Aneurysmal subarachnoid haemorrhage: Volumetric quantification of the blood distribution pattern to accurately predict the ruptured aneurysm location.

BACKGROUND: In spontaneous subarachnoid haemorrhage (SAH) accurate determination of the bleeding source is paramount to guide treatment. Traditionally, the bleeding pattern has been used to predict the aneurysm location. Here, we have tested a software-based tool, which quantifies the volume of intracranial blood and stratifies it according to the regional distribution, to predict the location of the ruptured aneurysm. METHODS: A consecutive series of SAH patients admitted to a single tertiary centre between 2012-2018, within 72 h of onset, harbouring a single intracranial aneurysm. A semi-automatized method of blood quantification, based on the relative density increase, was applied to initial non-contrast CTs. Five regions were used to define the bleeding patterns and to correlate them with aneurysm location: perimesencephalic, interhemispheric, right/left hemisphere and intraventricular. RESULTS: 68 patients were included for analysis. There was a strong association between the distribution of blood and the aneurysm location (p < 0.001). In particular: ACom and interhemispheric fissure (p < 0.001), MCA and ipsilateral hemisphere (p < 0.001), ICA and ipsilateral hemisphere and perimesencephalic cisterns (p < 0.001), PCom and hemispheric, perimesencephalic and intraventricular (p = 0.019), and PICA and perimesencephalic and intraventricular (p < 0.001). The internal diagnostic value was high (AUROC ≥ 0.900) for these locations. CONCLUSION: Regional automatised volumetry seems a reliable and objective tool to quantify and describe the distribution of blood within the subarachnoid spaces. This tool accurately predicts the location of the ruptured aneurysm; its use may be prospectively considered in the emergency setting when speed and simplicity are attained.

16 Years (2006-2021) of Surface Ozone Measurements in Córdoba (Southern Spain): Trends and the Impact of the COVID-19 Lockdown.

Surface ozone concentrations (O3) during the period 2006-2021 are analysed at Córdoba city (southern Iberian Peninsula) in suburban and urban sampling sites. The aims are to present the levels and temporal variations, to explore trends and to quantity the variation in O3 concentrations in the context of the COVID-19 lockdown. The O3 means are higher in the suburban station (62 µg m-3 and 51.3 µg m-3), being the information level threshold only exceeded twice during this period. The daily evolution shows a maximum at about 17:00 UTC, whereas the minimum is reached at about 9:00 UTC, with higher levels in the suburban station. The seasonal evolution of this daily cycle also presents monthly differences in shape and intensity between stations. The trends are analysed by means of daily averages and daily 5th and 95th percentiles, and they show a similar increase in all of these parameters, with special emphasis on the daily P95 concentrations, with 0.27 µg m-3 year-1 and 0.24 µg m-3 year-1. Finally, the impact of the COVID-19 lockdown shows a decline in O3 concentrations over 10%.

Covalent Organic Framework Nanoplates Enable Solution-Processed Crystalline Nanofilms for Photoelectrochemical Hydrogen Evolution.

As covalent organic frameworks (COFs) are coming of age, the lack of effective approaches to achieve crystalline and centimeter-scale-homogeneous COF films remains a significant bottleneck toward advancing the application of COFs in optoelectronic devices. Here, we present the synthesis of colloidal COF nanoplates, with lateral sizes of ∼200 nm and average heights of 35 nm, and their utilization as photocathodes for solar hydrogen evolution. The resulting COF nanoplate colloid exhibits a unimodal particle-size distribution and an exceptional colloidal stability without showing agglomeration after storage for 10 months and enables smooth, homogeneous, and thickness-tunable COF nanofilms via spin coating. Photoelectrodes comprising COF nanofilms were fabricated for photoelectrochemical (PEC) solar-to-hydrogen conversion. By rationally designing multicomponent photoelectrode architectures including a polymer donor/COF heterojunction and a hole-transport layer, charge recombination in COFs is mitigated, resulting in a significantly increased photocurrent density and an extremely positive onset potential for PEC hydrogen evolution (over +1 V against the reversible hydrogen electrode), among the best of classical semiconductor-based photocathodes. This work thus paves the way toward fabricating solution-processed large-scale COF nanofilms and heterojunction architectures and their use in solar-energy-conversion devices.

