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INTRODUCTION: A current limitation of single chamber implantable cardioverter defibrillators (ICDs) is the lack of an atrial lead to reliably detect atrial fibrillation (AF) episodes. A novel ventricular based atrial fibrillation (VBAF) detection algorithm was created for single chamber ICDs to assess R-R variability for detection of AF. METHODS: Patients implanted with Visia AF™ ICDs were prospectively enrolled in the Medtronic Product Surveillance Registry from December 15, 2015 to January 23, 2019 and followed with at least 30 days of monitoring with the algorithm. Time to device-detected daily burden of AF ≥ 6 min, ≥6 h, and ≥23 h were reported. Clinical actions after device-detected AF were recorded. RESULTS: A total of 291 patients were enrolled with a mean follow-up of 22.5 ± 7.9 months. Of these, 212 (73%) had no prior history of AF at device implant. However, 38% of these individuals had AF detected with the VBAF algorithm with daily burden of ≥6 min within two years of implant. In these 80 patients with newly detected AF by their ICD, 23 (29%) had a confirmed clinical diagnosis of AF by their provider. Of patients with a clinical diagnosis of AF, nine (39%) were newly placed on anticoagulation, including five of five (100%) patients having a burden >23 h. CONCLUSIONS: Continuous AF monitoring with the new VBAF algorithm permits early identification and actionable treatment for patients with undiagnosed AF that may improve patient outcomes.
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Fibrilación Atrial , Desfibriladores Implantables , Humanos , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/terapia , Fibrilación Atrial/etiología , Desfibriladores Implantables/efectos adversos , Fibrilación Ventricular/etiologíaRESUMEN
Photo-assisted single-chamber microbial electrolysis cells (MECs) incorporating semiconductor cathodes are attractively promising for exclusive hydrogen without CH4 and CO2. However, the unsustainable, high cost, and unstable metal catalysts on the cathodes along with the intricacies behind the interplay of circuital current, light illumination, and bacterial communities on both electrodes are poorly understood. Herein, photo-assisted single-chamber MECs incorporating ZnFe2O4/g-C3N4 cathodes are demonstrated to achieve efficient production of exclusive hydrogen (0.11 ± 0.01 m3/m2/day; 1.70 ± 0.04 m3/m3/day) with a solar-to-hydrogen conversion efficiency of 4.08 ± 0.17% and an energy efficiency relative to electrical input of 233 ± 5%. The ZnFe2O4/g-C3N4 structured cathodes exhibited appreciable higher photocurrents than the controls (g-C3N4: 4.3-fold; ZnFe2O4: 3.3-fold), and negligible leaking of Fe and Zn after the 4th-cycle operation. Circuital current and light illumination were proven to varying degree shape both electrodes for building up functional bacterial communities with metabolic regulation at the prolonged operation of 12 batch cycles. Energy metabolism and carbohydrate metabolism along with membrane transport, signal transduction, and cell motility based on PICRUSt functional prediction further confirmed the photo-assisted single-chamber MECs for efficient hydrogen production. This study provided a sustainable, cost-effective, and efficient approach for achieving high rates of exclusive hydrogen production and offered new insights for ingenious interplay of circuital current, light illumination, and bacterial communities for efficient hydrogen production in the photo-assisted single-chamber MECs. KEY POINTS: ⢠ZnFe2O4/g-C3N4 cathodes of single-chamber MECs achieve efficient H2 production. ⢠Light irradiation and circuit current shape bacterial communities on both electrodes. ⢠Circuital current contributes to less leaking of Fe and Zn, and thus system stability.
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Fuentes de Energía Bioeléctrica , Electrólisis , Electrodos , Hidrógeno/metabolismo , Electricidad , Bacterias/metabolismoRESUMEN
We report a case report of a 68-year-old man with chemotherapy-induced cardiomyopathy and uncontrolled permanent atrial fibrillation. Cardiac resynchronization therapy implantation and atrioventricular junction ablation were planned. DF-1 single chamber defibrillator was connected to lead's defibrillation and a lead destinated to left bundle branch area pacing. This system leads to reduce costs by one-third, improve battery longevity, and provide a more physiological pacing.
