Cardioversion Safety - Are We Doing Enough?

There is a considerable periprocedural risk of thromboembolic events in atrial fibrillation patients undergoing cardioversion, and treatment with anticoagulants is therefore a hallmark of cardioversion safety. Based on retrospective subgroup analyses and prospective studies, non-vitamin K anticoagulants are at least as efficient as vitamin K-antagonists in preventing thromboembolic complications after cardioversion. The risk of thromboembolic complications after cardioversion very much depends on the comorbidities in a given patient, and especially heart failure, diabetes, and age >75 years carry a markedly increased risk.

Arrhythmias and sleep apnea: physiopathologic link and clinical implications.

Available evidence suggests a pathogenetic role of sleep breathing disorders in both atrial and ventricular arrhythmias with non-negligible clinical implications. Scientific literature has reported convincing findings on the link between sleep breathing disorders and arrhythmias. The coexistence of these conditions should be appropriately managed because OSA treatment may reduce arrhythmia recurrence.

Feasibility of automated detection of sleep apnea using implantable pacemakers and defibrillators: a comparison with simultaneous polysomnography recording.

Purpose: Sleep-related breathing disorders (SRBD) have been associated with adverse cardiovascular events and prognosis. Some modern pacemakers (PMK) and implantable cardioverter defibrillators (ICD) are equipped with thoracic impedance monitoring systems which allow detecting fluctuations in tidal volume occurring in SRBD. This study aimed at assessing the accuracy of a novel transthoracic impedance-based PMK/ICD sensor for automatic detection of SRBD.

European Cardiac Arrhythmia Society Statement on the cardiovascular events associated with the use or abuse of energy drinks.

Energy drinks are increasingly used by young people and young athletes in order to improve their performance alone or in association of other substances, particularly alcohol. In recent years, a number of reports of reports have raised attention on the side-effects associated with the use or abuse of energy drinks particularly serious cardiovascular events. The European Cardiac Arrhythmia Society (ECAS) has undertaken a systematic and critical review of reported data on cardiovascular events including life-threatening arrhythmias with or without cardiac arrest and other cardiovascular events, and discussed in this review the possible causal effect of caffeine and other ingredients contained in energy drinks and the reported events.

Update on cardiac implantable electronic devices: from the injectable loop recorder to the leadless pacemaker, to the subcutaneous defibrillator.

A very fast-paced improvement of technology in the field of cardiac implantable devices has been observed in the last ten years. The aim of this review is to highlight the most important innovations which have been recently introduced in this field, such as the leadless pacemaker (a heart stimulator without intracardiac leads), the subcutaneous defibrillator (a completely extracardiac defibrillator device), the injectable loop recorder (a miniaturized subcutaneous continuous echocardiographic monitor provided by alarms and telephonic transmission) and many other new devices which will completely change the clinical practice in this field over the next decade.

Multicenter study on parathyroidectomy (PTX) in Italy: preliminary results.

Background: When medical therapy is unable to achieve biochemical control of secondary hyperparathyroidism, parathyroidectomy (PTX) is indicated, fortunately in a minority of patients. Thus, data on PTX prevalence and biochemical control are limited and, in particular in Italy, date back to 1999.

Methods: We designed a prospective, observational and multicenter study to collect data from dialysis units distributed throughout the Italian regions.

Benefit of dual-chamber pacing with Closed Loop Stimulation in tilt-induced cardio-inhibitory reflex syncope (BIOSync trial): study protocol for a randomized controlled trial.

Background: The efficacy of dual-chamber cardiac pacing in neuro-mediated reflex syncope with a cardio-inhibitory response to the Tilt-Table test (TT) has not been definitively assessed so far. The lack of reproducibility of results from previous studies may be partially explained by discrepancies in subject selection and some weaknesses in design and methods. The European Society of Cardiology (ESC) has set a class IIb indication to pacemaker implantation in this population recommending further research.

An Italian Translation and Validation of the near Activity Visual Questionnaire (NAVQ).

Purpose: To validate the Near Activity Vision Questionnaire (NAVQ) in Italian to allow the assessment of presbyopia corrections in Italian-speaking patients.

Methods: An Italian version of the NAVQ was arranged through several steps: an initial forward translation (from English to Italian), a backward translation (from Italian to English), and finally a consensual version to check against the original NAVQ. This prospective study enrolled native Italian-speaking presbyopic patients with corrected distance visual acuity of 0.

