A Real-world Experience of Atrioventricular Synchronous Pacing with Leadless Ventricular Pacemakers

Aims: The MicraTM transcatheter pacing system (TPS) (Medtronic) is the only leadless pacemaker that promotes atrioventricular (AV) synchrony via accelerometer-based atrial sensing. Data regarding the real-world experience with this novel system are currently lacking. We sought to characterize patients undergoing MicraTM -AV implants, describe percentage AV synchrony achieved, and analyze the causes for suboptimal AV synchrony. Methods: In this retrospective cohort study, electronic medical records from 56 consecutive patients undergoing MicraTM -AV implants at the Mayo Clinic sites in Minnesota, Florida, and Arizona with a minimum follow-up of 3 months were reviewed. Demographic data, comorbidities, echocardiographic data, and clinical outcomes were compared among patients with and without atrial synchronous-ventricular pacing (AsVP) ≥70%. Results: Fifty-six percent of patients achieved AsVP ≥70%. Patients with adequate AsVP had smaller body mass indices, a lower proportion of congestive heart failure and pulmonary hypertension. Echocardiographic parameters and procedural characteristics were similar across the two groups. Active device troubleshooting was associated with higher AsVP. The likely reasons for low AsVP were persistent atrial arrhythmias, small A4-wave amplitude, and inadequate device reprogramming. Importantly, in patients with low AsVP, subjective clinical worsening was not noted during follow-up. Conclusion: With the increasing popularity of leadless PM, it is paramount for device implanting teams to be familiar with common predictors of AV synchrony and troubleshooting with MicraTM -AV devices.

Download Full-text

Post-Operative Dysphagia in Anterior Cervical Discectomy and Fusion

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211015582 ◽

2021 ◽

pp. 000348942110155

Author(s):

Leonard Haller ◽

Khush Mehul Kharidia ◽

Caitlin Bertelsen ◽

Jeffrey Wang ◽

Karla O’Dell

Keyword(s):

Risk Factors ◽

Medical Records ◽

Assessment Tool ◽

Demographic Data ◽

Anterior Cervical Discectomy ◽

Cervical Discectomy ◽

Long Term Follow Up

Objective: We sought to identify risk factors associated with long-term dysphagia, characterize changes in dysphagia over time, and evaluate the incidence of otolaryngology referrals for patients with long-term dysphagia following anterior cervical discectomy with fusion (ACDF). Methods: About 56 patients who underwent ACDF between May 2017 to February 2019 were included in the study. All patients were assessed for dysphagia using the Eating Assessment Tool (EAT-10) survey preoperatively and late postoperatively (≥1 year). Additionally, 28 patients were assessed for dysphagia early postoperatively (2 weeks—3 months). Demographic data, medical comorbidities, intraoperative details, and post-operative otolaryngology referral rates were collected from electronic medical records. Results: Of the 56 patients enrolled, 21 patients (38%) had EAT-10 scores of 3 or more at long-term follow-up. None of the demographics, comorbidities, or surgical factors assessed were associated with long-term dysphagia. Patients who reported no long-term dysphagia had a mean EAT-10 score of 6.9 early postoperatively, while patients with long-term symptoms had a mean score of 18.1 ( P = .006). Of the 21 patients who reported persistent dysphagia symptoms, 3 (14%) received dysphagia testing or otolaryngology referrals post-operatively. Conclusion: Dysphagia is a notable side effect of ACDF surgery, but there are no significant demographics, comorbidities, or surgical risk factors that predict long-term dysphagia. Early postoperative characterization of dysphagia using the EAT-10 questionnaire can help predict long-term symptoms. There is inadequate screening and otolaryngology follow-up for patients with post-ACDF dysphagia.

Download Full-text

Computed tomography-guided percutaneous trephine removal of the nidus in osteoid osteoma patients: experience of a single center in Brazil

Radiologia Brasileira ◽

10.1590/0100-3984.2014.0024 ◽

2015 ◽

Vol 48 (4) ◽

pp. 211-215 ◽

Cited By ~ 6

Author(s):

Marcelo Petrilli ◽

Andreza Almeida Senerchia ◽

Antonio Sergio Petrilli ◽

Henrique Manoel Lederman ◽

Reynaldo Jesus Garcia Filho

Keyword(s):