Photomemristive sensing via charge storage in 2D carbon nitrides.

Photomemristive sensors have the potential to innovate current photo-electrochemical sensors by incorporating new sensing capabilities including non-invasive, wireless and time-delayed (memory) readout. Here we report the charge storing 2D carbon nitride potassium poly(heptazine imide), K-PHI, as a direct photomemristive sensing platform by capitalizing on K-PHI's visible light bandgap, large oxidation potential, and intrinsic optoionic charge storage properties. Utilizing the light-induced charge storage function of K-PHI nanosheets, we demonstrate memory sensing via charge accumulation and present potentiometric, impedimetric and coulometric readouts to write/erase this information from the material, with no additional reagents required. Additionally, wireless colorimetric and fluorometric detection of the charging state of K-PHI nanoparticles is demonstrated, enabling the material's use as particle-based autonomous sensing probe in situ. The various readout options of K-PHI's response enable us to adapt the sensitivities and dynamic ranges without modifying the sensing platform, which is demonstrated using glucose as a model analyte over a wide range of concentrations (50 µM to 50 mM). Since K-PHI is earth abundant, biocompatible, chemically robust and responsive to visible light, we anticipate that the photomemristive sensing platform presented herein opens up memristive and neuromorphic functions.

Applying reflective multicriteria decision analysis to understand the value of therapeutic alternatives in the management of gestational and peripartum anaemia in Spain.

BACKGROUND: The objective of the FeminFER project was to assess the value of ferric carboxymaltose following a multicriteria decision analysis in obstetrics and gynaecology in Spain. METHODS: Ferric carboxymaltose (FCM) and ferrous sulphate were evaluated using the EVIDEM framework. Ten stakeholders participated to collect different perspectives. The framework was adapted considering evidence retrieved with a PICO-S search strategy and grey literature. Criteria/subcriteria were weighted by level of relevance and an evidence-based decision-making exercise was developed in each criterion; weights and scores were combined to obtain the value of intervention relative to each criterion/subcriterion, that were further combined into the Modulated Relative Benefit-Risk Balance (MRBRB). RESULTS: The most important criterion favouring FCM was Compared Efficacy/Effectiveness (0.183 ± 0.07), followed by Patient Preferences (0.059 ± 0.10). Only Direct medical costs criterion favoured FS (-0.003 ± 0.03). MRBRB favoured FCM; 0.45 ± 0.19; in a scale from -1 to + 1. CONCLUSIONS: In conclusion, considering the several criteria involved in the decision-making process, participants agreed with the use of FCM according to its MRBRB.

Conductivity Mechanism in Ionic 2D Carbon Nitrides: From Hydrated Ion Motion to Enhanced Photocatalysis.

Carbon nitrides are among the most studied materials for photocatalysis; however, limitations arise from inefficient charge separation and transport within the material. Here, this aspect is addressed in the 2D carbon nitride poly(heptazine imide) (PHI) by investigating the influence of various counterions, such as M = Li+ , Na+ , K+ , Cs+ , Ba2+ , NH4 + , and tetramethyl ammonium, on the material's conductivity and photocatalytic activity. These ions in the PHI pores affect the stacking of the 2D layers, which further influences the predominantly ionic conductivity in M-PHI. Na-containing PHI outperforms the other M-PHIs in various relative humidity (RH) environments (0-42%RH) in terms of conductivity, likely due to pore-channel geometry and size of the (hydrated) ion. With increasing RH, the ionic conductivity increases by 4-5 orders of magnitude (for Na-PHI up to 10-5 S cm-1 at 42%RH). At the same time, the highest photocatalytic hydrogen evolution rate is observed for Na-PHI, which is mirrored by increased photogenerated charge-carrier lifetimes, pointing to efficient charge-carrier stabilization by, e.g., mobile ions. These results indicate that also ionic conductivity is an important parameter that can influence the photocatalytic activity. Besides, RH-dependent ionic conductivity is of high interest for separators, membranes, or sensors.

