 15) or a high (n = 17) loading dose of amiodarone. The conventional dose consisted of 600 mg twice a day for 10 days. The high dose regimen consisted of 50 mg/kg body weight per day on days 1 to 3, 30 mg/kg per day on days 4 and 5 and 600 mg twice a day on days 6 to 10. An electrophysiologic test was performed in the baseline state and after 3 and 10 days of therapy. An adequate response to amiodarone was defined as the inability to induce ventricular tachycardia or the ability to induce only relatively slow (cycle length > or = 350 ms) hemodynamically stable ventricular tachycardia. RESULTS: After 3 days of therapy, 2 of 14 patients who received the conventional loading dose and 6 of 15 patients who received the high dose loading regimen had an adequate response to amiodarone (p = 0.08). After 10 days of therapy, four patients in each group had an adequate response to amiodarone (p = NS). Three patients who received the high dose and one patient who received the conventional dose of amiodarone had an adequate response after 3 days of therapy but not after 10 days of therapy. There were significant increases in the sinus cycle length, atrioventricular block cycle length, ventricular effective refractory period and ventricular tachycardia cycle length after 3 and 10 days of therapy compared with baseline values regardless of the dosing regimen. The extent of the effects of amiodarone on these variables after 3 and 10 days of therapy was similar with both dosing regimens. CONCLUSIONS: The therapeutic and electrophysiologic effects of conventional and high dose loading regimens of amiodarone do not differ significantly after 3 or 10 days of therapy. High oral loading doses of amiodarone do not offer any significant clinical advantage over a conventional loading dose of amiodarone for controlling ventricular tachycardia induced by programmed stimulation.

Effect of shock polarity on ventricular defibrillation threshold using a transvenous lead system.

OBJECTIVES: The purpose of this study was to determine whether the polarity of a monophasic shock used with a transvenous lead system affects the defibrillation threshold. BACKGROUND: The ability to implant an automatic defibrillator depends on achieving an adequate defibrillation threshold. METHODS: A transvenous defibrillation lead with distal and proximal shocking electrodes was used in this study. In 29 consecutive patients, the defibrillation threshold, using a stepdown protocol was determined twice in random order: 1) with the distal coil as the anode, and 2) with the polarity reversed. Only the 20 patients in whom an adequate defibrillation threshold could be obtained with the transvenous lead alone were included in this study. These patients were 61 +/- 14 years old (mean +/- SD) and had a mean ejection fraction of 28 +/- 12%. RESULTS: The mean defibrillation threshold was 11.5 +/- 5.0 J with the distal coil as the anode versus 16.9 +/- 7.7 J with the distal coil as the cathode (p = 0.04). The defibrillation threshold was lower by a mean of 9 +/- 7 J with the former configuration in 14 patients and was lower by a mean of 7 +/- 6 J with the latter configuration in 3 patients; in 3 patients it was the same with both configurations. Use of a subcutaneous patch was avoided in five patients by utilizing the distal electrode as the anode. CONCLUSIONS: Defibrillation thresholds with monophasic shocks are approximately 30% lower with the distal electrode as the anode. The use of anodal shocks may obviate the need for a subcutaneous patch and allow more frequent implantation of a transvenous lead system.

Comparison of implantation of nonthoracotomy defibrillators in the operating room versus the electrophysiology laboratory.