Computed Tomography ◽

Osteoid Osteoma ◽

Medical Records ◽

Demographic Data ◽

Procedural Pain ◽

Lesion Site ◽

Single Center ◽

Ct Guided ◽

Patients Experience

Abstract Objective: To report the results of computed tomography (CT)-guided percutaneous resection of the nidus in 18 cases of osteoid osteoma. Materials and Methods: The medical records of 18 cases of osteoid osteoma in children, adolescents and young adults, who underwent CT-guided removal of the nidus between November, 2004 and March, 2009 were reviewed retrospectively for demographic data, lesion site, clinical outcome and complications after procedure. Results: Clinical follow-up was available for all cases at a median of 29 months (range 6–60 months). No persistence of pre-procedural pain was noted on 17 patients. Only one patient experienced recurrence of symptoms 12 months after percutaneous resection, and was successfully retreated by the same technique, resulting in a secondary success rate of 18/18 (100%). Conclusion: CT-guided removal or destruction of the nidus is a safe and effective alternative to surgical resection of the osteoid osteoma nidus.

Download Full-text

Where No Universal Health Care Identifier Exists: Comparison and Determination of the Utility of Score-Based Persons Matching Algorithms Using Demographic Data (Preprint)

10.2196/preprints.10436 ◽

2018 ◽

Author(s):

Anthony Waruru ◽

Agnes Natukunda ◽

Lilly M Nyagah ◽

Timothy A Kellogg ◽

Emily Zielinski-Gutierrez ◽

...

Keyword(s):

Health Care ◽

Medical Records ◽

Demographic Data ◽

Program Planning ◽

Hiv Care ◽

Universal Health Care ◽

Health Care Settings ◽

Care And Treatment ◽

Universal Health

BACKGROUND A universal health care identifier (UHID) facilitates the development of longitudinal medical records in health care settings where follow up and tracking of persons across health care sectors are needed. HIV case-based surveillance (CBS) entails longitudinal follow up of HIV cases from diagnosis, linkage to care and treatment, and is recommended for second generation HIV surveillance. In the absence of a UHID, records matching, linking, and deduplication may be done using score-based persons matching algorithms. We present a stepwise process of score-based persons matching algorithms based on demographic data to improve HIV CBS and other longitudinal data systems. OBJECTIVE The aim of this study is to compare deterministic and score-based persons matching algorithms in records linkage and matching using demographic data in settings without a UHID. METHODS We used HIV CBS pilot data from 124 facilities in 2 high HIV-burden counties (Siaya and Kisumu) in western Kenya. For efficient processing, data were grouped into 3 scenarios within (1) HIV testing services (HTS), (2) HTS-care, and (3) within care. In deterministic matching, we directly compared identifiers and pseudo-identifiers from medical records to determine matches. We used R stringdist package for Jaro, Jaro-Winkler score-based matching and Levenshtein, and Damerau-Levenshtein string edit distance calculation methods. For the Jaro-Winkler method, we used a penalty (р)=0.1 and applied 4 weights (ω) to Levenshtein and Damerau-Levenshtein: deletion ω=0.8, insertion ω=0.8, substitutions ω=1, and transposition ω=0.5. RESULTS We abstracted 12,157 cases of which 4073/12,157 (33.5%) were from HTS, 1091/12,157 (9.0%) from HTS-care, and 6993/12,157 (57.5%) within care. Using the deterministic process 435/12,157 (3.6%) duplicate records were identified, yielding 96.4% (11,722/12,157) unique cases. Overall, of the score-based methods, Jaro-Winkler yielded the most duplicate records (686/12,157, 5.6%) while Jaro yielded the least duplicates (546/12,157, 4.5%), and Levenshtein and Damerau-Levenshtein yielded 4.6% (563/12,157) duplicates. Specifically, duplicate records yielded by method were: (1) Jaro 5.7% (234/4073) within HTS, 0.4% (4/1091) in HTS-care, and 4.4% (308/6993) within care, (2) Jaro-Winkler 7.4% (302/4073) within HTS, 0.5% (6/1091) in HTS-care, and 5.4% (378/6993) within care, (3) Levenshtein 6.4% (262/4073) within HTS, 0.4% (4/1091) in HTS-care, and 4.2% (297/6993) within care, and (4) Damerau-Levenshtein 6.4% (262/4073) within HTS, 0.4% (4/1091) in HTS-care, and 4.2% (297/6993) within care. CONCLUSIONS Without deduplication, over reporting occurs across the care and treatment cascade. Jaro-Winkler score-based matching performed the best in identifying matches. A pragmatic estimate of duplicates in health care settings can provide a corrective factor for modeled estimates, for targeting and program planning. We propose that even without a UHID, standard national deduplication and persons-matching algorithm that utilizes demographic data would improve accuracy in monitoring HIV care clinical cascades.