Transfer of 1D Photonic Crystals via Spatially Resolved Hydrophobization.

1D photonic crystals (1DPCs) are well known from a variety of applications ranging from medical diagnostics to optical fibers and optoelectronics. However, large-scale application is still limited due to complex fabrication processes and bottlenecks in transferring 1DPCs to arbitrary substrates and pattern creation. These challenges were addressed by demonstrating the transfer of millimeter- to centimeter-scale 1DPC sensors comprised of alternating layers of H3 Sb3 P2 O14 nanosheets and TiO2 nanoparticles based on a non-invasive chemical approach. By depositing the 1DPC on a sacrificial layer of lithium tin sulfide nanosheets and hydrophobizing only the 1DPC by intercalation of n-octylamine via the vapor phase the 1DPC can be detached from the substrate by immersing the sample in water. Upon exfoliation of the hydrophilic sacrificial layer, the freestanding 1DPC remains at the water-air interface. In a second step, it can be transferred to arbitrary surfaces such as curved glass. In addition, the transfer of patterned 1DPCs is demonstrated by combining the sacrificial layer approach with area-resolved intercalation and etching. The fact that the sensing capability of the 1DPC is not impaired and can be modified after transfer renders this method a generic platform for the fabrication of photonic devices.

Relaxed Current Matching Requirements in Highly Luminescent Perovskite Tandem Solar Cells and Their Fundamental Efficiency Limits.

Perovskite-based tandem solar cells are of increasing interest as they approach commercialization. Here we use experimental parameters from optical spectroscopy measurements to calculate the limiting efficiency of perovskite-silicon and all-perovskite two-terminal tandems, employing currently available bandgap materials, as 42.0% and 40.8%, respectively. We show luminescence coupling between subcells (the optical transfer of photons from the high-bandgap to low-bandgap subcell) relaxes current matching when the high-bandgap subcell is a luminescent perovskite. We calculate that luminescence coupling becomes important at charge trapping rates (≤106 s-1) already being achieved in relevant halide perovskites. Luminescence coupling increases flexibility in subcell thicknesses and tolerance to different spectral conditions. For maximal benefit, the high-bandgap subcell should have the higher short-circuit current under average spectral conditions. This can be achieved by reducing the bandgap of the high-bandgap subcell, allowing wider, unstable bandgap compositions to be avoided. Lastly, we visualize luminescence coupling in an all-perovskite tandem through cross-section luminescence imaging.

Complementary effectiveness of carotid sinus massage and tilt testing for the diagnosis of reflex syncope in patients older than 40 years: a cohort study.

AIMS: Indications, methodology, and diagnostic criteria for carotid sinus massage (CSM) and tilt testing (TT) have been standardized by the 2018 Guidelines on Syncope of the European Society of Cardiology. Aim of this study was to assess their effectiveness in a large cohort which reflects the performance under 'real-world' conditions. METHODS AND RESULTS: We analysed all patients who had undergone CSM and TT in the years 2003-2019 for suspected reflex syncope. Carotid sinus massage was performed according to the 'Method of Symptoms'. Tilt testing was performed according to the 'Italian protocol' which consists of a passive phase followed by a sublingual nitroglycerine phase. For both tests, positive test was defined as reproduction of spontaneous symptoms in the presence of bradycardia and/or hypotension. Among 3293 patients (mean age 73 ± 12 years, 48% males), 2019 (61%) had at least one test positive. A bradycardic phenotype was found in 420 patients (13%); of these, 60% were identified by CSM, 37% by TT, and 3% had both test positive. A hypotensive phenotype was found in 1733 patients (53%); of these, 98% were identified by TT and 2% had both TT and CSM positive. CONCLUSION: The overall diagnostic yield of the tests in patients >40-year-old with suspected reflex syncope was 61%. Both CSM and TT are useful for identifying those patients with a bradycardic phenotype, whereas CSM has a limited value for identifying the hypotensive phenotype. Since the overlap of responses between tests is minimal, both CSM and TT should be performed in every patient over 40 years receiving investigation for unexplained but possible reflex syncope.

