CONGENITAL HEART DISEASE, Issue 3 2008
Jan Nemec MD
ABSTRACT A patient with a sporadic heart,hand syndrome, which includes thumb hypoplasia, septum primum atrial septal defect, and cleft mitral valve is described. During attempted placement of a pacemaker lead, persistence of left superior and inferior vena cava was found in addition to the right-sided caval veins. This corresponds to persistence of left-sided supracardinal vein present during fetal development. [source]

Short-Term Effects of Right Ventricular Pacing on Cardiorespiratory Function in Patients With a Biventricular Pacemaker

CONGESTIVE HEART FAILURE, Issue 6 2008
Stefan Toggweiler MD
The intention of this study was to evaluate the short-term effect of right ventricular (RV) pacing on cardiorespiratory function in patients with a biventricular pacemaker. A group of 26 patients with a biventricular pacemaker was enrolled in this cross-over, single-blind study. All patients underwent spiroergometry and electrocardiography in RV and biventricular pacing mode. Peak work capacity (102±32 W and 107±34 W for RV and biventricular pacing mode, respectively; P<.01) and peak oxygen consumption (21.4±6.7 mL/min/kg and 22.6±7.0 mL/min/kg for RV and biventricular pacing mode, respectively; P<.01) were significantly lower in the RV pacing mode. Heart rate at rest was significantly higher with active RV pacing. Short-term RV pacing in patients with a biventricular pacemaker resulted in a higher heart rate at rest, a lower peak work capacity, and a lower peak oxygen consumption compared with that in the biventricular pacing mode. [source]

Role of the Echocardiography Laboratory in Diagnosis and Management of Pacemaker and Implantable Cardiac Defibrillator Infection

ECHOCARDIOGRAPHY, Issue 9 2007
Edmund Kenneth Kerut M.D.
First page of article [source]

Device-Related Infection Among Patients With Pacemakers and Implantable Defibrillators: Incidence, Risk Factors, and Consequences

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2010
PABLO B. NERY M.D.
Risk Factors and Complications of Pacemaker and ICD Infection.,Background: Device-related infection is a major limitation of device therapy for cardiac arrhythmia. Methods: The authors analyzed the incidence and risk factors for cardiac device infection (CDI) among consecutive patients implanted with pacemaker (PM) or implantable cardioverter defibrillator (ICD) (including cardiac resynchronization therapy devices) at a tertiary health center in Hamilton, Ontario, Canada. Most patients with device-related infections were identified by an internal infection control system that reports any positive wound and blood cultures following surgery, between 2005 and the present. A retrospective review of patient records was also performed for all patients who received an ICD or PM between July 1, 2003 and March 20, 2007. Results: A total of 24 infections were identified among 2,417 patients having device surgery (1%). Fifteen of these infections (60%) were diagnosed within 90 days of the last surgical procedure. Univariate analysis showed that patients presenting with CDI were more likely to have had a device replacement, rather than a new implant, had more complex devices (dual/triple chamber vs single), and were more likely to have had a prior lead dislodgement. Multivariate analysis found device replacement (P = 0.02) and cardiac resynchronization therapy (CRT)/dual-chamber devices (P = 0.048) to be independent predictors of infection. One patient developed septic pulmonary emboli after having laser-assisted lead extraction. No patient died and 22 patients received a new device. Conclusion: CDI occurs in about 1% of cases in high volume facilities. Pulse generator replacement surgery and dual- or triple-chamber device implantation were associated with a significantly increased risk of infection. (J Cardiovasc Electrophysiol, Vol. pp. 786-790, July 2010) [source]

Newly Detected Atrial Fibrillation Following Dual Chamber Pacemaker Implantation

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2006
JIM W. CHEUNG M.D.
Introduction: Pacemaker (PPM)-detected atrial high-rate episodes (AHREs) of even 5-minute duration may identify patients at increased risk for stroke and death. In this study, we sought to determine the incidence of newly detected atrial fibrillation (AF defined as an AHRE ,5 minutes) in patients following dual-chamber PPM implantation and to define the clinical predictors of developing AF. Methods and Results: We evaluated 262 patients (142 male; age 74 ± 12 years) without documented AF who underwent PPM implantation for sinus node dysfunction (n = 122) or atrioventricular block (n = 140). Information regarding patient demographics, cardiovascular diseases, and medication history was obtained. The cumulative percentages of ventricular pacing as well as the frequency, duration, and time to first episode of an AHRE were also determined. During follow-up of 596 ± 344 days, an AHRE ,5 minutes was detected in 77 (29%) patients. Of these, 47 (61%) patients had an AHRE ,1 hour, 22 (29%) patients had an AHRE ,1 day, and 12 (16%) patients had an AHRE ,1 week. An AHRE ,5 minutes was seen in 24% and 34% of patients at 1 year and 2 years, respectively. Among patients with sinus node dysfunction, ,50% cumulative ventricular pacing was the only significant predictor of an AHRE ,5 minutes (HR 2.2; CI 1.0,4.7; P = 0.04). Conclusions: Within 1 year of PPM implantation, AF is detected in 24% of patients without history of AF. In patients with sinus node dysfunction, ,50% cumulative right ventricular pacing is associated with a 2-fold increase in risk of developing AF. [source]

