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pacemaker scars

Chan Soon Park, Myung-Jin Cha, Eue-Keun Choi, Seil Oh
BACKGROUND AND OBJECTIVES: Left bundle branch block (LBBB) with left axis deviation (LAD) has a worse prognosis than LBBB with a normal axis, and myocardial dysfunction has been suggested as a cause of left axis deviation. This study investigated the prognostic significance of the QRS axis in patients with LBBB and analyzed its relationship with the amount of myocardial scarring. SUBJECTS AND METHODS: A total of 829 patients were diagnosed with LBBB at Seoul National University Hospital from October 2004 to June 2014...
March 2017: Korean Circulation Journal
Salma Haj Kheder, Thomas Hummel, Heike Majewski, Rafael Jimènez, Alexander Wutzler
CASE REPORT: A 49-year-old man with Still's disease presented with a rash above his pacemaker scar. In 2012, there was a replacement of the generator in which the position was changed from subpectoral to subcutaneous. A revision operation was performed after the local finding became worse, turning from a granuloma to a macula. THERAPY: During surgery, a superficial position of the leads was revealed. Both leads and generator were removed with great effort from the granulation tissue...
February 21, 2017: Herzschrittmachertherapie & Elektrophysiologie
Martin Grett, Martin Christ, Jan-Peter Röing Gen Nölke, Hans-Joachim Trappe
BACKGROUND AND PROBLEM: Recently published results of the DANISH study raise concerns, if primary prophylactic ICD implantations in patients with nonischemic cardiomyopathy (NICM) and severe reduced left ventricular ejection fraction (LVEF) should be performed without further risk stratification. There was no significant difference in the overall mortality of patients with or without ICD and CRT defibrillator (CRT-D) or CRT pacemaker (CRT-P), respectively. Clinical risk scores to identify patients with ischemic cardiomyopathy (ICM) who benefit most from an ICD have been recommended...
February 15, 2017: Herzschrittmachertherapie & Elektrophysiologie
Federico Ferrando-Castagnetto, Roberto Ricca-Mallada, Alejandro Vidal, Rodolfo Ferrando
OBJETIVE: To evaluate left ventricular mechanical dyssynchrony (LVMD) associated to prolonged right ventricular pacing through an innovative imaging technique, as a pilot study in Uruguay. METHODS: We performed 99mTc-MIBI gated-SPECT and phase analysis in 12 patients with pacemakers implanted at least one year before scintigraphy due to advanced atrioventricular block. Clinical data, QRS duration, rate, mode and site of pacing in right ventricle, chamber diameters, presence and extension of myocardial scar and ischemia and rest LVEF were recorded...
January 25, 2017: Archivos de Cardiología de México
Jonathan M Behar, Simon Claridge, Tom Jackson, Ben Sieniewicz, Bradley Porter, Jessica Webb, Ronak Rajani, Stamatis Kapetanakis, Gerald Carr-White, Christopher A Rinaldi
Cardiac resynchronization therapy (CRT) is an effective pacemaker delivered treatment for selected patients with heart failure with the target of restoring electro-mechanical synchrony. Imaging techniques using echocardiography have as yet failed to find a metric of dyssynchrony to predict CRT response. Current guidelines are thus unchanged in recommending prolonged QRS duration, severe systolic function and refractory heart failure symptoms as criteria for CRT implantation. Evolving strain imaging techniques in 3D echocardiography, cardiac MRI and CT may however, overcome limitations of older methods and yield more powerful CRT response predictors...
February 2017: Expert Review of Cardiovascular Therapy
Shai Tejman-Yarden, Bruria Ben-Zeev, Yuval Goldshmit, Georgia Sarquella-Brugada, Assi Cicurel, Uriel Katz, David Mishali, Michael Glikson
BACKGROUND: Pacing can be a successful treatment for pallid breath-holding spells, primarily in individuals with severe bradycardia. PATIENT DESCRIPTION: We describe an 18-month-old girl experiencing severe pallid breath-holding spells in whom repeated electrocardiographic, Holter, and electroencephalographic monitoring tests were all normal. RESULTS: Using a subcutaneous insertable cardiac monitor, severe bradycardia was detected during one of this girl's episodes...
