An unusual position for the permanent pacing wire.
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ABSTRACT:
SUBMITTER: Mishra PK
PROVIDER: S-EPMC4360661 | biostudies-other | 2014 Dec
REPOSITORIES: biostudies-other
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Project description:Infectious complications related to retained temporary epicardial pacing wires are rare. We report a case of a focal retroaortic abscess in association with retained pacing wires that became manifest 3 years after surgery for tricuspid valve endocarditis.
| S-EPMC3548537 | biostudies-literature
Project description:Extensive knowledge of the anatomy of the atrioventricular conduction axis, and its branches, is key to the success of permanent physiological pacing, either by capturing the His bundle, the left bundle branch or the adjacent septal regions. The inter-individual variability of the axis plays an important role in underscoring the technical difficulties known to exist in achieving a stable position of the stimulating leads. In this review, the key anatomical features of the location of the axis relative to the triangle of Koch, the aortic root, the inferior pyramidal space and the inferoseptal recess are summarised. In keeping with the increasing number of implants aimed at targeting the environs of the left bundle branch, an extensive review of the known variability in the pattern of ramification of the left bundle branch from the axis is included. This permits the authors to summarise in a pragmatic fashion the most relevant aspects to be taken into account when seeking to successfully deploy a permanent pacing lead.
| S-EPMC8576516 | biostudies-literature
Project description:Cardiac dyssynchrony is the proposed mechanism for pacemaker-induced cardiomyopathy, which can be prevented by biventricular pacing. Left bundle branch pacing and His bundle pacing are novel interventions that imitate the natural conduction of the heart with, theoretically, less interventricular dyssynchrony. One of the surrogate markers of interventricular synchrony is QRS duration. Our study aimed to compare the change of QRS duration before and after implantation between types of cardiac implantable electronic devices (CIEDs): left bundle branch pacing versus His bundle pacing versus biventricular pacing and conventional right ventricular pacing. A literature search for studies that reported an interval change of QRS duration after CIED implantation was conducted utilizing the MEDLINE, EMBASE, and Cochrane databases. All relevant works from database inception through November 2020 were included in this analysis. A random-effects model, Bayesian network meta-analysis was used to analyze QRS duration changes (eg, electrical cardiac synchronization) across different CIED implantations. The mean study sample size, from 14 included studies, was 185 subjects. The search found 707 articles. After exclusions, 14 articles remained with 2,054 patients. The His bundle pacing intervention resulted in the most dramatic decline in QRS duration (mean difference, - 53 ms; 95% CI - 67, - 39), followed by left bundle branch pacing (mean difference, - 46 ms; 95% CI - 60, - 33), and biventricular pacing (mean difference, - 19 ms; 95% CI - 37, - 1.8), when compared to conventional right ventricle apical pacing. When compared between LBBP and HBP, showed no statistically significant wider QRS duration in LBBP with mean different 6.5 ms. (95% CI - 6.7, 21). Our network meta-analysis found that physiologic pacing has the greatest effect on QRS duration after implantation. Thus, HBP and LBBP showed no significant difference between QRS duration after implantation. Physiologic pacing interventions result in improved electrocardiography markers of cardiac synchrony, narrower QRS duration, and might lower electromechanical dyssynchrony.
| S-EPMC8190182 | biostudies-literature
Project description:The patient's Cr (creatinine), BUN (blood urea nitrogen), HBG (hemoglobin), VT (ventricular tachycardia), pacing frequency, puncture point, emergency to permanent pacing time, pacing current (mA), pacing threshold current (mA), and admission diagnosis data were collected. The data were subjected to frequency statistics, curve regression analysis, PLS regression analysis, adjustment analysis, chi-square test, ridge regression analysis, discriminant analysis, negative binomial regression analysis, Poisson regression analysis, and stepwise regression analysis. Some findings include the following: (1) Cr has a significant positive effect on HBG, and BUN has a significant negative effect on HBG. (2) VT has a negative correlation with age and a positive correlation with CK-MB and CK (creatinine kinase). (3) Myocarditis has a negative correlation with age and a significant positive correlation with CTnI (cardiac troponin I). (4) AST (aspartate transaminase) and ALT (alanine aminotransferase) have a significant positive impact on DDI (D-dimer), while CTnI has a significant negative impact on DDI. MYO (myoglobin) has no impact relationship to DDI. (5) ALT has a significant positive relationship with APTT (partial thromboplastin time). (6) Alb (albumin) and TBIL (total bilirubin) have a significant positive effect on PLT (platelet) count, while pro-BNP (B-type natriuretic peptide) and MYO have a significant negative effect on PLT. (7) CK has a significant positive effect on INR (international normalized ratio). (8) The relationship between sinus node dysfunction and VT significantly affect the pacing frequency (beats/minute). For third-degree atrioventricular block, different samples of sinus node dysfunction showed significant differences. (9) There is a significant positive correlation between pacing current (mA) and pacing threshold current (mA). (10) There was a significant positive correlation between perceived voltage (mV) and the time from emergency to permanent pacing. Admission diagnosis has a significant positive impact on the time from emergency to permanent pacing. The change (increase) in time from emergency to permanent pacing was 1.137-fold when an additional condition was diagnosed on admission.