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Fibrilación Atrial , Terapia de Resincronización Cardíaca , Cardiomiopatías , Anciano , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/terapia , Fascículo Atrioventricular , Estimulación Cardíaca Artificial , Desfibriladores , Bloqueo Cardíaco , Humanos , Masculino , Resultado del TratamientoRESUMEN
Generally, high bioelectroactivity of anodophilic biofilm favors high power generation of microbial fuel cell (MFC); however, it is not clear whether it can promote denitrification of MFC synchronously. In this study, we studied the impact of anodophilic biofilm bioelectroactivity on the denitrification behavior of air-cathode MFC (AC-MFC) in steady state and found that high bioelectroactivity of anodophilic biofilm not only favored high power generation of the AC-MFC, but also promoted the growth of denitrifers at the anodes and strengthened denitrification. Anodophilic biofilms of AC-MFC with various bioelectroactivity were acclimated at conditions of open circuit (OC), Rext of 1000 Ω and 20 Ω (denoted as AC-MFC-OC, AC-MFC-1000Ω, and AC-MFC-20Ω, respectively) and performed for over 100 days. Electrochemical tests and microbial analysis results showed that the anode of the AC-MFC-20Ω delivered higher current response of both oxidation and denitrification and had higher abundance of electroactive bacteria than the AC-MFC-OC, AC-MFC-1000Ω, demonstrating a higher bioelectroactivity of the anodophilic biofilms. Moreover, these electroactive bacteria favored the accumulation of denitrifers, like Thauera and Alicycliphilus, probably by consuming trace oxygen through catalyzing oxygen reduction. The AC-MFC-20Ω not only delivered a 61.7% higher power than the AC-MFC-1000Ω, but also achieved a stable and high denitrification rate constant (kDN ) of 1.9 h-1 , which was 50% and 40% higher than that of the AC-MFC-OC and AC-MFC-1000Ω, respectively. It could be concluded that the high bioelectroactivity of the anodophilic biofilms not only favored high power generation of the AC-MFC, but also promoted the enrichment of denitrifers at the anodes and strengthened denitrification. This study provided an effective method for enhancing power generation and denitrification performance of the AC-MFC synchronously.
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Fuentes de Energía Bioeléctrica/microbiología , Biopelículas , Desnitrificación/fisiología , Aire , Electrodos/microbiologíaRESUMEN
We report a case of a 54-year-old female, known symptomatic sick sinus syndrome, who had undergone a single-chamber pacemaker (VVI, St. Jude Medical, VERITY ADxXL SC SN 2413520) implantation in 2011. Electrocardiography (ECG) performed on a recent visit to the pacemaker clinic showed intermittent double pacing spikes on top of the T wave (Fig. 1A). What is the mechanism?
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AIMS: Leadless pacing has become an alternative approach for patients requiring a single-chamber pacemaker. Conventionally, leadless Micra Transcatheter Pacing System (TPS) pacemakers are implanted via a right femoral venous access. However, due to various reasons, a left-sided femoral venous approach may be necessary. We hypothesized that a left-sided femoral venous approach is as safe and effective when compared with a right-sided approach. We assessed indications, procedural characteristics, safety and mid-term outcomes of Micra TPS implantation via a left femoral venous approach when compared with the conventional right-sided approach. METHODS AND RESULTS: In this retrospective single-centre analysis, 143 consecutive patients undergoing Micra TPS implantation were included. 87% (125/143) underwent Micra TPS implantation via a right, and 13% (18/143) via a left femoral venous access. The mean age at implantation was 79.8 ± 7.5 years. Acute procedural success, mean procedure and fluoroscopy times as well as device parameters at implantation and follow-up (mean 15 ± 11.5 months) were similar between the two groups. Five major complications (3.5%) were encountered, all using a right-sided approach. After a transfemoral TAVI procedure, left femoral venous access was used in 42% of cases when compared with 8% in the remaining population (P = 0.003). CONCLUSIONS: A left femoral venous access for Micra TPS implantation is safe and effective with an excellent implantation success rate similar to a conventional right femoral venous access without longer implantation and fluoroscopy times. The most frequent reason for choosing left vs. right femoral venous access was a previous transfemoral TAVI procedure.
