The confirmation of the occurrence of supraventricular arrhythmias (SVAs) is possible only if a surface electrocardiogram (ECG) is recorded during an episode, or if SVAs occur during 24 h ambulatory monitoring (Holter). The automatic interpretation of memory functions in DDD pacemakers may be useful in this diagnostic task over longer periods of follow up. This hypothesis was tested in 384 men and 233 women (mean age = 70 +/- 11 years) who had received Chorus 6034/6035, 6234 or 7034 pacemakers (ELA Medical, Montrouge, France) with fall-back function in case of sustained SVAs. The Automatic Interpretation for Diagnostic Assistance (AIDA) algorithm included in these pacemakers was compared with 24 h Holters recorded simultaneously (D1) and with the clinical history of symptoms consistent with SVAs up to 28 days of follow up (D28). Indications for pacing were atrioventricular block (AVB) in 269 patients, sinus node dysfunction (SND) in 248, and AVB + SND in 100. SVAs were documented before implant in 199 patients (32%). Among the 617 patients included at D1, 76 (12.4%) developed at least one SVA episode, lasting between 1 min and 24 hours, simultaneously recorded on Holter and by AIDA with a 93.8% sensitivity and 94.2% specificity. Data from 354 patients were available for analysis at D28. AIDA diagnosed SVAs in 179 patients (50.6%), 104 of whom (65%) had remained asymptomatic and 117 of whom (65%) had had no SVA documented before implant. Among the 354 patients, AIDA diagnosed SVAs in 76 (21%) asymptomatic patients who had no known SVA before implant. The prevalence of SVA in our AVB population was higher than reported in previous studies: 89 patients (56.3%) with AVB had SVAs versus 90 patients (45.9%) with other diagnoses (p = 0.55). Furthermore atrial pacing was associated with fewer SVAs. These first clinical results of the AIDA study demonstrate that the memory functions of Chorus pacemakers and the AIDA software are reliable to analyze the prevalence of SVA at 1 month of follow-up. From a clinical point of view, AIDA is a valuable tool to evaluate the efficacy of antiarrhythmic therapy, particularly as it pertains to the prevention of stroke due to atrial fibrillation.

AimsCardiac resynchronization therapy (CRT) is a recommended treatment of heart failure (HF) patients with depressed left ventricular ejection fraction and wide QRS. The optimal right ventricular (RV) lead position being a matter of debate, we sought to examine whether RV septal (RVS) pacing was not inferior to RV apical (RVA) pacing on left ventricular reverse remodelling in patients receiving a CRT-defibrillator.Methods and resultsPatients (n = 263, age = 63.4 ± 9.5 years) were randomly assigned in a 1:1 ratio to RVS (n = 131) vs. RVA (n = 132) pacing. Left ventricular end-systolic volume (LVESV) reduction between baseline and 6 months was not different between the two groups (−25.3 ± 39.4 mL in RVS group vs. −29.3 ± 44.5 mL in RVA group, P = 0.79). Right ventricular septal pacing was not non-inferior (primary endpoint) to RVA pacing with regard to LVESV reduction (average difference = −4.06 mL; P = 0.006 with a −20 mL non-inferiority margin). The percentage of ‘echo-responders’ defined by LVESV reduction >15% between baseline and 6 months was similar in both groups (50%) with no difference in the time to first HF hospitalization or death (P = 0.532). Procedural or device-related serious adverse events occurred in 68 patients (RVS = 37) with no difference between the two groups (P = 0.401).ConclusionThis study demonstrates that septal RV pacing in CRT is non-inferior to apical RV pacing for LV reverse remodelling at 6 months with no difference in the clinical outcome. No recommendation for optimal RV lead position can hence be drawn from this study.ClinicalTrials. gov numberNCT 00833352.

This report should alert public health and prison authorities to this issue, and garner resources to address such an alarming rise. The findings from this short report demonstrate the need for a further examination of the mechanisms affecting self-harm among prisoners in this population, particularly the relationship between self-strangulations/hangings and overcrowding.

This study confirmed the technical feasibility and noninferior performance of ICD leads implanted in the RV mid-septum versus the apex.

First inappropriate therapy occurred in 11% of 636 ICD recipients followed for ∼2 years. Nearly 50% of FIT could have been prevented by improving device programming.