Carbon nitride-based light-driven microswimmers with intrinsic photocharging ability.

Controlling autonomous propulsion of microswimmers is essential for targeted drug delivery and applications of micro/nanomachines in environmental remediation and beyond. Herein, we report two-dimensional (2D) carbon nitride-based Janus particles as highly efficient, light-driven microswimmers in aqueous media. Due to the superior photocatalytic properties of poly(heptazine imide) (PHI), the microswimmers are activated by both visible and ultraviolet (UV) light in conjunction with different capping materials (Au, Pt, and SiO2) and fuels (H2O2 and alcohols). Assisted by photoelectrochemical analysis of the PHI surface photoreactions, we elucidate the dominantly diffusiophoretic propulsion mechanism and establish the oxygen reduction reaction (ORR) as the major surface reaction in ambient conditions on metal-capped PHI and even with TiO2-based systems, rather than the hydrogen evolution reaction (HER), which is generally invoked as the source of propulsion under ambient conditions with alcohols as fuels. Making use of the intrinsic solar energy storage ability of PHI, we establish the concept of photocapacitive Janus microswimmers that can be charged by solar energy, thus enabling persistent light-induced propulsion even in the absence of illumination-a process we call "solar battery swimming"-lasting half an hour and possibly beyond. We anticipate that this propulsion scheme significantly extends the capabilities in targeted cargo/drug delivery, environmental remediation, and other potential applications of micro/nanomachines, where the use of versatile earth-abundant materials is a key prerequisite.

Toward Standardized Photocatalytic Oxygen Evolution Rates Using RuO2@TiO2 as a Benchmark.

Quantitative comparison of photocatalytic performances across different photocatalysis setups is technically challenging. Here, we combine the concepts of relative and optimal photonic efficiencies to normalize activities with an internal benchmark material, RuO2 photodeposited on a P25-TiO2 photocatalyst, which was optimized for reproducibility of the oxygen evolution reaction (OER). Additionally, a general set of good practices was identified to ensure reliable quantification of photocatalytic OER, including photoreactor design, photocatalyst dispersion, and control of parasitic reactions caused by the sacrificial electron acceptor. Moreover, a method combining optical modeling and measurements was proposed to quantify the benchmark absorbed and scattered light (7.6% and 81.2%, respectively, of λ = 300-500 nm incident photons), rather than just incident light (≈AM 1.5G), to estimate its internal quantum efficiency (16%). We advocate the adoption of the instrumental and theoretical framework provided here to facilitate material standardization and comparison in the field of artificial photosynthesis.

Reproducibility of carotid sinus massage.

AIMS: The reproducibility of carotid sinus massage (CSM) is debated. The aim of this study was to assess the reproducibility according to the methodology and diagnostic criteria defined by the guidelines on syncope of the European Society of Cardiology. METHOD: Among 2800 patients with syncope who underwent CSM in the years 2005-2019, 109 patients (62 males; mean age 76 ± 10 years) had performed a second CSM after a median of 28 months. Carotid sinus hypersensitivity (CSH) was diagnosed when CSM elicited a pause of >3 s and/or a fall in systolic blood pressure >50 mm Hg without reproduction of spontaneous symptoms. Carotid sinus syndrome (CSS) was established when spontaneous symptoms were reproduced in the presence of bradycardia and/or hypotension. RESULTS: The reproducibility of CSM was 78% for 18 CSS patients, 41% for 29 CSH patients, and 77% for 62 negative patients. The corresponding interrater agreement was good for CSS (kappa = 0.66), moderate for negative CSM (kappa = 0.42), and poor for CSH (kappa = 0.30). Combining CSH and negative tests, their reproducibility rose to 90% with kappa = 0.66. CONCLUSION: CSS but not CSH has a good reproducibility. About half of patients with CSH had a negative response at the second test, thus suggesting a great overlap between them.