Download Full-text

Treatment of refractory Aspergillus otomycosis with voriconazole: case series and review

The Journal of Laryngology & Otology ◽

10.1017/s0022215114001273 ◽

2014 ◽

Vol 128 (6) ◽

pp. 547-551 ◽

Cited By ~ 7

Author(s):

Hsu-Chueh Ho ◽

Shih-Hsuan Hsiao ◽

Cheng-Yung Lee ◽

Chen-Chi Tsai

Keyword(s):

Medical Records ◽

Therapeutic Option ◽

Demographic Data ◽

Local Treatment ◽

Case Series ◽

Surgical Debridement ◽

Underlying Diseases ◽

Lost To Follow Up

AbstractBackground:Voriconazole is a broad-spectrum azole exhibiting strong anti-Aspergillus activity and good long-term tolerance. However, the evidence for voriconazole efficacy against refractory Aspergillus otomycosis is weak.Method:We reviewed the medical records of patients with Aspergillus otomycosis treated with voriconazole from January 2008 to June 2012 in a Taiwanese regional hospital. Demographic data and information regarding underlying diseases, clinical features, treatment and outcome were assessed.Results:In total, 14 cases of Aspergillus otomycosis were treated with voriconazole, including 5 patients with Aspergillus invasive otitis externa. All patients had failed to respond to local treatment, antibiotics or topical agents. One case was lost to follow up. The symptoms of two patients recurred after voriconazole treatment: one patient received a second 12-week course of voriconazole and was cured; and symptoms of the other patient recurred after a second 12-week course of voriconazole, leading to surgical debridement. The remaining 11 patients were cured by voriconazole treatment without extensive surgical debridement.Conclusion:This study demonstrates that voriconazole can be a very effective and convenient therapeutic option for the management of refractory Aspergillus otomycosis.

Download Full-text

A new leadless pacemaker with atrioventricular synchronous pacing replacing a still working VVI leadless pacemaker: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab305 ◽

2021 ◽

Author(s):

Massimo Moltrasio ◽

Rita Sicuso ◽

Fabrizio Tundo ◽

Claudio Tondo

Keyword(s):

Pacemaker Implantation ◽

Good Alternative ◽

Functional Class ◽

Ventricular Pacing ◽

Short Term ◽

Jude Medical ◽

Leadless Pacemaker ◽

Atrial Sensing ◽

Asynchronous Pacing

Abstract Background A new intracardiac leadless pacemaker (ILP) has been developed to ensure atrioventricular synchrony during ventricular pacing. Recent studies have shown feasibility and safety of accelerometer-based atrial sensing and an improvement in atrioventricular synchrony among patients with atrioventricular block implanted with the Micra AV ILP (Medtronic Inc, Minneapolis, Minnesota, US). However, no data exists about the benefits of a VDD ILP in patients wearing a still working VVI Nanostim ILP (St Jude Medical, St Paul, Minnesota, US). We describe the feasibility of the procedure and the absence of device-related adverse events in the short-term follow-up. Case summary We present the case of a 72-year-old man implanted with a VVI ILP (Nanostim, St Jude Medical, St Paul, MN) on May 2014, who has developed symptomatic high percentage of VVI asynchronous pacing and was treated with an upgrade to synchronous AV PM ILP—Micra AV (Medtronic Inc, Minneapolis, Minnesota, US), which has improved symptoms and functional class. Discussion ILPs represent the best current option for patients requiring pacemaker implantation who are at high risk of infection and bleeding. Our case shows that the new AV synchronous ILP is a good alternative to VVI ILP in patients with sinus rhythm and a strong need for ventricular pacing.

Download Full-text

Locking or Non-locking Hook Plate in Treatment of Unstable Lateral Clavicle Fracture

ARS Medica Tomitana ◽

10.2478/arsm-2014-0027 ◽

2015 ◽

Vol 20 (3) ◽

pp. 150-152

Author(s):

Şerban Al. O. ◽

Obadâ B.

Keyword(s):

Medical Records ◽

Demographic Data ◽

Clavicle Fracture ◽

Shoulder Function ◽

Hook Plate ◽

Lateral Clavicle Fracture ◽

Lateral Clavicle ◽

Clavicular Hook Plate ◽

Clavicle Fractures

Abstract The purpose of this study was to compare the outcomes and complications of locking or nonlocking clavicular hook plate for fixation of unstable lateral clavicle fractures. All patients with unstable Neer type II lateral clavicle fractures were operated in our hospital from January 2011 to December 2012. The included participants received either locking or nonlocking clavicular hook plate operations. Demographic data, medical records and radiographs were reviewed retrospectively. At the last follow-up, shoulder function was evaluated with Constant-Murley scoring system. Our findings suggest that locking clavicular hook plates are equally useful for treating unstable lateral clavicular fractures, but in face of complicated ones, the locking hook plate would not get more benefits than nonlocking hook plate.