Pacemaker and Defibrillator Lead Extraction: Predictors of Mortality during Follow-Up

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2010
SHOAIB HAMID M.D.
Background:Extraction of cardiac implantable electric devices is an accepted procedure when systems become infected or malfunction. However, there is an associated morbidity and mortality. We report our 5-year experience and identify predictors of mortality, and long-term follow-up. Methods:We analyzed extraction data from January 2003 to November 2007. Extraction methods used were: locking stylets, telescoping sheaths ± laser, and femoral work stations. Results:One hundred and eighty-three cases were referred, aged 65 ± 16 years (range 28,83); 76% were males. Mean implant time was 75 months (range 4,312 months) and indications were: pocket infection (48%), nonfunctioning lead (22%), erosion through skin (18%), endocarditis/septicemia (11%), bilateral superior vena cava thrombosis (0.5%), and painful lead (0.5%). The number of leads extracted were 369, with complete removal in 90.7% and partial in 7.6%. There were no intraoperative deaths but five (2.7%) died within the same admission as their extraction from overwhelming sepsis. Twelve deaths (6.6%) occurred during an average follow-up of 965 days (range 40,1670). Multivariate logistic regression demonstrated that C-reactive protein preprocedure was predictive of acute in-hospital mortality. Conclusions:Intravascular lead extraction is a safe and efficient method of removing leads. However, there is a subgroup of patients with systemic sepsis with raised inflammatory markers who are at high risk of in-hospital mortality. Long-term follow-up demonstrates mortality which is a marker of the underlying etiology for device implantation, with heart failure patients particularly at risk. (PACE 2010; 33:209,216) [source]

Transfemoral Snaring and Stabilization of Pacemaker and Defibrillator Leads to Maintain Vascular Access During Lead Extraction

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2009
AVI FISCHER M.D.
Background: Lead extraction is an effective method for removing pacemaker and defibrillator leads and to obtain venous access when central veins are occluded. Objective: We report a series of patients who required lead extraction and preservation of vascular access requiring a vascular snare introduced from the femoral vein to provide traction on the lead. This technique allowed advancement of the extraction sheath beyond the level of vascular occlusion, preserving vascular access in all patients. Methods: All patients had peripheral contrast venography performed immediately prior to the procedure to identify the site(s) of venous occlusion. An extraction sheath was employed and with direct manual traction, the lead tip pulled free from the myocardial surface prior to advancement of the sheath beyond the occlusion. A transfemoral snare was used to grasp the distal portion of the lead and traction was used to immobilize the lead. Results: In all patients, transfemoral snaring of the leads was necessary to allow safe advancement of a sheath to open the occluded venous system. There were no complications in any of the patients. Conclusion: Our series demonstrates the simple and safe technique of transfemoral lead snaring to assist lead extraction and maintain vascular access in the setting of venous occlusion, when the distal lead tip pulls free of the myocardium before an extraction sheath is passed beyond the point of venous obstruction. [source]

Treatment of Inappropriate Sinus Tachycardia with Ivabradine in a Patient with Postural Orthostatic Tachycardia Syndrome and a Dual Chamber Pacemaker

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2009
SITARA KHAN M.R.C.P.
We present the case of a 44-year-old woman with postural orthostatic tachycardia syndrome (POTS) and a dual chamber pacemaker. The patient suffered from inappropriate sinus tachycardia that had been resistant to treatment with traditional rate-slowing medications. Ivabradine,the specific sinus node If current inhibitor,was used to successfully lower the heart rate. The patient had no evidence of POTS on repeat autonomic function testing, and there was a corresponding symptomatic benefit. We propose that this class of drugs, the use of which is established as antianginals, should be considered in patients with resistant inappropriate sinus tachycardia. [source]

The Ischemia-Modified Albumin in Relation to Pacemaker and Defibrillator Implantation: The Mechanism of IMA Formation and the Role of Reactive Oxygen Speciespt

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2008
Debashis Roy M.D.
No abstract is available for this article. [source]

The Ischemia-Modified Albumin in Relation to Pacemaker and Defibrillator Implantation

