Background-Long-term cessation of oral anticoagulation (OAC) after catheter ablation of atrial fibrillation (AF) has been deemed controversial.

AimCardiac resynchronization therapy (CRT) is a valid therapeutic option for patients with heart failure (HF). However, the elderly population was not well represented in the guidelines. The primary end point was to evaluate the impact of advanced age on clinical response and cardiovascular and total mortality of patients undergoing CRT. The secondary end point was to assess the rate of acute complications related to the procedure. Methods and resultsA total of 249 consecutive patients with HF and optimized treatment, QRS � 120 ms, ejection fraction (EF) � 35% and functional class (FC) III/ IV (NYHA) underwent CRT and divided into 3 groups: Group I-< 65 years-88/ 249 (35%); Group II-65 to 75 years (old)-72/ 249 (29%); Group III-� 75 years (very old)-89/ 249 (36%). The improvement in FC and increase in EF (>10%) and/ or decrease in the left ventricular end systolic diameter (LVESD) >15% were the criteria of responsiveness. The favorable clinical response (p = ns) and cardiovascular mortality (p = 0.737) was similar in the 3 groups. In the group of very old patients, a significant increase in total mortality was observed (p = 0.03). The rate of acute complications related to the procedure did not differ between the groups (p = ns). ConclusionThe response to CRT and cardiovascular mortality were not affected by the advanced age and should not be an exclusion factor of this therapy. The procedure has been shown to be safe in elderly patients due to low rate of acute complications.

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The skull of a dissection room subject was noted to have a hole in the left squamous temporal bone similar to a lesion in the Kabwe (Broken Hill) skull. Kabwe man has an 8 x 8 mm hole situated 2 cm above and slightly anterior to the left external auditory meatus (EAM). This report describes a possible mechanism for the causation of that lesion. which is illustrated by features on a modern skull. The subject is a 55-year-old man who died from carcinoma of the stomach in 1942. The skull was macerated, defatted and stored after the cadaver had been dissected by medical students. In the squamous temporal bone there was an oval shaped 9 x 8 mm hole. The base of the oval was situated 11 mm above the superior margin of the EAM with the central axis of the hole being in line with the anterior margin of the EAM. This hole forms the base of a larger intracranial pit measuring 21 mm in diameter. The hole has an irregular margin except superiorly where it is smooth and rounded, indicative of healing.Intracranially, the petrous temporal bone displayed a marked exophytic, bony outgrowth suggestive of a chronic infective condition. The tegmen tympani contained a hole 3 mm in diameter in the middle of the exophytic area. No sign of disease in the mastoid process was noted. These findings are compatible with advanced chronic ear disease which has tracked into the extradural space through the tegmen tympani, become loculated, and then eroded the squamous temporal bone.The Kabwe skull shows signs compatible with chronic ear disease. It is suggested that a mechanism similar to the one described in the modern skull could explain the lesion in the left squamous temporal bone of Kabwe man.