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The study identifies the relationship between amiodarone use and pacemaker insertion for atrial fibrillation (AF) patients. Based on results involving 1,005 patients from 17 centers in the United States and Canada, it was found that amiodarone use was associated with an increased risk of pacemaker insertion. A significant risk for women was detected over men at 95 percent confidence level. After adjustments were made for weight, body mass index (BMI), amiodarone dosage and use of other antiarrhythmic drugs, the risk was still evident. It was concluded that increased pacemaker insertion use is greater in women when related to amiodarone use for AF, regardless of weight or BMI.

Background: Cardiac arrest due to ventricular arrhythmia in the absence of a reversible cause or contraindication has been a class I indication for insertion of an implantable cardioverter defibrillator since 1998. We compared and contrasted the use of implantable cardioverter defibrillator therapy in Canada and the United States among adults who survived a cardiac arrest. Method: Data on hospital separations from April 1, 1994 through March 31, 2003 were obtained from the Health Person-Oriented Information Database maintained by Statistics Canada and from the US National Hospital Discharge Survey on all patients with a primary diagnosis of cardiac arrest, ventricular fibrillation or ventricular flutter for the same 9-year period. We excluded all records of patients with a secondary diagnosis of acute myocardial infarction. Results: In Canada, 3793 patients survived to discharge after a cardiac arrest; 628 (16.6%) of these were implanted with a cardioverter defibrillator before discharge. The implant rate rose steadily from 5.4% in 1994/95 to 26.7% in 2002/03. In the United States, 23 688 (30.2%) of 78 538 such survivors received an implantable cardioverter defibrillator before discharge. Logistic regression analysis indicated that sex, age, fiscal year, the hospital's teaching status, hospital size and patient history of heart failure were positive predictors of implantable cardioverter defibrillator implantation. Age, renal failure, liver failure and cancer were negative predictors of receiving an implantable cardioverter defibrillator. Interpretation: The rate of use of implantable cardioverter defibrillator therapy for cardiac arrest survivors in Canada is increasing, but still is lower than the rate in the United States. [ABSTRACT FROM AUTHOR]

Surveys of pacing practice have shown a steady increase in pacemaker implantation rates in the past 15 years, despite no major changes in United States guidelines for permanent pacing. There are no data to explain why this is occurring. In this study, records were extracted from the National Hospital Discharge Survey to investigate this. There were 3 major findings. First, age-adjusted implantation rates increased progressively over the study period from 370 per million in 1990 to 612 per million in 2002. Second, it was found that the escalating implantation rate is attributable to increasing implantation for isolated sinus node dysfunction (SND). Implantation for SND increased significantly over the study period (by 102%), whereas implantation for all other indications did not. The increasing implantation for SND is due primarily to the increasing prevalence of SND, with a lesser increase in implantation rate relative to prevalence rate. The third major finding of this study is that there has been a progressive relative and absolute increase in the dual-chamber implantation rate. In 2002, 82.8% of all initial pacemaker implantations were dual-chamber devices. Furthermore, the National Hospital Discharge Survey data indicate that the major randomized pacing trials seem to have had no impact on pacing practice in the United States. In conclusion, age-adjusted implantation rates increased progressively over the study period. This escalating implantation rate is primarily attributable to increasing implantation for SND. [Copyright &y& Elsevier]

Reports from case series have estimated the incidence of peripartum cardiomyopathy (PC) at 1 case/1,485 live births to 1 case/15,000 live births and probable mortality rates of 7% to 60%. The objective of this study was to produce the first population-based study of the incidence, mortality, and risk factors for PC. The National Hospital Discharge Survey was used. Discharge information was available for 3.6 million patient discharges from 1990 to 2002. There were an estimated 16,296 cases of PC from 1990 to 2002. During this period, there were 51,966,560 live births in the United States. Thus, the incidence of PC was 1 case/3,189 live births. There was a trend toward an increase in PC incidence during the study period, with an estimate for the years 2000 to 2002 of 1 case/2,289 live births. The in-hospital mortality rate was 1.36% (95% confidence interval 0% to 10.2%). The total mortality rate was 2.05% (95% confidence interval 0.29% to 10.8%). Patients with PC were older (mean age 29.7 vs 26.9 years), were more likely to be black (32.2% vs 15.7%), and had a higher incidence of pregnancy associated hypertensive disorders (22.5% vs 5.87%) compared with national data. In conclusion, the incidence of PC is relatively uncommon, occurring at an average frequency of 1 case/3,189 live births from 1990 to 2002. The estimated mortality of 1.36% to 2.05% (95% confidence interval 0.29% to 10.8%) is less than previously reported from most case series.