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2008
EFTIHIA SBAROUNI M.D.
Background: Ischemia-modified albumin (IMA) is considered a marker of myocardial ischemia whereas cardiac enzymes are released when cardiac necrosis occurs. It has previously been shown that permanent pacemaker-defibrillator insertion is associated with myocardial injury expressed as cardiac enzyme rise. Objective: We assessed whether pacemaker-defibrillator implantation also induces changes in IMA plasma levels and whether, therefore, myocardial ischemia precedes necrosis. Methods: We studied 64 consecutive patients undergoing pacemaker or defibrillator implantation; 43 were men and 21 women and their age was 70 ± 11 years (range 23,84 years). Blood samples were collected at baseline, six hours and 48 hours following the procedure. IMA measured by the albumin cobalt binding test (ACB, Integra 800 analyzer), as well as creatine kinase (CK), the MB isoenzyme of creatine kinase (CK-MB) and cardiac troponin I (Tn-I) were evaluated. Results: Data analysis showed that compared to baseline measurements, IMA increased at six hours (P = 0.015) and at 48 hours (P = 0.003)[97.6 ± 10.2 vs 101.4 ± 10.7 vs 102.1 ± 9.2 U/mL at baseline, six hours and 48 hours, respectively]; similarly, CK increased at six hours (P = 0.0001) and remained high at 48 hours (P = 0.0001) [74.9 ± 49.9 vs 136.1±186.7 vs 115.2 ± 63.9 mIU/mL], while CK-MB increased at six hours (P = 0.0001), but returned to baseline values at 48 hours (P = 0.05) [0.90 ± 0.89 vs 1.27 ± 134 vs 0.71 ± 0.63 ng/mL] and Tn-I increased at six hours (P = 0.0001) and returned to baseline levels at 48 hours (P = 0.32) [0.057 ± 0.23 vs 0.16 ± 0.36 vs 0.03 ± 0.045 ng/mL]. Conclusion: Permanent pacemaker-defibrillator insertion is associated with myocardial ischemia and necrosis. [source]

Effect of Transvenous Cardiac Resynchronization Therapy Device Implantation on Cardiac Troponin I Release

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2007
TIMUCIN ALTIN M.D.
Background: Pacemaker and implantable cardioverter defibrillator (ICD) implantation increases cardiac troponin I (cTnI) levels which indicates myocardial injury. During implantation of a cardiac resynchronization therapy (CRT) device, balloon inflation for coronary sinus (CS) venogram, cannulation of CS side branch, and electrode advancement may interfere with CS drainage and, hence, may decrease the washout of toxic metabolites from the heart. Thus, CRT implantation may further increase cTnI levels. In this study, we investigated the effects of CRT implantation on cTnI release. Methods: We included 10 patients (mean age = 57 ± 15 years) in whom a successful transvenous CRT system was implanted (CRT group). Twenty patients (mean age = 65 ± 10 years) who underwent a transvenous pacemaker or ICD implantation were included as the control group. Blood samples for cTnI were drawn at baseline and at six, 12, 18, and 24 hours thereafter. Results: Baseline median cTnI levels were similar in CRT and control groups (0.03 ng/mL vs 0.02 ng/mL, respectively; P = 0.1). Postoperative cTnI levels during 24 hours were significantly higher in the CRT group (P < 0.05) by two-way repeated measures of analyis of variance. Post hoc analysis revealed that cTnI levels were higher at the 6th, 12th, 18th, and 24th hours compared to baseline levels (P < 0.001, P < 0.001, P < 0.01, and P < 0.01, respectively). There was a significant difference in the area under the curves (AUCs) of cTnI measurements (1.79 hr·ng/mL in the CRT group and 0.78 hr·ng/mL in the control group, P < 0.05). Conclusion: Postoperative cTnI levels were higher after CRT implantation than simple pacemaker/ICD implantation. This may be due to CS manipulation during CRT implantation. [source]

Evaluation of Atrial Thrombus Formation and Atrial Appendage Function in Patients with Pacemaker by Transesophageal Echocardiography

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2006
ABOLFATH ALIZADEH M.D.
Background: Physiologic pacing is claimed to be superior to ventricular pacing in as much as it entails lower risk of atrial fibrillation, stroke, and atrial remodeling. There are few data on the relation between atrioventricular (AV) synchrony and atrial clot formation. Utilizing transesophageal echocardiography (TEE), this study sought to evaluate the effect of AV synchrony loss on left atrial physiology, atrial stasis, and clot formation. Methods: We conducted a cross-sectional study on patients with both AV and ventricular pacing with left ventricular ejection fraction (LVEF) >30%. TEE enabled us to explore atrial and pacing leads thrombi and measure left atrial appendage (LAA) flow velocity Results: A total 72 patients (mean age, 65 ± 11.7) were enrolled in the study. The pacing mode was VVI in 53% and AV sequential in 47% of patients. LVEF (mean ± SD; %) was 53.3 ± 6.2% in ventricular pacing mode and 52.2 ± 6.6 in physiologic pacing mode. Thrombus formation on pacing lead (<10 mm in 97% of patients) was observed in 32% of all the patients (23% in patients with AV sequential pacing mode and 39% with VVI mode). Left atrial appendage flow velocity (LAA-FV) was significantly higher among the patients with AV sequential pacing mode (49.44 ± 18 cm/s vs 40.94 ± 19.4 cm/s, P value = 0.02). LAA-FV >40 cm/s was detected in 60% of the patients, 60% of whom were in physiologic mode. Left atrial size was significantly larger among the patients with VVI pacing mode (42.3 ± 2.3 mm vs 37.79 ± 4.5 mm, P = 0.001). Multivariate analysis showed no relation between LAA-FV and age, hypertension, diabetes mellitus, left atrial size, and left ventricular function. Only one patient had right atrial clot. There was no thrombus in the ventricles and atrial appendage. Conclusion: Long-term loss of AV synchrony induced by VVI pacing is associated with the impairment of LAA contraction. Thrombus formation in the LAA is not increased by VVI pacing in patients with relatively good left ventricular (LV) function and sinus rhythm. [source]