| S-EPMC8413046 | biostudies-literature
Project description:Nonsyndromic unilateral permanent canine agenesis, particularly in the lower jaw, is an infrequent clinical observation that has occasionally been reported in the scientific literature. The main aim of the present case report and study is to give insights into the clinical features and genetic information of a nonsyndromic patient affected by unilateral lower canine agenesis and her relatives. A young girl of 9-year-old with a Class II skeletal malocclusion, sella turcica bridging, and severe overjet but no other dental anomalies is described. No associations were found with other types of dental agenesis and previously described genetic variations of the CTNNB1 gene. The possibility of a novel genetic locus should be considered as a possible genetic etiology for this extremely rare condition in a nonsyndromic patient. Based on scientific literature written in English, the present clinical case is one of the first reports to describe a nonsyndromic permanent unilateral mandibular canine agenesis.
| S-EPMC6134732 | biostudies-literature
Project description:BackgroundIn the era of an expanding use of transcatheter aortic valve replacement (TAVR), conduction disturbances and the requirement for permanent pacemaker (PPM) implantation remains a clinical concern.HypothesisUsing a single-center experience, we sought to identify predictors of ventricular pacing burden after TAVR in patients who required PPM implantation.MethodsWe conducted a retrospective study of 359 consecutive patients with symptomatic severe aortic valve stenosis who underwent TAVR at our institution between September 2013 and July 2019. Thirty patients (8.4%) required a PPM within 30 days after TAVR. Pre and post-TAVR electrocardiograms, pre-TAVR echocardiograms and computed tomography (CT), TAVR procedural details and post-TAVR device interrogation records at 1, 3, and 6 months were reviewed.ResultsMean percentage of ventricular pacing (VP%) at 1, 3, and 6 months was 58%, 59%, and 56% respectively. Using univariate logistic regression analysis, patients who had low VP% < 5% at 6 months were more likely to have a prosthesis/echocardiography-derived left ventricular outflow tract (LVOT) diameter ratio < 1.3 (OR 7.00, P-value .048), prosthesis/CT-derived aortic annulus diameter ratio < 1.02 (OR 7.11, P-value .047), post-TAVR new-onset LBBB (OR 16.80, P-value .019), time to PPM implantation greater than 2 days post-TAVR (OR 9.38, P-value .026) and pre-TAVR use of a beta blocker (OR 9.40, P-value .026).ConclusionsIn patients who required a PPM implantation post-TAVR, a lower TAVR prosthesis/LVOT or aortic annulus diameter ratio, post-TAVR new-onset LBBB and later time of PPM implantation showed a trend toward predicting a low VP% at 6 months.
| S-EPMC7661645 | biostudies-literature
Project description:After cardiac operations, careful management substantially reduces the risks of negative complications during or after the removal of temporary epicardial pacing wires. Herein, we report the case of a 58-year-old man who, 4 days after undergoing aortic root replacement, developed pericardial tamponade after the removal of temporary epicardial pacing wires. Consequent to the tamponade, a right-to-left shunt developed through a previously undiagnosed patent foramen ovale. The patient underwent emergency surgery to repair myocardium that had ruptured due to the removal of the wires, and he recovered uneventfully.
