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Biomedical subjects

M Castrucci

Publications and source records attributed to M Castrucci.

At least 19 recordsLinked to original sources
PubMed2002

[Primary Burkitt lymphoma of the heart--diagnosis and therapy].

An 85-year-old patient suffered from progressive deterioration (NYHA III) for several months. Cardiac disease was suspected. Echocardiography as well as a CT scan of the heart revealed a heart tumor to be the cause. Tumor staging was negative. After transvenous biopsy, the diagnosis of a Burkitt lymphoma could be established. Due to the advanced age of the patient, the intended surgical therapy was turned down and the patient was treated with 6 courses of a potentially therapeutic chemotherapy (CHOP scheme), which was well tolerated by the patient. The following CT scan showed a complete remission of the tumor. Six months after chemotherapy the patient is in NYHA stage I.

Aged↗
PubMed2001

Antitachycardia pacing for rapid VT during ICD charging: a method to prevent ICD shocks.

In patients with ICDs, rapid VTs are usually treated with shocks. It is unknown, if antitachycardia pacing (ATP) delivered once for rapid VT during capacitor charging can avoid painful shocks without increasing the risk of syncope. In patients in whom rapid monomorphic VT (cycle length 300-220 ms) could be reproducibly induced during predischarge ICD testing, the success of cardioversion (defibrillation threshold plus 10 J) and a single ATP attempt (burst with 8 or 16 stimuli) was compared using a randomized crossover study design. Consciousness of the patients was checked by the signal from a button constantly pushed by the patient. In 20 patients (ejection fraction 0.50 +/- 0.19) rapid VTs (253 +/- 26 ms) were reproducibly induced. A single burst successfully terminated 11 (55%) of 20 rapid VTs, 6 episodes could not be terminated with a single burst pacing and 3 VTs accelerated. Rapid VTs not terminated by ATP were significantly faster than those that could be terminated (246 vs 258 ms, P = 0.026). Cardioversion (19 +/- 3 J) terminated the VTs in all cases. No patient suffered syncope during rapid VTs. A single ATP may terminate rapid VT with cycle lengths < 300 ms in 55% of patients without increasing the risk of syncope. Therefore, in rapid VTs one attempt of ATP may be suitable as an additional therapy option during ICD capacitor charging to avoid painful shocks without compromise of safety. Thus, future ICDs should implement the option of ATP during charging of capacitors.

Adult↗
PubMed2000

[Incidental findings in cardiology. Diagnosing today what can cause illness tomorrow].

Among the anatomical and functional findings in cardiology, congenitally corrected transposition of the major vessels (ventricular inversion), bicuspid aortic valve and prolapse of the mitral valve with simultaneous mitral insufficiency have at least a potential for causing future problems. In such cases, regular cardiological checks or a further diagnostic work-up is to be recommended. The assessment of cardiac sounds can usually be correctly interpreted on the basis of the history, physical examination and auscultation. Among the electrocardiological findings, complete left bundle-branch block and prolongation of the QT segment, mandate clarification of a structural heart condition. Furthermore, in the event of ventricular extrasystoles, right-ventricular cardiomyopathy needs to be excluded. Such isolated conduction disorders as left-anterior fascicular block or right bundle-branch block are of no prognostic significance.

Heart Diseases↗
PubMed2000

Ventricular tachycardias above the initially programmed tachycardia detection interval in patients with implantable cardioverter-defibrillators: incidence, prediction and significance.