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Marcapaso Artificial , Estimulación Cardíaca Artificial , Remoción de Dispositivos , Humanos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: The safety and efficacy of the leadless pacemaker (LP) have been confirmed in previous reports, yet studies on LPs in superelderly patients are limited. METHODS AND RESULTS: A total of 62 patients aged over 85 years old were implanted with single-chamber pacemakers due to symptomatic bradyarrhythmia at Sakakibara Heart Institute from May 2014 through July 2019. We divided them into two groups, a transvenous (TV) single-chamber pacemaker group (35 patients) and an LP group (27 patients), and compared the groups. Mean participant age was 90.3 ± 3.8 y.o., 41.9% were male, and mean participant body mass index (BMI) was 21.3 kg/m2 . The LP group contained a significantly larger proportion of patients with dementia than the TV group did (63% vs. 37.1%, P = .04). The complication-free rate tended to be lower in the LP group in spite of the higher frequency of dementia (88.6% vs. 92.6%, P = .68). At implantation, the pacing threshold was significantly higher in the LP group than in the TV group (1.30 ± 0.91 V vs. 0.71 ± 0.23 V, P < .01), but over the first 3 months after the operation the pacing threshold in the LP group gradually improved (0.82 ± 0.2 V vs. 1.05 ± 1.02 V, P = .16). The procedure time and time from operation to discharge were also shorter in the LP group. CONCLUSIONS: LP implantation appears to be safe and is accordingly becoming the cornerstone for Japanese superelderly patients indicated for single-chamber pacemakers, even for those with small bodies and dementia. However, careful procedures and long follow-ups are needed until a greater volume of data is reported.
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Bradicardia/terapia , Marcapaso Artificial , Factores de Edad , Anciano de 80 o más Años , Diseño de Equipo , Estudios de Factibilidad , Femenino , Humanos , Masculino , Implantación de Prótesis/métodos , Estudios RetrospectivosRESUMEN
Over half of century, sanitary landfill was and is still the most economical treatment strategy for solid waste disposal, but the environmental risks associated with the leachate have brought attention of scientists for its proper treatment to avoid surface and ground water deterioration. Most of the treatment technologies are energy-negative and cost intensive processes, which are unable to meet current environmental regulations. There are continuous demands of alternatives concomitant with positive energy and high effluent quality. Microbial fuel cells (MFCs) were launched in the last two decades as a potential treatment technology with bioelectricity generation accompanied with simultaneous carbon and nutrient removal. This study reviews capability and mechanisms of carbon, nitrogen and phosphorous removal from landfill leachate through MFC technology, as well as summarizes and discusses the recent advances of standalone and hybrid MFCs performances in landfill leachate (LFL) treatment. Recent improvements and synergetic effect of hybrid MFC technology upon the increasing of power densities, organic and nutrient removal, and future challenges were discussed in details.
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Fuentes de Energía Bioeléctrica , Eliminación de Residuos , Contaminantes Químicos del Agua , Nitrógeno , Instalaciones de Eliminación de ResiduosRESUMEN
BACKGROUND: Leadless pacemakers (LPMs) have been shown to have lower postoperative complications than traditional permanent pacemakers but there have been no studies on the outcomes of LPMs in patients with transcatheter heart valve replacements (THVRs). This study determined outcomes of LPMs compared to transvenous single-chamber pacemakers (SCPs) post-THVR. METHODS: This is a retrospective single-center study including 10 patients who received LPMs post-THVR between February 2017 and August 2018 and a comparison group of 23 patients who received SCP post-THVR between July 2008 and August 2018. LPM or SCP was implanted at the discretion of electrophysiologists for atrial fibrillation with slow ventricular response or sinus node dysfunction with need for single-chamber pacing only. RESULTS: LPMs were associated with decreased tricuspid regurgitation (P = 0.04) and decreased blood loss during implantation (7.5 ± 2.5 cc for LPMs vs 16.8 ± 3.2 cc for SCPs, P = 0.03). Five LPM patients had devices positioned in the right ventricular septum as seen on transthoracic echocardiogram. Frequency of ventricular pacing was similar between LPM and SCP groups. In the LPM group, one case was complicated by a pseudoaneurysm and one death was due to noncardiac causes. There was one pneumothorax and one pocket infection in the SCP group. CONCLUSIONS: In this small retrospective study, LPMs were feasible post-THVR and found to perform as well as SCPs, had less intraprocedural blood loss, and were associated with less tricuspid regurgitation. Further, larger studies are required to follow longer-term outcomes and complications.
