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Background: In modern society, death has become ‘forbidden’ fed by the medical technology to conquer death. The technological paradigm is challenged by a social-liberal political ideology in postmodern Western societies. The question raised in this study was as follows: Which arguments, attitudes, values and paradoxes between modern and postmodern tendencies concerning treatment and care of older persons with an implantable cardioverter defibrillator appear in the literature? Aims: The aim of this study was to describe and interpret how the field of tension concerning older persons with an implantable cardioverter defibrillator – especially end-of-life issues – has been expressed in the literature throughout the last decade. Methods: Paul Ricoeur’s reflexive interpretive approach was used to extract the meaningful content of the literature involving qualitative, quantitative and normative literature. Analysis and interpretation involved naive reading, structural analysis and critical interpretation. Ethical considerations: The investigation complied with the principles outlined in the Declaration of Helsinki. Findings and discussions: The unifying theme was ‘Normativity under change’. The sub-themes were ‘Death has become legitimate’, ‘The technological imperative is challenged’ and ‘Patients and healthcare professionals need to talk about end-of-life issues’. There seems to be a considerable distance between the normative approach of how practice ought to be and findings in empirical studies. Conclusion: Modern as well as postmodern attitudes and perceptions illustrate contradictory tendencies regarding deactivation of the implantable cardioverter defibrillator and replacement of the implantable cardioverter defibrillator in older persons nearing the end of life. The tendencies challenge each other in a struggle to gain position. On the other hand, they can also complement each other because professionalism and health professional expertise cannot stand alone when the patient’s life is at stake but must be unfolded in an alliance with the patient who needs to be understood and accepted in his vulnerability. [ABSTRACT FROM AUTHOR]

Aims: Cardiac resynchronization therapy (CRT) improves symptoms, left ventricular function, and survival in patients with heart failure (HF) and wide QRS. The benefit of adding implantable cardioverter-defibrillator (ICD) backup is debated. We analysed the long-term outcome of patients with HF due to ischaemic cardiomyopathy (ICM) or non-ischaemic cardiomyopathy (NICM) treated with a CRT device with or without defibrillator backup.Methods and Results: In this observational study, consecutive patients with an ejection fraction ≤35% and QRS width ≥120 ms receiving a CRT device at Aarhus University Hospital, Denmark from 2000 to 2010 were included. Baseline characteristics were retrieved from patient files and survival data were obtained from the Danish Civil Registration System. The primary outcome was all-cause mortality. The effect of ICD backup was estimated using Cox proportional hazards model, and the multivariate analyses were adjusted for a priori selected variables. We included 917 HF patients, 427 with NICM, and 490 with ICM. Median follow-up was 4.0 years. Adjusted hazard ratio (aHR) for all-cause mortality was 0.76 [95% confidence interval (95% CI), 0.60-0.97; P = 0.03] in all patients; 0.96 (95% CI, 0.60-1.51; P = 0.85) in patients with NICM, and 0.74 (95% CI, 0.56-0.97; P = 0.03) in patients with ICM. In patients with NICM, ICD backup seemed to be associated with improved survival among non-responders to CRT (P = 0.08), but not among responders (P = 0.61).Conclusion: Adding an ICD backup is associated with better survival in CRT recipients. This effect was evident among patients with ICM, but not in patients with NICM. [ABSTRACT FROM AUTHOR]

Aim The aim of the present study was to validate pacemaker telemetry as a diagnostic feature for detecting atrial tachyarrhythmias (AT) during pacemaker treatment in patients with sick sinus syndrome (SSS). Methods and results Patients with SSS and bradytachy syndrome (n = 28, 20 women), mean age 71 ± 10.3 years, were included. The patients were treated with AAIR (n = 14) or DDDR pacing. At a routine follow-up visit pacemaker telemetry was reset and the patients underwent Holter recording for at least 24 h. Episodes of atrial fibrillation (AF) during Holter recording were compared with episodes of AT detected by the pacemaker. Only episodes of AF lasting for at least 1 min during Holter recording were registered. Conclusion Pacemaker telemetry was found to be a reliable tool for detecting AT in patients with SSS. [ABSTRACT FROM PUBLISHER]

Seventy-nine patients admitted for VVI pacemaker treatment were randomly given a Siemens-Elema 412 S endocardial electrode (tip material vitreous carbon, tip area 12 mm2) (41 patients) or a Siemens-Elema 415 S endocardial electrode (tip material platinum, tip area 12 mm2) (38 patients). The groups did not differ in age, sex, magnitude of intracardiac signal or indication for pacemaker treatment. Pacing threshold was measured by the vario technique at 3 and 15 months after the implantation. In the group of carbon-tip electrodes and in the group of platinum-tip electrodes stimulation thresholds at implantation were 0.49 ± 0.10 V and 0.54 ± 0.14 V (ns), at months 31.40 ± 0.45 V and 1.57 ± 0.53 V (ns), and at months 151.12 ± 0.33 V and 1.37± 0.38 V (P = 0.003), respectively. After 1 year, 88% of the patients in the carbon-tip group and 66% (P = 0.04) in the platinum-tip group fulfilled our criteria for reducing pacemaker output from 5.0 V to 2.5 V. In comparable platinum-tip and carbon-tip pacing electrodes, the chronic stimulation threshold was lower in the carbon-tip than in the platinum-tip electrode. [ABSTRACT FROM AUTHOR]