OBJECTIVES: This retrospective study was performed to provide data on ventricular tachycardias (VT) with a cycle length longer than the initially programmed tachycardia detection interval (TDI) in patients with implantable cardioverter defibrillators (ICDs). BACKGROUND: It has been clinical practice to program a safety margin of 30 to 60 ms between the slowest spontaneous or inducible VT and the TDI. METHODS: Baseline characteristics of 659 consecutive patients with ICDs were prospectively; follow-up information was retrospectively collected. RESULTS: During a mean follow-up of 31+/-23 months, 377 patients (57.2%) had at least one recurrent VT or ventricular fibrillation; 47 patients (7.1%) suffered 61 VTs above the TDI. The risk of a VT above the TDI ranged between 2.7% and 3.5% per year during the first four years after ICD implantation. The difference between the cycle length of the slowest VT before ICD implantation, spontaneous or induced, and the first VT above TDI was 108+/-58 ms. Fifty-four VTs (88.5%) above the TDI were associated with significant clinical symptoms (angina or palpitation 63.9%, heart failure 6.6% and syncope 8.2%). Six patients (9.8%) had to be resuscitated. Kaplan-Meyer analysis identified New York Heart Association class II or III (p = 0.021), ejection fraction < 0.40 (p = 0.027), spontaneous (p<0.001) or inducible (p<0.001) monomorphic VTs and the use of class III antiarrhythmic drugs (amiodarone, p<0.001; sotalol, p = 0.004) as risk predictors of VTs above the TDI. The risk of recurrent VTs above TDI was 11.8%, 12.5% and 26.6% during the first, second and third year after first VT above TDI, respectively. CONCLUSIONS: The risk of VTs above the TDI is significantly increased in some patients, and many VTs above TDI cause significant clinical symptoms. A larger safety margin between spontaneous or inducible VTs and the TDI seems to be necessary in selected patients. This is in conflict with an increased risk of inadequate episodes and demands highly specific and sensitive detection algorithms in these patients.

Defibrillators, Implantable↗
PubMed2000

Is there a need for routine testing of ICD defibrillation capacity? Results from more than 1000 studies.

AIMS: Benefits and complications of postoperative implantable cardioverter-defibrillator tests are controversial matters. This study sought to assess the necessity of defibrillation function tests after implantation. METHODS AND RESULTS: We retrospectively analysed 1007 implantable cardioverter-defibrillator tests in 587 systems and 556 patients. Nine hundred and thirty implantable cardioverter-defibrillator tests (89.4%) were routinely performed. Seventy-one tests (7%) were performed after a change in the antiarrhythmic drug regimen and six tests (0.60%) because of a suspected dysfunction of the implantable cardioverter-defibrillator. During routine tests, four systems (0.4%) failed to defibrillate the patient. However, in all but one test, abnormalities of the system had been observed before the test. After the addition of antiarrhythmic drugs, two of 71 implantable cardioverter-defibrillator systems (2.8%) failed to defibrillate the patient. One of six systems tested due to a suspected dysfunction failed to defibrillate the patient. During 16 tests (1.6%), complications occurred. CONCLUSIONS: Our experience demonstrates that postoperative tests of the defibrillation function of implantable cardioverter-defibrillators rarely reveal dysfunctions. As testing is unpleasant for the patient and not free of complications, tests might be restricted to those patients in whom a dysfunction is suspected and to those patients in whom class I or class III antiarrhythmic drugs have been added to the antiarrhythmic drug regimen.

Adolescent↗
PubMed1999

Efficacy and safety of the initial use of stability and onset criteria in implantable cardioverter defibrillators.

INTRODUCTION: Inappropriate therapies are the most frequent adverse event in patients with implantable cardioverter defibrillators (ICDs). Most ICDs offer a stability criterion to discriminate ventricular tachycardia (VT) from atrial fibrillation and an onset criterion to discriminate VT from sinus tachycardia. The efficacy and safety of these criteria, if used immediately after implantation, is unknown. METHODS AND RESULTS: In a case control study, 87 patients in whom stability and onset criteria had been activated immediately after ICD implantation were matched to 87 patients in whom these criteria had not been activated. The groups were matched for known predictors of inappropriate therapies. With stability and onset criteria off, 24 patients (28%) received inappropriate therapies due to atrial fibrillation (n = 14) or sinus tachycardia (n = 11); with stability and onset on, only 11 patients (13%) were treated by the ICD due to atrial fibrillation (n = 5) or sinus tachycardia (n = 7) (log rank: P = 0.029). Five patients suffered inappropriate therapies despite the fact that onset (n = 4) or stability (n = 1) criteria were not fulfilled once tachycardias continued for a prespecified duration. Only one patient experienced a failure to detect VT due to the onset criterion; none because of stability. CONCLUSION: The immediate use of stability and onset criteria after ICD implantation reduces inappropriate therapies due to atrial fibrillation and sinus tachycardia. Because of the potential for underdetection of VT, this approach should be limited to tachycardia rates hemodynamically tolerated by the patient.

Atrial Fibrillation↗
PubMed1999

Contrast transcranial Doppler ultrasound in the detection of right-to-left shunts: comparison of different procedures and different contrast agents.

