bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Acceptability of Implantation of Internal Cardioverter‐Defibrillators Under Local Anesthetic and Conscious Sedation
Authors: FOX DAVID J. , DAVIDSON NEIL C. , BENNETT DAVID H. , CLARKE BERNARD , GARRATT CLIFFORD J. , HALL MARK C.S. , ZAIDI AMIR M. , PATTERSON KAY , FITZPATRICK ADAM P. 
Published: July 2007

Background: Implantation and testing of implantable defibrillators (ICDs) using local anesthetic and conscious sedation is widely practiced; however, some centers still use general anesthesia. We assessed safety and patient acceptability for implantation of defibrillators using local anesthetic and conscious sedation.
Methods: The records of 500 consecutive device implants from two UK cardiac centers implanted under local anesthetic and conscious sedation from January 1996 to December 2004 were reviewed. Procedure time, left ventricular ejection fraction (LVEF) sedative dosage (midazolam), analgesic dosage (fentanyl or diamorphine), requirement for drug reversal, and respiratory support were recorded. Patient acceptability of the procedure was also assessed.
Results: Of 500 implants examined, 387 were ICDs, 88 were biventricular ICDs, and 25 were generator changes. Patients with biventricular‐ICDs had significantly longer (mean ± SD) procedure times 129.7 ± 7.6 minutes versus 63.3 ± 32.3 minutes; P < 0.0001 and lower LVEF 24.4 ± 8.4% versus 35.7 ± 15.4%; P < 0.0001. There were no differences in the doses (mean ± SD) of midazolam 8.9 ± 3.5 mg versus 8.0 ± 3.1 mg; P = NS, diamorphine 4.3 ± 2.0 mg versus 3.8 ± 1.7 mg; P = NS or fentanyl 94.4 ± 53.7 mcg versus 92.2 ± 48.6 mcg; P = NS, between the two groups. There were no deaths or tracheal intubations in either group. Acceptability was available for 373 of 500 (75%) patients, 41 of 373 (11%) described “discomfort,” but from these 41 patients only 14 of 373 (3.8%) declined a second procedure under the same conditions.
Conclusions: Implantation of defibrillators under local anesthetic and sedation is safe and acceptable to patients. General anesthesia is no longer routinely required for implantation of defibrillators.
Localization of Accessory Pathways in the Wolff‐Parkinson‐White Pattern—Physician Versus Computer Interpretation of the Same Algorithm
Authors: McGAVIGAN ANDREW D. , CLARK ELAINE , QUINN F. RUSSELL , RANKIN ANDREW C. , MACFARLANE PETER W. 
Published: July 2007

Background: There are several published algorithms for the prediction of accessory pathway (AP) location in the Wolff‐Parkinson‐White syndrome from the 12‐lead electrocardiogram (ECG). Most depend on stepwise criteria, and minor disagreements between observers over QRS transition point or delta wave axis may lead to different classification of pathway location. We compared the utility of a computerized program in identifying pathway location from the ECG using the algorithm published by Fitzpatrick and coworkers3 against physician assessment with the same algorithm.
Methods: Thirty‐one 12‐lead ECGs with an overt preexcitation pattern were examined by three physicians and AP localized to one of eight anatomical sites using the Fitzpatrick algorithm, with disagreements resolved by consensus. Similarly, pathway location was determined by the Glasgow ECG program with the Fitzpatrick algorithm incorporated into its logic.
Results: The agreement between each physician and their consensus was 28/31, 29/31, and 29/31. Similarly, assessment by the Glasgow program produced agreement with the physician consensus in 29/31 cases. Of the 24 patients who underwent radiofrequency ablation, the program localized the pathway to the true or adjacent annular region in 20, compared to 20/24 by physician assessment of the algorithm, producing a similar predictive accuracy to published data.
Conclusion: This study has shown that incorporation of the Fitzpatrick algorithm for AP location into a widely used computer program results in the same level of performance as that of experienced physicians and may be useful in clinical practice as an aid to referral for electrophysiological study and ablation.
The Safety and Efficacy of Ibutilide in Children and in Patients with Congenital Heart Disease
Authors: HOYER ANDREW W. , BALAJI SESHADRI 
Published: July 2007