Effect of Right Ventricular Apex Pacing on the Tei Index and Brain Natriuretic Peptide in Patients with a Dual-Chamber Pacemaker

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2006
HITOSHI ICHIKI
Background: Asynchronous electrical activation induced by right ventricular apex (RVA) pacing can cause various abnormalities in left ventricular (LV) function, particularly in the context of severe LV dysfunction or structural heart disease. However, the effect of RVA pacing in patients with normal LV and right ventricular (RV) function has not been fully elucidated. The aim of this study was to characterize the effects of RVA pacing on LV and RV function by assessing isovolumic contraction time and isovolumic relaxation time divided by ejection time (Tei index) and by assessing changes in plasma brain natriuretic peptide (BNP). Methods: Doppler echocardiographic study and BNP measurements were performed at follow-up (mean intervals from pacemaker implantation, 44 ± 75 months) in 76 patients with dual chamber pacemakers (sick sinus syndrome, n = 30; atrioventricular block, n = 46) without structural heart disease. Patients were classified based on frequency of RVA pacing, as determined by 24-hour ambulatory electrocardiogram (ECG) that was recorded just before echocardiographic study: pacing group, n = 46 patients with RVA pacing ,50% of the time, percentage of ventricular paced 100 ± 2%; sensing group, n = 30, patients with RVA pacing <50% of the time, percentage of ventricular paced 3 ± 6%. Results: There was no significant difference in mean heart rate derived from 24-hour ambulatory ECG recordings when comparing the two groups (66 ± 11 bpm vs 69 ± 8 bpm). LV Tei index was significantly higher in pacing group than in sensing group (0.67 ± 0.17 vs 0.45 ± 0.09, P < 0.0001), and the RV Tei index was significantly higher in pacing group than in sensing group (0.34 ± 0.19 vs 0.25 ± 0.09, P = 0.011). Furthermore, BNP levels were significantly higher in pacing group than in sensing group (40 ± 47 pg/mL vs 18 ± 11 pg/mL, P = 0.017). With the exception of LV diastolic dimension (49 ± 5 mm vs 45 ± 5 mm, P = 0.012), there were no significant differences in other echocardiographic parameters, including left atrium (LA) diameter (35 ± 8 mm vs 34 ±5 mm), LA volume (51 ± 27 cm3 vs 40 ± 21 cm3), LV systolic dimension (30 ± 6 mm vs 29 ± 7 mm), or ejection fraction (66 ± 9% vs 63 ± 11%), when comparing the two groups. Conclusions: These findings suggest that the increase of LV and RV Tei index, LVDd, and BNP are highly correlated with the frequency of the RVA pacing in patients with dual chamber pacemakers. [source]

Implant of a Biventricular Pacemaker in a Patient with Dextrocardia and Persistent Left Superior Vena Cava

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2006
CHRISTIAN POTT
Congenital anomalies of the heart can pose challenges to cardiac invasive procedures. Here, we present the case of a 40-year-old man with the combination of dextrocardia, a persistent left superior vena cava, and idiopathic dilated cardiomyopathy. We describe the successful implantation of a biventricular pacemaker,defibrillator under this complex anatomic condition. [source]

Pacemaker Tachycardia in a Minute Ventilation Rate-Adaptive Pacemaker Induced by Electrocardiographic Monitoring

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2006
WENDY LAU
Programmed upper rate pacing occurred in a patient with a rate-adaptive pacemaker when he was connected to a cardiac monitor in an emergency department. The tachycardia was mistakenly interpreted to be ventricular tachycardia and the patient received multiple DC shocks as well as intravenous amiodarone and sotalol, resulting in severe hemodynamic deterioration. It is important that physicians working in the hospital environment be familiar with this pacemaker-monitor interaction as the problem may be easily rectified by disconnecting the monitor or by reprogramming the pacemaker to a nonrate-adaptive pacing mode. [source]

Changing Trends in Pacemaker and Implantable Cardioverter Defibrillator Generator Advisories

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2002
WILLIAM H. MAISEL
MAISEL, W.H., et al.: Changing Trends in Pacemaker and Implantable Cardioverter Defibrillator Generator Advisories. Pacemaker and implantable cardioverter defibrillator (ICD) generator recalls and safety alerts (advisories) occur frequently, affect many patients, and are increasing in number and rate. It is unknown if advances in device technology have been accompanied by changing patterns of device advisory type. Weekly FDA Enforcement Reports from January 1991 to December 2000 were analyzed to identify all advisories involving pacemaker and ICD generators. This article represents additional analysis of previously cited advisories and does not contain additional recalls or safety alerts over those that have been previously reported. The 29 advisories (affecting 159,061 devices) from the early 1990s (1991,1995) were compared to the 23 advisories (affecting 364,084 devices) from the late 1990s (1996,2000). While the annual number of device advisories did not change significantly, ICD advisories became more frequent and a three-fold increase in the number of devices affected per advisory was observed. The number of devices affected by hardware advisories increased three-fold, due primarily to a 700-fold increase in electrical/circuitry abnormalities and a 20-fold increase in potential battery/capacitor malfunctions. Other types of hardware abnormalities (defects in the device header, hermetic seal, etc.) became less common. The number of devices recalled due to firmware (computer programming) abnormalities more than doubled. The remarkable technological advances in pacemaker and ICD therapy have been accompanied by changing patterns of device advisory type. Accurate, timely physician and patient notification systems, and routine pacemaker and ICD patient follow-up continue to be of paramount importance. [source]

