Activated protein C in patients with septic shock: a consecutive case series.

Background: The recommendation to restrict the use of activated protein C (APC) to patients with severe sepsis and the highest risk of death originates from large trials that were subject to major exclusion criteria.

Objective: To investigate the effect of APC on prognosis in 'real world' patients.

Method: Consecutive case series at tertiary care hospital including 63 adults with septic shock and multi-organ failure treated with APC (24 mcg/kg/h) for up to 96 h in addition to standard care.

Pacing lead inserted via the subclavian artery caused acute coronary syndrome.

Unlabelled: Introduction of a cardiac pacing lead via the subclavian artery is a rare complication in the process of pacemaker implantation. Removal of the lead from the arterial system imposes an increased risk of cerebral thrombembolism and, in case of arterial puncture, an increased risk of bleeding.

Methods And Results: Here we describe an acute coronary syndrome caused by a pacing lead inserted via the subclavian artery with the tip implanted close to the ostium of the left coronary artery.

Progression of heart failure in right univentricular pacing compared to biventricular pacing.

Background: Cardiac resynchronization therapy (CRT) improves hemodynamics and symptoms of heart failure by reducing ventricular dyssynchronity. Conversely, recent studies have demonstrated that right univentricular pacing in patients with an ejection fraction below 40% aggravates heart failure. In this retrospective study, we compared progression of disease in patients with mild to moderate heart failure that were treated with a right univentricular pacing device and patients with congestive heart failure that were treated with a biventricular system.

Adverse effects of direct current cardioversion on cardiac pacemakers and electrodes Is external cardioversion contraindicated in patients with permanent pacing systems?

Use of pacing in sick sinus syndrome and recent developments in pacemaker therapy for intermittent atrial fibrillation raise the question of whether external electrical cardioversion should be used for termination of atrial fibrillation. This paper analyzes three cases of pacemaker and/or electrode dysfunction appearing after direct current (DC) cardioversion for termination of atrial fibrillation. Despite similar conditions during cardioversion in all cases, different dysfunctions reflecting damage to the pulse generator and/or a rise of the stimulation threshold in both, atrial and ventricular leads, have been observed.