Background: The safety and efficacy of ibutilide in the cardioversion of atrial flutter and atrial fibrillation in children and in patients with congenital heart disease (CHD) is unknown.
Methods: Data from 19 patients (age 6 months to 34 years, median 16 years) who received ibutilide for atrial flutter or atrial fibrillation between 1996 and 2005 was retrospectively reviewed. There were 15 patients with CHD (14 had prior heart surgery); four children had normal heart structure.
Results: There were 74 episodes of atrial flutter and four episodes of atrial fibrillation (median episodes per patient was one, range 1–31). Ibutilide converted 55 of all the episodes (71%). Ibutilide was successful during its first‐ever administration in 12 of 19 patients (63%). Fourteen episodes in six patients required electrical cardioversion after ibutilide failed. There were no episodes of symptomatic bradycardia. One patient went into torsade de pointes and one patient had nonsustained ventricular tachycardia.
Conclusion: With careful monitoring, ibutilide can be an effective tool in selected patients for cardioversion of atrial flutter.
Concordance Between Mechanical and Electrical Dyssynchrony in Heart Failure Patients: A Function of the Underlying Cardiomyopathy?
Authors: TOURNOUX FRANÇOIS , DONAL ERWAN , LECLERCQ CHRISTOPHE , DE PLACE CHRISTIAN , CROCQ CHRISTOPHE , SOLNON AUDE , COHEN‐SOLAL ALAIN , MABO PHILIPPE , DAUBERT JEAN‐CLAUDE 
Published: July 2007

Background: Cardiac resynchronization therapy (CRT) improves heart failure (HF) symptoms through a reduction of cardiac mechanical dyssynchrony. Mechanical dyssynchrony is currently estimated by electrical dyssynchrony (QRS duration). It is known that electrical and mechanical dyssynchrony are not well correlated in HF patients. However, there is limited information about whether this relationship might be influenced by the underlying cardiomyopathy. Methods: Doppler echocardiography was performed in 88 patients presenting with heart failure due to ischemic (n = 42) or nonischemic (n = 46) heart disease, left ventricular ejection fraction <40%, New York Heart Association class II–IV, regardless of their QRS duration. Interventricular dyssynchrony was assessed by the time interval between preaortic and prepulmonary ejection times. Intraventricular dyssynchrony was ascertained by (1) the delay between the earliest and the latest peak negative longitudinal strain recorded in the basal and mid‐segments of the lateral and septal walls (TMinMax) and (2) the standard deviation of time‐to‐peak in the same segments (SDdys). Results: The correlation coefficient between QRS duration and mechanical interventricular dyssynchrony was r = 0.47 (P < 0.001) in patients with nonischemic disease and nonsignificant in patients with ischemic disease. Similarly, the correlation coefficient between QRS duration and mechanical intraventricular dyssynchrony was significant in patients with nonischemic disease (r = 0.37, P = 0.01 for TMinMax; r = 0.42, P = 0.003 for SDdys) and nonsignificant in patients with ischemic disease. Conclusion: The concordance between electrical dyssynchrony assessed by QRS duration and mechanical dyssynchrony assessed by myocardial strain is dependent upon the underlying cardiomyopathy. This observation may improve our understanding of the various responses observed in CRT patients.
Autonomic Tone Attenuates Drug‐Induced QT Prolongation
Authors: SMITH ANDREW H. , NORRIS KRIS J. , RODEN DAN M. , KANNANKERIL PRINCE J. 
Published: July 2007

Introduction: The QT interval is a predictor of sudden death. Many drugs prolong the QT, primarily through IKr block. Autonomic tone directly affects heart rate and ventricular repolarization, but its effects in the setting of IKr block are unknown. Objective: Determine the effects of autonomic tone on heart rate and QT interval after IKr block. Methods and Results: Healthy adults (n = 9) were administered ibutilide with ECGs obtained at regular intervals. On a separate day, subjects were administered intravenous propranolol and atropine to induce autonomic block, resulting in intrinsic heart rate and QT interval; ibutilide was administered again, with serial ECGs obtained at regular intervals. No differences in baseline RR, QT, or QTc intervals were seen between the two study days. Ibutilide in the setting of intact autonomic tone prolonged QTc by 43 ± 8 msec (P = 0.001) and prolonged RR interval by 93 ± 39 msec (P = 0.04). Autonomic block alone on the second day prolonged QTc by 16.7 ± 9.4 msec (P = 0.02). An additional 68 ± 5 msec prolongation of QTc was seen with ibutilide in the setting of double autonomic block (P = 0.036). There was no effect of ibutilide on intrinsic heart rate (P = 0.125). Conclusion: Autonomic block results in an exaggeration of drug‐induced QT prolongation by ibutilide. IKr block has no effect on intrinsic heart rate. QT‐prolonging drugs may have more deleterious effects in those with underlying autonomic dysfunction, thus increasing the risk for sudden death.
Cost Comparison of Catheter Ablation and Medical Therapy in Atrial Fibrillation
Authors: KHAYKIN YAARIV , MORILLO CARLOS A. , SKANES ALLAN C. , MCCRACKEN AARON , HUMPHRIES KARIN , KERR CHARLES R. 
Published: July 2007