BACKGROUND AND PURPOSE: Cardiac right-to-left shunts can be identified by transesophageal echocardiography (TEE) and by transcranial Doppler ultrasound (TCD) with the use of different contrast agents and different provocation procedures. Currently, data on an appropriate time window for the appearance of contrast bubbles in the TCD recording after the injection of the contrast medium and the comparison of different provocation maneuvers to increase right-to-left shunting are insufficient. METHODS: Forty-six patients were investigated by both TEE and bilateral TCD of the middle cerebral artery. The following protocol with 6 injection modes was applied in a randomized way: (1) injection of 10 mL of agitated saline without Valsalva maneuver, (2) injection of 10 mL of agitated saline with Valsalva maneuver, (3) injection of 10 mL of a commercial galactose-based contrast agent (Echovist) without Valsalva maneuver, (4) injection of 10 mL of Echovist with Valsalva maneuver, (5) injection of 10 mL of Echovist with standardized Valsalva maneuver, and (6) injection of 10 mL of Echovist with coughing. RESULTS: In 20 patients, a right-to-left shunt was demonstrated by TEE and contrast TCD (shunt-positive). Sixteen patients were negative in both investigations, no patient was positive on TEE and negative on TCD, and 10 patients were only positive on at least 1 TCD investigation but negative during TEE. The amount of microbubbles detected in the various tests decreased in the following order: Echovist and Valsalva maneuver, Echovist with coughing, Echovist and standardized Valsalva maneuver, saline with Valsalva maneuver, Echovist, and saline. With a time window of 20 to 25 seconds for the bubbles to appear in the TCD recording and with a sequence of first Echovist and Valsalva maneuver and then Echovist with coughing, all shunts were reliably identified with a specificity of 65% compared with TEE as the traditional gold standard. The time of first microbubble appearance was not helpful to distinguish between shunts detected on TEE and other shunts. CONCLUSIONS: TCD performed twice with 2 provocation maneuvers using Echovist is a sensitive method to identify cardiac right-to-left shunts also identified by TEE.

Adult↗
PubMed1998

Syncope in patients with an implantable cardioverter-defibrillator: incidence, prediction and implications for driving restrictions.

OBJECTIVES: This retrospective study was undertaken to provide information on occurrence, risk prediction and prevention of syncope in patients with an implantable cardioverter-defibrillator (ICD). BACKGROUND: ICDs effectively terminate ventricular tachycardia and fibrillation (VT/VF). Incapacitating symptoms, such as syncope, may still occur. METHODS: We performed a retrospective analysis of data from 421 patients (clinical history, outpatient chart reviews and episode data) with mean (+/-SD) follow-up of 26 +/- 18 months. RESULTS: Of 421 patients, 229 (54.4%) had recurrent VT/VF, and 62 (14.7%) had syncope. The actuarial survival rate free of VT/VF was 58%, 45% and 37% and that for survival free of syncope was 90%, 85% and 81% at 12, 24 and 36 months after implantation, respectively. Once VT/VF had occurred, 76%, 68% and 62% of patients remained free of syncope during the following 12, 24 and 36 months, and 68%, 64% and 56% remained free of second syncope 12, 24 and 36 months after first syncope, respectively. In cases of syncope, the mean cycle length (CL) of VT was 251 +/- 56 ms. A low baseline left ventricular ejection fraction (LVEF), induction of fast VT (CL <300 ms) during programmed ventricular stimulation and chronic atrial fibrillation (AF) were associated with an increased risk of syncope. If the LVEF was >40%, fast VT had not been induced, and patients had no chronic AF; 96%, 92% and 92% of patients remained free of syncope after 12, 24 and 36 months, respectively. Once patients had a VT recurrence, syncope during the first VT and a high VT rate were the strongest risk predictors of future syncope. CONCLUSIONS: Identification of patients with an ICD with a low and high risk of syncope seems to be feasible and might help as a guide to driving restrictions in such patients.

Adolescent↗
PubMed1997

[Results of testing defibrillator function of implanted cardioverter/defibrillators].

