Advance health planning and treatment preferences among recipients of implantable cardioverter defibrillators: an exploratory study.
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Adult↗
Biomedical subjects
Todd Cohen
Publications and source records attributed to Todd Cohen.
The utility of implantable loop recorders for diagnosing unexplained syncope in 100 consecutive patients: five-year, single-center experience.
INTRODUCTION: The purpose of this study was to retrospectively review the 5-year experience of a university hospital with implantable loop recorders (ILR) for the diagnosis of recurrent, unexplained syncope or presyncope. METHODS: One hundred patients with syncope or presyncope of unknown etiology (negative tilt-table test, electrophysiology study and neurologic workup) underwent prolonged monitoring with an ILR from March 2000 to December 2004. All implants were performed using a first-generation (manual activation) or second-generation (manual plus automatic activation) ILR. RESULTS: One hundred patients (70 women, 30 men) with a mean age of 68 +/- 18 years received the ILR. Twenty-three patients had coronary artery disease; 2 patients had dilated cardiomyopathy. Ten patients received a first-generation ILR, and 90 patients received a second-generation ILR. After 9 +/- 8 months' follow up, ILR interrogation identified an arrhythmogenic etiology to the syncope/presyncope in 45 patients with 55 events. Eight patients had a diagnosis by ILR less than 2 months from the date of implantation. Twenty-six patients had documented symptomatic bradycardia (asystole, sinus pauses, atrial fibrillation with long pauses); 11 patients had episodes of sinus tachycardia with heart rates of 130 to 140 beats/minute; 2 patients had atrial tachycardia; 5 patients had multiple episodes of nonsustained ventricular tachycardia (NSVT); 1 patient had sustained ventricular tachycardia, and 4 patients had paroxysmal supraventricular tachycardia. All arrhythmias were treated successfully by pacemaker/ICD implantation, radiofrequency catheter ablation and/or medications. One patient had seizure activity, which was detected by ILR as high-frequency noise. Two patients failed to activate their device, as it was a first-generation device. CONCLUSION: Five-year experience with the ILR in 100 consecutive patients confirms the utility of this device in the diagnosis of recurrent, infrequent, unexplained syncope or presyncope. It helped diagnose 45% of patients with unexplained syncope with negative electrophysiologic and neurologic workup. Most of these patients had an arrhythmogenic etiology to their syncope. Medical therapy, device therapy, and/or catheter ablation helped successfully treat all patients with an arrhythmogenic etiology detected by ILR.
Adrenergic beta-Antagonists↗
A novel radiation protection drape reduces radiation exposure during fluoroscopy guided electrophysiology procedures.
OBJECTIVE: The purpose of this study was to evaluate a novel disposable lead-free radiation protection drape for decreasing radiation scatter during electrophysiology procedures. BACKGROUND: In recent years, there has been an exponential increase in the number of electrophysiology (EP) procedures exposing patients, operators and laboratory staff to higher radiation doses. METHODS: The RADPAD was positioned slightly lateral to the incision site for pectoral device implants and superior to the femoral vein during electrophysiology studies. Each patient served as their own control and dosimetric measurements were obtained at the examiner's elbow and hand. Radiation badge readings for the operator were obtained three months prior to RADPAD use and three months after introduction. RESULTS: Radiation dosimetry was obtained in twenty patients: 7 electrophysiology studies, 6 pacemakers, 5 catheter ablations, and 2 implantable cardioverter-defibrillators. Eleven women and nine men with a mean age of 63 +/- 4 years had an average fluoroscopy time of 2.5 +/- 0.42 minutes per case. Mean dosimetric measurements at the hand were reduced from 141.38 +/- 24.67 to 48.63 +/- 9.02 milliroentgen (mR) per hour using the protective drape (63% reduction; p < 0.0001). Measurements at the elbow were reduced from 78.78 +/- 7.95 mR per hour to 34.50 +/- 4.18 mR per hour using the drape (55% reduction; p < 0.0001). Badge readings for three months prior to drape introduction averaged 2.45 mR per procedure versus 1.54 mR per procedure for 3 months post-initiation (37% reduction). CONCLUSION: The use of a novel radiation protection surgical drape can significantly reduce scatter radiation exposure to staff and operators during a variety of EP procedures.
Electrophysiologic Techniques, Cardiac↗
AcK-knowledge reversible acetylation.
In 1966, the histone was identified as the first protein subject to reversible acetylation. The ensuing 30 years of research on histone acetylation has been critical for elucidating how gene transcription and chromatin remodeling are regulated at the molecular level. This central focus on histones, however, has also restricted our understanding of reversible acetylation, and therefore the enzymes that catalyze this reaction, to cellular processes predominantly associated with chromatin. The study of reversible acetylation has become more or less synonymous with histone acetylation. Recent developments-including increased ability to detect acetylated proteins, the characterization of novel acetyltransferases and deacetylases, and the identification of specific inhibitors for these enzymes-have revealed that this histone-central paradigm probably reflects only a fraction of the cellular processes regulated by reversible acetylation. New studies have uncovered unexpected roles for reversible acetylation in many diverse areas, thereby establishing protein acetylation as a highly versatile signaling modification that has functions beyond gene transcription and chromatin remodeling.
Acetylation↗