5D CNS+ Software for Automatically Imaging Axial, Sagittal, and Coronal Planes of Normal and Abnormal Second-Trimester Fetal Brains.

The purpose of this study was to test new 5D CNS+ software (Samsung Medison Co, Ltd, Seoul, Korea), which is designed to image axial, sagittal, and coronal planes of the fetal brain from volumes obtained by 3-dimensional sonography. The study consisted of 2 different steps. First in a prospective study, 3-dimensional fetal brain volumes were acquired in 183 normal consecutive singleton pregnancies undergoing routine sonographic examinations at 18 to 24 weeks' gestation.

Hyperferritinemia-cataract syndrome: Long-term ophthalmic observations in an Italian family.

Background: Hyperferritinemia-cataract syndrome (HCS) is a rare Mendelian condition characterized by bilateral cataract and high levels of serum ferritin in the absence of iron overload.

Methods: HCS was diagnosed in three adult siblings. In two of them it was possible to assess lens changes initially in 1995 and again in 2013.

Extracapillary proliferation is an independent predictive factor in Immunoglobulin A nephropathy.

Background: Oxford classification of Immunoglobulin A Nephropathy (IgAN) identifies four pathological features as predictors of renal outcome (MEST-score): mesangial proliferation (M); endocapillary proliferation (E); segmental glomerulosclerosis (S); tubular atrophy/interstitial fibrosis (T). In particular extracapillary proliferation (Ex) was not considered as an independent histological variable predicting renal outcome. Recently the VALIGA study provided a validation of the Oxford classification in a large European cohort of IgAN patients and re-stated that Ex is not associated with a worse renal prognosis.

Vitamin D, allergies and asthma: focus on pediatric patients.

In recent years, the interest of the scientific world towards vitamin D gradually increased, and several studies have been conducted to dissect its possible role in modulating the development/course of allergic diseases. Also, Vitamin D supplementation has been assessed as a beneficial approach for treating allergies in some, but not all studies. We reviewed herein the available and relevant literature concerning the possible links between Vitamin D, its supplementation and allergic diseases.

Clinical management of nondialysis patients with chronic kidney disease: a retrospective observational study. Data from the SONDA study (Survey Of Non-Dialysis outpAtients).

Background: A lack of awareness of chronic kidney disease (CKD) often results in delayed diagnosis and inadequate treatment.

Purpose: The objective of this study was to assess the therapeutic management and outcome of nondialysis CKD patients.

Methods: Three hundred ninety-seven patients (54.

Vestibular evoked myogenic potential in vestibular neuritis.

This study wants to show the diagnostic value of vestibular evoked myogenic potential (VEMP) in the diagnosis of vestibular neuritis (VN), independently of the caloric test results. Twenty patients were enrolled with acute vertigo caused by VN. VEMP was tested with the binaural simultaneous stimulation method.

Validity of Italian adaptation of the Dizziness Handicap Inventory (DHI) and evaluation of the quality of life in patients with acute dizziness.

The impact of dizziness on Quality of Life (QoL) can be assessed by the Dizziness Handicap Inventory (DHI), which is used as a discriminative and evaluative tool. Although the DHI is available in several languages, an equivalent version for the Italian population is not yet available. Aim of this study was to translate the DHI into the Italian language (DHI-I), assess its correlation to the Italian version of the Short Form-36 Health Survey and to investigate its reliability in evaluating the QoL of patients with acute dizziness.

Appearance of HbeAg in an occult persistent hepatitis B virus infection.

Occult hepatitis B virus infection (OBI) is characterized by the presence of ongoing viral replication with very low levels of viremia (<200 IU/ml), and negativity for HBsAg, while the so-called 'false' OBI with higher levels of HBV-DNA that are negative for HBsAg are usually due to the occurrence of mutations of the HBsAg sequence that may alter the recognition by some immunoassays. We describe here a case of occult HBV infection that combines both aspects. A male patient with severe systemic diseases, positive for anti-HBc and anti-HBs and negative for all other HBV markers, including HBsAg, since at least 4 years, showed a positivity for HBeAg at a follow-up control in November 2008; HBV-DNA testing by real-time PCR evidenced very low levels of viremia (<40 IU/ml), direct sequencing of the surface antigen-coding and Pol/RT coding regions allowed the identification of genotype D, serotype adw2, one immune escape mutation (G145R) and no drug resistance mutations.