P Wave Duration and Morphology Predict Atrial Fibrillation Recurrence in Patients with Sinus Node Dysfunction and Atrial-Based Pacemaker

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2002
ANTONIO DE SISTI
DE SISTI, A., et al.: P Wave Duration and Morphology Predict Atrial Fibrillation Recurrence in Patients with Sinus Node Dysfunction and Atrial-Based Pacemaker. P wave duration and morphology have never been systematically evaluated as markers of AF in patients with a conventional indication to pacing. This study correlated sinus P wave duration and morphology and the incidence of AF in patients with sinus node dysfunction (SND), previous history of AF before implant, and atrial-based pacemaker. Included were 140 patients (86 men, 54 women; mean age 71.8 ± 10.4 years) with recurrent paroxysmal AF and who received a DDD (128 patients) or AAI (12 patients) pacemaker for SND. Forty-nine patients had structural heart disease. Sinus P wave duration and morphology was evaluated in leads II, III. Twenty-two patients had an abnormal P wave morphology, diphasic (+/-) in 5 and notched (+/+) in 17. The basic pacemaker rate was programmed between 60 and 70 beats/min. Rate responsive function was activated in 65 patients. During a follow-up of 27.6 ± 17.8 months, AF was documented in 87 patients. Forty-four patients developed permanent AF, following at least one episode of paroxysmal AF in 26 cases. Statistical analysis used Cox model regression. Univariate predictors of AF (P < 0.10) were drugs (mean: 2 ± 1.4) and DC shock before pacing (16/140 patients), P wave duration (mean 112.5 ± 24.6 ms), basic pacemaker rate (mean 68 ± 5 beats/min), and drugs in the follow-up (mean 1.2 ± 0.94). Multivariate analysis showed that P wave duration (b = 0.013, s.e. = 0.004; P = 0.003), and drugs before pacing (b = 0.2; s.e.= 0.08; P < 0.01) resulted in a significant independent predictor of AF. Actuarial incidence of patients free of AF at 30 months was 35%: 56% in patients with a P wave < 120 ms, and 13% in those with P wave , 120 ms (P < 0.01 by Score test). Univariate predictors of permanent AF were drugs and DC shock before pacing, left atrial size (mean 39 ± 6 mm), P wave duration, abnormal P wave morphology (22/140 patients), and drugs in the follow-up. Multivariate analysis showed that P wave morphology was the most important predictor of permanent AF (b = - 0.56, s.e.= 0.2; P = 0.008). Incidence of patients free of permanent AF at 30 months was 69%: 74% in patients with normal P wave, compared to 28% in the case of abnormal P wave morphology (P < 0.01). P wave duration and morphology are good markers of postpacing AF recurrence in patients with SND and an atrial-based pacemaker. This observation suggests that intra- and interatrial conduction disturbances be extensively evaluated before implantation, and the indication for atrial resynchronization procedures be reevaluated. [source]

Noninstrumental Pacemaker and Defibrillator Lead Removal.

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2002
The Importance of the Rotation Forces
First page of article [source]

Performance of a Rate Responsive Accelerometer-Based Pacemaker with Autocalibration During Standardized Exercise and Recovery

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2002
STEPHANE GARRIGUE
GARRIGUE, S., et al.: Performance of a Rate Responsive Accelerometer-Based Pacemaker with Autocal-ibration During Standardized Exercise and Recovery. The rate responsiveness of a single chamber, accelerometer-based pacemaker with an autocalibration function (Opus G VVIR pacemaker, ELA Medical) was studied with a daily life protocol developed to automatically optimize the programming of accelerometer-based sensors. This new sensor was compared with two other body activity sensors that were manually optimized patient by patient. Forty-three pacemaker recipients (mean age 71 ± 11 years), paced > 95% of the time, underwent a daily life protocol consisting of rapid walking for 6 minutes (W), climbing upstairs for 1.5 minutes (U), and downstairs for 1.5 minutes (D), alternated by recovery phases. The results were compared with performances measured in a control population of healthy subjects and in two paced patient populations (one equipped with a Dash Intermedics VVIR pacemaker and the other equipped with a Sensolog III Pacesetter/St. Jude VVIR pacemaker). Sex distribution and mean age between paced patients and control subjects were statistically comparable. The mean heart rate achieved by all paced patients at each time sample was compared with the normograms, assigning acceleration (slope) and rate (rate) scores for exercise and recovery phases. Scores ranged from -10 (hypochronotropic) to +10 (hyperchronotropic). Zero represents exact concordance with the responses of healthy individuals, and values between -2.5 and +2.5 were considered statistically similar to normal. During W, although the overall performances of the Dash, Sensolog, and Opus G did not statistically differ from healthy controls, the scores obtained by the Opus G were significantly closer to controls than those of the two other pacemakers (P = 0.02). For U, the three sensors were hypochronotropic (P = 0.03), though the Opus G was associated with a heart rate response closer to that of healthy controls (P = 0.04). D provided similar mean heart rate scores for the Opus G and the Dash compared with healthy controls, in contrast with the hyperchronotropic behavior of the Sensolog (P = 0.02). Opus G revealed a physiological modulation of the heart rate for W and D tests with a slightly hypochronotropic behavior during U. The Opus G autocalibration function provided daily life performances closer to those of healthy controls than two other pacemakers equipped with a body activity sensor that were manually optimized. [source]

