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Temporary Pacing Using Tunnelled Active-Fixation Leads Allows Prolonged Reliable Pacing with a Low Rate of Complications
S70
Abstracts
ABSTRACTS
renal dysfunction, and measured plasma ADMA concentrations. doi:10.1016/j.hlc.2007.06.178 174 Familial Muscular Ventricular Septal Defects and Aneurysm of the Muscular Interventricular Septum Mugur I. Nicolae 1 , Kim M. Summers 2 , Dorothy J. Radford 1,∗ 1 Department of Cardiology, The Prince Charles Hospital, Bris-
bane, Australia; 2 School of Molecular and Microbial Sciences, The University of Queensland, Brisbane, Australia Introduction: Familial clustering of muscular ventricular septal defects is unusual despite the fact that such defects are encountered at a rate of 53.2 per 1000 live births 1 . Isolated ventricular septal defect is the most common congenital cardiac malformation. It accounts for one quarter to one half of all cases of congenital heart defects 2 . This lesion is usually said to be of multifactorial aetiology, and although there is a genetic component in its origin, it has been rare to find the defect running in families. We report a family in whom there appears to be dominant Mendelian inheritance of muscular ventricular septal defects together with the association of a rare symptomatic aneurysm of the muscular interventricular septum. Family case presentations: Three siblings had muscular ventricular septal defects and two required surgical closure. One of their offspring had a rare congenital aneurysm of the muscular interventricular septum requiring surgery. Another had a small muscular ventricular septal defect which closed spontaneously. Their father had echocardiographic evidence suggestive of a closed muscular defect. Paternal cousins have had ventricular septal defect, transposition of the great arteries and Tetralogy of Fallot. There was no evidence of 22q11 deletion. Conclusions: Although ventricular septal defects are the most common congenital heart defect, such familial clustering is extremely uncommon. The distribution of cases in this family suggests autosomal dominant inheritance. With echocardiography and more precise diagnosis of defects which close, a larger genetic component may be revealed in other families. doi:10.1016/j.hlc.2007.06.179 175 The Effect of Low Dose Colchicine on hs-CRP in Patients with Stable Coronary Artery Disease (CAD) Independent of Aspirin and Statin Therapy M. Nidorf ∗ , C. Blanton, P.L. Thompson Sir Charles Gairdner Hospital and WA Heart Research Institute, Western Australia, Australia Background: In patients with stable CAD, elevated biomarkers of inflammation including high sensitivity CReactive Protein [hs-CRP] level ≥2.0 mg/L predict vascular
Heart, Lung and Circulation 2007;16:S1–S201
events. Since long-term low-dose colchicine is known to be a safe, effective means of dampening inflammation, we conducted an open-label pilot study to determine the effect of colchicine 0.5 mg/d or 0.5 mgbd in patients with stable CAD in whom the hs-CRP was ≥2.0 mg/L despite taking both aspirin and high dose statin. Methods: Plasma hs-CRP was measured in 385 consecutive patients with clinically stable CAD who were taking aspirin and statin therapy. In 116 [32%] patients hs-CRP was ≥2.0 mg/L. In 20 of these patients, hs-CRP was simply remeasured at 4 weeks, and in 64 patients hs-CRP was remeasured after 4–6 weeks of open label colchicine at doses of 0.5 mg/d [n = 22] or 0.5 mg bd [n = 42]. Results: In the 20 patients who received no treatment, the mean hs-CRP fell from 4.28 ± 2.03 mg/L to 3.70 ± 2.30 mg/L [mean change −11.0%: p NS]. In contrast, hs-CRP fell in all patients who received colchicine, falling from 4.69 ± 2.00 mg/L to 2.64 ± 1.80 mg/L [mean change −42%; p < 0.001] in patients taking 0.5 mg/d, and from 4.58 ± 2.05 mg/L to 1.78 ± 1.38 mg/L [mean change −60% p < 0.001] in patients taking 0.5 mg bd. No significant sideeffects were reported. Conclusion: Small doses of colchicine lower hs-CRP significantly in patients with clinically stable CAD, independent of aspirin and statin therapy. There appears to be dose response effect in the range 0.5–1.0 mg/day. Determining whether this will translate into a clinically important effect in such patients warrants further study. doi:10.1016/j.hlc.2007.06.180 176 Temporary Pacing Using Tunnelled Active-Fixation Leads Allows Prolonged Reliable Pacing with a Low Rate of Complications Graham Orsbourn 1,∗ , Nigel Lever 2 , Scott Harding 3 University, Wellington, New Zealand; 2 Auckland University, Auckland, New Zealand; 3 Wellington Hospital Cardiology Department, Wellington, New Zealand 1 Otago