November 2016: Pediatric Neurology
Federico Ferrando-Castagnetto, Roberto Ricca-Mallada, Alejandro Vidal, Fabián Martínez, Rodolfo Ferrando
Pacemaker stimulation is associated with unpredictable severe cardiac events. We evaluated left ventricular mechanical dyssynchrony (LVMD) during prolonged septal right ventricular pacing. We performed 99mTc-MIBI gated-SPECT and phase analysis in 6 patients with pacemakers implanted at least one year before scintigraphy due to advanced atrioventricular block. Using V-Sync of Emory Cardiac Toolbox we obtained phase bandwidth (PBW) and standard deviation (PSD) from rest phase histogram. Clinical variables, QRS duration, rate and mode of pacing in septal right ventricle wall, chamber diameters, presence and extension of myocardial scar and ischemia and rest LVEF were recorded...
2016: Medicina
Sachin Diwadkar, Aarti A Patel, Michael G Fradley
Bortezomib is a proteasome inhibitor used to treat multiple myeloma and mantle cell lymphoma. Traditionally, bortezomib was thought to have little cardiovascular toxicity; however, there is increasing evidence that bortezomib can lead to cardiac complications including left ventricular dysfunction and atrioventricular block. We present the case of a 66-year-old man with multiple myeloma and persistent asymptomatic elevations of cardiac biomarkers who developed complete heart block and evidence of myocardial scar after his eighth cycle of bortezomib, requiring permanent pacemaker placement...
2016: Case Reports in Cardiology
Haseeb Munaf Seriwala, Muhammad Shahzeb Khan, Muhammad Bilal Munir, Irbaz Bin Riaz, Haris Riaz, Samir Saba, Andrew H Voigt
Cardiac pacemakers are a critical management option for patients with rhythm disorders. Current efforts to develop leadless pacemakers have two primary goals: to reduce lead-associated post-procedural morbidity and to avoid the surgical scar associated with placement. After extensive studies on animal models and technological advancements, these devices are currently under investigation for human use. Herein, we review the evidence from animal studies and the technological advancements that have ushered in the era of use in humans...
January 2016: Journal of Cardiology
Jean-Claude Daubert, Albin Behaghel, Christophe Leclercq, Philippe Mabo
Major improvements in implantable electrical cardiac devices have been made during the last two decades, notably with the advent of automatic internal defibrillation (ICD) to prevent sudden arrhythmic death, and cardiac resynchronisation (CRT) to treat the discoordinated failing heart. They now constitute a major therapeutic option and may eventually supersede drug therapy. The coming era will be marked by a technological revolution, with improvements in treatment delivery, safety and efficacy, and an expansion of clinical indications...
March 2014: Bulletin de L'Académie Nationale de Médecine
Kaytlyn A Gerbin, Xiulan Yang, Charles E Murry, Kareen L K Coulombe
Cardiac tissue engineering is a promising approach to provide large-scale tissues for transplantation to regenerate the heart after ischemic injury, however, integration with the host myocardium will be required to achieve electromechanical benefits. To test the ability of engineered heart tissues to electrically integrate with the host, 10 million human embryonic stem cell (hESC)-derived cardiomyocytes were used to form either scaffold-free tissue patches implanted on the epicardium or micro-tissue particles (~1000 cells/particle) delivered by intramyocardial injection into the left ventricular wall of the ischemia/reperfusion injured athymic rat heart...
2015: PloS One
Seung-Ah Lee, Myung-Jin Cha, Youngjin Cho, Il-Young Oh, Eue-Keun Choi, Seil Oh
Long-term right ventricular apical pacing (RVAP) is reportedly associated with heart failure (HF) development. However, the predictors of pacing-induced HF (PHF) remained unclear. We retrospectively enrolled 234 patients without structural heart disease who underwent a permanent pacemaker implantation with RVAP between 1982 and 2004. RVAP-induced HF was defined as left ventricular ejection fraction decrease >5 % with HF symptom without other HF development etiology. The QRS duration of a paced beat (pQRSd) and myocardial scar score were analyzed from each patient's 12-lead ECG...
July 2016: Heart and Vessels
Hea Won Ann, Jin Young Ahn, Yong Duk Jeon, In Young Jung, Su Jin Jeong, Boyoung Joung, MoonHyoung Lee, Nam Su Ku, Sang Hoon Han, June Myung Kim, Jun Yong Choi
OBJECTIVES: The use of cardiac implantable electronic device (CIED; pacemakers, implantable cardioverter-defibrillators [ICD], cardiac re-synchronized therapy [CRT]) implantation, one essential treatment for cardiac arrhythmias, is increasing. Infectious complications related to implants are the main reason for device removal and patient morbidity. We sought to identify the incidence of infectious complications among patients with cardiac device implantation and analyze the risk factors for infectious complications...
