The importance of specific-site pacing is increasingly recognized in cardiac resynchronization therapy (CRT). Using current pacing technology, site selection is still largely limited by coronary vein anatomy, whereas left ventricular (LV) endocardial pacing using current lead technology is risky and challenging. To overcome limitations and complications with current LV pacing, the feasibility of a new technology enabling LV endocardial stimulation without the use of a lead is being evaluated in patients. Patients presented in this report are part of the Wireless Stimulation Endocardially for CRT Trial (WiSE-CRT) study investigating the safety and performance of the WiCS®-LV system, an implantable cardiac pacing system capable of leadless pacing based on converting ultrasound energy to electrical energy. Three patients are presented: (i) a patient with an existing implantable defibrillator, (ii) a patient with a CRT system whose LV lead does not capture, and (iii) a CRT patient classified as a non-responder. All three patients were successfully treated. Acute electrical pacing thresholds ranged from 0.7 to 1.0 V at 0.5 ms; all patients retained captured at 6 months. Functional New York Heart Association class significantly changed (Pre: III in two patients, and IV in one patient; Post: I in one patient, II in one patient, and II–III in one patient), and LV ejection fraction increased from 23.7 ± 3.4% to 39 ± 6.2% (P < 0.017). This report on three first-in-man cases shows that leadless endocardial pacing may be safely applied and effective, conferring short- to-mid-term symptomatic benefits. These promising findings are yet to be substantiated by larger ongoing studies. http://clinicaltrials.gov/ct2/show/NCT01294527.
Abstract Cancer cachexia has been linked to gut bacterial alterations, but alterations of gut viruses, mostly bacteriophages, have not yet been explored. We performed shotgun metagenomic sequencing of DNA from stool samples of 78 cachectic and 42 non-cachectic cancer patients. K-mer-based matching to reference databases revealed abundance variations of bacteria and viruses. Beyond bacterial alterations, cachectic patients exhibited significantly lower bacteriophage abundance, predominantly affecting Caudovirales and Siphoviridae species (double-stranded DNA) but also Inoviridae and Microviridae families (single-stranded DNA). Machine learning models exploiting the data for classification between cachectic and non-cachectic state yielded an AUC of 0.704. Caudovirales and Siphoviridae species were among the top-most important classifiers. AUC increased to 0.850 with solely antibiotic-exposed samples from 20 cachectic and 10 non-cachectic patients. This study is the first to suggest a link between cancer cachexia and intestinal bacteriophage richness. This could constitute a new basis for hypothesis-driven research in cancer cachexia diagnosis and treatment.
Background Long-term health sequelae of the Coronavirus Disease 2019 (COVID-19) are a major public health concern. However, evidence on post-acute COVID-19 syndrome (post-COVID-19) is still limited, particularly for children and adolescents. Utilizing comprehensive healthcare data on approximately 46% of the German population, we investigated post-COVID-19-associated morbidity in children/adolescents and adults. Methods and findings We used routine data from German statutory health insurance organizations covering the period between January 1, 2019 and December 31, 2020. The base population included all individuals insured for at least 1 day in 2020. Based on documented diagnoses, we identified individuals with polymerase chain reaction (PCR)-confirmed COVID-19 through June 30, 2020. A control cohort was assigned using 1:5 exact matching on age and sex, and propensity score matching on preexisting medical conditions. The date of COVID-19 diagnosis was used as index date for both cohorts, which were followed for incident morbidity outcomes documented in the second quarter after index date or later.Overall, 96 prespecified outcomes were aggregated into 13 diagnosis/symptom complexes and 3 domains (physical health, mental health, and physical/mental overlap domain). We used Poisson regression to estimate incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs). The study population included 11,950 children/adolescents (48.1% female, 67.2% aged between 0 and 11 years) and 145,184 