Postoperative tests of implantable cardioverter defibrillators (ICDs) are routinely performed to ensure appropriate defibrillation by the device. However, efficacy and complications of this procedure are unknown. To scrutinize the currently accepted indications to test the defibrillation function of the ICD we retrospectively analyzed 844 ICD-tests in 439 ICD-systems and 409 patients. 755 ICD-tests (89.4%) were routinely performed (57% before discharge and 43% during follow-up); 58 tests (6.9%) were performed after a change of the antiarrhythmic drug regimen, 24 tests (2.9%) after a revision of a part of the ICD-system, and seven tests (0.8%) because of a suspected dysfunction of the ICD. During routine-tests six ICD-systems (0.8%) failed to defibrillate the patient. However, in all but one test abnormalities of the ICD-system had been observed before the test. After addition of antiarrhythmic drugs, three of 58 ICD-systems (5.2%) failed to defibrillate the patient during the test (amiodarone: n = 2, flecainide: n = 1). Four of seven ICD-systems (57%) tested due to a suspected dysfunction failed to defibrillate the patient. After revisions of parts of the ICD-systems, ICD-tests never revealed a failure of defibrillation. During 16 ICD-tests (1.9%) complications occurred. The most frequent complications was inappropriate shocks (n = 10; 1.2%), the most severe one (transient) neurologic symptoms (n = 4; 0.48%). Our experience demonstrates that postoperative tests of the defibrillation function of ICDs rarely reveal ICD-dysfunction. As testing is unpleasant for the patient and not free of complications, tests might be restricted to those patients in whom an ICD-dysfunction is suspected (based on clinical presentation, results of chest-x-ray, testing of sensing signal and stimulation threshold) or class I or class III antiarrhythmic drugs have been added to the antiarrhythmic drug regimen.

Adolescent↗
PubMed1997

Multidisciplinary conservative treatment of difficult bile duct stones: a real alternative to surgery.

56 patients with large CBD or intrahepatic stones underwent endoscopic and/or percutaneous treatment followed by extracorporeal shock wave lithotripsy. Percutaneous access to the biliary tract was chosen when an endoscopic approach was not possible (hepaticojejunostomy in 5 patients, 1 juxtapapillary diverticulum and 1 inflammatory bile duct stricture). Visualization of stones was achieved radiologically in 32 patients and by ultrasound in 24. The procedure was successful in 47 of 56 treated patients (83.9%). Clearance of the biliary tract was obtained in 25 cases (53%), whereas in 22 cases (47%) complete clearing of biliary tract was obtained only after endoscopic extraction of fragments (17 cases) or percutaneous (5 cases). The median number of shock waves in each session was 1725 (range 300-3166), which were applied during one (n = 30), two (n = 22) or three sessions (n = 4). The only complications were 1 case of symptomatic hyperamylasemia and 3 cases of macrohematuria. In conclusion, extracorporeal lithotripsy combined with endoscopic and/or percutaneous treatment is a real alternative to surgery for difficult stones.

Aged↗
PubMed1997

Color Doppler imaging in the assessment of vascular involvement by pancreatic carcinoma.

OBJECTIVE: The aim of our study was to assess the accuracy of color Doppler imaging in diagnosing the involvement of peripancreatic vessels by pancreatic carcinoma. SUBJECTS AND METHODS: We prospectively evaluated the color Doppler images of 61 patients with pancreatic carcinoma. Our evaluations occurred before surgery and focused on vascular involvement. Absence of contact or a short contiguity (< or = 2 cm) between tumors and peripancreatic vessels was considered to be a sign of resectability on color Doppler imaging; a long contiguity (> 2 cm), compression, encasement, or thrombosis was considered to be a sign of unresectability. In all patients, the sonographic diagnosis was compared with the surgical results. RESULTS: With color Doppler imaging, we detected signs of vascular involvement in 26 of 33 patients in whom vascular involvement was found at surgery. We detected no vascular involvement in 25 of 28 patients in whom no vascular involvement was found at surgery. No false-positive diagnoses occurred when vascular encasement was revealed by color Doppler imaging. For diagnosis of vascular involvement, the sensitivity, specificity, and overall accuracy of color Doppler imaging were 79%, 89%, and 84%, respectively; positive and negative predictive values were 89% and 79%, respectively. CONCLUSION: Color Doppler imaging is a sensitive and highly specific technique in assessing vascular involvement by pancreatic cancer when absence of contact or vascular encasement is seen. When vascular encasement is detected by color Doppler imaging, a definitive diagnosis of unresectability can be made, and further diagnostic procedures can be avoided. When sonography is used in the initial evaluation of pancreatic cancer, color Doppler imaging can improve the selection of patients for further diagnostic examinations or surgical exploration.