Aims: Treatment with evidence-based heart failure (HF) medication reduces morbidity and mortality, yet they remain underused and underdosed. Cardiac resynchronization therapy (CRT) improves haemodynamics, and might allow for optimization of HF medication. We analysed treatment with HF medication after CRT implantation, long-term adherence to this treatment, and its association with patient survival., Methods and Results: This observational study included 826 consecutive patients who received a CRT device at a tertiary centre. Data were obtained from patient files and prescription data from the Danish National Prescription Registry. Doses are expressed as percentages of target doses. We used Cox proportional hazard model to compute adjusted hazard ratios (aHRs) for survival with 95% confidence intervals (CIs), adjusted for potential confounders. During the median (quartiles) follow-up of 4.4 (3.0-6.7) years, 324 patients died. Daily doses of beta-blocker (BB) (53 (27-90) vs. 43 (22-75)%; P < 0.001) and angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) (78 (45-100) vs. 74 (44-97)%; P = 0.02) had increased after 6-month follow-up compared with pre-implantation doses. After 4 years, adherence was 95% to BB and 94% to ACEi/ARB. Treatments with low (≤50%) and high (>50%) doses were associated with prolonged survival for BB (low: aHR 0.65 (0.47-0.90); P = 0.009, and high: aHR 0.50 (0.35-0.70); P < 0.001) and for ACEi/ARB (low: aHR 0.68 (0.46-1.00); P = 0.05, and high: aHR 0.55 (0.38-0.80); P = 0.002)., Conclusion: After CRT implantation, optimization of HF treatment is possible, and long-term adherence to HF medication remains high. Higher doses of BB and ACEi/ARB were associated with prolonged survival., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)

Aims: To assess the long-term mortality and occurrence of post-ablation atrial fibrillation in patients undergoing a radiofrequency ablation for the Wolff-Parkinson-White (WPW) syndrome., Methods and Results: A retrospective cohort study of patients (N = 362) subjected to radiofrequency ablation of the WPW syndrome at Aarhus University Hospital from 1990 to 2011. A comparison cohort (N = 3619) was generated from the Danish National Board of Health Central Population Registry. We found no significant difference in all-cause mortality when comparing the WPW group with the control group [hazard ratio (HR): 0.77 and confidence interval (CI): 0.47-1.25]. After radiofrequency ablation, the WPW group had a significantly higher risk of atrial fibrillation than the control group (HR: 4.77 and CI: 3.05-7.43). Atrial fibrillation prior to ablation (HR: 4.66 and CI: 2.09-10.41) and age over 50 years (HR: 9.79 and CI: 4.29-22.36) at the time of ablation were independent risk factors for post-ablation atrial fibrillation in the WPW group., Conclusion: Patients with radiofrequency ablation-treated WPW syndrome have a post-ablation mortality that is similar to the background population. The risk of atrial fibrillation remains high after radiofrequency ablation of the WPW syndrome., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)

Segmental pulmonary vein isolation (SPVI) and circumferential pulmonary vein isolation (CPVI) are the two main approaches to radiofrequency ablation in patients with atrial fibrillation (AF). The aim of this retrospective study was to investigate the safety level and patient outcome of both approaches. The overall freedom from symptoms was 73% and 25% after CPVI and SPVI, respectively. Our study concludes that CPVI is an effective treatment of highly symptomatic and drug-resistant AF and when used in laboratories by experienced electrophysiologists has a promising and reproducible outcome ratio and safety level.

Aim: The aim of the present study was to validate pacemaker telemetry as a diagnostic feature for detecting atrial tachyarrhythmias (AT) during pacemaker treatment in patients with sick sinus syndrome (SSS)., Methods and Results: Patients with SSS and bradytachy syndrome (n = 28, 20 women), mean age 71 +/- 10.3 years, were included. The patients were treated with AAIR (n = 14) or DDDR pacing. At a routine follow-up visit pacemaker telemetry was reset and the patients underwent Holter recording for at least 24 h. Episodes of atrial fibrillation (AF) during Holter recording were compared with episodes of AT detected by the pacemaker. Only episodes of AF lasting for at least 1 min during Holter recording were registered. AT detected by the pacemaker telemetry was defined as: an atrial high rate episode with a rate of > or = 220 bpm for > or = 5 min, atrial sensing with a rate of > or = 170 bpm in > or = 5% of total counted beats, mode-switching in > or = 5% of total time recorded or a mode-switching episode of > or = 5 min. Twenty-eight Holter recordings (mean duration 31.5 h, range 20-72 h) were used for evaluation. Ten patients had one or more episodes of AF lasting at least 1 min on their Holter recordings. Nine of these patients had AT detected by their pacemaker telemetry according to our criteria. None of the patients had AT detected by the pacemaker telemetry and not by the Holter recording. The specificity and sensitivity for detection of AT recorded by the pacemaker telemetry in this study was 100% and 90%, respectively. The false-positive rate was 0%., Conclusion: Pacemaker telemetry was found to be a reliable tool for detecting AT in patients with SSS.