Background Routine addition of an atrial lead during an implantable cardioverter‐defibrillator (ICD) implantation for primary prevention of sudden cardiac death, in patients without pacing indications, was not shown beneficial in contemporary studies. We aimed to investigate the use and safety of single‐ versus dual‐chamber ICD implantations in these patients. Methods and Results Using the National Inpatient Sample database, we identified patients with no pacing indications who underwent primary‐prevention ICD implantation in the United States between 2015 and 2019. Sociodemographic and clinical characteristics, as well as in‐hospital complications, were analyzed. Multivariable logistic regression was used to identify predictors of in‐hospital complications. An estimated total of 15 940 patients, underwent ICD implantation for primary prevention of sudden cardiac death during the study period, 8860 (55.6%) received a dual‐chamber ICD. The mean age was 64 years, and 66% were men. In‐hospital complication rates in the dual‐chamber ICD and single‐chamber ICD group were 12.8% and 10.7%, respectively ( P <0.001), driven by increased rates of pneumothorax/hemothorax (4.6% versus 3.4%; P <0.001) and lead dislodgement (3.6% versus 2.3%; P <0.001) in the dual‐chamber ICD group. Multivariable analyses confirmed atrial lead addition as an independent predictor for “any complications” (odds ratio [OR], 1.1 [95% CI, 1.0–1.2]), for pneumo/hemothorax (odds ratio, 1.1 [95% CI, 1.0–1.4]), and for lead dislodgement (odds ratio, 1.3 [95% CI, 1.1–1.6]). Conclusions Despite lack of evidence for clinical benefit, dual‐chamber ICDs are implanted for primary prevention of sudden cardiac death in a majority of patients who do not have pacing indication. This practice is associated with increased risk of periprocedural complications. Avoidance of routine implantation of atrial leads will likely improve safety outcomes.
Background: Acute kidney injury is associated with adverse outcomes after acute ST elevation myocardial infarction (STEMI). It remains unclear, however, whether subclinical increase in serum creatinine that does not reach the consensus criteria for acute kidney injury is also related to adverse outcomes in STEMI patients undergoing primary percutaneous coronary intervention. Methods: We conducted a retrospective study of 1897 consecutive STEMI patients between January 2008 and May 2016 who underwent primary percutaneous coronary intervention, and in whom acute kidney injury was not diagnosed throughout hospitalization. We investigated the incidence of subclinical acute kidney injury (defined as serum creatinine increase of ≥ 0.1 and < 0.3 mg/dl) and its relation to a composite end point of adverse in hospital outcomes. Results: Subclinical acute kidney injury was detected in 321 patients (17%). Patients with subclinical acute kidney injury had increased rate of the composite end point of adverse in-hospital events (20.3% vs. 9.7%, p<0.001), a finding which was independent of baseline renal function. Individual components of this end point (occurrence of heart failure, atrial fibrillation, need for mechanical ventilation and in-hospital mortality) were all significantly higher among patients with subclinical acute kidney injury ( p< 0.05 for all). In a multivariable regression model subclinical acute kidney injury was independently associated with higher risk for adverse in-hospital events (odds ratio 1.92.6, 95% confidence interval: 1.23–2.97, p=0.004). Conclusions: Among STEMI patients treated with primary percutaneous coronary intervention, small, subclinical elevations of serum creatinine, while not fulfilling the consensus criteria for acute kidney injury, may serve as a significant biomarker for adverse outcomes.
During studies of transplacental virus infections in random bred hamsters purchased with timed pregnancies from three commercial dealers, spontaneous hemorrhagic necrosis of the central nervous system was seen in fetuses harvested near term. Ninety-seven pregnant hamsters from three colonies were examined during a 6-month period; this condition was seen in 25 of 41, 19 of 36, and five of 20 litters. Hamsters from another commercial colony were received, housed, and fed under the same conditions, but remained free of the disease. The pathological process was characterized by multiple spreading zones of edema, malacia, and hemorrhage. Lesions were restricted to neural tissues, including the retina and internal ear. Neuroepithelial proliferation with rosette formation, accompanying the destructive process, constituted a striking reparative response. No inflammatory reaction or cytopathic effects suggestive of virus-induced disease were seen. Studies on the cause of this condition were negative at the time when the disease disappeared spontaneously.
blood, mammary glands, and milk removed from the stomachs of sucklings all had infectivity titers of approximately 10-3-10-4/0.1 ml when tested in rat embryo tissue cultures. Rat virus continued to be recoverable for a number of days after the appearance of circulating (HAI) antibodies. Proliferation of virus in mammary tissue and excretion of virus brought to the gland by the bloodstream are postulated to have been the chief mechanisms involved in the virolactia.
This study focused on the unique nature of K-virus pneumonitis in suckling mice. This process, rather than being a conventional pneumonitis, is characterized by viral replication and cytopathic effects restricted exclusively to pulmonary endothelium. The selective viral attack on this air-blood interface suggests that K-virus is an endotheliotrope that requires a richly oxygenated intracellular milieu for replication. This possibility has been explored by studies of the course of K-virus infection in suckling mice under conditions of normal (21 per cent), increased (40 per cent), and decreased (10 per cent) 02 content of inspired air. The absence of critical modulating influences of these varied environmental conditions rules out a significant role of tissue 02 concentrations as determinants of the selective tropism of K-virus.
Atrial fibrillation (AF) catheter ablation in cancer patients has been evaluated in very few studies. We aimed to investigate utilization trends and in-hospital outcomes of AF catheter ablation among cancer patients in a large US inpatient registry.