High-dose calcitriol therapy and progression of cardiac vascular calcifications.

Background: Dialysis patients show a very high prevalence of cardiovascular complications, affected as they are with abnormal and accelerated vascular calcifications and, eventually, calcium and phosphorous metabolism disorders. Multislice computed tomography (MSCT) provides a reproducible, high-resolution imaging of calcium contained in cardiac arteries, measured by Agatston score. The aim of the present study was to evaluate the influence of high-dose and low-dose calcitriol therapy on the progression of cardiac vascular calcifications in dialyzed patients.

Management of syncope: clinical and economic impact of a Syncope Unit.

Aims: Aim of this observational study is to evaluate the clinical performance of a Syncope Unit, in order to assess whether the implemented organization really improves syncope management.

Methods And Results: The study enrolled patients with unexplained syncope who were consecutively referred to our Syncope Unit, either as outpatients or during hospitalization, in a 2-month period. The design of this observational study consists in three phases: a retrospective analysis of their clinical management in the 9 months prior to the first attendance at the Syncope Unit (phase one), their subsequent clinical management in the Syncope Unit (phase two) and a 9-month follow-up (phase three).

Permanent pacing lead insertion through the cephalic vein using an hydrophilic guidewire.

The cephalic vein (CV) should be preferred to the subclavian vein for the insertion of permanent pacing leads because of better results. Unfortunately, the direct lead introduction using the standard CV cutdown is often unsuccessful. This study evaluated the efficacy and safety of a steerable hydrophilic guidewire (HGW) for lead insertion through the CV.

Upper lateral cartilage suspension over dorsal grafts: a treatment for internal nasal valve dynamic incompetence.

The internal nasal valve incompetence (INVI) can be divided into (1) static: when the articulation between the dorsal edge of the upper lateral cartilages and the dorsal edge of the septum forms an angle less than 10 to 15 degrees and (2) dynamic: when the upper lateral cartilages collapse attracted by the negative pressure during inspiration. To correct both the static and dynamic components in severe cases of INVI, the authors propose a surgical technique consisting of upper lateral cartilages suspension over dorsal grafts; the dorsal margins of the two upper lateral cartilages are pulled dorsally and sutured together over the dorsal edge of the septum and over the dorsal-spreader grafts. The post-operative results of 12 patients affected by INVI with severe nasal obstruction were evaluated.

Determinants of psychiatric inpatient admission to general hospital psychiatric wards: an epidemiological study in a region of central Italy.

Objective: To determine which factors contribute to the decision to admit individuals to psychiatric wards in general hospitals.

Method: Data on 1,379 individuals undergoing psychiatric evaluation in eight emergency rooms in a region of central Italy were collected. A logistic regression analysis was used to evaluate the likelihood of psychiatric admission considering the independent effects of demographic, social, and clinical factors and of the history of psychiatric treatment.

Excision and replacement of nasal septum in aesthetic and functional nose surgery: setting criteria and establishing indications.

Despite the technical details of the excision and replacement of the nasal septum both in aesthetic and functional nasal surgery have been extensively reviewed, in the opinion of the authors a clear and precise definition of the indications of this technique is still lacking. A simplified classification of the nasal septum deformities, based on the site and the direction of the fracture or bending axis, is proposed to establish reproducible guidelines to nasal septum surgery. On the basis of this classification the post-operative results of 227 patients affected by obstructive nasal septum deviation were evaluated.

Effect of electrode configuration and capacitor size on internal atrial defibrillation threshold using leads currently used for ventricular defibrillation.

Background: Previous studies have shown that endocardial atrial defibrillation, using lead configurations specifically designed for ventricular defibrillation, is feasible but the substantial patient discomfort might prevent the widespread use of the technique unless significant improvements in shock tolerability are achieved. It has been suggested that the peak voltage or the peak current but not the total energy delivered determines the patient pain perception and therefore, lower defibrillating voltage and current achieved with modifications in lead and waveforms may increase shock tolerability. This study was undertaken to evaluate the effect, on the atrial defibrillation threshold (ADFT), of the addition of a patch electrode (mimicking the can electrode) to the right ventricle (RV)-superior vena cava (SVC) lead configuration.