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Background: Conduction system pacing (CSP) and atrioventricular junction ablation (AVJA) improve outcomes in patients with symptomatic, refractory atrial fibrillation (AF). Superior approach (SA) from the pocket via axillary or subclavian vein has been proposed as an alternative to the conventional femoral venous access (FA) to perform AVJA. Objective: To assess the feasibility and safety of SA for AVJA performed simultaneously with CSP, and to compare this approach with FA. Methods: A prospective, observational study, enrolling consecutive patients with symptomatic, refractory AF undergoing simultaneous CSP and AVJA. Results: A total of 107 patients were enrolled: in 50, AVJA was primarily attempted with SA, in 69 from FA. AVJA with SA was successful in 38 patients (76.0%), while in 12 patients, a subsequent FA was required. AVJA from FA was successful in 68 patients (98.5%), while in one patient, a left‐sided approach via femoral artery was required. Compared with FA, SA was associated with a significantly longer duration of ablation (238.0 ± 218.2 vs. 161.9 ± 181.9 s; p =.035), a significantly shorter procedure time (28.1 ± 19.8 vs. 19.8 ± 16.8 min; p =.018), an earlier ambulation (2.7 ± 3.2 vs. 19.8 ± 0.1 h; p <.001), and an earlier discharge from procedure completion (24.0 ± 2.7 vs. 27.1 ± 5.1 h; p <.001). After a median follow‐up of 12 months, the rate of complications was similar in the two groups (2.0% in SA, 4.3% in FA; p =.483). Conclusion: Simultaneous CSP and AVJA with SA is feasible, with a safety profile similar to FA. Compared to FA, this approach reduces the procedure times and allows earlier ambulation and discharge. [ABSTRACT FROM AUTHOR]

Background: Placement of central venous catheters (CVCs) is essential and routine practice in the management of children with congenital heart disease. The purpose of the present protocol is to evaluate the risk for infectious complications in terms of catheter colonization, catheter line-associated bloodstream infections, and catheter-related bloodstream infections (CRBSIs), and the mechanical complications from different central venous access sites in infants and newborns undergoing cardiac surgery., Methods: One hundred sixty patients under 1 year of age and scheduled for cardiac surgery will be included in this randomized controlled trial (RCT); patients will be randomly allocated to the jugular or femoral vein arms. CVC insertion will be performed by one of three selected expert operators., Discussion: The choice of the insertion site for central venous catheterization can influence the incidence and type of infectious complications in adults but this is not unanimously evidenced in the pediatric setting. The experimental hypothesis of this RCT is that the jugular insertion site is less likely to induce catheter colonization and CRBSI than the femoral site., Trial Registration: ClinicalTrials.gov Identifier: NCT03282292 . Registered on 12 September 2017.

The article presents a study which is focused on analyzing the diagnostic accuracy of multiorgan point-of-care ultrasonography (POC-US) in patients suffering from pulmonary embolism (PE). The study was conducted on 357 patients suffering from PE with a Wells score and a positive D-dimer result. According to the results, the test has 90 percent sensitivity and 86 percent specificity for identifying PE.

Purpose of Study: We report our experience with ultrafiltration to remove fluid overload in patients with diuretic-resistant, decompensated, congestive heart failure., Methods: From 2005 to 2008, 42 patients with heart failure and left ventricular ejection fraction less than 40% were treated with ultrafiltration. Patients were hospitalized for acute decompensation. Mean age was 69 years (67% men). Cause of heart failure was ischemic in 52% of cases. New York Heart Association (NYHA) class was III (64%) or IV (36%). All patients were on optimal heart failure drugs. Average dose of furosemide before ultrafiltration was 250 mg. Exclusion criteria were contraindications to anticoagulants, hematocrit more than 50%, glomerular filtration rate less than 30 ml/min and cardiogenic shock. Ultrafiltration was performed using a venous femoral bilumen catheter and anticoagulation with heparin., Results: Each patient underwent one to four ultrafiltration treatments (total 70). Mean duration of a treatment was 6 h. Eighty-six percent of treatments removed more than 4000 ml of fluids; 10% removed 2000-4000 ml; 4% removed less than 2000 ml (1600-6900 ml). One ultrafiltration was aborted because of persistent hypotension. Other complications include two cases of bleeding from vascular access and six cases of worsened renal function. One patients required dialysis. Six-month mortality after ultrafiltration was 26%. Hospitalization rate, 6 months after, was 30% (compared to 66% 6 months before). Average furosemide dose, 6 months after, was 125 mg., Conclusion: Ultrafiltration removed fluid overload in diuretic-resistant, severe, congestive heart failure in our single-center experience. Six months after ultrafiltration, hospitalization rates were reduced by 36% and furosemide dose was 50% lower, compared to the previous 6 months. Worsened renal function was the most common complication (14% of patients).

Background: A retrospective study was performed using a multiple-choice questionnaire in order to analyse the normal procedures and trends regarding the insertion and management of emergency dialysis access in patients with acute renal failure in 23 Centres in Piedment and the Aosta Valley, regions in the north of Italy with about 4.5 million inhabitants., Methods: The observation period ran from January 1996 to July 1997. A questionnaire with 19 main questions and 90 possible multiple answers sent to 22 Centres for adults and the only pediatric centre in both regions., Results: An analysis of the results showed that the most frequently used site in these regions is the subclavian vein (37.8%), followed by the internal jugular vein (32%), the femoral site (28.8%) and peritoneal catheter (1.4%); in pediatric patients, 5% used the femoral site, 10% the subclavian vein, 20% the internal jugular vein and 65% the peritoneal catheter. In 4 centres (18.2%), nephrologists do not position any type ofd access for acute renal failure. In 50% of centres, all doctors insert femoral catheters autonomously., Conclusions: Some choices, such as the subclavian route, are open to criticism and may perhaps be linked to customary procedures used by anesthetists and intensive care specialists. Some centres only have relative automomy for insertion, and lastly some types of catheters and techniques are not used. The peritoneal catheter has been abandoned by adult centres as an access in acute kidney failure patients.

Long survival on dialysis and wide admissions of very old and high risk patients, have focused attention to the problem of vascular access in uremic patients. The situation is critical in the USA, where PTFE/bovine grafts are utilized in about 75% of the cases. conversely, AV fistulas are the main type of access in Piedmont, where their use approaches 90% of the cases, Cimino-Brescia fistulas account for 58% of vascular accesses versus 25% and 9% of proximal AV fistulas and PTFE/bovine grafts, respectively. However, the latter progressively increase as age and time on dialysis increase. Snuff box fistulas are used only for 3% of the cases and this figure is steadily decreasing. In the meanwhile basilic vein superficializations, even if limited in numbers (1%), provided in some centres satisfactory results in term of survival and function. However, the type of access that deserved in the last few years the highest interest is the internal jugular vein cannulation (Canaud/Tesio catheter). In a preliminary series of 51 cannulations in 47 patients, this vascular access was permanent in 28 cases. A possible future routine utilization of jugular vein catheters is advisable in cases where a waiting period (up to a few months) is requested to allow a new fistula to mature or to maintain an empty abdomen in a patient temporarily withdrawn from peritoneal dialysis. Due to the heavy engagement for catheter maintenance and the high number of removals for systemic (9.8%) or skin exit infections (13.7%), a longer stay of indwelling catheters, although actually safe, should be limited to selected cases.