Epidemiology of Pacemaker Implantation among Patients in Tanta University Hospitals

Background: This study describes cardiac pacing activity during 2021: demographic data of patients underwent permanent pacemaker implantation (PPM), risk factors, clinical presentations, indications, mode of pacing, and complications post PPM implantation. Cardiac pacemakers have become the common treatment of symptomatic bradycardia or high-grade atrioventricular block. Methods: The study was carried out at the department of cardiology Tanta University Hospitals. 102 patients were included in this study. This study was done over a period of six months from October 2020 until April 2021 and follow up for 6 months. All the data about the patients underwent permanent pacemaker implantation were collected by the coordinator in the participating cardiac center. Results: The most frequent risk factors of PPM implantation was hypertension (69%), followed by diabetes mellitus (29%), coronary artery disease (21%), chronic kidney disease (18%), hypothyroidism (6%), cardiomyopathy (3%), valvular heart disease (2%) and congenital heart disease (1%). The most common indication is complete heart block (69%), followed by second degree heart block "mobeitz type 2" (13%), slow atrial fibrillation (7%), symptomatic heart failure patients with LVEF ? 35% , QRS ? 150 ms (6%), trifascicular block (3%), sick sinus syndrome (2%). The most frequent mode of pacing used in our study was DDD mode (63%), followed by VVI mode (32%) with (78%) sinus rhythm and (22%) atrial fibrillation rhythm, then CRT-D (4%). Overall complication rate (9%) within 6 months. In our study the most common complication is infection (5%), followed by haematoma (1%), lead fracture (1%), pneumothorax (1%), and lead displacement (1%). Conclusion: Approximately three-quarters of the patients related to atrioventricular block underwent permanent pacemaker implantaion. Approximately more than half of pacemakers related to patients underwent permanent pacemaker implantation were dual chamber pacemakers. Infection is the most common complication in our study and this is important for strict infection control measures.

Cardiac Perforation by Permanent Pacemaker Lead, One Year after Implantation — An Unusual Occurrence and Its Management

Delayed Cardiac Perforation by Permanent Pacemaker lead beyond one year of implantation is rare. It is also rarer in passive fixation lead, compared to active fixation lead. There is no Universal consensus regarding management of such cases with percutaneous versus surgical removal of the lead followed by re-implantation. Here we report a case of Right Ventricular (RV) perforation by a passive fixation permanent lead, in an 81-year-old lady, 14 months after implantation, who presented with Pacemaker capture failure but in hemodynamically stable condition. Pacemaker lead had migrated up to the Lower Lobe of Left Lung, Perforating Right Ventricle, pericardium and Left Pleura. We managed this case with open lead removal under direct vision by Lower Median Sternotomy, followed by implantation of an Epicardial Lead and Pacemaker

A Case of Surgical Repair for End-Stage Tricuspid Regurgitation with Severe Liver Dysfunction and Hepatic Encephalopathy / 日本心臓血管外科学会雑誌

We report the case of a patient with severe tricuspid regurgitation and severe liver dysfunction who was successfully treated by tricuspid valve repair with spiral suspension and perioperative management of high cardiac output. The patient was a 77-year-old woman who presented with chronic atrial fibrillation with bradycardia (heart rate approximately 50 bpm). She had been diagnosed with severe tricuspid valve and mitral valve regurgitation at the age of 74. As her heart failure and hepatic failure grew worse, and hepatic encephalopathy also occurred, she was admitted to the hospital. Her Child-Pugh score for liver disease was Grade C at the preoperative assessment, suggesting that she was in the high-risk category for open heart surgery. Therefore, further medical treatment was required before selecting the surgical treatment. After the implantation of a pacemaker (VVI mode, 80 bpm), the cardiac output increased with a cardiac index of 5.17 L/min/m2 compared with 2.97 L/min/m2 prior to pacemaker implantation. Furthermore, the symptoms of heart failure improved and total bilirubin decreased from 3.9 mg/dl to 1.7 mg/dl, and surgery was performed. Tricuspid regurgitation was treated with spiral suspension, and mitral regurgitation due to annular dilation was treated with annuloplasty. Following the surgery, the cardiac index was maintained from 4.3 L/min/m2 to 5.8 L/min/m2 with central venous pressure below 10 mmHg by the assistance of intra-aortic balloon pumping. The patient was extubated 30 h after surgery, and was discharged on postoperative day 54. At the time of discharge, total bilirubin was 1.5 mg/dl. At 1.5 post-operative years, the patient is New York Heart Association functional Class II and tricuspid valve regurgitation is mild.

