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Background: Cardiovascular implantable electronic device (CIED) infection rates are increasing faster than implantation rates. More effective antimicrobial prophylaxis may help reduce CIED infections and improve clinical outcomes. The AIGIS(Rx)(®) antibacterial envelope is a polymer mesh implanted in the generator pocket with the CIED. After implantation it releases two antibiotics, minocycline and rifampin, that have been shown to reduce infections associated with other medical devices. The purpose of this retrospective cohort study is to determine the rate of CIED implantation success and CIED infection in procedures utilizing the antibacterial envelope., Methods: This study enrolled consecutive CIED procedures utilizing the antibacterial envelope at 10 US academic, community, and Veterans Affairs medical centers. Procedures following an explantation for a prior CIED infection or off-label use of the antibacterial envelope were excluded., Results: The 624 eligible procedures (age 70 ± 13 years, 68.1% men, 27.2% renal insufficiency, 35.4% oral anticoagulant use, 67.8% replacement/revision procedures) utilized pacemakers (35%), implantable cardioverter-defibrillators (ICD)(29%), and cardiac resynchronization therapy with defibrillator devices (CRT-D)(36%). Nearly half of the patients (49%) had at least three predefined risk factors for CIED infection. CIED implantation was successful in 621 procedures (99.5%[95% confidence interval (CI) 98.8-99.9]). There were three major infections (0.48%[95%CI 0.17-1.40]) after 1.9 ± 2.4 months follow-up. The infections followed one ICD revision and two CRT-D replacements. There were seven deaths; none was a result of the antibacterial envelope or the CIED procedure., Conclusions: CIED procedures that utilized an antibacterial envelope had a high rate of CIED implantation success (>99%). Although the follow-up to date is short, there was also a low rate of infection (<0.50%) in this population at high risk for CIED infection., (©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.)

This study assesses a technique for quantifying the frequency spectrum of atrial fibrillation (AF) using the surface electrocardiogram. Electrocardiograhic recordings were obtained in 61 patients during AF. After bandpass filtering, the QRST complexes were subtracted using a template-matching algorithm. The resulting fibrillatory baseline signal was subjected to Fourier transformation and displayed as a frequency power spectrum. These frequency spectra were compared to direct measurements from the right atrium and coronary sinus in 35 patients undergoing electrophysiologic study. The clinical use of this technique was explored by correlating fibrillatory frequency with the behavior of the arrhythmia in 26 patients referred for cardioversion. The electrocardiographic frequency spectrum during AF was characterized by a single peak that varied widely between patients (range 228 to 480 beats/min). There was a strong correlation between electrocardiographic peak frequency and that measured in the right atrium and coronary sinus (r = 0.79 to 0.98, p <0.0001). Episodes of AF that terminated in < 5 minutes had a lower frequency than those that persisted > 5 minutes (324 +/- 36 vs 402 +/- 78 beats/min, p = 0.001). Chronic AF (< 3 months in duration) had a lower frequency than chronic AF (present > 3 months) (336 +/- 48 vs 408 +/- 60 beats/ min, p = 0.012). Fibrillation frequency was an accurate predictor of conversion with ibutilide. Success rate was 100% in patients with peak frequency < 360 beats/min versus 29% in patients with frequencies > or = 360 beats/min (p = 0.003). Automatic analysis of the frequency content of the fibrillatory baseline on the surface electrocardiogram accurately reflects the average rate of AF. This measurement correlates with the clinical pattern of the arrhythmia and predicts the response to administration of ibutilide.

Recent technological advances in implantable defibrillator systems (ICD) have changed implantation approaches. The aim of this study was to investigate the influence of these improvements on procedure times, implant-related charges, patient recovery, and morbidity. Ninety-six consecutive patients undergoing implantation of a nonthoracotomy ICD were studied. Implantation was performed under general anesthesia with the generator placed abdominally in 22 patients (group I) and pectorally in 40 patients (group II). Thirty-four patients underwent pectoral implantation using conscious sedation (group III). Groups were comparable with respect to clinical variables. Implantation duration and total procedure duration were shorter in group III (67 +/- 21 minutes and 117 +/- 30 minutes) when compared with group I (100 +/- 25 minutes and 157 +/- 39 minutes) and group II (86 +/- 24 minutes and 153 +/- 34 minutes, P < 0.05). Patients in group III did not require admission to the Post-Anesthesia Care Unit. In contrast, patients in groups I and II spent 92 +/- 28 minutes and 91 +/- 31 minutes in the Post-Anesthesia Care Unit. Implantation-related charges were reduced in patients having pectoral implantation using conscious sedation ($1451 +/- 217 vs. $2354 +/- 550 and $2796 +/- 384, P < 0.05). Patients in group III had a lower frequency of postoperative oral analgesic use (3.2 +/- 2.7 doses, P < 0.05) and a shortened post-operative length of stay (1.9 +/- 1.6 days, P < 0.05) when compared with groups I (5.7 +/- 4.0 doses and 3.3 +/- 1.4 days) and II (5.2 +/- 3.5 doses and 2.6 +/- 1.1 days). The overall complication rate was low (6.3%), with no differences between groups. Advances in ICD technology have simplified implantation, leading to shorter, less painful, and less expensive procedures.

A single-blinded, randomized trial was conducted to determine whether a mailed postcard improved follow-up in uncontrolled hypertensives. One hundred and seven patients with a systolic blood pressure (BP) of 180 or more or a diastolic blood pressure of 110 or more at an inner-city, hospital-based walk-in clinic were enrolled; mean age was 56 years, 95 percent were African American, 73 percent were female, and mean BP was 193/106. Patients were required to be aware of their diagnosis and to have been informed of their need for medication at least a month before the trial. Of those who received postcard reminders, 45 percent followed up within 10 days, compared with 47 percent of controls (p = 0.93). At 30 days, 64 percent of the intervention group followed up, compared with 55 percent of controls (p = 0.36). In an adjusted logistic regression model, there was no difference in follow-up. Correlates of appointment noncompliance at one month included alcoholism and lack of insurance in an adjusted logistic regression model. Follow-up in severe hypertensives was poor, and a mailed postcard reminder had no effect in a walk-in setting.