Unexpected Ventricular Asystole in a DDD Pacemaker: What is the Mechanism?

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2002
STÉPHANE GARRIGUE
No abstract is available for this article. [source]

Unexpected ICD Pulse Generator Failure Due to Electronic Circuit Damage Caused by Electrical Overstress

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2001
ROBERT G. HAUSER
Hauser, R., et al.: Unexpected ICD Pulse Generator Failure Due to Electronic Circuit Damage Caused by Electrical Overstress. Because it is a lifesaving device, the unexpected failure of an ICD can be catastrophic. We report ICD electronic circuit failure due to electrical overstress damage (EOS) to the high voltage hybrid circuit and other electronic components in a series of ICD pulse generator models. Data were obtained from the Multicenter Registry of Pacemaker and ICD Pacemaker and Lead Failures, and from the manufacturers' adverse event reports, that were in the FDA's Manufacturer and User Facility Device Experience (MAUDE) database. Of 16 nonbattery Guidant/CPI ICD pulse generator failures reported to the registry, 6 (38%) have been confirmed by the manufacturer to be EOS related, and Guidant/CPI has reported 273 such failures to the FDA as of 12/29/00. The signs of failure included loss of telemetry and inability to deliver therapy, and some patients have experienced serious adverse events. Hybrid circuit damage may have occurred during capacitor charging or reform, and the majority appears to have happened during normal ICD function. While the incidence of this problem is unknown, a management strategy should be adopted that includes routine follow-up every 3 months and device evaluation after a shock or exposure to external defibrillation or electrosurgical devices. This study suggests that additional data are needed to determine the incidence of this problem, and that our present methods for monitoring the performance of ICDs following market release are inadequate. [source]

Transient Exit Block of a DDD Pacemaker with Unipolar Leads in Subcutaneous Emphysema Following Pneumothorax

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2001
CHRÍSTOPHE MELZER
MELZER, C., et al.: Transient Exit Block of a DDD Pacemaker with Unipolar Leads in Subcutaneous Emphysema Following Pneumothorax. This case report describes a transient pacemaker exit block due to subcutaneous emphysema following pneumothorax. Pneumothorax after pacemaker implantation is rare, but development of subcutaneous emphysema under such circumstances is even more uncommon. Exit block develops only with the use of unipolar leads; with implantation of bipolar leads, this complication cannot occur. [source]

Ancillary Tools in Pacemaker and Defibrillator Lead Extraction Using a Novel Lead Removal System

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2001
ANTONIS S. MANOLIS
MANOLIS, A.S., et al.: Ancillary Tools in Pacemaker and Defibrillator Lead Extraction Using a Novel Lead Removal System. A previous report described our preliminary experience with a highly successful pacing lead removal system (VascoExtor). Extending this experience, we found it necessary to use additional tools to enhance the success of percutaneous lead extraction with this system. In the present series, we used the standard locking stylets (S and K), and recently, one newer type of stylet (Magic) over the last 3 years in 34 patients to extract 48 pacemaker leads in 31 patients and 3 defibrillator (ICD) leads in 3 patients. Lead extraction was carried out in 23 men and 11 women (aged 64 ± 17 years) because of pacemaker infection (n = 21), pacemaker (n = 8) or ICD (n = 3) lead malfunction, or prior to ICD implant (n = 2). Leads were in place for 3.5 ± 3.7 years. Infections, involving pocket and lead(s), were due to S. epidermidis (n = 13), S. aureus (n = 6), S. aureus plus E. coli (n = 1), or fungi (n = 1). Of the 48 pacing leads, 31 were ventricular, 15 atrial, and 2 were VDD leads. The ICD leads were two double-coil leads (CPI) and one single-coil lead (Telectronics). Using the S (n = 12), K (n = 8), or Magic (n = 3) stylets, all pacing leads in 23 patients and the ICD leads in 2 patients were successfully removed from a subclavian approach using the locking stylets. However, in nine (26.5%) patients ancillary tools were required. In four patients, lead fragments were captured with use of a noose catheter, a pigtail catheter, and a bioptome from a right femoral approach. In two patients, locking could not be effected and a noose catheter from the right femoral vein was used, aided by a pigtail and an Amplatz catheter and a bioptome to remove three leads. In a patient with an ICD lead, a combined subclavian (stylet S) and right femoral approach (noose catheter) was required. In a patient with a dysfunctional ventricular lead 12 years old, a motor drive unit was used to facilitate the exchange of locking stylets, but extraction failed. In another patient, a fragment of a dysfunctional ventricular lead remained intravascularly despite resorting to a femoral approach. Finally, lead removal was completely (32/34, 94%) or partially (1/34, 3%) successful in 33 (97%) of 34 patients for 50 (98%) of 51 leads without complications. In conclusion, to enhance the success of pacing or ICD lead extraction with use of the VascoExtor locking stylets, an array of ancillary tools were required in more than one fourth of patients. [source]

