Cardioneuroablation for the treatment of reflex syncope and functional bradyarrhythmias. a scientific statement of the european heart rhythm association (ehra) of the esc, the heart rhythm society (hrs), the asia pacific heart rhythm society (aphrs) and the latin american heart rhythm society (lahrs)

Cardioneuroablation has emerged as a potential alternative to cardiac pacing in selected cases with vasovagal reflex syncope, extrinsic vagally induced sinus bradycardia-arrest or atrioventricular block. The technique was first introduced decades ago, and its use has risen over the past decade. However, as with any intervention, proper patient selection and technique are a prerequisite for a safe and effective use of cardioneuroablation therapy. This document aims to review and interpret available scientific evidence and provide a summary position on the topic.

Remote electrocardiographic monitoring with a wireless implantable loop recorder: minimizing the data review burden.

INTRODUCTION: Currently available implantable loop recorders (ILRs) are hampered by limited memory, sensing artifacts, and need for manual memory download. Remote monitoring techniques that automatically transfer stored recordings for review may enhance ILR utility. However, automatic electrocardiograph (ECG) detection and transmission of an excessive number of tracings directly to physicians may be burdensome. This pilot study assessed the utility of direct ILR transmission to a central ECG monitoring center on the burden of data to be reviewed by the physician. METHODS: Patients with unexplained syncope were implanted with a novel ILR with automatic (i.e., independent of patient intervention) wireless telemetry download. Transmitted recordings underwent a two-step review process: initial algorithmic filtering followed by human overread at a monitoring center using predefined criteria. RESULTS: Forty patients were enrolled and followed for 8.5 ± 5.1 months. A total of 223,226 ECG recordings were transmitted to the monitoring center (on average 660 per patient per month). Algorithmic filtering eliminated 191,305 ECGs as artifact (89%), with monitoring center overread of 31,921 strips. Ultimately, 117 relevant ECGs were selected for further evaluation by the physician (0.0053%). One or more relevant ECGs were identified for 20 patients (50%). CONCLUSIONS: Automatic ILR recording and wireless technique is feasible for remote ECG monitoring by ILRs. However, sensitive criteria for recording and transmission may result in an excessive ECG burden. The two-step screening process in this pilot study minimized physician overread time while providing clinically relevant recordings in a substantial proportion of patients.

Enteroviruses in a Trinidad nursery

A longitudinal study of illness and prevalence of enteroviruses was carried out in a Trinidad residential nursery. 92 enteroviruses (46 strains of Coxsackie B virus and 46 of poliovirus) were recovered from 233 faecal specimens (39.5 percent). The percentage of children who excreted viruses at any one time rose from 48 percent to 90 percent, being related to the number of specimens examined from each child. Apparent interference between Coxsackie B viruses and polioviruses was observed and the significance of this in relation to poliovirus vaccination is discussed. (AU)

Some aspects of erythrocyte Glucose-6-Phosphate dehydrogenose deficiency in Trinidad

The glucose-6-phoshate dehydrogenose (G6PD) activity of erythrocyte samples in Trinidad was investigated, using the Motulsky cresyl blue decolourization test. Of 91 specimens taken from normal negroes, 12.1 percent showed absent enzyme activity and of 71 specimens from East Indians, 7 percent showed the same deficiency. As was to be expected (G6PD) deficiency being inherited as a sex linked character) in both groups there was a preponderance of males having the enzyme defected. Three out of thirteen (23.1 percent) of children with severe cerebral palsy and five out of twenty-seven (18.5 percent) of mentally defective children were found to be G6PD deficient as compared with 12.1 percent of normal controls. The role of virus infection in precipitating hemolytic episodes in people with G6PD deficiency was investigated. G6PD deficient and normal erythrocytes were incubated for 60 minutes with a standard dose (approx. 3,000 PFU) of VEE virus and were then stained for Heinz bodies. Whereas Heinz body counts of 0.5 percent or less were found in samples of normal erythrocytes, levels of 1.5 percent or more were found in erythrocytes with G6PD deficiency. Erythrocyte G6PD deficiency is then shown to be present in Trinidad (more frequently in the negro population than in East Indian); the percentage of negroes with this enzyme deficiency is close to that reported from the U.S.A. It is suggested that this enzyme deficiency may play a part in the aetiology of cerebral palsy and that virus infections may be concerned in the precipitation of hemolytic episodes (AU)

A longitudinal study of respiratory illness in Trinidadian families

In a study undertaken in March 1961 it was found that the incidence of minor respiratory illness in Trinidad is of the same order as that seen in more temperate countries. In rural Trinidad, this incidence also appears to be associated with rain fall. No investigation has as yet been undertaken with respect to the causative agents involved (AU)