July 2015: International Journal of Infectious Diseases: IJID
Kelvin C Lau, J William Gaynor, Stephanie M Fuller, Karen A Smoots, Maully J Shah
BACKGROUND: Multiple cardiac operations and resultant myocardial scarring have been implicated in the overall reduced performance of epicardial pacing systems in patients with congenital heart disease (CHD). OBJECTIVE: The aim of the study is to evaluate long-term permanent epicardial pacing lead survival in patients with CHD who had epicardial lead placement in association with surgical repair or palliation. METHODS: A retrospective review of patients who had implantation of epicardial pacing systems between January 1984 and June 2010 was conducted...
March 2015: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Darragh J Twomey, Prashanthan Sanders, Kurt C Roberts-Thomson
Macroreentrant atrial tachycardia is a common complication following surgery for congenital heart disease (CHD), and is often highly symptomatic with potentially significant hamodynamic consequences. Medical management is often unsuccessful, requiring the use of invasive procedures. Cavotricuspid isthmus dependent flutter is the most common circuit but atypical circuits also exist, involving sites of surgical intervention or areas of scar related to abnormal hemodynamics. Ablation can be technically challenging, due to complex anatomy, and difficulty with catheter stability...
2015: Current Cardiology Reviews
Jippe C Balt, Maurits C E F Wijffels, Lucas V A Boersma, Eric F D Wever, Jurriën M ten Berg
OBJECTIVE: The purpose of the present study was to determine the incidence of ventricular arrhythmias before and after alcohol septal ablation (ASA). BACKGROUND: In patients with hypertrophic obstructive cardiomyopathy (HOCM), gradient reduction by ASA is an alternative for surgical myectomy. However, concerns exist about whether the induction of a myocardial scar during ASA may create substrate for ventricular arrhythmias. METHODS: The study group consisted of 44 patients in whom ASA was performed for symptomatic, drug-refractory hypertrophic cardiomyopathy...
December 2014: Heart: Official Journal of the British Cardiac Society
Matthew R Williams, Suzanne M Shepard, Nicole K Boramanand, John J Lamberti, James C Perry
BACKGROUND: Many patients with congenital heart disease require permanent pacing for rhythm management but cannot undergo transvenous lead placement. In others, epicardial scarring prohibits adequate sensing and pacing thresholds using epicardial leads. This study describes long-term lead performance using a transmural atrial (epicardial to endocardial) pacing approach in patients with congenital heart disease. METHODS AND RESULTS: For transmural atrial (TMA) lead access, a bipolar, steroid-eluting transvenous lead was placed from the epicardium via purse-string incision or atriotomy and affixed to atrial endocardium...
August 2014: Circulation. Arrhythmia and Electrophysiology
Kevin Vernooy, Caroline J M van Deursen, Marc Strik, Frits W Prinzen
Cardiac resynchronization therapy (CRT) emerged 2 decades ago as a useful form of device therapy for heart failure associated with abnormal ventricular conduction, indicated by a wide QRS complex. In this Review, we present insights into how to achieve the greatest benefits with this pacemaker therapy. Outcomes from CRT can be improved by appropriate patient selection, careful positioning of right and left ventricular pacing electrodes, and optimal timing of electrode stimulation. Left bundle branch block (LBBB), which can be detected on an electrocardiogram, is the predominant substrate for CRT, and patients with this conduction abnormality yield the most benefit...
August 2014: Nature Reviews. Cardiology
Lior Shabtai, Stacy C Specht, Shawn C Standard, John E Herzenberg
BACKGROUND: Patients with congenital limb shortening can present with joint instability, soft tissue contractures, and significant leg length discrepancy. Classically, lengthening is done with external fixation, which can result in scarring, pin site infection, loss of motion, and pain. We therefore developed an alternative to this approach, a new, controllable, internal lengthening device for patients with congenital limb shortening. QUESTIONS/PURPOSES: We evaluated this device in terms of (1) healing index, (2) complications, (3) accuracy of the device's external controller, and (4) adjacent-joint ROM...
December 2014: Clinical Orthopaedics and related Research
Evan Adelstein, David Schwartzman, Raveen Bazaz, Sandeep Jain, John Gorcsan, Samir Saba
BACKGROUND: Pacemaker-dependent patients with left ventricular dysfunction benefit from upgrade to cardiac resynchronization therapy (CRT). Those at low risk for ventricular tachyarrhythmias may benefit similarly from upgrade to a CRT-defibrillator or CRT-pacemaker. OBJECTIVE: To determine whether coronary artery disease (CAD), because of associated scar that supports reentry, predicts higher risk of appropriate shocks in pacemaker-dependent patients upgraded to a CRT-defibrillator...
June 2014: Heart Rhythm: the Official Journal of the Heart Rhythm Society
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