Feasibility and Initial Results of an Internet-Based Pacemaker and ICD Pulse Generator and Lead Registry

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2001
ROBERT HAUSER
HAUSER, R., et al.: Feasibility and Initial Results of an Internet-Based Pacemaker and ICD Pulse Generator and Lead Registry. The medical community has no independent source of timely information regarding the performance of pacemaker and ICD pulse generators and leads. Accordingly, the authors established an Internet-based registry of pacemaker and ICD pulse generator and lead failures (www.pacerandicregistry.com). During the first year, they found three previously unreported device problems that were promptly communicated to the participants. Of the failures reported, 11% of ICD and 10% of pacemaker pulse generator failures were heralded by signs other than the expected elective replacement indicator (ERI). Average ICD battery longevity was 4.0 ± 0.7 years, and average dual chamber pacemaker battery longevity was 6.8 ± 2.6 years. Disrupted insulation accounted for 54% of pacemaker and 29% of ICD lead failures. Compared to pacemaker pulse generator and lead failure, ICD device failures were more likely to cause severe clinical consequences. In conclusion, an Internet-based registry is feasible and capable of providing timely data regarding the signs, causes, and clinical consequences of pacemaker and ICD failures. [source]

Transvenous Pacemaker Insertion Ipsilateral to Chronic Subclavian Vein Obstruction: An Operative Technique for Children and Adults

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2000
MARC OVADIA
OVADIA, M., et al.: Transvenous Pacemaker Insertion Ipsilateral to Chronic Subclavian Vein Obstruction: An Operative Technique for Children and Adults. Subclavian vein occlusion limits insertion of pacing electrodes in children and adults. The concern is greatest in children with a long-term need for pacing systems necessitating use of the contralateral vein and potential bilateral loss of access in the future. We describe an operative technique to provide ipsilateral access in chronic subclavian vein occlusion in five consecutive pediatric (n = 4, mean age 6.5 years) and adult (n = 1, age 70 with bilateral subclavian vein occlusion) patients in whom this condition was noted at the time of pacemaker or ICD implant. Occlusion was documented by venography. Pediatric cardiac diagnoses included complete heart block in all patients, tetralogy of Fallot in three, and L-transposition of the great vessels in one. Percutaneous brachiocephalic (innominate) or deep subclavian venous access was achieved by a supraclavicular approach using an 18-gauge Deseret angiocath, a Terumo Glidewire, and dilation to permit one or two 9,11 Fr sheaths. Electrode(s) were positioned in the heart and tunneled (pre, or retroclavicularly) to a pre, or retropectoral pocket. Pacemaker and ICD implants were successful in all without any complication of pneumothorax, arterial or nerve injury, or need for transfusion. Inadvertent arterial access did not occur as compared with prior infraclavicular attempts. One preclavicularly tunneled electrode dislodged with extreme exertion and was revised. Ipsilateral transvenous access for pacemaker or ICD is possible via a deep supraclavicular percutaneous approach when the subclavian venous obstruction is discovered at the time of implant. In children, it avoids the use of the contralateral vein that may be needed for future pacing systems in adulthood. This venous approach provides access large enough to allow even dual chamber pacing in children and can be accomplished safely. [source]

Quality-of-Life in Pacemaker and Implantable Cardioverter Defibrillator Recipients

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2000
CECILIA LINDE
No abstract is available for this article. [source]

Electrosurgery, Pacemakers and ICDs: A Survey of Precautions and Complications Experienced by Cutaneous Surgeons

