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Aims: Many patients have a cardiac implantable electronic device (CIED) extracted at the time of heart transplantation. CIED components may be retained after heart transplantation, but their frequency, nature, and clinical significance is uncertain., Methods and Results: Consecutive patients that underwent heart transplantation over 10 years from 1 January 2007 until 1 January 2017 were identified from the unit database. Pre- and post-operative chest radiographs were reviewed by two independent observers for the presence of CIED components. Adverse events relating to any retained CIED component were recorded. Two hundred and six patients had a CIED removed at the time of transplantation. Retained CIED components were present in 86 (42%) patients. The most common retained CIED components were suture sleeves and superior vena cava (SVC) coils of dual coil implantable cardioverter-defibrillator (ICD) leads. An SVC coil was retained in 25% of patients that had a dual coil ICD lead. Seven adverse events were associated with CIED removal or retained CIED components, including one fatal event. However, retained CIED components were not associated with reduced long-term survival after heart transplantation., Conclusion: Retained CIED components were seen in 42% of patients that had a CIED prior to transplantation, may be associated with serious adverse events but are not associated with reduced long-term survival. Cardiac surgeons should be aware of all CIED system components and be familiar with techniques for their complete removal at the time of transplantation.

Aims: To determine the number of patients with a primary or secondary prevention implantable cardioverter-defibrillator (ICD) indication who are eligible for subcutaneous ICD (S-ICD) implantation according to the S-ICD manufacturer's surface electrocardiogram (ECG) screening template., Methods and Results: One hundred and ninety-six ICD patients with a non-paced ventricle were assessed using erect and supine ECG limb lead recordings to simulate the three S-ICD sensing vectors. Each ECG lead was scrutinized by two independent observers. Subcutaneous ICD eligibility required two or more leads to satisfy the S-ICD screening template in both erect and supine positions. Overall, 85.2% of patients [95% confidence interval (CI): 80.2-90.2%] fulfilled surface ECG screening criteria. The proportion of patients with 3, 2, 1, and 0 qualifying leads were 37.2% (95% CI: 30.4-44.0%), 48.0% (95% CI: 41.0-55.0%), 11.2% (95% CI: 6.8-15.6%), and 3.6% (95% CI: 1.0-6.2%). The S-ICD screening template was satisfied more often by Lead III (primary vector, 83.7%, 95% CI: 78.5-88.9%) and Lead II (secondary vector, 82.7%, 95% CI: 77.4-88.0%) compared with Lead I (alternate vector, 52.6%, 95% CI: 45.6-59.6%). A prolonged QRS duration was the only baseline characteristic independently associated with ineligibility for S-ICD implantation. There was 92.9% agreement between the two independent observers in assessment of eligibility using the S-ICD screening template., Conclusion: About 85.2% of patients with an indication for a primary or secondary prevention ICD have a surface ECG that is suitable for S-ICD implantation when assessed with an S-ICD screening template. There is minor inter-observer variation in assessment of eligibility using the S-ICD screening template., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013. For permissions please email: journals.permissions@oup.com.)

Transitional cell carcinomas (TCC) of the urinary bladder are known to express proteins which can yield potentially immunogenic peptide epitopes for expression in the context of cell surface class I or class II MHC antigens. However, additional costimulatory ligands must also be expressed before such a cell might directly induce full activation and proliferation of resting, antigen-specific T lymphocytes. Intravesical therapy might be used to manipulate T cell costimulation in order to promote specific rejection of TCC cells. This in vitro study examined the potential of such a strategy by transfection of the prototypical TCC line J82 with the important costimulatory molecules CD80 (B7-1) and CD86 (B7-2). Untransfected J82 cells expressed class I and II MHC antigens, a range of cell adhesion molecules, though did not induce T cell proliferation in a robust, allogeneic co-culture system. Transfected J82 cells expressed CD80 or CD86 at levels comparable to an antigen-presenting B cell line. Furthermore, functional surface expression of CD80 and CD86 was demonstrated in a mitogen-dependent assay of costimulation. However, neither CD80+ nor CD86+ transfectant J82 cells could induce significant proliferation of antigen-specific CD4+ T cells. Further analysis showed that bystander J82 cells could inhibit independent T cell activation in an effect dependent on direct cell contact. This inhibitory effect was associated with increased cell death in the responding lymphocyte population and is concordant with surface expression of CD95L by the J82 cell line.