Evaluation of the human petrotympanic fissure using anatomized cadaveric specimens and multi-detector CT imaging.

PURPOSE: The purpose of the current study is twofold. First, to investigate the variability of the petrotympanic fissure's (PTF) morphology in anatomized human cadaveric specimens using multi-detector computed tomography (MDCT), and second, to compare the resulting measurements to investigate the possibilities of applying MDCT in the determination of PTF morphology in living humans. METHODS: Specimens (n = 15) containing the temporal bone and TMJ were obtained from embalmed adult female (53.3%) and male (46.7%) cadavers and imaged using a helical 16-row scanner. Afterwards, cryosections were obtained and morphometric parameters were measured. Degree of agreement between both determinations was investigated and morphometric variables were also compared between PTF types. RESULTS: Three different types of PTF were identified. Type 1 was a wide tunnel-shaped structure. It was found in 20% of the cases. Type 2 was wide in the entrance but gradually narrows to the tympanic cavity. It was found in 46.7% of specimens. Finally, type 3, which was observed in 33.3% of the cases, was wide at the entrance of the mandibular fossa, followed by a middle region with flat-shaped tunnel structure and a narrow exit. The PTF's vertical diameters at the mandibular fossa, midpoint, and tympanic cavity and the width at the mandibular fossa all were significantly greater in type 1 specimens. CONCLUSIONS: MDCT is suitable for investigating the variable morphology of human PTF and its association with middle ear's and TMJ pathologies.

Dipole reorientation and local density of optical states influence the emission of light-emitting electrochemical cells.

Herein, we analyze the temporal evolution of the electroluminescence of light-emitting electrochemical cells (LECs), a thin-film light-emitting device, in order to maximize the luminous power radiated by these devices. A careful analysis of the spectral and angular distribution of the emission of LECs fabricated under the same experimental conditions allows describing the dynamics of the spatial region from which LECs emit, i.e. the generation zone, as bias is applied. This effect is mediated by dipole reorientation within such an emissive region and its optical environment, since its spatial drift yields a different interplay between the intrinsic emission of the emitters and the local density of optical states of the system. Our results demonstrate that engineering the optical environment in thin-film light-emitting devices is key to maximize their brightness.

Tracking Molecular Diffusion in One-Dimensional Photonic Crystals.

The intuitive use, inexpensive fabrication, and easy readout of colorimetric sensors, including photonic crystal architectures and Fabry-Pérot interference sensors, have made these devices a successful commercial case, and yet, understanding how the diffusion of analytes occurs throughout the structure is a key ingredient for designing the response of these platforms on demand. Herein, the diffusion of amines in a periodic multilayer system composed of two-dimensional nanosheets and dielectric nanoparticles is tracked by a combination of spectroscopic measurements and theoretical modelling. It is demonstrated that diffusion is controlled by the molecular size, with larger molecules showing larger layer swelling and slower diffusion times, which translates into important sensor characteristics such as signal change and saturation time. Since the approach visualizes the analyte impregnation process in a time- and spatially resolved fashion, it directly relates the macroscopic color readout into microscopic processes occurring at the molecular level, thus opening the door to rational sensor design.

Absorption enhancement in methylammonium lead iodide perovskite solar cells with embedded arrays of dielectric particles.