DERMATOLOGIC SURGERY, Issue 4 2001
Hazem M. El-Gamal MD
Background. Minimal information is available in the literature regarding the precautions implemented or complications experienced by cutaneous surgeons when electrosurgery is used in patients with pacemakers or implantable cardioverter-defibrillators (ICDs). The literature pertinent to dermatologists is primarily based on experiences of other surgical specialties and a generally recommended thorough perioperative evaluation. Objective. To determine what precautions are currently taken by cutaneous surgeons in patients with pacemakers or ICDs, and what types of complications have occurred due to electrosurgery in a dermatologic setting. Methods. In the winter of 2000, a survey was mailed to 419 U.S.-based members of the American College of Mohs Micrographic Surgery and Cutaneous Oncology (ACMMSCO). Results. A total of 166 (40%) surveys were returned. Routine precautions included utilizing short bursts of less than 5 seconds (71%), use of minimal power (61%), and avoiding use around the pacemaker or ICD (57%). The types of interference reported were skipped beats (eight patients), reprogramming of a pacemaker (six patients), firing of an ICD (four patients), asystole (three patients), bradycardia (two patients), depleted battery life of a pacemaker (one patient), and an unspecified tachyarrhythmia (one patient). Overall there was a low rate of complications (0.8 cases/100 years of surgical practice), with no reported significant morbidity or mortality. Bipolar forceps were utilized by 19% of respondents and were not associated with any incidences of interference. Conclusions. Significant interference to pacemakers or ICDs rarely results from office-based electrosurgery. No clear community practice standards regarding precautions was evident from this survey. The use of bipolar forceps or true electrocautery are the better options when electrosurgey is required. These two modalities may necessitate fewer perioperative precautions than generally recommended, without compromising patient safety. [source]

Device-Related Infection Among Patients With Pacemakers and Implantable Defibrillators: Incidence, Risk Factors, and Consequences

A Prospective Pediatric Clinical Trial of Digital Music Players: Do They Interfere with Pacemakers?

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2009
CHRISTINE C. CHIU M.Sc.
Background: There has been recent concern in the media about iPodÔ interference with pacemakers. We systematically tested two types of digital music players (DMP) on pacemaker or ICD function in children. Methods/Results: Patients were monitored by a 6-lead ECG and programmer telemetry. The pacemaker was tested in bipolar and unipolar sensing at normal and maximal sensitivities. The order of DMP tested was randomized. Each DMP was placed on top of the pacemaker pocket, put into "play" mode three times (5 seconds each), with and without programmer wand placed one cm adjacent to DMP. Pacemaker interference was defined as: pacing inhibition, inappropriate pacing, oversensing, or detection of high-rate episodes associated with the use of DMP. Of the 67 patients (mean age 12 ± 5 years), 62 had pacemakers and five had ICDs; 39 endocardial and 28 epicardial systems. Patients were tested with SansaÔ (67), iPodÔ 30 GB (51), and other DMPs (43). There was no evidence of interference with pacemaker function by any DMP under any of the study conditions (each performed in triplicate). Reproducible programmer telemetry interference was shown in 11 cases (Medtronic 6/47, St. Jude Medical 5/18, Guidant 0/2) related to use of iPodÔ (6), SansaÔ (1), or others (4). None of these were associated with any evidence of pacemaker malfunction. Conclusion: Interference with pacemaker function could not be shown with iPodÔ or MP3 players. No additional precaution beyond standard is necessary for patients with pacemakers when they are using these players. [source]

Incidence of Atrial Arrhythmias Detected by Permanent Pacemakers (PPM) Post-Pulmonary Vein Antrum Isolation (PVAI) for Atrial Fibrillation (AF): Correlation with Symptomatic Recurrence

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2007
ATUL VERMA M.D.
Background: Studies examining AF recurrences post-PVAI base recurrence on patient reporting of symptoms. However, whether asymptomatic recurrences are common is not well known. Objective: To assess the incidence of atrial tachycardia/fibrillation post-PVAI as detected by a PPM and whether these recurrences correlate to symptomatic recurrence. Methods: Eighty-six consecutive patients with symptomatic AF and PPMs with programmable mode-switch capability underwent PVAI. Mode switching was programmed post-PVAI to occur at an atrial-sensed rate of >170 bpm. Patients were followed with clinic visits, ECG, and PPM interrogation at 1, 3, 6, and 9 months post-PVAI. The number and duration of mode-switching episodes (MSEs) were recorded at each visit and is presented as median (interquartile range). Results: The patients (age 57 ± 8 years, EF 54 ± 10%) had paroxysmal (65%) and persistent (35%) AF pre-PVAI. Sensing, pacing, and lead function were normal for all PPMs at follow-up. Of the 86 patients, 20 (23%) had AF recurrence based on symptoms. All 20 of these patients had appropriate MSEs detected. Of the 66 patients without symptomatic recurrence, 21 (32%) had MSEs detected. In 19 of these patients, MSEs were few in number, compared with patients with symptomatic recurrence (16 [4,256] vs 401 [151,2,470], P < 0.01). The durations were all <60 seconds. All of these nonsustained MSEs occurred within the first 3 months post-PVAI, gradually decreasing over time. The other 2 of 21 remaining patients had numerous (1,343 [857,1,390]) and sustained (18 ± 12 minutes) MSEs that also persisted beyond 3 months (1 beyond 6 months). Therefore, the incidence of numerous, sustained MSEs in asymptomatic patients post-PVAI was 2 of 66 (3%). Conclusions: Detection of atrial tachyarrhythmias by a PPM occurred in 30% of patients without symptomatic AF recurrence. Most of these episodes were <60 seconds and waned within 3 months. Sustained, asymptomatic episodes were uncommon. [source]