Determination of the isotopic composition of single sub-micrometer-sized uranium particles by laser ablation coupled with multi-collector inductively coupled plasma mass spectrometry.

RATIONALE: A multi-collector inductively coupled plasma (MC-ICP) mass spectrometer coupled to a UV ns-laser ablation (LA) system was used to measure uranium isotopic ratios (234 U/238 U, 235 U/238 U and 236 U/238 U) in single uranium particles of various sizes and isotopic compositions, including home-made sub-micrometric natural uranium particles of narrow size distribution (415 ± 60 nm). METHODS: The LA-ICP mass spectrometer was operated in wet plasma conditions thanks to simultaneous injection of the laser aerosol and water vapor through a desolvating nebulizer. The isotopic ratios were corrected for mass bias and gain factors between detectors. The 236 U/238 U ratios were also corrected for the presence of 235 U hydrides and tailing of the 238 U+ peak. RESULTS: 236 U/238 U ratios were successfully measured in micrometer-sized particles from the NBS U050 certified standard material with a 236 U/238 U ratio of ~5 × 10-4 . The analysis of 77 natural uranium sub-µm-sized particles yielded a very good trueness with respect to the expected 234 U/238 U and 235 U/238 U ratios, while the measurement errors for single particles ranged from -2.7% to +2.1% for 235 U/238 U and from -17% to +33% for the 234 U/238 U ratios. Their relative combined standard uncertainties ranged from 3.3% to 32.8% and from 0.4% to 4.0% for 234 U/238 U and 235 U/238 U ratios, respectively. In addition, extremely low detection limits, in the attogram range, were achieved. CONCLUSIONS: This study demonstrates that coupling of a ns-laser ablation system with a MC-ICP mass spectrometer allows measurements of the isotopic composition in natural uranium particles of a few hundreds of nm with very good trueness, average combined standard uncertainties of ~1% for 235 U/238 U ratios and 12% for 234 U/238 U ratios, and detections limits of a few ag for minor isotopes.

Toroidal diamond anvil cell for detailed measurements under extreme static pressures.

Over the past 60 years, the diamond anvil cell (DAC) has been developed into a widespread high static pressure device. The adaptation of laboratory and synchrotron analytical techniques to DAC enables a detailed exploration in the 100 GPa range. The strain of the anvils under high load explains the 400 GPa limit of the conventional DAC. Here we show a toroidal shape for a diamond anvil tip that enables to extend the DAC use toward the terapascal pressure range. The toroidal-DAC keeps the assets for a complete, reproducible, and accurate characterization of materials, from solids to gases. Raman signal from the diamond anvil or X-ray signal from the rhenium gasket allow measurement of pressure. Here, the equations of state of gold, aluminum, and argon are measured with X-ray diffraction. The data are compared with recent measurements under similar conditions by two other approaches, the double-stage DAC and the dynamic ramp compression.

Comparing results of X-ray diffraction, µ-Raman spectroscopy and neutron diffraction when identifying chemical phases in seized nuclear material, during a comparative nuclear forensics exercise.

This work presents the results for identification of chemical phases obtained by several laboratories as a part of an international nuclear forensic round-robin exercise. In this work powder X-ray diffraction (p-XRD) is regarded as the reference technique. Neutron diffraction produced a superior high-angle diffraction pattern relative to p-XRD. Requiring only small amounts of sample, µ-Raman spectroscopy was used for the first time in this context as a potentially complementary technique to p-XRD. The chemical phases were identified as pure UO2 in two materials, and as a mixture of UO2, U3O8 and an intermediate species U3O7 in the third material.

In-SEM Raman microspectroscopy coupled with EDX--a case study of uranium reference particles.

Information about the molecular composition of airborne uranium-bearing particles may be useful as an additional tool for nuclear safeguards. In order to combine the detection of micrometer-sized particles with the analysis of their molecular forms, we used a hybrid system enabling Raman microanalysis in high vacuum inside a SEM chamber (SEM-SCA system). The first step involved an automatic scan of a sample to detect and save coordinates of uranium particles, along with X-ray microanalysis. In the second phase, the detected particles were relocated in a white light image and subjected to Raman microanalysis. The consecutive measurements by the two beams showed exceptional fragility of uranium particles, leading to their ultimate damage and change of uranium oxidation state. We used uranium reference particles prepared by hydrolysis of uranium hexafluoride to test the reliability of the Raman measurements inside the high vacuum. The results achieved by the hybrid system were verified by using a standalone Raman microspectrometer. When deposited on exceptionally smooth substrates, uranyl fluoride particles smaller than 1000 nm could successfully be analyzed with the SEM-SCA system.

