Background —A recent study has shown that the implantable atrial defibrillator can restore sinus rhythm in patients with recurrent atrial fibrillation when therapy was delivered under physician observation. The objective of this study was to evaluate the safety and efficacy of ambulatory use of the implantable atrial defibrillator. Methods and Results —An atrial defibrillator was implanted in 105 patients (75 men; mean age, 59±12 years) with recurrent, symptomatic, drug-refractory atrial fibrillation. After successful 3-month testing, patients could transition to ambulatory delivery of shock therapy. Patients completed questionnaires regarding shock therapy discomfort and therapy satisfaction using a 10-point visual-analog scale (1 represented “not at all,” 10 represented “extremely”) after each treated episode of atrial fibrillation. During a mean follow-up of 11.7 months, 48 of 105 patients satisfied criteria for transition and received therapy for 275 episodes of atrial fibrillation. Overall shock therapy efficacy was 90% with 1.6±1.2 shocks delivered per episode (median, 1). Patients rated shock discomfort as 5.2±2.4 for successful therapy and 4.2±2.2 for unsuccessful therapy ( P >0.05). The satisfaction score was higher for successful versus unsuccessful therapy (3.4±3.3 versus 8.7±1.3, P <0.05). There was no ventricular proarrhythmia observed throughout the course of this study. Conclusions —Ambulatory use of an implantable atrial defibrillator can safely and successfully convert most episodes of atrial fibrillation, often requiring only a single shock. Successful therapy is associated with high satisfaction and only moderate discomfort.
In 1934, Powell (1) estimated the cost of repairs and replacement on boilers damaged by intercrystalline cracking or embrittlement during the preceding four years at approximately 200,000 dollars per year. In spite of this outlay no extensive experimental work was in progress on this specific problem, although a related investigation concerning the solubility of sodium sulphate in boiler water salines was under way at the Bureau of Mines. This situation existed because many operators believed a satisfactory solution to the difficulty was available if conditions believed to be correct were maintained in boilers. These conditions which had been accepted as correct involved principally the maintenance in the boiler water of such concentrations of sodium sulphate and alkalinity that the ratios suggested by the A.S.M.E. for the prevention of embrittlement were satisfied. These ratios it will be recalled were based upon data gathered from boilers throughout the country and were later supported by the important pioneer work of Parr and Straub. On the other hand many competent engineers believed that the use of sodium sulphate for protection was based on contradictory operating data.The solubility studies at the Bureau of Mines under the auspices of the Joint Research Committee on Boiler Feedwater Studies attempted to establish an accurate basis for the use of sodium sulphate
The radial variation in electrical and chemical characteristics of cable insulation between conductor and sheath has been investigated by a new method whereby the power factor and the total oxidation products in the oil are determined for the individual layers of paper tapes. The results of this investigation applied to several types of service aged cable are reported in this article.
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