Letter to the Editor

Abstract

The article by Guyomar et al. about "Interference between pacemaker and video capsule endoscopy" 1 is very interesting and leads us to make some comments.With regards to the gaps or blank periods during the examination, these may be due to other causes rather than interference, for instance the increase in the recorder's temperature, which as protection, when it reaches a given level, ceases to record momentarily, and according to our experience, this always occurred in the first half of the recording. 2 It is difficult to think that a device (the PM) that generates 70 electrical stimuli per minute may interfere with another (the capsule) that activates 120 times per minute, when the reverse would be easier to understand.Although it is true that there is interference with pacemakers, why the pulse generator was reprogrammed to VOO/70 beats/min before ingestion, if the authors had confirmed earlier the absence of pacing inhibition by the video transmission?According to our experience, 3 the interference observed was low, and it manifested due to noise mode function forcing asynchronous behavior and functional VOO or DOO pacing. What Guyomar et al., performed during 8 hours with reprogramming the pacemaker was what the capsule could do sporadically as a response to interference.It is also reasonable to think that there will be neither modification of the PM settings nor interference while it is in asynchronic mode, such as explained by the authors, so the conclusion results are evident.We believe that monitoring and programming precautions should be taken only with those patients with positive interference with an external test or pacemaker-dependence patients and the failure of the endoscopic recording should be considered to be due to causes different from pacemaker interference.

Complementary Therapies for Treating Survivors of Torture

“…32 These descending pathways provide the mechanisms for cognitive, attentional, and emotional strategies to alter pain perception at the spinal cord level. 33 The neural mechanisms involved include the actions of various inhibi-tory neurotransmitters 34 from higher centres in the brain 35 that attenuate nociceptive signals. 36 However, in chronic pain states, normal inhibitory control mechanisms are disrupted.…”