In the field of hybrid organic-inorganic perovskite based photovoltaics, there is a growing interest in the exploration of novel and smarter ways to improve the cells light harvesting efficiency at targeted wavelength ranges within the minimum volume possible, as well as in the development of colored and/or semitransparent devices that could pave the way both to their architectonic integration and to their use in the flowering field of tandem solar cells. The work herein presented targets these different goals by means of the theoretical optimization of the optical design of standard opaque and semitransparent perovskite solar cells. In order to do so, we focus on the effect of harmless, compatible and commercially available dielectric inclusions within the absorbing material, methylammonium lead iodide (MAPI). Following a gradual and systematic process of analysis, we are capable of identifying the appearance of collective and hybrid (both localized and extended) photonic resonances which allow to significantly improve light harvesting and thus the overall efficiency of the standard device by above 10% with respect to the reference value while keeping the semiconductor film thickness to a minimum. We believe our results will be particularly relevant in the promising field of perovskite solar cell based tandem photovoltaic devices, which has posed new challenges to the solar energy community in order to maximize the performance of semitransparent cells, but also for applications focusing on architectonic integration.

Absorption and Emission of Light in Optoelectronic Nanomaterials: The Role of the Local Optical Environment.

Tailoring the interaction of electromagnetic radiation with matter is central to the development of optoelectronic devices. This becomes particularly relevant for a new generation of devices offering the possibility of solution processing with competitive efficiencies as well as new functionalities. These devices, containing novel materials such as inorganic colloidal quantum dots or hybrid organic-inorganic lead halide perovskites, commonly demand thin (tens of nanometers) active layers in order to perform optimally and thus maximizing the way electromagnetic radiation interacts with these layers is essential. In this Perspective, we discuss the relevance of tailoring the optical environment of the active layer in an optoelectronic device and illustrate it with two real-world systems comprising photovoltaic cells and light emitting devices.

Caso clínico: embarazo ectópico cervical, presentación de un caso clínico / Clinical case: cervical ectopic pregnancy, presentation of a clinical case

RESUMEN Antecedentes: El embarazo cervical es una forma rara del embarazo ectópico y representa < 1% de todos los embarazos ectópicos. Objetivo: Se presenta el caso de un embarazo ectópico cervical. Se realiza una revisión literaria sobre las diferentes opciones de manejo y tratamiento. Caso clínico: Mujer de 32 años en la semana 7+4 de embarazo en la que se objetiva un saco gestacional ístmico vascularizado, que ofrece dudas diagnósticas. Se establece el diagnóstico de embarazo ectópico cervical y se realiza un cerclaje por metrorragia. Conclusión: El embarazo ectópico cervical sigue siendo un reto importante en el campo del embarazo. El éxito del tratamiento conservador depende principalmente del diagnóstico precoz, lo que puede reducir las posibilidades de hemorragia grave y de histerectomía.

ABSTRACT Background: Cervical pregnancy is a rare type of ectopic pregnancy and it represents <1% of all ectopic pregnancies. Objetive: The case of a cervical ectopic pregnancy is presented. A literary review is carried out on the different management and treatment options. Case report: A 32-year-old woman in week 7 + 4 of pregnancy in which is objetived a vascularized isthmic gestational sac, which ofeers diagnostic doubt. The diagnosis of ectopic cervical pregnancy is established and cercaclage is performed by metrorrhagia. Conclusion: Cervical ectopic pregnancy remains a major challenge in the field of early pregnancy. The success of conservative treatment depends primarily on early diagnosis, which may reduce the chances of severe bleeding and require a hysterectomy.

Mortalidad materna en España en el periodo 2010-2012: resultados de la encuesta de la Sociedad Española de Ginecología (SEGO) / Maternal mortality in Spain from 2010 to 2012: results of Spanish Society of Gynaecology Survey (SEGO)