Introduction: There is emerging evidence for clinical superiority of catheter ablation over rate and rhythm control strategies in paroxysmal atrial fibrillation (PAF). The objective of this study was to compare costs related to medical therapy versus catheter ablation for PAF in Ontario (Canada). Methods: Costs related to medical therapy in the analysis included the cost of anticoagulation, rate and rhythm control medications, noninvasive testing, physician follow‐up visits, and hospital admissions, as well as the cost of complications related to this management strategy. Costs related to catheter ablation were assumed to include the cost of the ablation tools (electroanatomic mapping or intracardiac echocardiography‐guided pulmonary vein ablation), hospital and physician billings, and costs related to periprocedural medical care and complications. Costs related to these various elements were obtained from the Canadian Registry of Atrial Fibrillation (CARAF), government fee schedules, and published data. Sensitivity analyses looking at a range of initial success rates (50–75%) and late attrition rates (1–5%), prevalence of congestive heart failure (CHF) (20–60%), as well as discounting varying from 3% to 5% per year were performed. Results: The cost of catheter ablation ranged from $16,278 to $21,294, with an annual cost of $1,597 to $2,132. The annual cost of medical therapy ranged from $4,176 to $5,060. Costs of ongoing medical therapy and catheter ablation for PAF equalized at 3.2–8.4 years of follow‐up. Conclusion: Catheter ablation is a fiscally sensible alternative to medical therapy in PAF with cost equivalence after 4 years.
Slow Atrioventricular Nodal Reentrant Arrhythmias: Clinical Recognition, Electrophysiological Characteristics, and Response to Radiofrequency Ablation
Authors: VIJAYARAMAN PUGAZHENDHI , ALAEDDINI JAMSHID , STORM RANDLE , OREN JESSE , WOOD MARK A , ELLENBOGEN KENNETH A. 
Published: July 2007

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is a common form of supraventricular tachycardia (SVT). Rarely, patients may present with an unusual form of atrioventricular nodal reentrant arrhythmia (AVNRA) with a cycle length greater than 600 ms. We describe the clinical presentation, electrophysiology characteristics, and response to radiofrequency ablation in a group of patients with AVNRA. Methods and Results: Six patients with slow documented sustained supraventricular arrhythmias at rates <100 bpm underwent electrophysiology study. Baseline clinical and electrophysiologic characteristics were: mean age 77 ± 5 years; left ventricular ejection fraction 51 ± 10%; hypertension 66%; diabetes mellitus 33%; coronary artery disease 33%; sinus cycle length 874 ± 110 ms; PR 261 ± 54 ms; atrial to His (AH) 181 ± 49 ms. AVNRA was diagnosed based on previously described criteria for AVNRT. Mean tachycardia cycle length (TCL) during AVNRA was 668 ± 74 ms. The AH and His to atrial (HA) intervals during the AVNRA was 434 ± 50 and 234 ± 81 ms, respectively. Two patients had slow–fast AVNRA while the others had slow–slow AVNRA. Most common symptoms reported during AVNRA were shortness of breath, fullness in the throat, chest tightness, dizziness, near‐syncope, and syncope. Radiofrequency catheter ablation (RFCA) of the slow pathway was performed successfully in five of six patients. Post‐ablation AV nodal Wenckebach occurred at 666 ± 49 ms compared with 521 ± 91 ms at baseline. Conclusion: AVNRA may occur at rates less than 100 bpm in the elderly and may be misdiagnosed as junctional rhythm. Slow AVNRA can cause significant symptoms. Slow pathway ablation can be successfully performed in AVNRA.
A Novel Early Onset Lethal Form of Catecholaminergic Polymorphic Ventricular Tachycardia Maps to Chromosome 7p14‐p22
Authors: BHUIYAN ZAHURUL A. , HAMDAN MOHAMED A. , SHAMSI EMAN T.A. , POSTMA ALEX V. , MANNENS MARCEL M.A.M. , WILDE ARTHUR A. M. , AL‐GAZALI LIHADH 
Published: July 2007