Production and characterization of plutonium dioxide particles as a quality control material for safeguards purposes.

Plutonium (Pu) dioxide particles were produced from certified reference material (CRM) 136 solution (CRM 136-plutonium isotopic standard, New Brunswick Laboratory, Argonne, IL, U.S.A., 1987) using an atomizer system on December 3, 2009 after chemical separation of americium (Am) on October 27, 2009. The highest density of the size distribution of the particles obtained from 312 particles on a selected impactor stage was in the range of 0.7-0.8 µm. The flattening degree of 312 particles was also estimated. The isotopic composition of Pu and uranium (U) and the amount of Am were estimated by thermal ionization mass spectrometry (TIMS), inductively coupled plasma mass spectrometry (ICPMS), and α-spectrometry. Within uncertainties the isotopic composition of the produced particles is in agreement with the expected values, which were derived from the decay correction of the Pu isotopes in the CRM 136. The elemental ratio of Am to Pu in the produced particles was determined on the 317th and 674th day after Am separation, and the residual amount of Am in the solution was estimated. The analytical results of single particles by micro-Raman-scanning electron microscopy (SEM)-energy-dispersive X-ray spectrometry (EDX) indicate that the produced particles are Pu dioxide. Our initial attempts to measure the density of two single particles gave results with a spread value accompanied by a large uncertainty.

Long-term follow-up on high-rate cut-off programming for implantable cardioverter defibrillators in primary prevention patients with left ventricular systolic dysfunction.

AIMS: Implantable cardioverter defibrillators (ICDs) are efficient in reducing mortality in patients with left ventricular systolic dysfunction. High-rate cut-off programming may be effective in reducing appropriate and inappropriate therapies, but as the long-term consequences on morbidity and mortality remain unclear, it is underutilized. METHODS AND RESULTS: We prospectively studied 365 consecutive patients (mean age 60 ± 10 years), with ischaemic (63%) or non-ischaemic cardiomyopathy and left ventricular dysfunction (mean ejection fraction 25 ± 7%), who were implanted with an ICD in primary prevention of sudden cardiac death (41% single chamber, 31% dual chamber, and 28% biventricular). All devices were programmed with a shock-only zone over 220 beats per minute (b.p.m.) and a monitoring zone between 170 and 220 b.p.m. During a median follow-up of 40 months, 41 patients received appropriate shocks (11.2%) and 24 inappropriate shocks (6.6%). Then, 306 patients never experienced any ICD shock (84%). Inappropriate discharges were related to supraventricular tachyarrhythmia in 10 patients, and noise/oversensing in 14 patients. Ventricular tachycardia episodes, sustained or not, were recorded in the monitoring zone in 43 patients (11.8%). Seven of these patients were symptomatic (1.9%), without lethal consequence. Sixty-two patients (17%) died: 35 from end-stage heart failure, 1 from unexplained sudden death, and 26 from a documented non-cardiac cause. CONCLUSION: High-rate cut-off (220 b.p.m.) shock-only ICD programming, in primary prevention patients with reduced left ventricular ejection fraction, appeared to be safe during a long-term follow-up. It also resulted in a very low rate of discharges, which are known to be deleterious in this population.

Plasma neutrophil gelatinase-associated lipocalin in kidney transplantation and early renal function prediction.

