br Conflict of interest br Introduction Antiarrhythmic devic

Conflict of interest
Introduction Antiarrhythmic device lead implantation using the cephalic vein (CV) cutdown technique is considered to be superior to the conventional subclavian vein puncture method with regards to the incidence of perioperative complications such as pneumothorax [1,2] and lead longevity [3]. However, manipulation of leads is sometimes difficult and results in frequent failure of lead placement [1,4,5] due to a kink in the CV [5].
Subjects and Methods
Results CV venography was performed in 205 patients. It was performed from both sides in 16 patients. As a result, 75 right and 146 left CV venographies were performed. According to the findings of the CV venographies, the CVs were classified into smooth type, kinked type, and no enhancement of the CV (Fig. 1). The kinked type was further divided into L-shaped, sigmoid-shaped, and override the Bax channel blocker as shown in Fig. 1. Comparisons between the right and left side CV venographies are summarized in Table 1. In 71% of the right CV venographies and 43% of the left CV venographies, the CV was of the smooth type. The kinked type was less frequently observed in the right CV (15%) as compared to the left CV (35%, p<0.05). The CV was not enhanced in 15% of the right CV venographies and 23% of the left side CV venographies. In the left side venography, persistent left superior vena cava (PLSVC) was found in 2 patients. Success rates and the reasons for failure in lead implantation upon using the CV cutdown technique in each condition are shown in Tables 2 and 3. On the right side, the success rates in lead implantation were 94% in smooth type CV, 82% in kinked type CV, and 27% in cases with no enhancement of the CV (Table 2). On the left side, the success rates were 92% in smooth type CV, 76% in kinked type CV, and 21% in cases with no enhancement of the CV (Table 3). Regarding the patients with an L-shaped kink in the CV, lead implantation was successful in approximately 90% of these patients. In contrast, passing the guidewire and sheath was extremely difficult in sigmoid-shaped kinks and in an override the clavicle type of CV. Therefore, lead implantation using the CV cutdown technique was unsuccessful in most of these patients. The CV was isolated and lead implantation was successful in only one-third of patients with this condition with no enhancement of the CV because of the failure to isolate or insert the guidewire due to the small size of the vessel. In patients with PLSVC, the device was basically implanted in the right side. The overall success rate in desired lead implantation was around 80%; however, there tended to be a higher success rate on the right side as compared to the left side (83% vs. 71%, respectively).
Discussion
Conclusion
Conflict of interest
Introduction Cardiac-implanted devices offer multiple programmable features and can store large amounts of diagnostic information related to the device function, arrhythmia frequency, hemodynamic or physiologic parameters, and patient activity. Traditional device follow-up requires direct interrogation of the device in order to view the programmed parameters and stored diagnostic data, identify and correct possible malfunctions, and optimize therapy by reprogramming the device [1]. As the use of implanted cardiac devices has expanded, the number of patients consulting device clinics has increased each year, extending the wait times at the clinic. Remote monitoring (RM) systems for cardiac-implanted devices that transmit data from the implanted device from remote locations to the medical institution through analog or wireless telephones have recently been introduced in Japan. The transmitters are able to interrogate the device, either manually by the patient\'s use of a telemetry wand or automatically using wireless technology [2]. RM systems consist of data acquisition by the device on a scheduled basis followed by transmission of predefined alerts to the physician as necessary [1]. RM has been widely used in the U.S. and in European countries. Recent studies from these countries have demonstrated positive effects of RM [3–6], but the benefits of RM have not been fully evaluated in Japan. The objective of the present study was to investigate the clinical benefits of RM, particularly with respect to outpatient wait times and times to detection of EVENTS that we defined sustained ventricular tachyarrhythmic events, worsening heart failure, and inappropriate therapy for supraventricular tachyarrhythmias (SVT), in a single center in Japan.