Introduction: Conventional temporary pacing is frequently associated with complications. This study was performed to investigate the reliability and safety of temporary tunnelled pacing (TTP). Methods: All patients treated with TTP at our institution were included in the analysis (n = 22). TTP involved transvenous placement of a bipolar active-fixation permanent pacing lead into the right ventricle and/or the right atrium. The lead was tunnelled subcutaneously 5–10 cm from the point of vascular access. Pacing was achieved using an external re-sterilised permanent pulse generator. Results: Mean patient age was 67 ± 10.7 years. Indications for pacing included AV block (50%), sick sinus syndrome (54.5%), and ventricular tachycardia (18.1%). Reasons for delaying permanent device implantation were: infected pacing system (22.7%), other infection (31.8%), ventricular arrhythmia management (18.1%), concurrent critical medical illness (27.3%). A single ventricular lead was used (68%), although 8 patients (36%) also received an atrial
lead to allow DDD pacing. There were no lead dislodgements, pacing failure, pneumothoraces, perforations or infection related to TTP. The median duration of TTP was 16 days (range 2–71 days). An intercurrent illness resulted in the death of 4 patients, 12 patients (54.5%) had a permanent pacemaker implantated, 2 (9.1%) ICD implantation, and 4 (18.2%) patients had resolution of their arrhythmias. Nine patients were transferred to another hospital and one patient was sent home for palliative care with the TTP in-situ. This allowed 101 tertiary hospital days to be saved. Conclusions: TTP is a reliable method of achieving prolonged temporary pacing whilst allowing patients to ambulate freely. doi:10.1016/j.hlc.2007.06.181 177 Amiodarone Lung: Drug Induced Pulmonary Toxicity the Middlemore Experience R.E. Park 1,2,∗ , M. Nisbet 2 , J. Garrett 2 , D. Heaven 1 1 Department 2 Department
of Cardiology, Middlemore Hospital, Auckland; of Respiratory Medicine, Middlemore Hospital,
Auckland Amiodarone hydrochloride is an effective treatment for supraventricular and ventricular arrhythmias; however it has a significant side effect profile. A review was undertaken of patients diagnosed with amiodarone induced pulmonary toxicity to determine their clinical characteristics, indications for use and clinical outcome. Methods: A retrospective chart review of consecutive patients at Middlemore Hospital with a discharge diagnosis of amiodarone induced interstitial lung disease from January 2000 to January 2007. Patients who had clinical and radiological features of amiodarone lung as assessed by a respiratory physician were included. Results: Twelve cases were identified; all were European with mean age 78 ± 5.9 years, eight male. The indications for amiodarone were control of AF/SVT (58%), VF (17%) or both (25%). At diagnosis all patients had shortness of breath and half reported cough. New interstitial changes and ground glass opacities were consistently observed on chest x-ray and HRCT-chest scan. Renal impairment calculated by eGFR was present in all patients. The mean duration of amiodarone treatment was 2.6 years (2 months – 7.4 years) and the median dose 200 mg/day (100–400 mg/day). Amiodarone was discontinued in all cases and 6 received steroids. Two patients died from respiratory failure, with median time from presentation to death of 64 days. Conclusions: Pulmonary toxicity from amiodarone remains an important cause of morbidity and mortality; and alternatives to long-term use including device-based therapy should be considered. Europeans were exclusively represented in our cohort and this may indicate a lower occurrence in Maori and Pacific Islanders. Care with
Abstracts