Aged↗
PubMed1997

[Abdominal abscesses: their treatment and the study of prognostic factors].

The aim of this study is to define outcome predictors that might influence the prognosis and the mortality rate either of percutaneous drainage (DP) or open surgical drainage (DC) for abdominal abscesses. Seventy-one patients with 81 intra-abdominal abscesses were prospectively studied. They were 40 males and 31 females. Mean age was 47 +/- 15 years. Thirty-six (50.7%) patients had a simple abscess, while 35 (49.2%) had a complex abscess. Abscesses occurred most commonly in the sub-hepatic area, pelvic and para-colic space. Thirty-two (45%) patients had a percutaneous drainage, while 39 (54.9%) underwent an operative drainage management. Criteria for treatment selection were not randomized. However the two groups were statistically similar in respect to clinical features, cirrhosis, nutritional status, APACHE II scores), genesis and characteristics (simple, complex) of the abscesses. The treatment was considered successful when not requiring further drainage and the patient survived. Abdominal abscesses were cured in 53 (74.6) patients. In 13 cases (18.3%) a further drainage was necessary to obtain a complex resolution. Post drainage complications were significantly higher in the surgical drainage group (38.4% vs 12%, p < 0.05) because of the high incidence of wound infections. The overall mortality rate was 7%. Using an univariate analysis model, the only significant variable related to unsuccessful outcome in both the percutaneous and surgical group was abscess complexity (p < 0.005). Elderly (p < 0.005), malnutrition (p < 0.03), presence of cancer (p < 0.05), a high APACHE II score (p < 0.005) and the presence of a complex abscess (p < 0.02) were significantly identified as determinants of death.

APACHE↗
PubMed1997

[Magnetic resonance of the brain: comparative assessment of conventional sequences versus fast sequences].

The conventional Spin-Echo sequences have been the most used acquisition techniques on Magnetic Resonance Imaging (MRI) of the brain, since the beginning of 1990s. Recently, however, technological developments proposed such new fast acquisition techniques, with a dramatic reduction in acquisition time as Gradient Echo, Turbo Spin Echo, Gradient Spin Echo ed Echo Planar sequences. We investigated the comparative adequacy of the new fast sequences, in brain MR studies versus conventional sequences, on medium field strength MR equipment (.5 T). On in vitro exams S/N ratio was evaluated and on in vivo study C/N ratio between white substance grey substance and fluid were evaluated, in 15 healthy volunteers. All the exams were carried out on Philips NT5 Gyroscan MR unit operating at .5 T, with 15 mT/m power gradients. Both conventional and fast sequences Spin-Echo (SE), Inversion Recovery (IR), Gradient-Echo (GE), Turbo Spin-Echo (TSE), Gradient Spin-Echo (GRASE) and Echo Planar (EPI), all optimized to obtain T1, T2 and T1-IR weighted images, were performed. The sequences were evaluated separately comparing different acquisition techniques relative to the same type of contrast (T1, T2, and T1-IR). The results indicate the superiority of the fast acquisition techniques, both in terms of quality and acquisition times, except for T1-weighted images, where the conventional Spin-Echo sequences confirmed to be superior. In conclusion, the present study suggests that fast acquisition techniques can improve the conventional protocol of sequences, in the anatomical representation of the normal brain even with medium field strength equipment only on T2 and T1-IR weighted images. On T1-weighted imaging conventional SE acquisition technique is still the best choice. The time saving obtained with fast sequences can therefore be used for an overall improvement in the quality of images, and to apply accessory acquisition plans on routine exams.

Brain↗
PubMed1997

[Embolization of iatrogenic renal vascular lesions with coaxial catheters and microcoils].

