Implanting a defibrillation coil into the azygos vein is feasible and safe. In a majority of patients with failed defibrillation efficacy testing, adding an azygos coil achieves success on repeat testing. Therefore, this technique is one option for lowering the defibrillation threshold in patients who fail DFT testing of their ICD.
Summary. Activation of the contact system in patients treated with ®brinolytic agents may be an important source of thrombin that activates thrombin-activated ®brinolysis inhibitor (TAFI) and attenuates ®brinolysis. Factor (F)XIIa in plasma increased 2-fold over 60 min in patients given either tissue plasminogen activator (t-PA) or streptokinase (SK). To determine whether FXIIa-mediated generation of thrombin and activated TAFI (TAFIa) attenuates ®brinolysis in vitro, plasma clots were incubated with SK (250 U mL À1 ) or t-PA (2.5 g mL
À1) and the rate of lysis was measured. Plasma FXIIa impaired lysis judging from marked acceleration when 2.5 mM corn trypsin inhibitor were added (lysis increased by 172 AE 144% for SK and 40 AE 31% for t-PA vs. no inhibitor, n 16, P < 0.01). Moreover, inhibition of thrombin with hirudin and TAFIa with carboxypeptidase inhibitor accelerated lysis. We conclude that activation of FXII increases thrombin generation, which promotes TAFIa-mediated attenuation of ®brinolysis.
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