Perfil clínico e evolução de pacientes com infecção relacionada a dispositivos cardíacos eletrônicos implantáveis / Clinical profile and outcome of patients with cardiac implantable electronic device-related infection

Resumo Fundamento Houve aumento expressivo na incidência de infecções relacionadas a dispositivos cardíacos eletrônicos implantáveis (DCEI) nos últimos anos, com impacto na mortalidade. Objetivos Verificar a proporção de pacientes com infecção de DCEI e analisar seu perfil clínico, as variáveis relacionadas com a infecção e sua evolução. Método Estudo retrospectivo, observacional e longitudinal com 123 pacientes com infecção de DCEI entre 6.406 procedimentos. Foram usados os testes paramétricos, e o nível de significância adotado na análise estatística foi de 5%. Resultados A idade média dos pacientes foi de 60,1 anos, e 71 eram homens. A média de internação foi de 35,3 dias, e houve remoção total do sistema em 105 pacientes. Identificaram-se endocardite infecciosa (EI) e sepse em 71 e 23 pacientes, respectivamente. A mortalidade intra-hospitalar foi 19,5%. Houve associação entre EI e extrusão do gerador (17,0% vs. 19,5% nos grupos com e sem EI, respectivamente, p = 0,04; associação inversa) e sepse (15,4% vs. 3,2%, p = 0,01). Houve associação entre morte intra-hospitalar e EI (83,3% vs. 52,0% com e sem morte, respectivamente, p = 0,005) e sepse (62,5% vs. 8,1%, p < 0,0001). Foi dada alta hospitalar a 99 pacientes. Durante a média de seguimento clínico de 43,8 meses, a taxa de mortalidade foi de 43%, e 65,2% dos pacientes com sepse faleceram (p < 0,0001). A curva de sobrevida de Kaplan-Meier não indicou associação significante com sexo, agente etiológico, fração de ejeção, EI e modalidade de tratamento. A taxa de mortalidade foi de 32,8% entre os pacientes submetidos a reimplante de eletrodos por via endocárdica e 52,2% entre aqueles por via epicárdica (p = 0,04). Não houve influência da etiologia chagásica, a qual correspondeu a 44,7% das cardiopatias de base, quanto às variáveis clínicas e laboratoriais ou à evolução. Conclusões A taxa de infecção foi de 1,9%, com predomínio em homens. Houve associação entre mortalidade intra-hospitalar e EI e sepse. Após a alta hospitalar, a taxa de mortalidade anual foi de 11,8%, com influência de sepse durante a internação e o implante epicárdico. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

Abstract Background In recent years, the incidence of infections related to cardiac implantable electronic devices (CIED) has increased sharply, impacting mortality. Objective To verify the proportion of patients with CIED infection; to analyze their clinical profile and the variables related to the infection and its progression. Methods Retrospective and longitudinal observational study including 123 patients with CIED infection among 6406 procedures. Parametric tests and a level of significance of 5% were used in the statistical analyses Results The mean age of patients was 60.1 years and mean length of stay in hospital was 35.3 days; most (71) patients were male, and the system was completely removed in 105 cases. Infectious endocarditis (IE) and sepsis were observed in 71 and 23 patients, respectively. Intra-hospital mortality was 19.5%. IE was associated with extrusion of the generator (17.0% vs 19.5% with and without IE, respectively, p = 0.04, inverse association) and sepsis (15.4% vs 3.2%, p = 0.01). Intra-hospital death was associated with IE (83.3% vs 52.0% with and without intra-hospital death, respectively, p = 0.005) and sepsis (62.5% vs 8.1%, p < 0.0001). Ninety-nine patients were discharged. During a mean follow-up of 43.8 months, mortality rate was 43%; among patients with sepsis, it was 65.2% (p < 0.0001). By applying a Kaplan-Meier survival curve, we did not indicate significant associations with sex, etiologic agent, ejection fraction, IE, or treatment modality. The death rate was 32.8% for patients subjected to endocardial electrode reimplantation and 52.2% for epicardial reimplantation (p = 0.04). Chagasic etiology (44.7% of the baseline heart diseases) did not influence clinical and laboratory variables or disease progression. Conclusion The infection rate was 1.9%, mostly in men. We observed an association of intra-hospital mortality with IE and sepsis. After discharge, the annual mortality rate was 11.8%, influenced by sepsis during hospitalization and epicardial implantation. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

Comparison of 1-year clinical results of transcatheter aortic valve replacement (TAVR) using prostheses with two different frame designs in 124 patients in a single center / 中国胸心血管外科临床杂志