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Estimulación Cardíaca Artificial/métodos , Procedimientos Quirúrgicos Cardíacos , Marcapaso Artificial , Complicaciones Posoperatorias/prevención & control , Reemplazo de la Válvula Aórtica Transcatéter , Insuficiencia de la Válvula Tricúspide/prevención & control , Anciano de 80 o más Años , Ecocardiografía , Femenino , Humanos , Masculino , Diseño de Prótesis , Estudios RetrospectivosRESUMEN
We evaluated the efficiency of an air purifier using the single-chamber method for the effective removal of airborne Staphylococcus epidermidis, a nosocomial infection-causing bacterium. In this experiment, the bacterial strain S. epidermidis was injected using a nebulizer into the test chamber, which was similar to a consumer living space (60 m3). The microbial sampling was conducted via the air sampler method, and the reduction in S. epidermidis growth was monitored by performing three consecutive tests. Initially, a blank test was conducted to determine the natural decay rate and calibrate the experimental setup. After injecting the bacterial strain from 1240 to 11180 CFU per unit volume (m3), the natural decay rate showed a maximum deviation of 3.1% with a sampling error of 1.1% p at a confidence level of 95%. In addition, the particle size distribution in the test chamber was found to range from 0.3 to 5.0 µm, and a subsequent decrease in large-sized particles was observed with the operation of the air purifier, which is the size similar to that of suspended airborne bacteria. This can be used to assess the performance of the air purifier by calibrating the natural reduction value to the reduced operation value. Thus, the single-chamber technique is a promising approach for analyzing the removal efficacy of airborne bacteria from indoor air.
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Filtros de Aire/normas , Microbiología del Aire , Staphylococcus epidermidis/aislamiento & purificación , Monitoreo del Ambiente , Tamaño de la PartículaRESUMEN
Leadless self-contained intracardiac pacemakers were developed with the aim of abolishing the short- and long-term risk of lead- and pocket-related complications associated with transvenous devices. Leadless pacemakers promise minimally invasive procedures, long battery lives, and small amounts of foreign materials in the body. Experiences with the pioneering single-chamber devices have provided reasons for optimism about the future of the leadless concept. In the future, as more patients receive and live longer with implantable devices, the total risk of procedure- and lead-related complications is expected to increase, adding a sense of urgency to the need for leadless alternatives to transvenous pacemakers. This review surveys the performance of currently available leadless pacemakers as well as emerging new innovative adaptations and applications of the leadless concept.
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Arritmias Cardíacas , Estimulación Cardíaca Artificial , Marcapaso Artificial , Arritmias Cardíacas/terapia , Diseño de Equipo , Cuerpos Extraños , HumanosRESUMEN
Although pacemakers and implantable defibrillators have become the standard treatment of bradycardic and tachycardic arrhythmias, long-term complications caused by the transvenously inserted pacing and defibrillation leads, such as electrode fracture, lead infection and tricuspid valve insufficiency are not uncommonly observed. Therefore, leadless pacemakers and purely subcutaneously implantable cardioverter defibrillators (S-ICDs) have been developed in recent years, which are implanted without transvenous electrodes with the aim to reduce long-term complications with these devices; however, currently available leadless pacemakers are limited to single chamber stimulation and SICDs are limited to pure defibrillation without antibradycardic, antitachycardic pacing or cardiac resynchronization capabilities. Thus, these devices cannot yet be used as multichamber pacemakers or defibrillators even though in these circumstances a higher complication rate is to be expected due to the multiple number of transvenous leads. This article summarizes the current state of knowledge on leadless pacemakers and ICDs, discusses the limitations of these devices and provides an outlook into their future development.
