Epileptic seizure in a patient with an implantable cardioverter-defibrillator: Quo vadis right ventricular lead?

The case of a 77-year-old man admitted for suspected epileptic seizure is reported. Patient history showed implantation of a single-chamber implantable cardioverter-defibrillator (ICD) after cardiac arrest in 2007 with replacement in 2012 due to battery depletion; the patient reported no previous syncope, unconsciousness or seizures. Interrogation records of the ICD showed five ventricular tachyarrhythmia episodes that corresponded to the "seizure". Further examination revealed incorrect position of the RV-lead. Diagnosis was a provoked epileptic seizure due to undersensing of ventricular tachycardia because of improper ICD lead implantation in the coronary sinus. Treatment consisted of implantation of a new device with an additional ICD lead into the right ventricle.

Trends in cardiovascular risk factors among patients with coronary heart disease: results from the EUROASPIRE I, II, and III surveys in the Münster region

BACKGROUND

Target values for cardiovascular risk factors in patients with coronary heart disease (CHD) are stated in guidelines for the prevention of cardiovascular disease. We studied secular trends in risk factors over a 12-year period among CHD patients in the region of Münster, Germany.

METHODS

The cross-sectional EUROASPIRE I, II and III surveys were performed in multiple centers across Europe. For all three, the Münster region was the participating German region. In the three periods 1995/96, 1999/2000, and 2006/07, the surveys included (respectively) 392, 402 and 457 ≤ 70-year-old patients with CHD in Münster who had sustained a coronary event at least 6 months earlier.

RESULTS

The prevalence of smoking remained unchanged, with 16.8% in EUROASPIRE I and II and 18.4% in EUROASPIRE III (p=0.898). On the other hand, high blood pressure and high cholesterol both became less common across the three EUROASPIRE studies (60.7% to 69.4% to 55.3%, and 94.3% to 83.4% to 48.1%, respectively; p<0.001 for both). Obesity became more common (23.0% to 30.6% to 43.1%, p<0.001), as did treatment with antihypertensive and lipid-lowering drugs (80.4% to 88.6% to 94.3%, and 35.0% to 67.4% to 87.0%, respectively; p<0.001 for both).

CONCLUSION

The observed trends in cardiovascular risk factors under-score the vital need for better preventive strategies in patients with CHD.

Functional and structural profiling of the human thrombopoietin gene promoter

Human thrombopoietin (TPO) is involved in cardiovascular disease as it regulates megakaryocyte development and enhances platelet adhesion/aggregation. The THPO promoter structure is still controversial. By reverse transcription-PCR, we confirm that THPO transcription is cell line-dependently initiated at two alternative promoters, which we newly designated P1a and P1. We subsequently electrophoretically scanned and resequenced these portions in 95 and 57 patients with cardiovascular disease, respectively, and identified seven variants (-1450/del58bp, C-920T [rs2855306], A-622G, C-413T [rs885838], C+5A, G+115A, and C+135T). After subcloning of 1032 bp of THPO P1 in pGL3-basic vector, five molecular haplotypes (MolHaps1-5) were observed: [A(-622)-C(-413)-C(+5)-G(+115); wild type (wt)], [A(-622)-T(-413)-C(+5)-G(+115)], [G(-622)-T(-413)-C(+5)-G(+115)], [A(-622)-C(-413)-A(+5)-G(+115)], [A(-622)-C(-413)-C(+5)-A(+115)], and analyzed in reporter gene assays in HEK293T and HepG2 cells. MolHaps 2, 4, and 5 were significantly more active than wt (all p values < or =0.01) in HEK293T cells, MolHap3 exerted a substantial loss of promoter activity (p < 0.0001 in HEK293T and p < 0.01 in HepG2, compared with wt). Electrophoretic mobility shift assays revealed that A-622G and C-413T individually differed from MolHaps in their DNA-protein interaction patterns. Supershift and chromatin immunoprecipitation assays identified CCAAT/enhancer-binding protein delta as the binding protein exclusively for the -622A allelic portion.

[Secondary prevention of coronary heart disease. Results from EuroASPIRE I and II in the region of Münster, Germany]

BACKGROUND

EuroASPIRE (European Action on Secondary Prevention through Intervention to Reduce Events) is a European multicenter study on secondary prevention in patients with coronary heart disease (CHD). The first cross-sectional survey was undertaken in 1995/96 among 3569 patients from nine countries. A second cross-sectional survey (EuroASPIRE II) was conducted in 1999/2000 among 5556 patients from 15 countries to evaluate among others whether coronary prevention had improved since the first.

METHODS

The present study was conducted in the region of Münster, Germany, as part of the EuroASPIRE study. Consecutive patients, men and women up to 70 years of age with established CHD, were identified retrospectively. A total of 392 (EuroASPIRE I) and 402 (EuroASPIRE II) patients participated. Information on cardiovascular risk factors, lifestyle and medication were obtained through medical records, interviews and examinations.

RESULTS

Both studies demonstrate a high prevalence of risk factors among CHD patients. At the time of the interview more than 60% of the patients in both surveys had two or more risk factors. The comparison of EuroASPIRE I and II reveals a substantial decrease of 20% in the prevalence of hypercholesterolemia, but an increase in the prevalence of hypertension and obesity. ACE-inhibitors, betablockers and lipid lowering drugs, especially statins, were used more frequently in EuroASPIRE II.

CONCLUSIONS

We conclude that secondary prevention of CHD in the region of Münster like in the other European study regions is less than optimal and has not substantially improved between 1996 and 2000. Potential reasons are discussed.

[Evaluation of secondary prevention of coronary heart disease. Results of the EUROSPIRE study in the Munster region]

BACKGROUND

New recommendations for secondary prevention of coronary heart disease (CHD) were issued by the European Society of Cardiology (ESC), the European Atherosclerosis Society (EAS) and the European Society of Hypertension (ESH) in 1994. The main objective of the EUROASPIRE study (European Action on Secondary Prevention by Intervention to Reduce Events) was to evaluate to what degree the new recommendations have been implemented and whether a significant risk factor reduction in patients who presented with CHD has been achieved. The present study was conducted in the region of Münster, Westphalia, Germany, as part of the nine-country EUROASPIRE study.

METHODS

A total of 524 patients (58.6 +/- 8.2 years) were included in the study by abstracting data from their medical records. According to the clinical event which led to admission to the hospital, patients belonged to the following four groups: 1) coronary artery bypass graft (CABG), 2) percutaneous transluminal coronary angioplasty (PTCA), 3) acute myocardial infarction, 4) acute myocardial ischemia. Initially, a pre-specified number of patients had been recruited with the goal of having 100 patients in each of the four groups participate in the follow-up interview and examination. At least 6 months and, on average, 20 months after hospital discharge for the acute event, 74.8% of the patients came to an interview and examination for an evaluation of their risk profile.

RESULTS

At the interview, 15.6% of the patients smoked, 22.7% were obese, 54.6% had blood pressure levels above 140/90 mm Hg and 31.3% a total cholesterol/HDL-cholesterol-ratio greater than 5. Risk factor modification over time was insufficient as only one-fifth of patients had values of their risk factors within the target range at the time of the interview.

CONCLUSION

The goals of secondary prevention have not been achieved in the region of Münster-there is clearly room for improvement. Considering the treatment of patients with CHD, the recommended strategies of secondary prevention need to be applied more intensively in clinical practice.