Objetivo: la Sociedad Española de Obstetricia y Ginecología establece como uno de sus objetivos el conocer la tasa de mortalidad materna en España durante el periodo 2010-2012 y sus principales causas. Sujetos y Método: con este fin, la Sociedad Española de Obstetricia y Ginecología constituye un grupo de trabajo que elabora una encuesta que se remite a los 191 jefes de servicio de hospitales públicos y privados españoles. El análisis de los datos se llevó a cabo de forma confidencial, al igual que los nombres de los centros de los que procedían. Se llevó a cabo un procedimiento confidencial de los datos y su procedencia. Se cruzaron. Se analizan las causas obstétricas directas e indirectas de los datos con los publicados por el Instituto Nacional de Estadística. Resultados: respondieron 45 hospitales (23,56%). La encuesta representa el 18,9% de los recién nacidos en España en ese periodo. La tasa de mortalidad materna fue de 6,00/100.000 nacidos. Se consideró una subestimación del 48% de los datos registrados por el Instituto Nacional de Estadística. Las causas obstétricas directas representaron el 37,5%, siendo la hemorragia postparto la más importante. La causa obstétrica indirecta representó el 56,25%. El porcentaje de autopsias fue de 31%. Conclusiones: la tasa de mortalidad materna fue de 6/100.000 nacidos. El porcentaje de subestimación en las cifras oficiales se cifra en 48%. La causa obstétrica directa representó el 37,5%, siendo la hemorragia postparto las más frecuente. Se proponen medidas para mejorar esta información en nuestro país (AU)

Objectives: One of the aims of the Spanish Society of Obstetrics and Gynaecology is to determine the rate of maternal mortality and its main causes for the period 2010-2012. Subjects and methods: To do this, the Spanish Society of Obstetrics and Gynaecology formed a working group to draft a survey sent to 191 heads of obstetrics and gynaecology services in public and private hospitals. Analysis of the data and their origin was confidential. The data were crossed with those published by the Spanish National Statistics Institute. Direct and indirect obstetric causes were analysed. Results: Forty-five hospitals responded (23.56%). The survey represented 18.9% of newborns in Spain in that period. The maternal mortality ratio was 6/100.000 births. An underestimation of 48% was observed in relation to the data from the Spanish National Statistics Institute. Direct obstetric causes accounted for 37.5% of deaths, the most important being postpartum haemorrhage. Indirect obstetric causes accounted for 56.25%. The percentage of autopsies was 31%. Conclusions: The maternal mortality ratio was 6/100.000 births. The percentage of underestimation regarding official figures was 48%. Direct obstetric causes accounted for 37.5% of deaths, the most important cause being postpartum haemorrhage. Measures to improve this information in Spain are proposed (AU)

Long-Term Outcome of Patients with Bifascicular Block and Unexplained Syncope Following Cardiac Pacing.

BACKGROUND: According to the ACC/AHA/HRS guidelines, cardiac pacing is reasonable in patients with bifascicular block (BF-B) and syncope when other causes have been excluded. The purpose of this study was to assess the long-term outcome of patients with BF-B and unexplained syncope following cardiac pacing. METHODS AND RESULTS: Between 2009 and 2015, we identified 43 consecutive patients (mean age of 78 ± 12 years, 64% males) who presented with syncope and BF-B and had received a pacemaker (PM). During a mean follow-up period of 31 ± 21 months, syncope recurred in seven patients (16%): 7% (95% standard error [SE] ± 3%) at 1 year and 18% (95% SE ± 7%) at 5 years. At univariable analysis, the only predictor of syncope recurrence was empiric pacing (P = 0.03). There were no syncope recurrences in the 12 patients who received a PM following a positive electrophysiological study (EPS) and the five patients with documentation of paroxysmal atrioventricular block (AVB) during cardiac monitoring (insertable loop recorder [ILR]), (EPS/ILR Group, n = 17) compared to seven of 26 (27%) patients who received empiric pacing (Empiric Group, n = 26; P = 0.02). Progression to high-degree AVB was documented during follow-up in 16 (37%) patients: nine of 17 (53%) patients in the EPS/ILR Group and seven of 26 (27%) patients in the Empiric Group (P = 0.11). There were no injuries reported during ILR monitoring. CONCLUSIONS: We have shown that syncope recurs not infrequently in patients with BF-B who received pacing for syncope. Nearly one in four patients who had empiric pacing suffered syncope recurrence compared to no recurrences in patients who received a PM following a positive EPS or documentation of transient AVB.