1124 4. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet 1999;354: 1896 – 900. 5. Touboul P, Brugada J, Capucci A, Crijns HJ, Edvardsson N, Hohnloser SH. Dronedarone for prevention of atrial fibrillation: a dose-ranging study. Eur Heart J 2003;24: 1481 –7. 6. Singh BN, Connolly SJ, Crijns HJ, Roy D, Kowey PR, Capucci A et al. Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter. N Engl J Med 2007; 357:987 – 99. 7. Davy JM, Herold M, Hoglund C, Timmermans A, Alings A, Radzik D et al. Dronedarone for the control of ventricular rate in permanent atrial fibrillation: the
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efficacy and safety of dRonedArone for the cOntrol of ventricular rate during atrial fibrillation (ERATO) study. Am Heart J 2008;156:527. e1. Køber L, Torp-Pedersen C, McMurray JJ, Gøtzsche O, Le´vy S, Crijns H et al. Increased mortality after dronedarone therapy for severe heart failure. N Engl J Med 2008;358: 2678 –87. Julious SA, Whitehead A. Investigating the assumption of homogeneity of treatment effects in clinical studies with application to meta-analysis. Pharm Stat 2012;11: 49 –56. doi:10.1002/pst.494. Epub 2011 Dec 2. Galbraith RF. Graphical display of estimates having differing standard errors. Technometrics 1988;30:271 –281. Chatterjee S, Ghosh J, Lichstein E, Aikat S, Mukherjee D. Meta-analysis of cardiovascular outcomes with dronedarone in patients with atrial fibrillation or heart failure. Am J Cardiol 2012;110:607 –13.
doi:10.1093/europace/eut344 Online publish-ahead-of-print 4 November 2013
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Inappropriate implantable cardioverter-defibrillator shocks in a public swimming pool Becker S.N. Alzand1*, Niels Leemput2, and Rik Willems1,3 1
Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium; 2Department of Electrical Engineering, University of Leuven, 3000 Leuven, Belgium; and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
3
* Corresponding author. Ronse General Hospital, Stefaan-Modest Glorieuxlaan, 559600 Ronse, Belgium. Tel: +31 433216750, Email: [email protected]
In a period of 1 year, three patients with an implantable cardioverter-defibrillator (ICD) presented to our outpatient clinic after receiving an ICD shock during a visit to one public swimming pool. Their electrograms showed high-frequency noise at a cycle length of 120 ms, well-matched with 50 Hz alternating current (Figure). We visited the pool with one patient and a team of engineers from our university. The noise was detectable in the water on the high-voltage electrodes near one of the exits. The signal became detectable on the pace/sense electrodes when the patient touched the handrails near this exit. A grounding connection was present at the handrail. Measurements at the handrail indicated a relatively high leakage currents which was in total within normal limits, but concentrated on this earthing conductor creating a high local electric field. Protection against excessive leakage current is guaranteed by differential fuses, which open the electrical circuit above a predefined threshold. This has not occurred in before, confirming that leakage current was within the accepted limits. This is an example of potential environmental hazards to patients with an ICD. With the growing number of ICD patients, clinicians should be well aware of these environmental hazards and patients should be well informed to minimize these unnecessary risks. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/ Documents/inappropriate-ICD-shocks.pdf. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2013. For permissions please email: [email protected].
EP CASE EXPRESS
S.H. Hohnloser et al.
8.
9.
10. 11.
efficacy and safety of dRonedArone for the cOntrol of ventricular rate during atrial fibrillation (ERATO) study. Am Heart J 2008;156:527. e1. Køber L, Torp-Pedersen C, McMurray JJ, Gøtzsche O, Le´vy S, Crijns H et al. Increased mortality after dronedarone therapy for severe heart failure. N Engl J Med 2008;358: 2678 –87. Julious SA, Whitehead A. Investigating the assumption of homogeneity of treatment effects in clinical studies with application to meta-analysis. Pharm Stat 2012;11: 49 –56. doi:10.1002/pst.494. Epub 2011 Dec 2. Galbraith RF. Graphical display of estimates having differing standard errors. Technometrics 1988;30:271 –281. Chatterjee S, Ghosh J, Lichstein E, Aikat S, Mukherjee D. Meta-analysis of cardiovascular outcomes with dronedarone in patients with atrial fibrillation or heart failure. Am J Cardiol 2012;110:607 –13.
doi:10.1093/europace/eut344 Online publish-ahead-of-print 4 November 2013
.............................................................................................................................................................................
Inappropriate implantable cardioverter-defibrillator shocks in a public swimming pool Becker S.N. Alzand1*, Niels Leemput2, and Rik Willems1,3 1
Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium; 2Department of Electrical Engineering, University of Leuven, 3000 Leuven, Belgium; and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
3
* Corresponding author. Ronse General Hospital, Stefaan-Modest Glorieuxlaan, 559600 Ronse, Belgium. Tel: +31 433216750, Email: [email protected]
In a period of 1 year, three patients with an implantable cardioverter-defibrillator (ICD) presented to our outpatient clinic after receiving an ICD shock during a visit to one public swimming pool. Their electrograms showed high-frequency noise at a cycle length of 120 ms, well-matched with 50 Hz alternating current (Figure). We visited the pool with one patient and a team of engineers from our university. The noise was detectable in the water on the high-voltage electrodes near one of the exits. The signal became detectable on the pace/sense electrodes when the patient touched the handrails near this exit. A grounding connection was present at the handrail. Measurements at the handrail indicated a relatively high leakage currents which was in total within normal limits, but concentrated on this earthing conductor creating a high local electric field. Protection against excessive leakage current is guaranteed by differential fuses, which open the electrical circuit above a predefined threshold. This has not occurred in before, confirming that leakage current was within the accepted limits. This is an example of potential environmental hazards to patients with an ICD. With the growing number of ICD patients, clinicians should be well aware of these environmental hazards and patients should be well informed to minimize these unnecessary risks. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/ Documents/inappropriate-ICD-shocks.pdf. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2013. For permissions please email: [email protected].