BACKGROUND: This prospective observational study aimed to assess the relevance of serial postoperative plasma neutrophil gelatinase-associated lipocalin (NGAL) measurements on prediction of early renal transplant function. METHODS: Plasma NGAL (pNGAL) was measured (Triage NGAL Test; Biosite Inc., Inverness Medical) in 41 patients scheduled for kidney transplantation from deceased or living donors, immediately before and after surgery, and at 12 hr, day 1, day 3, and day 7. A delayed graft function (DGF) was defined as the need for dialysis during the first week. The results were expressed as median (Q1, Q3). RESULTS: Of the 41 consecutive patients enrolled, all had a high preoperative pNGAL level: 453 ng/mL (382, 595). Fifteen (36.6%) presented a DGF. In patients with DGF, pNGAL was significantly higher at 12 hr (571 [467, 634] vs. 242 [158, 299] ng/mL, P<0.0001) and at day 1 (466 [356, 627] vs. 165 [91, 248] ng/mL, P<0.0001). A pNGAL higher than 400 ng/mL 12 hr after transplantation predicted DGF with a sensitivity of 93.3%, a specificity of 88.5%, and an odds ratio of 63.2 (P=0.0004). This predictive performance was higher than for plasma creatinine. CONCLUSIONS: pNGAL level early and accurately predicted DGF after renal transplantation. pNGAL measurements allowed monitoring of the renal function in this striking situation of ischemia-reperfusion aggression. Early identification of patients at risk of DGF, before graft lesions are consolidated, opens the field of a precise monitoring of renal injury and the impact of future protective therapeutics.

Investigation of methanol oxidation over Au/catalysts using operando IR spectroscopy: determination of the active sites, intermediate/spectator species, and reaction mechanism.

FTIR spectroscopy coupled with mass spectrometry has been used to study the mechanism of methanol oxidation at low temperatures on nanostructured Au/CeO(2) and Au/TiO(2) catalysts. Activity and selectivity toward CO(2) have been investigated through simultaneous analysis of adsorbed surface species and gaseous species, and some key steps in the oxidation pathway, active sites, and intermediate species are proposed. Among the detected species, some kinds of methoxy species formed on the support were identified as intermediates, which further transform into formates whose oxidation was found to be the rate-determining step for the reaction. The role of the support and the noble metal in the mechanism are revealed using operando spectroscopy.

Kidney retrieval after sudden out of hospital refractory cardiac arrest: a cohort of uncontrolled non heart beating donors.

INTRODUCTION: To counter the shortage of kidney grafts in France, a non heart beating donor (NHBD) program has recently been implemented. The aim of this study was to describe this pilot program for kidney retrieval from "uncontrolled" NHBD meaning those for whom attempts of resuscitation after a witnessed out-of-hospital cardiac arrest (CA) have failed (Maastricht 1 and 2), in a centre previously trained for retrieval from brain dead donors. METHODS: A prospective, monocentric, descriptive study concerning NHBD referred to our institution from February 2007 to June 2008. The protocol includes medical transport of refractory CA under mechanical ventilation and external cardiac massage, kidney protection by insertion of an intraaortic double-balloon catheter (DBC) with perfusion of a hypothermic solution, kidney retrieval and kidney preservation in a hypothermic pulsatile perfusion machine. RESULTS: 122 potential NHBD were referred to our institution after a mean resuscitation attempt of 35 minutes (20-95). Regarding the contraindications, 63 were finally accepted and 56 had the DBC inserted. Organ retrieval was performed in 27 patients (43%) and 31 kidneys out of the 54 procured (57%) have been transplanted. Kidney transplantation exclusion was related to family refusal (n = 15), past medical history, time constraints, viral serology, high vascular ex vivo resistance of the graft and macroscopic abnormalities. The 31 kidneys exhibited an expected high delayed graft function rate (92%). Despite these initial results transplanted kidney had good creatinine clearance at six months (66 +/- 24 ml/min) with a 89% graft survival rate at six months. CONCLUSIONS: This study shows the feasibility and efficacy of an organ procurement program targeting NHBD allowing a 10% increase in the kidney transplantation rate over 17 months. With a six months follow-up period, the results of transplanted kidney function were excellent.

Implantable loop recorder for recurrent syncope: influence of cardiac conduction abnormalities showing up on resting electrocardiogram and of underlying cardiac disease on follow-up developments.

AIMS: The implantable loop recorder is a useful diagnostic tool in dealing with recurrent syncope in patients. We tested to determine the influence of cardiac conduction abnormalities that turn up on resting electrocardiogram (ECG) and the impact of underlying cardiac disease on developments during follow-up. METHODS AND RESULTS: Ninety-five consecutive patients received an implantable loop recorder to monitor recurrent syncope (n = 4.9+/-3.8) of unknown aetiology after cardiac investigations, including an electrophysiological study. Resting ECG was abnormal, suggesting an arrhythmic syncope, in 29 (30.5%) patients, while 21 (22.1%) patients had an underlying cardiac disease. During an average follow-up period of 10.2+/-5.2 months, 43 (45.2%) patients developed a new syncope associated in 27 of them (62.8%) with an arrhythmic event. Syncope was no more frequent in the subgroup of patients with cardiac conduction abnormalities on resting ECG, while the frequency of arrhythmic events was similar whether or not the ECG was normal. In the subgroup of patients with cardiac disease with normal left ventricular ejection fraction, the occurrence of syncope was less frequent, and the number of arrhythmic events was no greater in these patients. CONCLUSION: Implantable loop recorder is a useful diagnostic tool for recurrent syncope of unknown aetiology.

