Background Myocardial scarring is associated with non-response to cardiac resynchronization therapy (CRT) and conduction delay. Little is known about the significance and cause of left ventricular (LV) paced conduction disturbance (LPCD). Objective The purpose of this study was to investigate the clinical impact of paced interlead electrical delay and the difference in each conduction time from LV pace to right ventricular (RV) sense (LVp-RVs) and from RV pace to LV sense (RVp-LVs) [(LVp-RVs) - (RVp-LVs)], in CRT. Methods Among 137 patients who underwent CRT implantation, LVp-RVs and RVp-LVs were measured intraoperatively. The relationships between [(LVp-RVs) - (RVp-LVs)] and perfusion defects on myocardial perfusion single photon emission computed tomography (SPECT) imaging or [(LVp-RVs) - (RVp-LVs)] and clinical outcomes were also assessed. Results After CRT implantation, 81 patients (59%) responded to CRT. [(LVp-RVs) - (RVp-LVs)] was significantly longer in non-responders than in responders (9.7±47.3 vs. -4.5±33.2 ms, p=0.042). Patients with LPCD [(LVp-RVs) > (RVp-LVs)] had higher perfusion defects in the anterolateral region (2.7±2.7 vs. 1.1±1.6, p=0.0015) on SPECT. Multivariate analysis showed that LPCD was the independent predictor of non-response to CRT (odds ratio 0.40 [95% confidence interval (CI) 0.17-0.90], p=0.026). During a median follow-up of 2.3 years (interquartile range 1.3-5.5), LPCD was the independent predictor of cardiac death and/or heart failure hospitalization in multivariate analysis (hazard ratio 1.82, 95%CI 1.11-3.03, p=0.018). Conclusions The LPCD could predict non-response to CRT and poor outcome. Further intervention, such as adjustment of pacing timing or multi-point/site pacing, may be needed in such patients.Background Venous ethanol infusion via an occlusive balloon has been utilized as bail-out approach to treat ablation-refractory ventricular arrhythmias (VA). Unfavorable venous anatomy - lack of intramural veins at the targeted site or collateral vein-ethanol shunting- limits its efficacy. Blocking collateral flow with a second balloon may optimize myocardial ethanol delivery. Objective To validate the "double balloon" approach to enhance ethanol delivery in cases of unfavorable venous anatomy. Methods Eight patients referred after failed ablations (LV summit, n=3, scar related ventricular tachycardia, VT n=5) underwent endocardial mapping and additional radiofrequency ablation without VA resolution. Coronary veins were mapped using a multipolar catheter or wire, and selective venograms were obtained. The double balloon was used when 1. Distal collateral branches shunted flow away from the targeted region, 2. The target vein had optimal signals only proximally, or 3. A large vein was targeted with multiple branches for a large area of interest. Results Acute successful ethanol infusion myocardial delivery and resolution of VA was accomplished utilizing the following veins the posterolateral LV veins (n=2 patients, 3 procedures), lateral LV vein (n=1), the apical anterior interventricular vein (AIV, n=1), the middle cardiac vein (MCV, n=1) and septal branches of the AIV (n=3). At a median 313.5 days of follow-up, 2 patients experienced recurrences. Conclusion The double balloon technique can enhance ethanol delivery to target isolated vein segments, block collateral flow, or target extensive areas, and can expand the utility of venous ethanol for VAs.Objectives Once a core outcome set (COS) has been defined, it is important to achieve consensus on how these outcomes should be measured. The aims of this systematic review were to gain insight into the methods used to select outcome measurement instruments and to determine whether methods have improved following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)/Core Outcome Measures in Effectiveness Trials (COMET) guideline publication. Study design and setting Eligible articles, which were identified from the annual COMET systematic review, concerned any COS development studies that provided a recommendation on how to measure the outcomes included in the COS. Data were extracted on the methods used to select outcome measurement instruments in accordance with the COSMIN/COMET guideline. Results Of the 118 studies included in the review, 48% used more than one source of information when finding outcome measurement instruments, and 74% performed some form of quality assessment of the measurement instruments. Twenty-three studies recommended one single instrument for each core outcome included in the COS. Clinical experts and public representatives were involved in selecting instruments in 62% and 28% of studies, respectively. Conclusion Methods used to select outcome measurement instruments have improved since the publication of the COSMIN/COMET guideline. Going forward, COS developers should ensure that recommended outcome measurement instruments have sufficient content validity. In addition, COS developers should recommend one instrument for each core outcome to contribute to the overarching goal of uniformity in outcome reporting.Introduction In the treatment of lymphedema, a plastic surgeon carries out only surgical treatment, while a therapist only performs complex physical therapy. https://www.selleckchem.com/products/GSK872-GSK2399872A.html Therefore, a combination treatment strategy is not performed in most cases. Our institution performs a combination of a lymphaticovenular anastomosis operation with complex physical therapy during the same hospitalization. Methods From advanced cases with stage II or more of lymphedema, we included patients who were hospitalized for two or more weeks for combined LVA and complex physical therapy. Out of the 28 cases studied, 26 cases were secondary lymphedema and 2 were primary lymphedema. There were 7 upper limb cases and 21 lower-limb cases. The mean length of hospital stay was 12 days (7-14 days). We performed a multisite LVA in all 28 patients. The mean number of anastomoses in each case (the side with the most edema for bilateral cases) was 3.96 (2-6). During hospitalization, lymphatic therapists who were familiar with complex physical therapy for lymphedema were trained to provide total care for lymphedema.