@#Objective    To compare and analyze the clinical effects of two kinds of frame design valves after transcatheter aortic valve replacement (TAVR). Methods    We retrospectively reviewed 124 patients who underwent TAVR and were followed up for 1 year. There were 71 males and 53 females aged 75.57±6.21 years. These patients were treated with Venus-A or Edwards Sapien aortic valves. The hemodynamics and cardiac function of these two kinds of transcatheter aortic valves (THV) were evaluated by echocardiography. The 30-day mortality and 1-year clinical effect of the patients were calculated. Results    Eight-one patients used Venus-A valve and 43 patients used Edwards Sapien valve. The aortic valve transaortic pressure gradient was reduced and the rate of perivalvular leakage was low (both 2.6%) in both groups, and there was no statistical difference between the two groups. The implantation rate of permanent pacemaker was 17.3% and 11.6%, respectively. The 1-month survival (94.0% and 93.0%) and 1-year survival (94.0% and 91.0%) rates were not statistically different. Conclusion    The two groups of THV with different stent structures have good short-term clinical effect and low implantation rate of permanent pacemaker.

Initial implantation experience and short-term follow-up results of implanting leadless intracardiac transcatheter pacing system / 中华心血管病杂志

Objective: To explore the utility and safety of leadless intracardiac transcatheter pacing system. Methods: The study was a prospective observational study. Patients underwent Micra transcatheter pacing system in Beijing Anzhen hospital from December 2019 to January 2020 were enrolled. The baseline characteristics, platelet count, hemoglobin, anticoagulation and/or antiplatelet therapy, mean procedural time, average fluoroscopy time, number of deployment and electrical parameters (threshold, R-wave amplitude, impedance) were recorded. Ultrasonography of bilateral femoral and iliac veins was performed in all patients. Patients were followed including access site complication, adverse event and device evaluation at implant, hospital discharge, 1 and 3 months post-implant. R-wave≥5 mV, impedance between 400 and 1 500 Ω and threshold increase≤1.5 V than implant is considered a stable parameter. Femoral access site complications included hematoma, hemorrhage, pseudoaneurysm, and arteriovenous fistula. Adverse events included dislodgement, cardiac effusion/perforation and infection. Left ventricular end diastolic diameter and ejection fraction before and at 1 month after implant were reported. Results: Five patients were enrolled and pacemaker implantation was successful in all 5 patients. Patients were all males and the average age was (78.4±8.4) years. 2 patients received aspirin and clopidogrel therapy, 1 patient suffered from anemia and thrombocytopenia occurred in 1 patient. No stenosis, occlusion and vascular malformation of bilateral femoral and iliac veins was observed. The mean implant time was (39.6±1.7) minutes. The average fluoroscopy time was (9.2±1.3) minutes and the number of deployment was (1.40±0.55). Electrical parameters(threshold, R-Wave amplitude and impedance) were as follows: (0.40±0.10) V/0.24 ms, (10.80±3.72) mV and (822.00±162.23) Ω at implant; (0.45±0.07) V/0.24 ms, (13.04±2.41) mV, and (748.0±91.5) Ω at discharge, (0.40±0.06) V/0.24 ms, (14.26±4.11) mV, and (700.0±91.7) Ω at 1 month post-implant and (0.39±0.05) V/0.24 ms, 14.40±3.97 mV, and (682.0±96.0) Ω at 3 months post-implant, respectively. Threshold increase was ≤1.5 V compared to that during implantation, electrical parameters were acceptable and stable. There was no difference in LVEDD [(44.00±5.24) mm vs. (44.00±5.34) mm,P=1.000] and EF [(62.00±3.39)% vs. (62.20±3.56)%, P=0.861] before and 1 month post-implant. No incidence of access site complications, cardiac effusion/perforation, dislodgment or infections occurred during the 3 months. Conclusions: The leadless transcatheter pacemaker implantation performed in our study archived a high implant success rate and favorable safety profile as well as associated with low and stable pacing thresholds. The long-term safety and benefit of leadless pacemaker need to be evaluated in future clinical studies.

