Abstract We report on a 64-year-old female patient who underwent cardiac surgery for left atrial myxoma, using the superior septal approach with large atrial septal wall resection and patch closure. ...The superior septal approach is reported to be a relatively safe method for preventing the development of sinus node dysfunction after cardiac surgery. However, this patient developed sinus node dysfunction after surgery and required the implantation of a permanent pacemaker. Moreover, in this case, determining the appropriate positions of the pacemaker leads was difficult because of the presence of a large conduction delay in the interatrium. Selecting the appropriate atrioventricular delay settings was important in order to achieve proper sequential contractions between the left atrium and the left ventricle.
Acute cervical spinal cord injury frequently results in bradydysrhythmia, which may lead to hypotension and asystole. Such symptoms are more common in the first 2 weeks after the injury. Treatment ...modalities include atropine, epinephrine, aminophylline, and pacemaker insertion. The criteria for pacemaker use in this population are not well defined. We describe characteristics of 3 patients who required permanent, transvenous pacemaker implantation for recurrent symptoms. In 2 of the 3 patients, transcutaneous pacing failed to provide adequate protection. Transcutaneous pacemakers are not reliable, as was the case of these patients, and early consideration for transvenous pacemaker insertion may be indicated, especially in hemodynamically unstable patients. In this report, all 3 patients required permanent pacemaker implantation.
Occlusion of the superior vena cava (SVCO) makes implantation of permanent pacemakers challenging and difficult. We describe an extended application of a Medtronic Attain (Medtronic Inc., ...Minneapolis, MN, USA) guide catheter (a tool designed for delivery of left ventricular pacing leads into the coronary sinus) for delivery of a right ventricular pacing lead via the azygous vein in a 72‐year‐old woman with SVCO secondary to long‐term central venous hemodialysis catheters. This approach allowed the use of an endocardial pacing lead, implantation under local anesthesia, and conventional positioning of the pacemaker generator in the pectoral region in a patient with SVCO.
Neurally-mediated syncope is the most common cause of transient loss of consciousness. In this report, we describe an index case of a 43-year-old man with multiple episodes of neurally-mediated ...syncope. He underwent tilt-table testing, resulting in asystole for 15 seconds with generalized convulsions. After permanent pacemaker implantation, the patient had another syncopal episode requiring adjustment of pacemaker settings. Current concepts of the pathophysiology as well as the diagnosis and management of this condition are discussed.
In adults the oblique vein of Marshall is usually absent or very thin, and it is hard to be found. In this case report we describe a case of persistence observed during pacemaker implantation.
Summary This report describes an asymptomatic case of atrial lead perforation which developed 5 years after pacemaker implantation. Although retrospective findings of computed tomography showed a ...screw-in atiral lead had already perforated 9 months after the implantation, the lead protrusion on chest X-rays and pacing failure had not been noticed until another 3 years later. At first, this complication was managed conservatively, however, a lead perforation progressively developed and, as a result, open surgery was performed to remove the lead. We therefore should be aware of the potential occurrence of a progressive protrusion of a perforated lead.
This research aims to investigate the feasibility in predicting, at several stages of the transcatheter aortic valve implantation (TAVI) procedure, the risk to develop cardiac conduction defects ...(CCD) requiring a permanent pacemaker installation. Adopting deep-learning techniques specifically designed for time series signals, 2197 electrocardiograms for 631 TAVI patients have been analyzed. The most important leads for the perioperative stages have been identified. The experimental results have shown that more information is available during- and in the post-procedure stages. The highest AUC results have been obtained on the following leads and stages: 0.635 (lead V1) at pre-procedure stage, 0.711 (lead III) at during-procedure stage and 0.721 (lead aVF) at post-procedure stage. Overall, the highest AUC result has been obtained for the post-procedure stage reaching an AUC of 0.740 for the lead V1. This study confirms that it is possible to identify and stratify even further, the risk for patients that will develop CCD after TAVI, by using the information available in the ECG data immediately following the procedure.
Sudden death is a serious problem in patients with myotonic dystrophy. Atrioventricular blocks (AVBs) and tachyarrhythmias are regarded as a cause of the cardiac sudden death. The increase of QRS ...width and the deviation of electrical axis are rather important because the main lesion of AVB is located in His-Purkinje system, while the prolongation of PR interval attracts our attention for AVB. The measurement of His-ventricle (HV) interval is indispensable to cardiac electrophysiological testing for the detection of His-Purkinje abnormalities. We measured "HV interval" (BHV) noninvasively, using His bundle potential recorded from the body surface by signal-averaged electrocardiogram. As a result, BHV correlated with QRS width and electrical axis (r=0.769, p<0.0001; r=-0.713, p=0.0004, respectively). Pacemaker implantation (PMI) is performed for the treatment of bradyarrhythmias based on the guideline of each country. Some reports revealed that prophylactic PMI did not improve the prognosis of asymptomatic case with severe muscle involvement, even if HV interval was over 70ms. It is important to assess PMI indication in each case, deliberating the extra-cardiac complications and prognosis.
During pacemaker implantation in a patient with permanent atrial fibrillation, it remained impossible to advance a passive fixation lead with fins through the right atrium. However, a lead with a ...retractable screw easily passed the right atrium and was positioned in the right ventricle. Transesophageal echocardiography revealed an extensive net-like perforated Eustachian valve within the right atrium that had caused entrapment of the anchor fins during lead implantation. Remnants of embryonal structures within the right atrium should be considered a rare possible barrier during pacemaker implantation.PUBLICATION ABSTRACT
Biventricular implantation procedures require contrast venography of the coronary sinus. The aim of our study was to evaluate the efficacy and safety of contrast venography obtained by direct manual ...contrast injection into the guiding catheter, compared with venography obtained after occlusion of the coronary sinus by a Swan-Ganz catheter.
Eighty-three patients were randomly assigned to direct or occlusive venography technique. The primary endpoint was complication rate. The secondary endpoints were rate of and time required for an adequate venography, total dose of contrast medium and total procedure time.
Four dissections of the coronary sinus were observed with the occlusive venography technique group while no complications were observed with the direct venography technique group (p=0.04). Rate of adequate venography was similar in the two groups (p=NS). The time needed for coronary sinus venography and the total dose of contrast medium was significantly lower in the direct venography technique group compared with the alternative (p<0.0001 and p=0.003, respectively); the total procedure time was not significantly different between the two groups (p=NS).
The direct venography technique shows a significantly lower incidence of complications and should be considered to be the first line approach to coronary sinus venography during biventricular pacemaker implantation.
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