Introduction: Previously, autosomal dominant catecholaminergic polymorphic ventricular tachycardia (CPVT [1]) was mapped to chromosome 1q42–43 with identification of pathogenic mutations in RYR2. Autosomal recessive CPVT (2) was mapped to chromosome 1p13–21, leading to the identification of mutations in CASQ2. In this study, we aimed to elucidate clinical phenotypes of a new variant of CPVT (3) in an inbred Arab family and also delineate the chromosomal location of the gene causing CPVT (3). Methods and Results: In a highly inbred family, clinical symptoms of CPVT appeared early in childhood (7–12 years) and in three of the four cases, the first appearance of symptoms turned into a fatal outcome. Parents of the affected children were first‐degree cousins and without any symptoms. Segregation analysis suggested an autosomal recessive inheritance. A genome‐wide search using polymorphic DNA markers mapped the disease locus to a 25‐Mb interval on chromosome 7p14‐p22. A maximal multipoint LOD score of 3.17 was obtained at marker D7S493. Sequencing of putative candidate genes, SP4, NPY, FKBP9, FKBP14, PDE1C, and TBX20, in and around this locus, did not reveal any mutation. Conclusions: We have identified a novel highly malignant autosomal recessive form of CPVT and mapped this disorder to a 25‐Mb interval on chromosome 7p14‐p22.
Effect of Pacing the Right Ventricular Mid‐Septum Tract in Patients with Permanent Atrial Fibrillation and Low Ejection Fraction
Authors: MUTO CARMINE , OTTAVIANO LUCA , CANCIELLO MICHELANGELO , CARRERAS GIOVANNI , CALVANESE RAIMONDO , ASCIONE LUIGI , IENGO RAFFAELE , ACCADIA MARIA , CELENTANO EDUARDO , TUCCILLO BERNARDINO 
Published: July 2007

Introduction: Permanent right ventricular (RV) pacing leads have been traditionally implanted in the right ventricular apex (RVA). Nowadays, some deleterious effects of RVA pacing have been recognized. The aim of this study was to evaluate the effect of different sites of RV pacing in patients with permanent atrial fibrillation (AF) and low ejection fraction (LEF) needing a pacemaker (PM) implantation. Methods: Two hundred seventy‐three patients with permanent AF and EF <30% underwent a one‐chamber rate responsive (VVIR) PM implant procedure. Patients were divided into two groups: Group A, including 113 patients with the pacing lead tip placed in the RV mid‐septum, and Group B of 120 patients with the pacing lead tip placed at the apex of RV. All patients had clinical and Echo control after 1, 3, 6, 12, and 18 months after PM implantation to assess New York Heart Association (NYHA) class and EF. Results: After 18 months, NYHA class changed in Group A from 2.9 ± 0.4 at implant to 1.7 ± 0.3 at 18 months (P = 0.01), and in Group B from 3.0 ± 0.5 at implant to 3.3 ± 0.6 at 18 months (P = n.s.). EF increased in Group A: 28 ± 2% at implant, 33 ± 1% at 18 months (P = 0.0125), while no significant changes were observed in Group B: at implant 27 ± 2%, 26 ± 2% at 18 months (P = n.s.). Conclusion: The present study suggests that more physiological pacing from the RV sept can improve EF and quality of life (QoL) in patients with permanent AF and low EF needing a PM.
Visual response of the tomato fruit fly, Neoceratitis cyanescens, to colored fruit models
Authors: Brévault T. , Quilici S. 
Published: July 2007

AbstractTo determine how mature females of the tomato fruit fly, Neoceratitis cyanescens (Bezzi) (Diptera: Tephritidae), detect host fruit after arriving in their host plant habitat, behavioral responses to colored models were observed in a laboratory flight chamber. Host‐seeking females oriented themselves preferentially towards bright orange spheres (3.7 cm in diameter), irrespective of their natal host fruit: tomato, bug weed, or black nightshade. Females oriented themselves preferentially towards the orange sphere when placed against a fluorescent yellow background as opposed to a black background, but the distribution of responses to the set of colored spheres did not vary significantly with background color. In a choice situation between bright orange spheres of various sizes (1.9, 3.7, and 7.5 cm in diameter), females landed preferentially on the bigger sphere. However, they preferred a yellow color when the latter was associated with two‐dimensional models, probably mimicking leaves. The attractiveness of orange spheres depended more on the proportion of reflected light in the spectral region around 610 nm than brightness of color in itself. Low light intensity significantly influenced the activity of the flies but not their visual preference. The strong response of females to bright orange spheres confirmed the importance of visual characteristics in short‐range mechanisms of host‐plant location in specialist insects. Responses to fruit visual stimuli are discussed relative to other Tephritidae, host‐finding strategy, and pest management.
Modeled global invasive potential of Asian gypsy moths, Lymantria dispar
Authors: Peterson A. Townsend , Williams Richard , Chen Guojun 
Published: July 2007

