ABSTRACT
Recent years, have witnessed extended and continuous indication of cardiac pacing. However, increasing number of patients suffered new congestive heart failure [CHF] and aggravated CHF after pacing therapy. We used blood B type nutriuretic peptide [BNP] to predict the occurrence of CHF in patients with different types of pacemakers. To assess single N-terminal brain nutriuretic peptide [NT-pro BNP] as a predictor tool for ventricular dysfunction in different cardiac pacing mode. Out of 480 consecutive patients with pacemaker more than 6 months, 79 patients with average age of 65 +/- 13, and more than 90% ventricular pacing participated in the present study. Those with CHF prior to pacemaker insertion were excluded. The patients underwent medical history and examination, echocardiography [M-mode, Doppler, and Tissue imaging] and blood sampling for pro-BNP. Twenty five, 12, and 42 patients had Dual chamber [DDDR], single chamber pacing with dual chamber sensing [VDDR], and Single chamber [VVIR] pacemakers respectively Single pro-BNP level in patient with DDDR and VDDR pacing was lower than in those with VVIR pacing [P< 0.0001] but in Echocardiography left ventricular [LV] dysfunction was not lower in DDDR than VDDR and VVIR pacing patients [P= 0.190]. Single level of pro-BNP is lower in double chamber pacing in comparison with single chamber pacing. Therefore, it seems that dual chamber pacing causes less LV dysfunction
ABSTRACT
The purpose of this prospective study is to quantify the risk of lower limb deep venous thrombosis [DVT] in patients requiring temporary transvenous femoral pacing and to evaluate the use of different enoxaparin dosages [Prophylactic or therapeutic] for thrombus prevention. Transvenous temporary cardiac pacemaker, with catheters frequently used along the femoral vein is useful to relieve difficult bradyarrythmias and some tachyarrythmias. Up to one-third of patients receiving transfemoral pacing develop asymptomatic DVT. At present, there are no recommendations for thrombus prophylaxis in these patients. Besides, the efficacy in this specific condition has not been studied. Sixty consecutive patients who underwent transvenous femoral pacing and had no contraindication to low molecular weight herparin [LMWH] therapy were divided into 3 groups each group consisted of 20 patietns. Group I received prophylactic enoxaparin [1mg/kg/day; subcutaneously], group II received therapeutic enoxaparin [1mg/kg/day every 12 hours; subcutaneously], and group III consisting of patients who were not treated with enoxaparin was considered as control groups. Patients were evaluated daily for clinical features of DVT. Color Doppler sonography imaging was performed on both lower limbs of all patients within 24 hours after removal of the temporary pacemakers. Of the sixty patients, two who belonged to group III, had definitive evidence of right lower limb DVT by color Doppler sonography. These two cases of DVT were asymptomatic and had thrombosis of femoral vein. No evidence of thrombus was detected in contra lateral lower limb. No DVT was detected among patients who received prophylactic or therapeutic doses of enoxaparin. No heparin related complications were detected in this study. There were no significant difference in the clinical characteristics among 2 groups [I,II] and control group. Correlations of age and gender with occurrence of DVT were not significant [P= 0.512, 0.737]. This study showed that DVT is a common complication of femoral pacing, and that its incidence can be reduced with the use of prophylaxis and therapeutic intravenous enoxaparin