Implantable cardioverter-defibrillators (ICDs) with nonthoracotomy lead systems are widely available, and are implanted either in the electrophysiology laboratory or the operating room. The purpose of this study was to prospectively evaluate the safety and efficacy of nonthoracotomy ICD implantation in an electrophysiology laboratory versus an operating room. During a 7-month period, 62 consecutive ICDs with nonthoracotomy lead systems were implanted in patients in an electrophysiology laboratory. During the next 10 months, 110 consecutive ICDs were implanted in patients in a surgical operating room. All ICD implantations were performed under general anesthesia by electrophysiologists. There were no differences in age (58 +/- 14 vs 62 +/- 12 years, p = 0.06), gender distribution (p = 0.3), frequency of structural heart disease (97% vs 97%, p = 0.9), ejection fraction (0.31 +/- 0.15 vs 0.29 +/- 0.13, p = 0.3), or presentation with cardiac arrest (65% vs 53%, p = 0.2) between patients undergoing ICD implantation in the electrophysiology laboratory and operating room, respectively. The rate of successful implantation and of complications for systems implanted in the electrophysiology laboratory (95% and 13%, respectively) and in the operating room (98% and 14%, respectively) were similar (p = 0.4 and p = 0.8, respectively). Specifically, the rate of infection (0% vs 4%, p = 0.3) and hematoma formation (2% vs 4%, p = 0.8) were not statistically significantly different. Three patients who had undergone ICD implantation in an operating room died within 30 days. ICDs with nonthoracotomy lead systems can be implanted with a similarly high rate of success and acceptable complication rate in the electrophysiology laboratory and in the operating room.

Electrophysiologic effects of sotalol and amiodarone in patients with sustained monomorphic ventricular tachycardia.

No prospective studies have compared sotalol and amiodarone during electropharmacologic testing. The purpose of this prospective, randomized study was to compare the electrophysiologic effects of sotalol and amiodarone in patients with coronary artery disease and sustained monomorphic ventricular tachycardia (VT). Patients with coronary artery disease and sustained monomorphic VT inducible by programmed stimulation were randomly assigned to receive either sotalol (n = 17) or amiodarone (n = 17). The sotalol dose was titrated to 240 mg twice daily over 7 days. Amiodarone dosing consisted of 600 mg 3 times daily for 10 days. An electrophysiologic test was performed in the baseline state and at the end of the loading regimen. An adequate response was defined as the inability to induce VT or the ability to induce only relatively slow hemodynamically stable VT. During the follow-up electrophysiologic test, 24% of patients taking sotalol and 41% of those taking amiodarone had an adequate response to therapy (p = 0.30). Amiodarone lengthened the mean VT cycle length to a greater degree than sotalol (28% vs 12%, p < 0.01). There were no significant differences in the effects of sotalol and amiodarone on the ventricular effective refractory period. In patients with coronary artery disease, amiodarone and sotalol are similar in efficacy in the treatment of VT as assessed by electropharmacologic testing. The effects of the 2 drugs on ventricular refractoriness are similar, but amiodarone slows VT to a greater extent than sotalol.

A randomized comparison of the right- and left-sided approaches to ablation of the atrioventricular junction.

Radiofrequency ablation of the atrioventricular (AV) junction may be performed using either a right- or left-sided approach. This study prospectively compared the left-sided approach with persistent attempts from the right side in patients in whom initial radiofrequency applications on the right side were unsuccessful. Twenty-one of 54 patients did not have complete AV block induced after 3 right-sided radiofrequency applications. These 21 patients were randomly assigned to undergo either the left-sided approach (n = 10) or to undergo additional attempts from the right side (n = 11). The right-sided approach was performed by positioning the ablation catheter to record the largest possible atrial and His bundle electrograms. The left-sided approach was performed by positioning the ablation catheter along the left ventricular septum, where a His bundle potential was recorded. If either approach was not successful after an additional 17 radiofrequency applications, the alternative approach was then used. The AV junction was successfully ablated in all 10 patients randomized to the left-sided approach, but in only 6 of 11 patients randomized to persistent right-sided attempts (p < 0.05). The 5 patients in whom the AV junction was not successfully ablated using the right-sided approach underwent the left-sided approach and had a successful outcome after a mean of 1.2 +/- 0.4 radiofrequency applications. The left-sided approach required significantly fewer radiofrequency applications after randomization than the right-sided approach (3 +/- 3.4 vs 11 +/- 7.6, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Ground beetle (Coleoptera: Carabidae) diversity, activity density, and community structure in a diversified agroecosystem.