adults (60.2% female, 51.1% aged between 18 and 49 years). The mean follow-up time was 236 days (standard deviation (SD) = 44 days, range = 121 to 339 days) in children/adolescents and 254 days (SD = 36 days, range = 93 to 340 days) in adults. COVID-19 and control cohort were well balanced regarding covariates. The specific outcomes with the highest IRR and an incidence rate (IR) of at least 1/100 person-years in the COVID-19 cohort in children and adolescents were malaise/fatigue/exhaustion (IRR: 2.28, 95% CI: 1.71 to 3.06, p < 0.01, IR COVID-19: 12.58, IR Control: 5.51), cough (IRR: 1.74, 95% CI: 1.48 to 2.04, p < 0.01, IR COVID-19: 36.56, IR Control: 21.06), and throat/chest pain (IRR: 1.72, 95% CI: 1.39 to 2.12, p < 0.01, IR COVID-19: 20.01, IR Control: 11.66). In adults, these included disturbances of smell and taste (IRR: 6.69, 95% CI: 5.88 to 7.60, p < 0.01, IR COVID-19: 12.42, IR Control: 1.86), fever (IRR: 3.33, 95% CI: 3.01 to 3.68, p < 0.01, IR COVID-19: 11.53, IR Control: 3.46), and dyspnea (IRR: 2.88, 95% CI: 2.74 to 3.02, p < 0.01, IR COVID-19: 43.91, IR Control: 15.27). For all health outcomes combined, IRs per 1,000 person-years in the COVID-19 cohort were significantly higher than those in the control cohort in both children/adolescents (IRR: 1.30, 95% CI: 1.25 to 1.35, p < 0.01, IR COVID-19: 436.91, IR Control: 335.98) and adults (IRR: 1.33, 95% CI: 1.31 to 1.34, p < 0.01, IR COVID-19: 615.82, IR Control: 464.15). The relative magnitude of increased documented morbidity was similar for the physical, mental, and physical/mental overlap domain. In the COVID-19 cohort, IRs were significantly higher in all 13 diagnosis/symptom complexes in adults and in 10 diagnosis/symptom complexes in children/adolescents. IRR estimates were similar for age groups 0 to 11 and 12 to 17. IRs in children/adolescents were consistently lower than those in adults. Limitations of our study include potentially unmeasured confounding and detection bias. Conclusions In this retrospective matched cohort study, we observed significant new onset morbidity in children, adolescents, and adults across 13 prespecified diagnosis/symptom complexes, following COVID-19 infection. These findings expand the existing available evidence on post-COVID-19 conditions in younger age groups and confirm previous findings in adults. Trial registration ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT05074953 .
Purpose: CRT does not always produce the desired clinical outcome due to problematic CS access, lead placement / dislodgement, phrenic nerve stimulation, chronic reliability lead issues, worsening heart failure or high risk ICD / pacemaker upgrades. Endocardial pacing for CRT is an alternative. The Wireless Stimulation of the Endocardium System (WiSE) comprises a battery-powered ultrasonic transmitter implanted in a left intercostal space and a leadless pacing electrode fixed directly onto the LV endocardium, replacing the CS lead. The WiSE System was evaluated in the multicentre SELECT-LV study. Method: WiSE was implanted in 34 pts indicated for CRT, but untreated due to various difficulties. 25 pts were followed for 12m. Primary and secondary endpoints were evaluated at 1 and 6m. Summary of results: Baseline characteristics: 25 male; NYHA 2.7 ± 0.6; age 65.8 ± 8.6 yrs; BMI 29.7 ± 4.8; intrinsic and RV paced QRSs were 163 ± 32 ms and 180 ± 30 ms respectively; EF 27.4 ± 5.4%; etiology ICM-10 / NICM-12 / both-3. By 12m, there were 2 deaths, 1 acute MI, 5 episodes of cardiac decompensation in 4 pts, and a resolved CVA in 1 pt who had failed to follow the post-op anticoagulation regimen. There were no instances of cardiac perforation or LV electrode dislodgement. Mean implant duration was 571 ± 136 days. Consistent CRT was achieved in 100%, 97% and 96% of pts at 1, 6 and 12m. BiV QRS durations were 129 ± 22, 129 ± 13 and 124 ± 17 ms at 1, 6 and 12m respectively. Reductions in BiV QRS duration compared with the baseline QRS for pts reaching 12m were 34 ± 27, 34 ± 28 and 39 ± 40 ms at 1, 6 and 12m respectively. The 6m clinical composite scores for these pts were 84% improved, 12% unchanged and 4% worsened. Conclusion: Wireless endocardial LV pacing is an alternative approach to CRT. These 12m data demonstrate the clinical benefit to our pts, previously untreated by CRT. BiV pacing is maintained with reverse electrical remodeling continuing to be evident 12m post implant.