AbstractAsian populations of gypsy moths, Lymantria dispar (L.) (Lepidoptera: Lymantriidae), remain poorly characterized – indeed, they are not presently accorded any formal taxonomic status within the broader species. Their ecology is similarly largely uncharacterized in the literature, except by assumption that it will resemble that of European populations. We developed ecological niche models specific to Asian populations of the species, which can in turn be used to identify a potential geographic distributional area for the species. We demonstrated statistically significant predictivity of distributional patterns within the East Asian range of these populations; projecting the Asian ecological niche model to Europe, correspondence with European distributions was generally good, although some differences may exist; projecting the ecological niche model globally, we characterized a likely potential invasive distribution of this set of populations across the temperate zone of both Northern and Southern Hemisphere.
Rebuilding the Ruined Churches of France
Authors: Gwynn Denis 
Published: July 2007

With the beginning of Lent the bishops of nine of the French dioceses in the devastated districts issued an appeal to the public for a loan of 200 million francs. The experiment is in itself a very considerable contribution to solving the problem of reconstruction in the Regions Libérées.Of the twelve dioceses which suffered partial or complete devastation in the war only nine are included in the list of co-operative reconstruction societies in whose names this appeal for public subscriptions is issued. The diocese of Nancy, which was the first to originate the idea of applying to the reconstruction of the ruined churches the legal privileges accorded to important syndicates of claimants to reparation money, has already successfully floated a preliminary loan for 15 million francs on its own account. It speaks well for the success of this more ambitious project that the whole amount asked for by the diocese of Nancy was subscribed locally within a few weeks. The present issue is the result of an agreement among the nine dioceses which suffered the most serious devastation, that they would make a joint appeal to the public so that none should be penalised by being behindhand in organising the necessary co-operative societies.The prospectus of the loan has now been distributed, and the first subscriptions are beginning to come in. There is no doubt, however, that the large amount asked for will take some time to materialise.Even the 200 million francs is only a fraction of the total amount that will be required to repair all the three thousand ruined churches of the Regions Liberies, and it is as well to state at once that the promoters of the loan are anxious to collect money wherever they can find generous friends.
On Waterloo Bridge
Authors: Essex Edwin 
Published: July 2007

Though starless is the sky to-night And clouds are sailing free,A thousand fairy points of light Go dancing to the sea.Reflections from the river-side Of lights both meek and bold,They fall along the outward tide In silver, red, and gold.They ripple on each tiny crest And tremble on the foam,The river will not let them rest Or shine for us at home.But onward from the magic town,If men would look with me,Its argosy it carries down From London to the sea.Edwin Essex, O.P.
Canon Dimnet and Democracy
Authors: Foster Paul U. 
Published: July 2007

Once,’ says Canon Dimnet, ‘I heard a shepherd saying that “the wind sat in France,”’ for the Canon was born in that frontier district of his country that was formerly part of the old Middle Kingdom of Lotharingia and later of the Duchy of Burgundy. Dimnet is a Frenchman born and bred; in My Old World he has created an unforgettable picture of the typical small town that was his birthplace, Trélon, with its gray spire dominating the flat landscape; but though the life of Trélon is French, its memories are of older allegiance, and the shepherd was recording in his phrase a time when, to the inhabitants of Trélon and all about Cambrai, the French were ‘foreigners.’It is perhaps not too fanciful to see in this frontier background an explanation of Canon Dimnet’s extraordinary feeling for a language and a culture not his own. An uncle early taught him ‘simple English words; door, window, pen, book . . . and had given our dog quite a standing in the street by calling him, for some reason, Euston.’ The little flame lighted by his uncle grew during school days until at last, on going to teach at Douai, Ernest Dimnet came into contact with the English Benedictine community in that town. The effect upon him was startling. Even in their Catholicism they betrayed a new world: ‘I used to think my Benedictine friends, monks though they were, even more unclerical than I was.