Incidence and Predictors of Infections and All-Cause Death in Patients with Cardiac Implantable Electronic Devices: The Italian Nationwide RI-AIAC Registry

Background: The incidence of infections associated with cardiac implantable electronic devices (CIEDs) and patient outcomes are not fully known. Aim: To provide a contemporary assessment of the risk of CIEDs infection and associated clinical outcomes. Methods: In Italy, 18 centres enrolled all consecutive patients undergoing a CIED procedure and entered a 12-months follow-up. CIED infections, as well as a composite clinical event of infection or all-cause death were recorded. Results: A total of 2675 patients (64.3% male, age 78 (70–84)) were enrolled. During follow up 28 (1.1%) CIED infections and 132 (5%) deaths, with 152 (5.7%) composite clinical events were observed. At a multivariate analysis, the type of procedure (revision/upgrading/reimplantation) (OR: 4.08, 95% CI: 1.38–12.08) and diabetes (OR: 2.22, 95% CI: 1.02–4.84) were found as main clinical factors associated to CIED infection. Both the PADIT score and the RI-AIAC Infection score were significantly associated with CIED infections, with the RI-AIAC infection score showing the strongest association (OR: 2.38, 95% CI: 1.60–3.55 for each point), with a c-index = 0.64 (0.52–0.75), p = 0.015. Regarding the occurrence of composite clinical events, the Kolek score, the Shariff score and the RI-AIAC Event score all predicted the outcome, with an AUC for the RI-AIAC Event score equal to 0.67 (0.63−0.71) p < 0.001. Conclusions: In this Italian nationwide cohort of patients, while the incidence of CIED infections was substantially low, the rate of the composite clinical outcome of infection or all-cause death was quite high and associated with several clinical factors depicting a more impaired clinical status.

Probable Genitourinary Adverse Events Associated With Atomoxetine in an Adult Male: A Case Report

Atomoxetine is a norepinephrine reuptake inhibitor used for treatment of attention-deficit/hyperactivity disorder. Prescribing information from the manufacturer lists genitourinary-related adverse events such as urinary hesitancy/retention and priapism as precautions for atomoxetine. We report a case of urinary hesitancy with milky, white-colored discharge associated with atomoxetine use in a 42-year-old male. The onset of genitourinary symptoms occurred within 2 days of atomoxetine 40 mg daily initiation. Laboratories, urinalysis, sexually transmitted infection analysis, and genital examinations were all unremarkable. Within 2 days of atomoxetine discontinuation, the genitourinary symptoms were no longer present. We calculated a Naranjo adverse event score of 5, indicating atomoxetine probably caused the genitourinary adverse events. A review of literature suggests that urine outflow obstruction-related adverse events occur more commonly in men compared to women. Discontinuation of atomoxetine appears to lead to rapid resolution of the adverse events. Additionally, spontaneous ejaculation and sexual side effects rarely occur with atomoxetine. Clinicians should educate and monitor patients explicitly for genitourinary-related adverse events, as they may not be spontaneously reported.

Capturing Ephemerality: George Brecht’s For a Drummer from the Perspective of a Performer

The main purpose of the article is to present an individual approach of analysing and reperforming For a Drummer by George Brecht, a legendary composer and a member of Fluxus. The text is divided into several parts. The first half of the article is dedicated to the history and definition of performance art, the second one focuses on a performer persona and their artistic abilities. The latter leads to an actual analysis of a creative process, starting with a short biographical background of Brecht, followed by reading and understanding of the event score with a culmination found in the author’s re-performance.

Being-in-the-Breathable: An Annotated Walk

This article explicates Robert Bean and Barbara Lounder’s 2017 collaborative artwork and public pedagogy project, Breathing-in-the-Breathable: An annotated walk. The authors contextualize the artwork in relation to its site, the ruins of a nineteenth-century tuberculosis sanatorium in the small Polish town of Sokołowsko. This site is a place historically associated with disease, healing and deadly conflict. The participatory project utilized an event score, objects, sound and embodied movement in exploring how the atmosphere and environment became explicit and weaponized by the use of gas warfare during the First and Second World Wars. Along with the site itself, the concept of ‘Being-in-the-Breathable’ (Sloterdijk, 2009) provided Bean and Lounder with a framework for this collaborative public artwork. The artists adopted walking as a creative method that disturbs histories, ideologies and habits, while simultaneously creating new networks of meaning spanning temporal frames, spaces, disciplinary boundaries, and embodied sensorial modalities (Ingold & Vergunst, 2008). The authors illustrate key points in the 90-minute artwork with colour images documenting the event.