INTRODUCTION: We report our experience with the superselective embolization of iatrogenic vascular injuries. We used new coaxial catheters and new microcoils to assess their technical features and efficacy. MATERIALS AND METHODS: Diagnostic angiography by catheterization of the main renal artery was performed in 7 patients with suspected renal vascular injury to detect injury presence and site. After super-selective catheterization of the feeding arteries with a coaxial catheter (Tracker 18), we performed embolization with platinum microcoils inserted using a coil pusher. The procedure efficacy was assessed at angiography and by comparing serum hemoglobin and hematocrit levels before and after embolization; posttreatment renal function was also studied. RESULTS: Selective embolization permitted complete occlusion of the arteries feeding the vascular injury in all patients, preserving as much parenchyma as possible. Hemoglobin and hematocrit levels were improved or unchanged after the maneuver (average hemoglobin level before embolization: 9.01 mg/dl versus 9.95 mg/dl after embolization; average hematocrit level before embolization: 27.3% versus 30.06% after embolization). We had no difficulty during microcoil insertion and the coaxial catheter was always stable. CONCLUSION: Superselective embolization of iatrogenic vascular injuries is an effective and definitive treatment. We recommend it in the patients with renal bleeding due to iatrogenic vascular injury after percutaneous diagnostic or therapeutic procedures.

Adolescent↗
PubMed1997

[Magnetic resonance study of patellofemoral cartilage with a fat-suppressed T1-3D gradient-echo sequence: a comparison with other acquisition technics at medium field strength].

PURPOSE: We compared GRE T1 3D FS sequence with other acquisition techniques available on medium field strength MR units (.5 T) in patellofemoral cartilage studies. MATERIAL AND METHODS: The imaging protocol scheduled Spin Echo (SE), Inversion Recovery (STIR), Gradient Echo (GRE), Turbo Spin Echo (TSE), Turbo-Inversion Recovery (Turbo-STIR), Gradient Spin Echo (GRASE) and Echo Planar (EPI) sequences, in some cases combined with Fat Suppression (FS) or Magnetization Transfer Contrast (MTC) sequences when suitable. In vitro studies were carried out for signal-to-noise ratio (SNR) evaluation, and in vivo on 10 healthy volunteers for contrast-to-noise ratio (CNR) evaluation between cartilage, bone marrow and fluid. The exams were carried out on MR equipment operating at .5 T, with 15 mT/m power gradients. RESULTS: In both in vitro and in vivo studies, GRE T1 3D FS sequences yielded better results in SNR and CNR than other sequences. The GRE T1 3D FS technique combines the advantages of the increased resolution of 3D images with the increased dynamic range of fat suppressed images, for better CNR between cartilage, fluid and bone marrow. CONCLUSION: GRE T1 3D FS sequences are the MR acquisition technique of choice in the assessment of the hyaline cartilage of the knee, even at medium field strength.

Adult↗
PubMed1996

[Conservative treatment of postoperative pancreatic fistula. Role of interventional radiology].

OBJECTIVE: To assess the role of interventional radiology in the conservative treatment of postoperative pancreatic fistula. CASE REPORT: A case of a high flow mixed entero-bilio-pancreatic fistula caused by dehiscence of pancreatic-jejunal anastomosis after duodenocephalopancreasectomy for endocrine neoplasm of the head of the pancreas, SETTING: General Surgery Division and Diagnostic Radiology. CONCLUSIONS: Conservative treatment represents at the time being, due to the current possibilities in assisting critical patients and in controlling pancreatic secretory activity, the first choice in pancreatic fistula treatment. The effectiveness of this treatment depends on the severity of inflammatory disease of the pancreas. Clinical (Ranson, Glasgow, APACHE II) and radiological (Balthazar, Vernacchia) parameter evaluation is a critical step in therapeutic choice. Surgery should be used in patients with severe pancreatitis. Conservative treatment represents the first choice in stable and critical patients with mild pancreatitis.

Adult↗
PubMed1995

Bipolar transvenous defibrillation: efficacy of two different positions of the anode.

For most nonthoracotomy defibrillation lead systems, the transvenous anode can positioned independently of the right ventricular (RV) cathode. Usually a vertical position in the superior vena cava (SVC) is chosen. However, it is unknown if this position yields the optimal defibrillation threshold (DFT). Therefore, in 15 patients undergoing defibrillator implantation the SVC position was compared in a crossover study design with a horizontal position in the left brachiocephalic vein (BCV). Mean DFT was not different for SVC and BCV (19.2 +/- 9.6 J vs 18.5 +/- 9.1 J) but DFT of individual patients differed by up to 12 joules. A positive correlation between impedance and DFT in the BCV position (r = 0.6; P < or = 0.05) indicated that the improved geometry of the defibrillation field with the BCV position is opposed by a higher impedance found for this position (63 +/- 15 omega vs 52 +/- 7 omega). Thus, defibrillation is not improved in general although individual patients might benefit.

Aged↗