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amiodarone prescriptions remains important especially in elderly patients. doi:10.1016/j.hlc.2007.06.182 178 The Publication Rate and Impact of Presentations at the Cardiac Society of Australia and New Zealand Annual Scientific Meetings V. Chand 1,2 , F.L. Rosenfeldt 1,2 , S. Pepe 1,2,∗ 1 Department
of Cardiothoracic Surgery, Alfred Hospital, Australia; 2 Department of Surgery, Monash University, Melbourne, Australia Introduction: Currently there is no information regarding cardiology publications arising from abstracts presented at the CSANZ annual scientific meetings. Aim: To determine the publication rate and indexed impact of original articles arising from abstracts presented between 1999 and 2005. Methods: Abstracts were obtained from Heart, Lung & Circulation or CSANZ’s website. Abstract authors and keywords were searched for publications (to 31/01/07) on the National Library of Congress PubMed database (USA). A match of abstract to retrieved full article was identified on the basis of authorship, similarities in titles and study design. The ISI Citation database (USA) was accessed for journal impact factors (IF). Results: A total of 2,172 abstracts resulted in 607 article publications (28%, mean IF = 4.32). Approximately 12% of publications had an IF between 4 and 9, while 18% had an IF > 9. Most publications were published within one (61%) and two years (84%), with a mean lag of 1.4 years. Surgical abstract presentations were notably low (2.4%). Since 1999, there has been a decrease in surgical submissions from 17% to 1.3%, however their publication rate remains markedly high (98%, mean IF = 3.13) Conclusions: (1) One in three presented abstracts result in publication. (2) Most are published within 1–2 years. (3) The average IF achieved is mid-range. In considering the diverse specialties within cardiology, the numerous barriers to publication and limited research resources available to members of CSANZ, this preliminary analysis indicates a moderately high quality and timely publication rate that may improve further when barriers are fully identified and addressed. doi:10.1016/j.hlc.2007.06.183
ABSTRACTS
Heart, Lung and Circulation 2007;16:S1–S201
Abstracts
ABSTRACTS
renal dysfunction, and measured plasma ADMA concentrations. doi:10.1016/j.hlc.2007.06.178 174 Familial Muscular Ventricular Septal Defects and Aneurysm of the Muscular Interventricular Septum Mugur I. Nicolae 1 , Kim M. Summers 2 , Dorothy J. Radford 1,∗ 1 Department of Cardiology, The Prince Charles Hospital, Bris-
bane, Australia; 2 School of Molecular and Microbial Sciences, The University of Queensland, Brisbane, Australia Introduction: Familial clustering of muscular ventricular septal defects is unusual despite the fact that such defects are encountered at a rate of 53.2 per 1000 live births 1 . Isolated ventricular septal defect is the most common congenital cardiac malformation. It accounts for one quarter to one half of all cases of congenital heart defects 2 . This lesion is usually said to be of multifactorial aetiology, and although there is a genetic component in its origin, it has been rare to find the defect running in families. We report a family in whom there appears to be dominant Mendelian inheritance of muscular ventricular septal defects together with the association of a rare symptomatic aneurysm of the muscular interventricular septum. Family case presentations: Three siblings had muscular ventricular septal defects and two required surgical closure. One of their offspring had a rare congenital aneurysm of the muscular interventricular septum requiring surgery. Another had a small muscular ventricular septal defect which closed spontaneously. Their father had echocardiographic evidence suggestive of a closed muscular defect. Paternal cousins have had ventricular septal defect, transposition of the great arteries and Tetralogy of Fallot. There was no evidence of 22q11 deletion. Conclusions: Although ventricular septal defects are the most common congenital heart defect, such familial clustering is extremely uncommon. The distribution of cases in this family suggests autosomal dominant inheritance. With echocardiography and more precise diagnosis of defects which close, a larger genetic component may be revealed in other families. doi:10.1016/j.hlc.2007.06.179 175 The Effect of Low Dose Colchicine on hs-CRP in Patients with Stable Coronary Artery Disease (CAD) Independent of Aspirin and Statin Therapy M. Nidorf ∗ , C. Blanton, P.L. Thompson Sir Charles Gairdner Hospital and WA Heart Research Institute, Western Australia, Australia Background: In patients with stable CAD, elevated biomarkers of inflammation including high sensitivity CReactive Protein [hs-CRP] level ≥2.0 mg/L predict vascular