2402Reduced heart rate variability is linked to clinical status in patients with a systemic right ventricle

Background Adult patients with congenital heart disease and a systemic right ventricle (sRV) are prone to develop heart failure. Decreased heart rate variability (HRV), a measure of autonomic dysfunction, is associated with morbidity and mortality in patients with congestive heart failure. The standard deviation of all intervals between normal sinus beats (SDNN) is a HRV parameter commonly reported as an indicator of autonomic function in these patients. Data about HRV and its clinical implications in patients with a sRV are scarce. Purpose To compare HRV parameters between patients with a sRV and healthy controls, and to assess their association with clinical status. Methods All available 24-hour Holter monitoring records of sRV patients under follow-up in our center and one record per healthy control subject were analysed. Holters with non-sinus rhythm were excluded. Time and frequency domain parameters were calculated and compared between both groups. Clinical landmarks such as arrhythmias or an episode of congestive heart failure, which occurred up until the time of the ambulatory ECG, were combined in a clinical event score. Determinants of SDNN were investigated with mixed model linear regression in the patients and with multivariate linear regression in the controls. Baseline characteristics, medication use, global longitudinal strain, validity as measured with bicycle exercise testing, and the clinical event score were taken into account. Results 113 Holters of 43 patients and 39 Holters of healthy controls were analysed. The patient group included 30 patients (70%) late after Mustard or Senning correction for transposition of the great arteries, and 13 patients with congenitally corrected transposition of the great arteries (30%). Age and gender were comparable in patients and controls. Several HRV parameters were significantly worse in patients compared with controls, including SDNN (138 in patients vs. 161 in controls, p=0.021). In the patients, clinical event score was the only significant determinant of a lower SDNN (p<0.001). In the controls, age was the only significant determinant of a lower SDNN (p=0.039). Conclusion Contrary to the healthy population, in patients with a sRV, HRV is associated with clinical status rather than age. This indicates that disease progression affects autonomic function more than ageing in this group. Further research is needed to clarify the relation between clinical outcome and autonomic function in sRV patients. Acknowledgement/Funding The Department of Cardiology of the LUMC received research grants from Medtronic, Biotronik, Boston Scientific and Edwards Lifesciences

‘Look Again’: Indeterminacy and Contemporary British Drama

The integration into conceptual art of techniques inspired by Fluxus (the international aggregate of artists who saw indeterminacy as imaginatively and linguistically enabling) has, in turn, given rise to a specific line in British playwriting since the mid-1990s, as evidenced in plays by Martin Crimp, Sarah Kane, and Tim Crouch which gesture towards conceptual art, performance art, and the event score. In this article Emilie Morin brings to light the affinities between this artistic moment in contemporary British theatre and the international avant-garde. She discusses the shared interest of Crimp, Kane, and Crouch in indeterminacy and the fusion between artistic media, paying particular attention to Crouch's redefinition of the status of the modern artwork in his play for galleries England (2007). Critical recognition of the experimental mode in which these playwrights operate has remained subsumed under a non-specific appreciation of their relationship to conceptual art, leaving important questions of form and legacy unaddressed. Here, the proximity between this marginal trend in British playwriting and developments in experimental music and performance art exploring ideas of indeterminacy is highlighted, and the contemporary problematization of performance as event and concept is reconfigured in relation to the legacies of Marcel Duchamp, John Cage, and Fluxus. Emilie Morin is Lecturer in the Department of English and Related Literature at the University of York and the author of Samuel Beckett and the Problem of Irishness (Palgrave Macmillan, 2009). Her research interests lie in European modernism and the avant-garde.