Is it safe to remove an infected cardiac implantable electronic device at the time of heart transplantation? Report of two cases.

Cardiac implantable electronic device (CIED) infections are treated with antibiotics and device explantation. Lack of CIED removal is associated with infection recurrence. However, CIED removal can be associated with major complications including death. We reported two patients with advanced heart disease who developed CIED infection due Staphylococcus epidermidis while awaiting for orthotopic heart transplantation (OHT). Both patients were managed with a different approach. They were treated with antibiotic therapy and had their CIED removal postponed until OHT. Both patients were kept on suppressive antibiotic treatment until undergoing simultaneous OHT and removal of infected CIED. None of the patients had infection recurrence. Large studies are needed to assess whether the approach of delaying CIED removal until OHT is safe among carefully selected patients with CIED infection.

Depression and anxiety predict decline in physical health functioning in patients with heart failure.

BACKGROUND: Few studies have examined the prospective influences of depression and anxiety on physical health functioning in heart failure (HF) patients. Prior studies were also limited by employing psychological measures containing somatic items confounded with HF symptoms. PURPOSE: This study examined whether depression, anxiety, social support, and their changes predicted the decline of physical functioning in HF patients over 6 months. METHODS: Participants were 238 HF patients among whom 164 provided follow-up data. The depression and anxiety measures did not contain somatic items. RESULTS: After controlling for baseline physical functioning and demographic and medical covariates, baseline depression and its increase, as well as baseline anxiety and its increase, independently predicted greater decline in physical functioning at 6 months. Social support and its change were not associated with either concurrent or follow-up physical functioning. CONCLUSIONS: Depression, anxiety, and their changes independently predicted the decline of physical health functioning over 6 months.

Digitized electrocardiograms recorded with bipolar right-infraclavicular leads compared to electrocardiograms recorded with unipolar chest V leads and bipolar lead II.

This article presents a method for the evaluation of cardiac depolarizations in a relatively short time with a minimum number of electrodes. With the negative electrode attached to the right infraclavicular region, voltage variations on the chest surface exhibit larger excursions than do the usual unipolar leads. Peak voltages of the PQRST waveforms measured on 12 normal patients by both methods were similar in polarity but were statistically significantly higher in the right infraclavicular leads. Data are presented on 21 normal patients, which show that digitized signals allow for an expanded time-scale leading to higher resolution of rate of change and onset and offset times. The digitized signals also more clearly define notches that distort the QRS complex. In 55 cardiac patients, the 12-lead unipolar electrocardiograms were visually compared to digitized electrocardiograms recorded by using the bipolar right infraclavicular leads. The authors suggest that RIC leads would be most useful in the design of a pocket-sized digitizing bipolar-lead electrocardiograph.