Download Full-text

Anti-MAG antibodies in 202 patients: clinicopathological and therapeutic features

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2017-316715 ◽

2017 ◽

Vol 89 (5) ◽

pp. 499-505 ◽

Cited By ~ 21

Author(s):

Juliette Svahn ◽

Philippe Petiot ◽

Jean-Christophe Antoine ◽

Christophe Vial ◽

Emilien Delmont ◽

...

Keyword(s):

Medical Records ◽

Severe Disease ◽

Age At Onset ◽

Disease Stage ◽

Antibody Titres ◽

Myelin Associated Glycoprotein ◽

Spectrum Of Patients ◽

Mean Time ◽

Clinical Worsening

ObjectiveTo assess the clinicopathological and therapeutic features of patients with low (≥1000 to <10 000 Bühlmann Titre Units) (BTU), medium (10 000–70 000) or high (≥70 000) anti-myelin-associated glycoprotein (anti-MAG) antibody titres.MethodsWe retrospectively and prospectively analysed standardised report forms and medical records of 202 patients from 14 neuromuscular centres.ResultsMean age at onset and mean time between symptom onset to last follow-up were respectively 62.6 years (25–91.4) and 8.4 years (0.3–33.3). Anti-MAG antibody titres at diagnosis were low, medium or high in 11%, 51% and 38% of patients. Patients presented with monoclonal gammopathy of undetermined significance in 68% of cases. About 17% of patients presented with ‘atypical’ clinical phenotype independently of anti-MAG titres, including acute or chronic sensorimotor polyradiculoneuropathies (12.4%), and asymmetric or multifocal neuropathy (3%). At the most severe disease stage, 22.4% of patients were significantly disabled. Seventy-eight per cent of patients received immunotherapies. Transient clinical worsening was observed in 12% of patients treated with rituximab (11/92). Stabilisation after rituximab treatment during the 7–12-month follow-up period was observed in 29% of patients. Clinical response to rituximab during the 6-month and/or 7–12-month follow-up period was observed in 31.5% of patients and correlated with anti-MAG titre ≥10 000 BTU.ConclusionOur study highlights the extended clinical spectrum of patients with anti-MAG neuropathy, which appears unrelated to antibody titre. Besides, it may also suggest beneficial use of rituximab in the early phase of anti-MAG neuropathy.

Download Full-text

P6549Conventional single lead ventricular pacemaker against leadless pacemaker system in real-world patients: prospective one center study. CARDIOCHUS Registry

European Heart Journal ◽

10.1093/eurheartj/ehz746.1139 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J L Martinez Sande ◽

J Garcia-Seara ◽

L Gonzalez-Melchor ◽

M Rodriguez-Manero ◽

J N Lopez-Canoa ◽

...

Keyword(s):

Real World ◽

Pacemaker Implantation ◽

P Value ◽

World Population ◽

Device Performance ◽

Single Chamber ◽

Leadless Pacemaker ◽

Major Complications ◽

Center Study

Abstract Background As more experience is obtained with leadless pacemakers systems (LPM), a great group of patients is considered for its implantation. There are issues that cannot be completely avoided with conventional transvenous pacemaker (VVI-PM) such as infectious or pocket related complications in which LPM are clearly superior. Purpose The aim of the study was to compare the clinical and device performance between LPM and VVIPM in the same period of time in a “real-world” population. Methods We performed a prospective, observational, one center study, including all patients with a single chamber pacemaker implantation within 3 years (June 2015-December 2018) and its mid-term follow-up. All clinical, electrical and echocardiographic characteristics, as well as implantation characteristics and complications, were described. Results We included a total of 339 patients with transvenous pacemakers, 195 patients with VVI-PM and 144 LPM. There were no significant differences in mortality between both groups during the follow-up (12,3±10 months), Figure 1. Although there were no significant differences in major complications (P-value 0,54), the number of total complications was lower in the LPM group (P-value 0,01) at the expense of fewer minor ones (P-value 0,02), Table 1. Table 1. Complications TVP (195) LPM (144) P value Major complications 11 (5.6%) 6 (4.2%) 0.54 Minor complications 10 (5.1%) 0 (0.0%) 0.01 Total Complications 21 (10.7%) 6 (4,2%) 0.02 Figure 1 Conclusions In our study, during the med-term follow-up, there were no significant differences in terms of mortality and the major complications between LMP and VVI-PM. Although, the number of minor complications were less with the LMP.

Download Full-text