Pacing-induced cardiomyopathy (PICM) consists of heart failure (HF) associated with a drop in the left ventricular ejection fraction (LVEF) in the setting of high-burden right ventricular pacing, with presentation that may range from subclinical to severe. Time to manifestation can go from weeks to years after device implantation. Treatment typically consists in an upgrade to a cardiac resynchronisation therapy (CRT) or His bundle pacing (HisP). Several risk factors for PICM have been described and should be considered before pacemaker (PM) implantation, as thorough patient selection for de novo CRT or HisP, may preclude its manifestation. We present the case of an 82-year-old patient presenting with acute congestive HF and new severely reduced LVEF, 30 days following dual chamber PM implantation for high-grade atrioventricular block. Treatment with HF medication and upgrade to a CRT permitted rapid resolution of the symptoms and normalisation of the LVEF at 1-month follow-up.
syncope.HUT was performed according to the Italian protocol, including NTG provocation in 25 patients.During follow-up lasting 1-2 years in 6 patients syncope recurred (group I) and in 26 patients did not (group II).
Arrhythmogenic cardiomyopathy (ACM), formerly known as arrhythmogenic right ventricular dysplasia, is a primary myocardial disorder characterized by ventricular arrhythmias and sudden cardiac death (SCD).1 Myocardial desmosomes are cell–cell junctions that reside within the intercalated disc. They consist of members of the cadherin family (desmocollin-2, desmoglein-2), which span the membrane mechanically coupling adjacent cells, and members of the plakin and armadillo families: plakoglobin (PKG), plakophilin-2 (PKP2), and desmoplakin (DSP1), which connect the cadherin complexes to the intermediate cytoskeleton filaments.
Hintergrund und Fragestellung: Die Notwendigkeit einer szintigraphischen Abklärung von Schilddrüsenknoten bei normalem TSH ist weiterhin Gegenstand nationaler und internationaler Diskussionen, die sich in unterschiedlichen Bewertungen von Leitlinien niederschlagen. Die amerikanische (ATA) und die europäische (ETA) Schilddrüsengesellschaft empfehlen – im Gegensatz zu den Leitlinien der Sektion Schilddrüse der Deutschen Gesellschaft für Endokrinologie und der Deutschen Gesellschaft für Nuklearmedizin – die Durchführung eines Schilddrüsenszintigramms nur noch bei erniedrigtem oder supprimiertem TSH, um eine vermutete Autonomie nachzuweisen. Ziel der vorliegenden prospektiven Studie war es, die funktionelle Aktivität szintigraphisch gesicherter fokaler Autonomien zu ermitteln, um zu klären, ob ein normaler TSH-Wert eine fokale Autonomie weitgehend ausschließen kann. Daten aus Deutschland zu dieser Fragestellung gab es zum Zeitpunkt dieser Untersuchung nicht. Patienten und Methoden: Aus einer unausgewählten Patientengruppe wurden Patienten mit Knotenstrumen (n = 476) kontinuierlich mittels Szintigramm auf das Vorliegen einer fokalen Autonomie untersucht. In dieser Patientengruppe wurde die studienmäßig angestrebte Anzahl von 100 autonomen Adenomen mit einer Mindestgröße über 1,0 cm ermittelt. Bei jedem Patienten wurden folgende Untersuchungen durchgeführt: Sonographie (inklusive Duplex), Szintigraphie und Labor (fT3, fT4, TSH, TPO-Antikörper). Der Referenzbereich des TSH lag zwischen 0,4–4,0 µU/ml. Ergebnisse: 21 % der Patienten (100/476) mit einer Knotenstruma hatten eine fokale Autonomie (> 1,0 cm). Bei 32 % aller fokalen Autonomien war das TSH erniedrigt (< 0,4 µU/ml) oder supprimiert, bei 68 % dagegen ≥ 0,4 µU/ml. Folgerung: Aufgrund dieser Daten besteht in der untersuchten Patientengruppe mit 100 autonomen Adenomen keine klinisch relevante Beziehung zwischen TSH-Spiegel und szintigraphisch erfassbarer fokaler Autonomie in einer Knotenstruma. Die TSH-Bestimmung ist daher ungeeignet, zwischen hyper- und hypofunktionellen Knoten zu unterscheiden. Die Punktion szintigraphisch nicht charakterisierter Knoten sollte unterbleiben, da autonome Adenome zytologisch häufig das Bild einer follikulären Neoplasie zeigen, einem Befund, der grundsätzlich eine OP-Indikation darstellt (Ausnahme: autonomes Adenom). Bei Schilddrüsenknoten > 1,0 cm sollte daher auch weiterhin routinemäßig bei der Erstdiagnostik eine Schilddrüsenszintigraphie erfolgen.