Abnormal nocturnal heart rate variability and QT dynamics in patients with Brugada syndrome.

BACKGROUND: In Brugada syndrome (BSY), most of the ventricular arrhythmic events are nocturnal, suggesting an influence of the autonomic nervous system. METHODS: In 46 patients (mean age = 41 +/- 14 years, 43 men) with electrocardiograms (ECG) consistent with BSY and structurally normal hearts, we measured heart rate variability (HRV) and QT dynamics (QT/RR slopes) on 24-hour ambulatory ECG. Type 1 BSY-ECG was spontaneous in 23 (50%) and induced in 23 patients. RESULTS: History of syncope was present in 23 patients (50%). Programmed ventricular stimulation induced ventricular tachyarrhythmias (VTA) in 13 patients (28%). A single patient developed ventricular tachycardia during a mean follow-up of 34 months. Compared to a control group matched for age and sex, HRV was decreased over 24 hours and during nighttime in patients with BSY (SDNN 122 +/- 44 vs 93 +/- 36 ms, P = 0.0008 and SDANN 88 +/- 39 vs 54 +/- 24 ms, P < 0.0001). QTend /RR slopes were decreased over 24 hours in patients with BSY (0.159 +/- 0.05 vs 0.127 +/- 0.05, P = 0.003) and particularly at night (0.123 +/- 0.04 vs 0.089 +/- 0.04, P = 0.0001). QTend /RR slopes were significantly decreased during nighttime in patients with spontaneous versus provoked BSY-ECG patterns. By contrast, HRV and QT/RR slopes were similar in symptomatic and asymptomatic patients, whether VTA were induced or not. CONCLUSIONS: Patients with a BSY-ECG pattern had lower HRV and QT/RR slopes than control subjects during nighttime. High-risk patients with spontaneous BSY-ECG patterns had the lowest nocturnal QTend/RR slopes. These unique repolarization dynamics might be related to the frequent nocturnal occurrence of VTA in BSY.

Trimethylamine as a probe molecule to differentiate acid sites in Y-FAU zeolite: FTIR study.

In heterogeneous catalysis acidity has a very important influence on activity and selectivity: correct determination of acidic properties is a base to improve industrial processes. The aim of this work was to study trimethylamine (TMA) as a probe molecule able to distinguish between the different Brønsted acid sites in zeolitic frameworks. Our work mainly focused on faujasite-type zeolites because the HY zeolite is one of the most used acidic catalysts in industrial processes. In this paper, typical IR bands assigned to TMA-protonated species (formed in supercages) are detected in the HY zeolite. TMA interacting by hydrogen bonding with the acid sites located in the sodalite units is also observed. The wavenumbers of some typical IR bands assigned to TMA-protonated species appear to depend on the acidic strength, and a complementary study with ZSM-5 and X-FAU samples confirms this proposition.

FTIR spectroscopy study of CO adsorption on Pt-Na-mordenite.

Different carbonyls are formed after CO adsorption at ambient temperature on a Pt-Na-mordenite (Pt-Na-MOR) sample. Pt(3+)(CO)(2) dicarbonyls (nu(s) at 2205 cm(-1) and nu(as) at 2167 cm(-1)) are decomposed without formation of monocarbonyls. The respective mixed-ligand species, Pt(3+)((12)CO)((13)CO), formed after (12)CO-(13)CO coadsorption, display bands at 2192 and 2131 cm(-1), in excellent agreement with the theoretically calculated values. Pt(2+)-CO species absorb at 2145 cm(-1) and are not able to accept a second CO molecule. Pt(+)-CO carbonyls are characterized by a band at 2111 cm(-1). Under CO equilibrium pressure, these species are converted into dicarbonyls (nu(s) at 2135 cm(-1) and nu(as) at 2101 cm(-1)). The respective mixed-ligand species, Pt(+)((12)CO)((13)CO), manifest bands at 2123 and 2069 cm(-1), in good agreement again with the theory. Different carbonyls of metallic platinum are observed below 2100 cm(-)(1). In addition, weakly adsorbed CO was registered as Na(+)-CO complexes (2177 and 2165 cm(-1)) and Na(+)-OC-Na(+) species (2138 cm(-1)). It was found that during desorption of CO platinum was reduced, ultimately to metal. However, heating in a NO + O(2) mixture leads to reoxidation of the metal particles and restoration of the initial state of the sample.