| S-EPMC2953237 | biostudies-literature
Project description:BackgroundCurrently, there is no clear consensus regarding the optimal waiting period before permanent pacemaker implantation in patients with conduction disorders following an inferior myocardial infarction.HypothesisWe aimed to elucidate the contemporary practice pattern of pacing, especially the timing of pacemaker implantation, for sinoatrial node and atrioventricular (AV) conduction disorders following an inferior ST-elevation myocardial infarction (STEMI).MethodsUsing the National Inpatient Sample database from 2010 to 2014, we identified patients with a primary diagnosis of inferior STEMI. Primary conduction disorders were classified into: (a) high-degree AV block (HDAVB) consisting of complete AV block or Mobitz-type II second-degree AV block, (b) sinoatrial node dysfunction (SND), and (c) no major conduction disorders.ResultsAmong 66 961 patients, 2706 patients (4.0%) had HDAVB, which mostly consisted of complete AV block (2594 patients). SND was observed in 393 patients (0.6%). Among the 2706 patients with HDAVB, 267 patients (9.9%) underwent permanent pacemaker. In patients with HDAVB, more than one-third (34.9%) of permanent pacemakers were placed within 72 hours after admission. The median interval from admission to permanent pacemaker implantation was 3 days (interquartile range; 2-5 days) for HDAVB vs 4 days (3-6 days) for SND (P < .001). HDAVB was associated with increased in-hospital mortality, whereas SND was not.ConclusionsIn patients who developed HDAVB following an inferior STEMI, only one in 10 patients underwent permanent pacemaker implantation. Despite its highly reversible nature, permanent pacemakers were implanted relatively early.
| S-EPMC6671775 | biostudies-literature
Project description:Background Conventional right ventricular pacing (RVP) has been associated with an increased incidence of atrial fibrillation (AF). We sought to compare the occurrence of new-onset AF and assessed AF disease progression during long-term follow-up between His bundle pacing (HBP) and RVP. Methods and Results We included patients undergoing initial dual-chamber pacemaker implants at Rush University Medical Center between January 1, 2016, and June 30, 2019. A total of 360 patients were evaluated, and 225 patients (HBP, n=105; RVP, n=120) were included in the study. Among the 148 patients (HBP, n=72; RVP, n=76) with no history of AF, HBP demonstrated a lower risk of new-onset AF (adjusted hazard ratio [HR], 0.53; 95% CI, 0.28-0.99; P=0.046) compared with traditional RVP. This benefit was observed with His or RVP burden exceeding 20% (HR, 0.29; 95% CI, 0.13-0.64; P=0.002), ≥40% (HR, 0.31; P=0.007), ≥60% (HR, 0.35; P=0.015), and ≥80% (HR, 0.40; P=0.038). There was no difference with His or RV pacing burden <20% (HR, 0.613; 95% CI, 0.213-1.864; P=0.404). In patients with a prior history of AF, there was no difference in AF progression (P=0.715); however, in a subgroup of patients with a pacing burden ≥40%, HBP demonstrated a trend toward a lower risk of AF progression (HR, 0.19; 95% CI, 0.03-1.16; P=0.072). Conclusions HBP demonstrated a lower risk of new-onset AF compared with RVP, which was primarily observed at a higher pacing burden.
| S-EPMC7763709 | biostudies-literature
Project description:Background:Complete heart block (CHB) is a frequent cause for acute admission in older patients with significant cardiac conduction disease. Common presenting symptoms are syncope and dyspnoea. Some patients may exhibit clinical and radiological signs of left ventricular (LV) decompensation, despite preserved LV ejection fraction on transthoracic echocardiography (TTE) and absent pre-existing LV dysfunction. Case summary:In this clinical report, we present a case of CHB associated with transient but severe elevation in pulmonary artery systolic pressure, measured as the equivalent right ventricular systolic pressure (RVSP = 99?mmHg) by TTE in the absence of right ventricular outflow tract obstruction, that subsequently 'normalized' after implantation of a permanent pacemaker. After searching our echocardiogram database, we did find other cases with similar findings. Discussion:There is limited literature describing transient acute elevation in estimated pulmonary pressures in the setting of new CHB that is subsequently reversed by permanent pacing. The true prevalence and mechanism of transient estimated pulmonary pressure as a result of CHB remains unknown. Based on our limited assessment, we postulate that the acute elevation in estimated pulmonary pressures is predominantly related to a compensatory augmentation of RV stroke volume and is caused by the underlying bradycardia and need to maintain forward cardiac output. This phenomenon may require further investigation and validation in future studies.
| S-EPMC7319818 | biostudies-literature