Optimizing conduction system pacing lead placement utilizing the image overlay technique

The His-bundle has several locations from which conduction system pacing can be achieved. Some locations offer better sensing, thresholds and paced QRS durations. Existing techniques to aid repositioning of an already deployed, but sub-optimally placed lead, include either simple memory of the initial lead position combined with its observation on an x-ray review screen or utilizing an additional vascular access and pacing lead with the first lead serving as a real-time marker (Two-lead technique). We describe a novel, readily available, cost-efficient, imaging-based approach to assist in the re-positioning of a pacing lead for His-bundle pacing (the Image Overlay Technique).

Hormone replacement use, age, and prognosis for women with non-small cell lung cancer

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Background: Lung cancer is the leading cancer cause of mortality in women. A recent report by Ganti et al, presented at ASCO, suggested that women who had been taking hormone replacement therapy (HRT) had significantly decreased survival after a lung cancer diagnosis. In addition, in women fit enough to be enrolled on randomized controlled trials in advanced lung cancer, younger women (under age 60) may have a worse prognosis than older women. The purpose of this current study was to do an institutional review on women diagnosed with lung cancer to determine whether these novel prognostic factor results could be duplicated. Methods: All female patients who were diagnosed with lung cancer between January 1999 and December 2003 were reviewed for age at diagnosis, stage, treatment, smoking history, hormonal therapy, performance status, weight loss, age at menopause, and overall survival. Patients were excluded if they had small cell lung cancer, were unknown primary, or had previous or synchronous non-lung, non-skin, cancers. Statistics were performed using Chi- Squared tests for categorical variables, while the Kaplan-Meier method and Cox-Regression models were used for univariate and multivariate analysis of overall survival. Results: Of 397 patients, the majority (68%) were stage 3 or 4. There were very few never smokers (5%). Twenty-nine percent of patients had prior HRT, with no effect on overall survival, with median survivals of 13 months in the non- HRT group and 14 months in the HRT group. The most powerful predictors of overall survival were: Stage, Performance Status, and Weight Loss. Patients aged 60–75 did as poorly as younger patients (median survival 10 months for stage 4 disease). Conclusions: Stage, performance status, and weight loss, are the most powerful predictors of survival for women with lung cancer. Patients with prior HRT use do not have inferior outcomes compared to non-HRT users. In a non-clinical trial population, patients under age 60 have similar outcomes as women aged 60 to 75.

No significant financial relationships to disclose.