NO2 disproportionation for the IR characterisation of basic zeolites.

NO2 disproportionation on alkaline zeolites is used to generate nitrosonium (NO+) and nitrate ions on the surface, and the infrared vibrations observed are very sensitive to the cation chemical hardness and to the basicity of zeolitic oxygen atoms.

Infrared evidence of three distinct acidic hydroxyls in defect-free HY faujasite.

Trimethylamine (TMA) and ammonia (NH(3)) were coadsorbed over a free extraframework aluminum (EFAL) HY zeolite, which allowed us to distinguish at least three different acidic hydroxyls in the faujasite structure.

Segmental wall motion abnormalities in idiopathic dilated cardiomyopathy and their effect on prognosis.

There is considerable variability in segmental wall motion abnormalities and in the prognosis of idiopathic dilated cardiomyopathy (IDC). Radionuclide ventriculography with Fourier analysis was performed in 107 patients with angiographically proved IDC. Amplitude analysis located the wall motion abnormalities. Using phase analysis in the left and right ventricles, the interventricular delay between the mean phase of the right and left ventricles was used to assess interventricular dyssynchrony and SDs of the mean phase in each ventricle was used to assess intraventricular dyssynchrony. Hypokinesis was global in 56 patients (52%) and localized in the anteroseptal wall in 34 (32%), the inferior wall in 12 (11%), the anteroseptal and inferior walls in 2 (2%), and the lateral wall in 3 (3%). Patients with localized wall motion abnormalities had larger left ventricular (LV) end-diastolic diameters (70 +/- 9 vs 66 +/- 8 mm, p = 0.009) and lower LV ejection fractions (25 +/- 9% vs 31 +/- 12%, p = 0.005). Intraventricular dyssynchrony was lower in patients with global hypokinesis (SD of LV mean phase 67 +/- 35 vs 48 +/- 22 ms, p = 0.002). With a follow-up of 27 +/- 23 months, increased SD of the LV phase (p = 0.005), decreased right ventricular ejection fraction (p = 0.006), decreased LV ejection fraction (p = 0.04), and localized wall motion abnormality (p = 0.009) were independent predictors of cardiac death or worsening heart failure leading to heart transplantation. Thus, segmental wall motion abnormalities are frequent in IDC and are associated with severe systolic dysfunction and a worse prognosis.

Pharmacokinetics of long-term sufentanil infusion for sedation in ICU patients.

OBJECTIVE: To determine the pharmacokinetics of long-term infusion of sufentanil in ICU patients. DESIGN AND SETTING: Open-label study in a surgical intensive care unit. PATIENTS: Ten consecutive patients without renal or hepatic failure requiring mechanical ventilation for at least 6 days. INTERVENTIONS: Patients received sufentanil (initial bolus 0.5 micro g/kg and continuous infusion rate of 0.5 micro g/kg per hour) and midazolam (initial bolus 0.08 mg/kg and continuous infusion 0.05 mg/kg per hour). Sedation was adjusted according to the Ramsay scale (score >3). Blood samples were taken during and up to 72 h after the infusion, and plasma concentrations were measured using a sensitive radioimmunoassay method. MEASUREMENTS AND RESULTS: Plasma concentration-time profiles of sufentanil and pharmacokinetic parameters such as initial postinfusion half-life (t(1/2alpha)), elimination half-life (t(1/2beta)), total clearance (Cl), volume of distribution (Vdbeta), and time required to obtain a 50% decrease in plasma concentration (tcp(0/2)). The mean duration of sedation was 12+/-7 days. The initial half-life t(1/2alpha) was 1.33+/-1.15 h. The observed prolonged elimination half-life (t(1/2beta)=25.5+/-9.4 h) was related to the large volume of distribution (Vdbeta=22.6+/-9.4 l/kg). The mean total clearance was 13.4+/-7.0 ml/kg per minute. The mean time required to obtain a 50% decrease in plasma concentration was short (tcp(0/2=)4.7+/-3.7 h). CONCLUSIONS: The pharmacokinetic analysis of sufentanil for ICU sedation revealed increased volume of distribution and elimination half-life. Nevertheless the rapid distribution and elimination processes suggest that the rapid reversibility of sedation with sufentanil is maintained after long duration of infusion. Further studies should be carried out to evaluate the clinical relevance of these results.