Heart, Lung and Circulation 2007;16:S1–S201
events. Since long-term low-dose colchicine is known to be a safe, effective means of dampening inflammation, we conducted an open-label pilot study to determine the effect of colchicine 0.5 mg/d or 0.5 mgbd in patients with stable CAD in whom the hs-CRP was ≥2.0 mg/L despite taking both aspirin and high dose statin. Methods: Plasma hs-CRP was measured in 385 consecutive patients with clinically stable CAD who were taking aspirin and statin therapy. In 116 [32%] patients hs-CRP was ≥2.0 mg/L. In 20 of these patients, hs-CRP was simply remeasured at 4 weeks, and in 64 patients hs-CRP was remeasured after 4–6 weeks of open label colchicine at doses of 0.5 mg/d [n = 22] or 0.5 mg bd [n = 42]. Results: In the 20 patients who received no treatment, the mean hs-CRP fell from 4.28 ± 2.03 mg/L to 3.70 ± 2.30 mg/L [mean change −11.0%: p NS]. In contrast, hs-CRP fell in all patients who received colchicine, falling from 4.69 ± 2.00 mg/L to 2.64 ± 1.80 mg/L [mean change −42%; p < 0.001] in patients taking 0.5 mg/d, and from 4.58 ± 2.05 mg/L to 1.78 ± 1.38 mg/L [mean change −60% p < 0.001] in patients taking 0.5 mg bd. No significant sideeffects were reported. Conclusion: Small doses of colchicine lower hs-CRP significantly in patients with clinically stable CAD, independent of aspirin and statin therapy. There appears to be dose response effect in the range 0.5–1.0 mg/day. Determining whether this will translate into a clinically important effect in such patients warrants further study. doi:10.1016/j.hlc.2007.06.180 176 Temporary Pacing Using Tunnelled Active-Fixation Leads Allows Prolonged Reliable Pacing with a Low Rate of Complications Graham Orsbourn 1,∗ , Nigel Lever 2 , Scott Harding 3 University, Wellington, New Zealand; 2 Auckland University, Auckland, New Zealand; 3 Wellington Hospital Cardiology Department, Wellington, New Zealand 1 Otago
Introduction: Conventional temporary pacing is frequently associated with complications. This study was performed to investigate the reliability and safety of temporary tunnelled pacing (TTP). Methods: All patients treated with TTP at our institution were included in the analysis (n = 22). TTP involved transvenous placement of a bipolar active-fixation permanent pacing lead into the right ventricle and/or the right atrium. The lead was tunnelled subcutaneously 5–10 cm from the point of vascular access. Pacing was achieved using an external re-sterilised permanent pulse generator. Results: Mean patient age was 67 ± 10.7 years. Indications for pacing included AV block (50%), sick sinus syndrome (54.5%), and ventricular tachycardia (18.1%). Reasons for delaying permanent device implantation were: infected pacing system (22.7%), other infection (31.8%), ventricular arrhythmia management (18.1%), concurrent critical medical illness (27.3%). A single ventricular lead was used (68%), although 8 patients (36%) also received an atrial
lead to allow DDD pacing. There were no lead dislodgements, pacing failure, pneumothoraces, perforations or infection related to TTP. The median duration of TTP was 16 days (range 2–71 days). An intercurrent illness resulted in the death of 4 patients, 12 patients (54.5%) had a permanent pacemaker implantated, 2 (9.1%) ICD implantation, and 4 (18.2%) patients had resolution of their arrhythmias. Nine patients were transferred to another hospital and one patient was sent home for palliative care with the TTP in-situ. This allowed 101 tertiary hospital days to be saved. Conclusions: TTP is a reliable method of achieving prolonged temporary pacing whilst allowing patients to ambulate freely. doi:10.1016/j.hlc.2007.06.181 177 Amiodarone Lung: Drug Induced Pulmonary Toxicity the Middlemore Experience R.E. Park 1,2,∗ , M. Nisbet 2 , J. Garrett 2 , D. Heaven 1 1 Department 2 Department