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Estimulación Cardíaca Artificial , Terapia de Resincronización Cardíaca/métodos , Desfibriladores Implantables , Marcapaso Artificial , Arritmias Cardíacas/terapia , Diseño de Equipo , Humanos , TaquicardiaRESUMEN
To investigate the effect of air-exposed biocathode (AEB) on the performance of single-chamber microbial fuel cell (SCMFC), wastewater quality, bioelectrochemical characteristics and the electrode biofilms were researched. It was demonstrated that exposing the biocathode to air was beneficial to nitrogen removal and current generation. In Test 1 of 95% AEB, removal rates of ammonia, total nitrogen (TN) and chemical oxygen demand (COD) reached 99.34%±0.11%, 99.34%±0.10% and 90.79%±0.12%, respectively. The nitrogen removal loading rates were 36.38gN/m3/day. Meanwhile, current density and power density obtained at 0.7A/m3 and 104mW/m3 respectively. Further experiments on open-circuit (Test 2) and carbon source (Test 3) indicated that this high performance could be attributed to simultaneous biological nitrification/denitrification and aerobic denitrification, as well as bioelectrochemical denitrification. Results of community analysis demonstrated that both microbial community structures on the surface of the cathode and in the liquid of the chamber were different. The percentage of Thauera, identified as denitrifying bacteria, maintained at a high level of over 50% in water, but decreased gradually in the AEB. Moreover, the genus Nitrosomonas, Alishewanella, Arcobacter and Rheinheimera were significantly enriched in the AEB, which might contribute to both enhancement of nitrogen removal and electricity generation.
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Fuentes de Energía Bioeléctrica , Thauera , Amoníaco/análisis , Biopelículas , Reactores Biológicos , Desnitrificación , Electricidad , Electrodos , Nitrificación , Nitrógeno/análisisRESUMEN
AIMS: Implantable cardioverter defibrillators (ICDs) are an effective primary prevention of sudden cardiac death. We examined whether dual-chamber (DC) ICDs confer a greater benefit than single-chamber (SC) ICDs, and compared the long-term outcomes of recipients of each type of device implanted for primary prevention. METHODS AND RESULTS: Between 2002 and 2012, the DAI-PP registry consecutively enrolled 1258 SC- and 1280 DC-ICD recipients at 12 French medical centres. The devices were interrogated at 4- to 6-month intervals during outpatient visits, with a focus on the therapies delivered. The study endpoints were incidence of appropriate therapies, ICD-related morbidity, and deaths from all and from specific causes. The mean age of the SC- and DC-ICD recipients was 59 ± 12 and 62 ± 11 years, respectively (P< 0.0001). The distribution of genders, New York Heart Association functional classes and glomerular filtration rates, and the rates of ischaemic vs. dilated cardiomyopathies and of defibrillation tests at implant, were similar in both study groups. The rates of periprocedural complications were 12.1% in the DC- vs. 8.8% in the SC-ICD groups (P= 0.008). Over a mean follow-up of 3.1 ± 2.2 years, pulse generators were replaced in 21.9% of the DC- vs. 13.6% of the SC-ICD group (P< 0.0001). The proportions of patients treated with ≥1 appropriate therapies (24.7 vs. 23.8%) and ≥1 inappropriate shocks (8.4 vs. 7.8%), and all-cause mortality (12.4 vs. 13.2%) were similar in both groups. CONCLUSION: In this large registry of ICD implanted for primary prevention, DC-ICDs were associated with higher rates of peri-implant complications and generator replacements, whereas the survival and rates of inappropriate shocks were similar in both groups. CLINICAL TRIAL NUMBER: NCT#01992458.
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Arritmias Cardíacas/terapia , Muerte Súbita Cardíaca/prevención & control , Desfibriladores Implantables , Cardioversión Eléctrica/instrumentación , Prevención Primaria/instrumentación , Anciano , Arritmias Cardíacas/complicaciones , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/mortalidad , Causas de Muerte , Muerte Súbita Cardíaca/etiología , Cardioversión Eléctrica/efectos adversos , Cardioversión Eléctrica/mortalidad , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare the clinical outcomes of a single- versus dual-chamber ICD for primary prevention of sudden cardiac death in a large, national ICD registry. METHODS: Data were collected from the prospective Israeli ICD Registry. Baseline characteristics and clinical outcomes including mortality, admissions for heart failure (HF), and ICD therapy were compared between the two groups. RESULTS: A total of 1,125 subjects, 37% with a single-chamber and 63% with a dual-chamber ICD, constructed the baseline cohort. Approximately 80% had ischemic heart disease (IHD). Mean follow-up was 22 months, mean ejection fraction was 30%, and mean QRS width was 103 milliseconds in both groups. During follow-up, there were no significant differences in the rate of mortality, admissions for HF, appropriate or inappropriate therapy, or in time to any of the clinical outcomes. Using multivariate analysis, single-chamber ICD was not associated with increased risk of death or admission for HF. In a subgroup of patients with IHD, single-chamber ICD was associated with a higher rate of inappropriate therapy. CONCLUSIONS: In this large retrospective population-based cohort, dual-chamber ICD showed no benefit in reducing the incidence of death or HF admissions, whereas in a subgroup of patients with IHD, single-chamber ICD was associated with increased inappropriate therapy. Further prospective studies are necessary to assess the benefit of dual-chamber ICD in reducing the rate of inappropriate therapy.