Family participation in care to the critically ill: opinions of families and staff.

BACKGROUND: Allowing family members to participate in the care of patients in intensive care units (ICUs) may improve the quality of their experience. No previous study has investigated opinions about family participation in ICUs. METHODS: Prospective multicenter survey in 78 ICUs (1,184 beds) in France involving 2,754 ICU caregivers and 544 family members of 357 consecutive patients. We determined opinions and experience about family participation in care; comprehension (of diagnosis, prognosis, and treatment) and satisfaction (Critical Care Family Needs Inventory) scores to assess the effectiveness of information to families and the Hospital Anxiety and Depression score for family members. RESULTS: Among caregivers 88.2% felt that participation in care should be offered to families. Only 33.4% of family members wanted to participate in care. Independent predictors of this desire fell into three groups: patient-related (SAPS II at ICU admission, OR 0.984); ICU stay length, OR 1.021), family-related (family member age, OR 0.97/year); family not of European descent, OR 0.294); previous ICU experience in the family, OR 1.59), and those related to emotional burden and effectiveness of information provided to family members (symptoms of depression in family members, OR 1.58); more time wanted for information, OR 1.06). CONCLUSIONS: Most ICU caregivers are willing to invite family members to participate in patient care, but most family members would decline.

Reliability of QRS duration and morphology on surface electrocardiogram to identify ventricular dyssynchrony in patients with idiopathic dilated cardiomyopathy.

Using Fourier phase analysis of equilibrium radionuclide angiography in both ventricles, inter- and intraventricular delays were correlated with QRS morphology and duration in 103 patients with idiopathic dilated cardiomyopathy. We found that left bundle branch block on the left axis may reflect a high intra-left ventricular dyssynchrony. A precise evaluation of the dyssynchrony appears useful because a high proportion of patients with incomplete bundle branch block, left anterior hemiblock, or "normal" QRS exhibit a marked intra-LV dyssynchrony and may respond to cardiac resynchronization therapy.

Ventricular dyssynchrony and risk markers of ventricular arrhythmias in nonischemic dilated cardiomyopathy: a study with phase analysis of angioscintigraphy.

Biventricular pacing is a new form of treatment for patients with dilated cardiomyopathy and ventricular dyssynchrony. Limited information is available regarding the relationship between ventricular dyssynchrony and risk markers of ventricular arrhythmias in idiopathic dilated cardiomyopathy (IDC). In 103 patients with IDC, Fourier phase analysis of both ventricles was performed from equilibrium radionuclide angiography (ERNA). The difference between the mean phase of the LV and RV was a measure of interventricular dyssynchrony, and the standard deviations of the mean phases in each ventricle measured intraventricular dyssynchrony. There were no significant differences in inter- and intraventricular dyssynchrony between patients with versus without histories of sustained VT or VF, nonsustained VT, abnormal signal-averaged ECG, or induced sustained monomorphic VT. Dyssynchrony was not related to decreased heart rate variability (HRV). LV and interventricular dyssynchrony were weakly related to QT duration and QT dispersion. During a follow-up of 27 +/- 23 months, 21 patients had major adverse cardiac events (MACE), including 7 cardiac deaths, 11 progression of heart failure leading to cardiac transplantation, and 3 sustained VT/VF. The only independent predictors of MACE were an increased standard deviation of LV mean phase (P = 0.003), a decreased HRV (standard deviation of normal-to-normal intervals, P = 0.004), and histories of previous VT/VF (P = 0.03) or nonsustained VT (P = 0.04). In conclusion, left intraventricular dyssynchrony evaluated with ERNA was an independent predictor of MACE in IDC and was not related to usual risk markers of ventricular arrhythmias. This may have implications for resynchronization therapy and/or the use of implantable cardioverter defibrillators in IDC.