ABSTRACT
Objective: To explore the occurrence rate of permanent pacemaker implantation (PPI) with relevant risk factors in patients after mechanical aortic valve replacement. Methods: A total of 1986 consecutive patients with mechanical aortic valve replacement were enrolled in this study. According to PPI conduction caused by severe arrhythmia , the patients were divided into 2 groups: PPI group,n=61 including 27 male with the average age of (53.6 ± 9.03) years and Non-PPI group,n=1925. The median follow-up time was (4.47 ± 4.36) years after valve replacement. Results: The patients in PPI group were with the elder age and higher ratio of pre-existing atrial ifbrillation (AF) than those in Non-PPI group,P1 year) was 2.22%. For PPI indications, there were 70.5% patients with high degree A-V block including 30 of AF combining long intervals, 12 of high degree A-V block, 1 of complete left bundle branch block (LBBB) and 14.8% patients with sick sinus syndrome/sinus arrest/ sinus bradycardia. Conclusion: PPI incidence was at a relative low level, the long term occurrence rate was higher than both short term and midterm; elder age, pre-existing AF could be the high risk factors for PPI requirement, and the major PPI indication was high degree AV block in clinical practice.
ABSTRACT
Objective: To observe the automatic ventricular capture management (VCM) conifrmed by paced depolarization integral (PDI) evoked response detection via the follow-up study in patients with Zephyr5826 pacemaker implantation. Methods: A total of 102 relevant patients were enrolled. In order to conduct PDI calculation, pacemakers were set by bipolar sensing and bipolar pacing at immediately after implantation. VCM functions were observed at 1 day, 7 days and 1 month, 3, 6, 12 months after implantation, the ventricular threshold by VCM test and manual test were compared. The symptoms of pectoralis major stimulus, diaphragm stimulus and palpitation were observed in all follow-up patients. Results: There was 1 patient died by MI at 1 month after Zephyr5826 pacemaker implantation, the rest 101 patients were followed-up for 12 months. VCM function was successfully turned-on at immediately after implantation in all patients, no pectoralis major stimulus and diaphragm stimulus occurred. VCM function was turned-off in 6/101 (5.9%) patients at 7 days after implantation due to intolerable palpitation caused by daily automatic VCM, instead they received manual test at follow-up visit. The coincidence rate of ventricular thresholds between VCM test and manual test were 100%. Ventricular pacing output voltage by VCM was (0.99 ± 0.48) V,n=608. Compared with regular pacing output voltage (2.5V, 0.4ms), VCM function may save 84% of energy consumption; compared to high pacing output voltage (3.5V, 0.4ms), VCM may save 92%. Loss of ventricular capture and poor sensation were not found by ECG and 24 h dynamic monitoring. Conclusion: Zephyr5826 pacemaker may conduct bipolar pacing and scanning with VCM function, it can be effectively and safely operated by low energy output. A few patients may not use VCM function due to intolerable palpitation.
ABSTRACT
Objective: Pocket infection in patients after total removal of implanted pacemaker has many problems for their electronic system; our research intends to explore the feasibility of conservatively treating such infection and retain the electronic system. Methods: A total of 4 patients with pacemaker pocket infection in our hospital from 2015-01 to 2016-02 were studied. Thorough debridement and disinfection were conducted in infected pockets and devices, meanwhile vacuum sealing drainage was applied. Electrode wire was kept and intravenous antibiotics were given for (7-10) days after the operation in all patients. Results: The average time of infection occurred at 14.75 months after operation with the type of isolated pacemaker pocket infection. Pocket vacuum suction drainage was performed, with the mean of 7.25 (5-10) months follow-up observation, infection was disappeared and the patients had good wound healing. Conclusion: With thorough debridement of infected pocket, rational treatment of residual electronic system and vacuum sealing drainage, the infection might be effectively controlled for complete recovery without lead extraction in relevant patients.