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Arritmias Cardíacas/terapia , Muerte Súbita Cardíaca/prevención & control , Desfibriladores Implantables , Cardioversión Eléctrica/instrumentación , Prevención Primaria/instrumentación , Anciano , Arritmias Cardíacas/complicaciones , Arritmias Cardíacas/mortalidad , Muerte Súbita Cardíaca/etiología , Cardioversión Eléctrica/efectos adversos , Cardioversión Eléctrica/mortalidad , Femenino , Insuficiencia Cardíaca/etiología , Humanos , Israel , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Modelos de Riesgos Proporcionales , Diseño de Prótesis , Falla de Prótesis , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Patients with implantable cardioverter defibrillators (ICDs) often have a history of atrial fibrillation (AF) or will develop AF after device implant. Optimal management of ICD patients includes early diagnosis of AF and monitoring of AF burden. We evaluated the performance of an algorithm for monitoring AF in single-chamber ICDs. METHODS: The RR interval variability-based detection algorithm determines RR variability by creating a Lorenz plot of the change in RR intervals for the most recent interval pair versus the previous interval pair. A new plot is created every 2 minutes and the AF evidence score of the plot is computed. Patient RR interval data from several Holter databases were pooled to test the performance of the AF detection algorithm. RESULTS: In total, 187 recordings from 186 patients were used to assess the performance of the AF detection algorithm integrated into a single-chamber ICD by comparing the ICD detection results to the Holter annotated truth. Thirty-five of 186 patients had a total of 94 AF episodes in their Holter recordings lasting a total of 250.5 hours (mean episode duration 7.2 hours). The generalized estimating equations-adjusted estimate of episode sensitivity was 94.8% with 95% lower confidence limit of 87.2%. Gross duration sensitivity was 95.0% for AF episodes of at least 6 minutes duration with gross duration specificity of 99.6%. CONCLUSION: This RR interval-based AF detection algorithm performs well with high sensitivity and specificity. Integration of this algorithm into single-chamber ICDs will help monitor and detect AF, thus facilitating optimal therapy to prevent AF-related sequelae.
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Fibrilación Atrial/diagnóstico , Desfibriladores Implantables , Algoritmos , Electrocardiografía Ambulatoria , Humanos , Monitorización Neurofisiológica , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Dual chamber implantable cardioverter defibrillators (ICDs) are considered to have better clinical outcomes than single chamber ICDs, however, an individual trial may not have sufficient power to prove it. This meta-analysis aimed to compare clinical outcomes of dual chamber ICDs (DC-ICDs) with single chamber ICDs (SC-ICDs) in secondary sudden cardiac death (SCD) prevention. METHODS: We searched Medline, the Cochrane Library, and other internet sources, without language or date restrictions for articles comparing clinical outcomes between DC-ICDs and SC-ICDs. Studies were selected for inclusion based on the following criteria: Randomised controlled trial.; Controlled design was used to compare SC-ICDs and DC-ICDs; Retrospective study if the survival analysis was performed. Efficacy endpoints were mortality, appropriate therapy, inappropriate detection of SVT, inappropriate therapy. Safety endpoints were lead-related complication and all complications. Relative risk (RR) or odds ratios (ORs) with 95% confidence intervals (CI) were calculated, and a χ2-based test of homogeneity was performed. RESULTS: We identified nine trials (n=2594) with a weighted mean follow-up of 18.9 months. Compared with DC-ICDs, SC-ICDs were associated with a significant reduction in lead complications (RR:3.30; 95% CI: 1.17-9.30; p=0.02). However, both groups had similar rates of mortality (OR: 0.91; 95%CI: 0.91-1.51; p=0.73), appropriate therapy (RR: 0.90; 95%CI: 0.73-1.11; p=0.32), inappropriate detection of SVT (RR: 1.82; 95%CI: 0.71-4.62; p=0.21), inappropriate therapy (RR: 2.08; 95%CI: -0.22-0.19; p=0.86) and all complications (OR: 1.27; 95%CI: 0.19-8.67; p=0.81). CONCLUSIONS: Besides more lead-related complications, DC-ICDs had similar efficacy and all complications as SC-ICDs in secondary sudden cardiac death prevention.