Diversity and abundance of ground beetles (Coleoptera: Carabidae) can be enhanced in vegetable and field intercropping systems, but the complexity of polycultures precludes the application of generalized assumptions of effects for novel intercropping combinations. In a field experiment conducted at Lacombe and Ellerslie, Alberta, Canada, in 2005 and 2006, we investigated the effects of intercropping canola (Brassica napus L.) with wheat (Triticum aestivum L.) on the diversity and community structure of carabid beetles, and on the activity density responses of individual carabid species. Shannon-Wiener diversity index scores and species evenness increased significantly as the proportion of wheat comprising total crop plant populations increased in one site-year of the study, indicating a positive response to enhanced crop plant species evenness in the intercrops, and in that same site-year, ground beetle communities in intercrops shifted to more closely approximate those in wheat monocultures as the percentage of wheat in the intercrops increased. Individual carabid species activity densities showed differing responses to intercropping, although activity densities of some potential root maggot (Delia spp.) (Diptera: Anthomyiidae) predators were greater in intercrops with high proportions of wheat than in canola monocultures. The activity density of Pterostichus melanarius (Illiger), the most abundant species collected, tended to be greater in canola monocultures than high-wheat intercrops or wheat monocultures. We conclude that intercrops of canola and wheat have the potential to enhance populations of some carabid species, therefore possibly exerting increased pressure on some canola insect pests.

Intracardiac echocardiography to guide transseptal left heart catheterization for radiofrequency catheter ablation.

INTRODUCTION: The purpose of this study was to assess the feasibility and safety of intracardiac echocardiography to guide transseptal puncture for radiofrequency catheter ablation. METHODS AND RESULTS: Transcatheter intracardiac echocardiography (9 MHz) was utilized to guide transseptal puncture in 53 patients undergoing radiofrequency catheter ablation. The anatomy and relationship of intra- and extracardiac structures were visualized with the ultrasound transducer positioned at the fossa ovalis. The tip of the transseptal dilator and tenting of the fossa ovalis and the left atrial wall were simultaneously visualized in a single ultrasound image in all patients. With maximum tenting of the fossa ovalis, the mean distance from the fossa to the left atrial wall was 11.9 +/- 5.8 mm (range: 1.8 to 25.6 mm). In four patients (8%), the tented fossa ovalis abutted the left atrial wall and the transseptal dilator was redirected with ultrasound guidance. Puncture of the interatrial septum was achieved through the fossa ovalis in each patient and required a single attempt in 51 patients (96%). The mean number of punctures per patient was 1.1 +/- 0.4. The mean time to perform transseptal catheterization was 18.2 +/- 6.8 minutes. There were no complications. CONCLUSION: Intracardiac echocardiography delineated the anatomy of intra- and extracardiac structures not identified with fluoroscopy and simplified correct positioning of the transseptal dilator, puncture of the fossa ovalis, and cannulation of the left atrium in a timely and uncomplicated fashion.

Effect of verapamil on immediate recurrence of atrial fibrillation.

INTRODUCTION: The purpose of this study was to assess the effect of verapamil on immediate recurrences of atrial fibrillation occurring after successful electrical cardioversion. METHODS AND RESULTS: The effect of verapamil on the recurrence of atrial fibrillation within 5 minutes after successful transthoracic cardioversion was assessed in 19 (5%) of 364 patients undergoing electrical cardioversion. The mean duration of atrial fibrillation was 4.44+/-3.0 months. In the 19 patients, cardioversion was successful after each of three consecutive cardioversion attempts per patient; however, atrial fibrillation recurred 0.4+/-0.3 minutes after cardioversion. Verapamil 10 mg was administered intravenously and a fourth cardioversion was performed. Cardioversion after verapamil was successful in each patient, and atrial fibrillation did not recur in 9 (47%) of 19 patients (P < 0.001 vs before verapamil). In the remaining 10 patients in whom atrial fibrillation recurred, the duration of sinus rhythm was significantly longer compared with before verapamil (3.6+/-2.4 min, P < 0.001). The density of atrial ectopy occurring after cardioversion was significantly less after verapamil (21+/-14 ectopic beats per min) compared with before verapamil (123+/-52 ectopic beats per min, P < 0.001). CONCLUSION: Among patients with immediate recurrence of atrial fibrillation after electrical cardioversion, acute calcium channel blockade by verapamil reduces recurrence of atrial fibrillation and extends the duration of sinus rhythm.