of Cardiology, Middlemore Hospital, Auckland; of Respiratory Medicine, Middlemore Hospital,
Auckland Amiodarone hydrochloride is an effective treatment for supraventricular and ventricular arrhythmias; however it has a significant side effect profile. A review was undertaken of patients diagnosed with amiodarone induced pulmonary toxicity to determine their clinical characteristics, indications for use and clinical outcome. Methods: A retrospective chart review of consecutive patients at Middlemore Hospital with a discharge diagnosis of amiodarone induced interstitial lung disease from January 2000 to January 2007. Patients who had clinical and radiological features of amiodarone lung as assessed by a respiratory physician were included. Results: Twelve cases were identified; all were European with mean age 78 ± 5.9 years, eight male. The indications for amiodarone were control of AF/SVT (58%), VF (17%) or both (25%). At diagnosis all patients had shortness of breath and half reported cough. New interstitial changes and ground glass opacities were consistently observed on chest x-ray and HRCT-chest scan. Renal impairment calculated by eGFR was present in all patients. The mean duration of amiodarone treatment was 2.6 years (2 months – 7.4 years) and the median dose 200 mg/day (100–400 mg/day). Amiodarone was discontinued in all cases and 6 received steroids. Two patients died from respiratory failure, with median time from presentation to death of 64 days. Conclusions: Pulmonary toxicity from amiodarone remains an important cause of morbidity and mortality; and alternatives to long-term use including device-based therapy should be considered. Europeans were exclusively represented in our cohort and this may indicate a lower occurrence in Maori and Pacific Islanders. Care with
Abstracts
S71
amiodarone prescriptions remains important especially in elderly patients. doi:10.1016/j.hlc.2007.06.182 178 The Publication Rate and Impact of Presentations at the Cardiac Society of Australia and New Zealand Annual Scientific Meetings V. Chand 1,2 , F.L. Rosenfeldt 1,2 , S. Pepe 1,2,∗ 1 Department
of Cardiothoracic Surgery, Alfred Hospital, Australia; 2 Department of Surgery, Monash University, Melbourne, Australia Introduction: Currently there is no information regarding cardiology publications arising from abstracts presented at the CSANZ annual scientific meetings. Aim: To determine the publication rate and indexed impact of original articles arising from abstracts presented between 1999 and 2005. Methods: Abstracts were obtained from Heart, Lung & Circulation or CSANZ’s website. Abstract authors and keywords were searched for publications (to 31/01/07) on the National Library of Congress PubMed database (USA). A match of abstract to retrieved full article was identified on the basis of authorship, similarities in titles and study design. The ISI Citation database (USA) was accessed for journal impact factors (IF). Results: A total of 2,172 abstracts resulted in 607 article publications (28%, mean IF = 4.32). Approximately 12% of publications had an IF between 4 and 9, while 18% had an IF > 9. Most publications were published within one (61%) and two years (84%), with a mean lag of 1.4 years. Surgical abstract presentations were notably low (2.4%). Since 1999, there has been a decrease in surgical submissions from 17% to 1.3%, however their publication rate remains markedly high (98%, mean IF = 3.13) Conclusions: (1) One in three presented abstracts result in publication. (2) Most are published within 1–2 years. (3) The average IF achieved is mid-range. In considering the diverse specialties within cardiology, the numerous barriers to publication and limited research resources available to members of CSANZ, this preliminary analysis indicates a moderately high quality and timely publication rate that may improve further when barriers are fully identified and addressed. doi:10.1016/j.hlc.2007.06.183
ABSTRACTS
Heart, Lung and Circulation 2007;16:S1–S201