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Muerte Súbita Cardíaca/etiología , Desfibriladores Implantables/efectos adversos , Muerte Súbita Cardíaca/prevención & control , Femenino , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Roughly one in six patients receiving conventional transvenous pacemaker systems experience significant complications within 1 year of implant, mainly due to the transvenous lead and subcutaneous pocket. A new helix-fixation single-chamber ventricular leadless pacemaker (LP) system capable of pre-deployment exploratory electrical mapping is commercially available. Such an LP may mitigate complications while streamlining the implantation. In this study, the initial real-world implant experience of the helix-fixation LP was evaluated following its commercial release. METHODS: In patients indicated for single-chamber right ventricular pacing, helix-fixation Aveir VR LPs (Abbott, Abbott Park, IL) were implanted using the dedicated loading tool, introducer, and delivery catheter. Implant procedural characteristics, electrical parameters, and any 30-day procedure-related adverse events of consecutive implant attempts were retrospectively evaluated. RESULTS: A total of 167 patients with Class I indication for permanent pacing received implants in four North American centers (57% male, 70 years old). Pre-fixation electrical mapping of potential sites allowed repositioning to be avoided in 95.7% of patients. Median [interquartile range] LP procedure and fluoroscopy durations were 25.5 min [20.0, 35.0] and 5.7 min [4.0, 9.2], respectively. Pacing capture threshold, sensed R-wave amplitude, and impedance were 0.8 V [0.5, 1.3], 9.0 mV [6.0, 12.0], and 705 Ω [550, 910], respectively. Implantation was successful in 98.8% of patients, with 98.2% free from acute adverse events. CONCLUSIONS: The initial, real-world experience of the helix-fixation ventricular leadless pacemaker demonstrated safe and efficient implantation with minimal repositioning, viable electrical metrics, and limited acute complications.
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In this study, a directional electrode separator (DES) was designed and incorporated into a single-chamber bioelectrochemical system (BES) to reduce migration and reoxidation of hydrogen. This issue arises when H2, generated at the cathode, travels to the anode where anodic biofilms use H2. To test the feasibility of our design, a 3D-printed BES reactor equipped with a DES was inoculated with anaerobic digestor granules and operated under fed-batch conditions using fermented corn stover effluent. The DES equipped reactor achieved significantly higher current densities (â¼53â¯A/m²) compared to a conventional single-chamber BES without a separator (â¼16â¯A/m²), showing a 3.3 times improvement. Control abiotic electrochemical experiments revealed that the DES exhibited significantly higher proton conductivity (456±127 µS/mm) compared to a proton exchange membrane (67±21 µS/mm) with a statistical significance of P=0.03. The DES also effectively reduced H2 migration to the anode by 21-fold relative to the control. Overall, incorporating a DES in a single-chamber BES enhanced anodic current density by reducing H2 migration to the anode.
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The present study delves into phototrophic cyanobacterial biomass production by concomitant CO2 sequestration, selecting an effective pretreatment condition followed by using this as feedstock for green fuel or bioelectricity production by Microbial Fuel Cells (MFC). The performance of the various photobioreactors were put up against Anabaena sp. PCC 7120 biomass production. Maximum microalgal biomass of 1.15 gL-1 was attained in an airlift bioreactor for 9 days under a light intensity of 100 µEm-2s-1. Pretreatment methods like sonication, HCl acid, and H2O2 treatment (2 % vv-1) were applied to digest harvested biomass. Higher power output (6.76 Wm-3) was attained, and 73.5 % COD was eliminated using 2 % (vv-1) acid pre-treated biomass. Better results were obtained using acid pre-treated biomass because the conductivity of the anolyte increased with the neutralization of acid-pre-treated biomass. The results demonstrate that cyanobacterial biomass could be employed successfully as a renewable resource for green fuel generation in MFCs.