Effects of partial and complete ablation of the slow pathway on fast pathway properties in patients with atrioventricular nodal reentrant tachycardia.

INTRODUCTION: The purpose of this study was to prospectively compare the effects of complete and partial ablation of slow pathway function on the fast pathway effective refractory period (ERP). METHODS AND RESULTS: The subjects were 20 patients (mean age 43 +/- 13 years) with atrioventricular nodal reentrant tachycardia (AVNRT), no structural heart disease, and easily inducible AVNRT. Autonomic blockade was achieved with propranolol (0.2 mg/kg) and atropine (0.04 mg/kg). After elimination of AVNRT and during autonomic blockade, the presence of residual slow pathway function was determined by the presence of a single AV nodal echo and/or dual AV nodal physiology. After autonomic blockade and before ablation, the mean fast pathway ERP was 319 +/- 44 msec and the mean slow pathway ERP was 251 +/- 31 msec. After slow pathway ablation and during autonomic blockade, 7 patients had residual slow pathway function and 13 did not. Complete loss of slow pathway function was associated with a shortening of the fast pathway ERP from 334 +/- 35 msec to 300 +/- 62 msec (P < 0.01), while the fast pathway ERP did not change significantly in patients with residual slow pathway function (291 +/- 29 msec vs 303 +/- 38 msec, respectively; P = 0.08). A shortening of 30 msec or more in the fast pathway ERP was observed in 11 of 13 patients who did not have residual slow pathway function, compared to 0 of 7 patients with residual slow pathway function (P < 0.001). CONCLUSION: Shortening of the fast pathway ERP after successful ablation of AVNRT is dependent upon complete loss of slow pathway function. This observation is consistent with electrotonic inhibition of the fast pathway by the slow pathway.

Nonthoracotomy lead implantable cardioverter defibrillators: normal radiographic appearance.

Recently, cardioverter defibrillators with leads and patches that can be implanted via a combination of transvenous and subcutaneous routes rather than via thoracotomy have been developed. Early experience in patients subject to serious ventricular arrhythmias suggests that, as with surgically implanted defibrillators, these nonthoracotomy defibrillators can reduce the risk of sudden death due to cardiac arrest [1]. Moreover, high perioperative complication rates associated with thoracotomy-inserted cardioverter defibrillators are avoided [2]. Four models are currently undergoing clinical trials in the United States. We have used three of these models: PCD (Medtronic, Minneapolis, MN), ENDOTAK (Cardiac Pacemakers Inc., St. Paul, MN), and RES-Q (Intermedics, Freeport, TX). This essay illustrates the normal radiographic appearance of these devices.

A quantitative fluoroscopic comparison of the coronary sinus ostium in patients with and without AV nodal reentrant tachycardia.