Background Interventional cardiologists may be immune to stress, allowing them to perform complex percutaneous interventions under pressure. Objectives To assess heart rate (HR) variations as a surrogate marker of stress of interventional cardiologists during percutaneous cardiac procedures and in every-day life. Design This is a single-centre observational study including a total of six male interventional cardiologists performing coronary interventions and pacemaker implantations. Participants were asked to record their HR with the Apple Watch Device during procedures, every-day life and control activities such as outpatient consultations, sport, marital conflicts and sexual intercourse. Results Average daily HR was 88±17 bpm. During work days, HR increased significantly during procedures (90±17 bpm) compared with days outside the cathlab (87±17 bpm, p=0.02). The average HR was higher during a regular week working (88±16 bpm) compared with weekends off (84±18 bpm, p=0.002). Complex cardiac procedures were associated with higher HR up to 122 bpm. Peak HR were higher during physical exertion. Of note, participants complained of hypersexuality and mania after night shifts. Conclusions Work and especially percutaneous cardiac procedures increase HR independently of physical exertion suggesting that interventional cardiologists experience mental stress and emotions.
Recent years have seen significant positive changes and developments in oral health–related policy and data on oral health and oral health care in Canada. Simultaneously, on the international stage, the momentum for oral health and related research continues to build. These changes have led to an initiative to create Canada’s first National Oral Health Research Strategy (NOHRS), which was recently published by the Canadian Institutes of Health Research–Institute of Musculoskeletal Health and Arthritis (Allison and Rock 2024). In this communication, we describe the process that was used to undertake this work. We present the resulting guiding principles, the research priority areas, and the framework that emerged, which included 6 strategic priorities grouped into 3 themes: (A) Leading Issues: (1) access to care, (2) inequities, identities, and oral health; (B) Emerging Methods: (3) artificial intelligence, (4) omics; and (C) Overarching Approaches: (5) environmental sustainability, (6) knowledge mobilization and implementation science. In addition, NOHRS includes a series of proposed goals and a timeline over the coming years. The point is to encourage a broad range of individuals and groups of people to engage with this high-level strategy and create plans to implement it. This strategy directly answers the call by the World Health Organization for countries to establish a national oral health research strategy (World Health Organization 2024). We have engaged in an extensive, broad consultative process, resulting in a Canadian NOHRS that is tailored to the needs of our community. Its aim is to galvanize our community into action to address the priorities we have identified. By engaging in this process, we build upon multiple oral health–related initiatives in Canada and on the international stage. We hope to inspire and facilitate similar, much-needed work elsewhere.
The implantable loop recorder developed by Medtronic (Reveal plus) is a small device inserted subcutaneously under local anesthesia in patients with syncope of unexplained origin. This device enables a single lead-ECG recording and has autonomy of two years. Memories are activated during episodes of bradycardia or tachycardia, either automatically or manually. Several studies have shown a high diagnostic rate reaching 50% and demonstrated its cost-effectiveness. There is also a significant reduction in syncopal episodes and a higher quality of life score in patients with syncope of unexplained origin.