INTRODUCTION: The purpose of this study was to perform a quantitative fluoroscopic analysis of the coronary sinus ostium and its relationship to the His bundle in patients with and without AV nodal reentrant tachycardia. Sites of slow pathway ablation are often near the coronary sinus ostium, which can be located within a few millimeters of the His bundle. Whether such close proximity of the coronary sinus ostium to the His bundle is unique to patients with AV nodal reentrant tachycardia is unknown. METHODS AND RESULTS: Fifty consecutive patients (mean age 39 +/- 14 years) with no structural heart disease underwent electrophysiologic testing and radiofrequency ablation. The study group consisted of 28 patients with inducible AV nodal reentrant tachycardia or dual AV nodal physiology and 22 patients in the control group. A coronary sinus venogram was performed in each patient. The coronary sinus ostium was similar in size in the study group (11.4 +/- 4.5 mm) and in the control group (10.5 +/- 3.6 mm, P = 0.2). The coronary sinus ostium was funnel shaped in half of the study patients and in half of the control patients (P = 1.0). The mean distance from the upper lip of the coronary sinus ostium to the tip of the His bundle catheter was 9.7 +/- 5.5 mm in the study group and 10.4 +/- 5.1 mm in the control group (P = 0.7). The mean distance from the lower lip of the coronary sinus ostium to the tip of the His-bundle catheter in the study group was 20.1 +/- 6.1 mm and 19.5 +/- 5.6 mm in the control group (P = 0.7). CONCLUSION: This study demonstrates a wide range of normal coronary sinus ostium diameters, morphology, and anatomic relationships with surrounding structures, with no demonstrable correlation to the presence or absence of dual AV node physiology or AV nodal reentrant tachycardia.

The economic impact of transvenous defibrillation lead systems.

The purpose of this study was to compare implant charges and convalescence for transvenous and epicardial defibrillation systems. Hospital stay, intensive care utilization, professional fees, and hospital bills were compared in 44 patients who underwent implantation of a cardiac defibrillator between September 1991 and May 1993. Twenty-five consecutive patients received an epicardial lead system, while 19 consecutive patients underwent implantation of the entire transvenous defibrillation system in the electrophysiology laboratory. There were no significant differences between the two groups in mean age or left ventricular ejection fraction. There was a significant reduction in postoperative hospital convalescence from 7.2 +/- 2.0 days with epicardial systems to 3.1 +/- 1.5 days with transvenous systems (P < 0.001). Postoperative intensive care unit stay was significantly reduced with transvenous systems compared with epicardial systems (0.1 +/- 0.2 vs 1.5 +/- 0.9 days; P < 0.001). Hospital charges were also significantly reduced with the transvenous lead system implants. Mean implant charges were lower with transvenous systems: $32,090 +/- $2,620 vs $38,307 +/- $2,701 (P < 0.001); convalescence charges were lower: $5,861 +/- $5,010 $12,447 +/- $4,969 (P < 0.001); the total hospital bill was also significantly lower with transvenous systems: $53,459 +/- $12,588 vs $71,981 +/- $16,172 (P < 0.001). Professional fees for implantation ($4,131 +/- $1,724 vs $6,100 +/- 0, P < 0.001), convalescence care ($1,258 +/- $960 vs $2,846 +/- $1,770; P < 0.001), and total professional fees ($12,925 +/- $4,772 vs $15,731 +/- $4,055, P < 0.05) were lower in the transvenous defibrillation group.(ABSTRACT TRUNCATED AT 250 WORDS)

Transvenous and subcutaneous implantable cardioverter defibrillators: radiographic assessment.

PURPOSE: To assess chest radiograph configurations in 102 patients following total or partial transvenous and subcutaneous insertion of a non-thoracotomy lead implantable cardioverter defibrillator (NTL-ICD) device. MATERIALS AND METHODS: The four overlapping system types reviewed were the Endotak (49 patients), PCD (32 patients), Res-Q (10 patients), and hybrid combinations of NTL-ICD and surgically inserted pericardial and epicardial automatic implantable cardioverter defibrillator (AICD) devices (15 patients). RESULTS: Abnormalities were detected on radiographs both at the time of implantation and at early follow-up. NTL-ICD electrodes partially replaced or augmented AICD systems in 11 patients (10.7%) because of sensing lead or defibrillation failure or infection. Defibrillation failure necessitated augmentation of NTL-ICD systems with AICD pericardial patches in four patients (3.9%). Catheter displacement, lead fracture, or pneumothorax was detected in eight patients (7.8%). CONCLUSION: Complex radiographic appearances may be seen and important abnormalities may be detected after insertion of these devices.