Bundles of care research on the influence of discomfort after pacemaker implantation / 中国实用护理杂志

Objective@#To explore the effect of intensive care on the comfort of patients after pacemaker implantation.@*Methods@#36 patients admitted from January 2016 to May 2017 were selected as routine care group, and 38 patients admitted from June 2017 to October 2018 were selected as cluster care group. Routine care was given in the postoperative routine care group, and intensive care was given in the intensive care group until the day before the postoperative discharge. The changes in comfort score, anxiety score, and lumbar and back pain score of the two groups were recorded and compared on the day before the surgery and the day before discharge.@*Results@#There were no statistically significant differences in comfort score, lumbar and back pain score and SAS score between the intensive care group and the preoperative conventional care group (all P > 0.05). Postoperative comfort score (43.71±3.29, 73.27±4.37), lumbar and back pain score (4.31±1.07, 1.56±1.04) and SAS score (53.49±6.18, 38.29±7.35) in the intensive care group were significantly better than those in the conventional care group, with statistically significant differences (t=8.478, 3.218, 6.293, all P < 0.05).@*Conclusion@#The application of bundles of care after pacemaker implantation can effectively improve patients′ body discomfort, cardiac rehabilitation effect and quality of life, which is worthy of clinical promotion.

Cardiac conduction block after transcatheter aortic valve replacement / 第二军医大学学报

Objective To evaluate the effectiveness of transcatheter aortic valve replacement (TAVR) using domestic valves for treating aortic valve stenosis or regurgitation, and to explore the incidence of cardiac conduction block after surgery and its influence on the prognosis of the patients. Methods The patients with severe aortic valve stenosis or regurgitation receiving TAVR surgery in our department from Sep. 2017 to Jan. 2018 were enrolled in this study. The TAVR surgery was performed with domestic valves (J-Valve or Venus-A), and the outcomes and incidence of complications were assessed after surgery. The patients were observed for the incidence of new-onset cardiac conduction block during and after TAVR and the recovery of arrhythmia during hospitalization. According to the presence of cardiac conduction block at discharge, the patients were divided into normal rhythm group and conduction block group. The baseline and postoperative characteristics, and left ventricular structure and function were compared between the two groups. Results Sixteen patients were enrolled in this study, including 12 in the normal rhythm group and 4 in the conduction block group. Brain natriuretic peptide ([1 114.87±802.32] pg/mL vs [530.39±276.26] pg/mL, P=0.026), aortic transvalvular pressure difference ([83.06±37.76] mmHg vs [24.14±9.73] mmHg, P0.05). Conclusion TAVR with domestic valves can effectively reduce the aortic transvalvular pressure difference with fewer complications. It may cause complete left bundle branch block, which has no significant influence on the short-term adverse cardiac events and cardiac function after operation.

Surgical Implantation of Endocardial Lead for Adult Congenital Atrioventricular Block Combined with Obstructed Bilateral Subclavian Vein / 日本心臓血管外科学会雑誌

<p>For A 38-year-old male diagnosed a congenital complete atrioventricular block in the neonatal period, epicardial lead and pacemaker was implanted through left thoracotomy. Although we tried to implant a pacemaker through the subclavian vein as an adult, it was unsuccessful because of obstruction of the bilateral subclavian vein. For this reason, we performed a pacemaker implantation with transatrial-endocardial lead through the right thoracotomy due to save the generator electric power. This is one of the useful techniques for cases with obstruction of the upper extremity vein.</p>

The effects of bandage rollers compression on prevention of pocket bleeding after pacemaker implantation / 重庆医学

Objective To evaluate the effect of bandage rollers compression on pocket hemostasis in patients after implantation of permanent pacemaker.Methods A total of 591 patients after implantation of permanent pacemaker were enrolled in this study and divided into trial group and control group.The wounds of 296 patients in trial group received compression by two bandage rollers,which were placed parallelly on the wound side by side,above the pocket of pacemaker,fixed by 3M adhesive tapes so that no bleeding of wound and no shifting of rollers.6 hours after the operation,the tapes and bandage rollers were released.The wounds of 295 patients in control group received compression by 1 000 g sand bag which were taken off 6 hours after the operation.The safety and effects of hemostasis in patients between the two groups were compared.Results The incidences of incision bleeding,pocket hematoma and pocket skin pressure injury were not significantly different between the two groups(P>0.05).The incidences of postoperative pain,urinary retention and insomnia were significantly different between the two groups(P<0.05).Conclusion The incidences of postoperative pain,urinary retention and insomnia are significantly reduced in patients who received bandage roller compression.

Effects Analysis of Special Rectification of Antibiotics for Prophylactic Use in Perioperative Period of Per-manent Cardiac Pacemaker Implantation in Our Hospital / 中国药房

OBJECTIVE:To provide reference for rational prophylactic application of antibiotics in perioperative period of per-manent cardiac pacemaker implantation. METHODS:600 cases performed permanent cardiac pacemaker implantation in 2010(be-fore rectification),2012(during rectification)and 2014(after rectification)were randomly sampled from our hospital,and divided into control group,intervention group one and intervention group two. The prophylactic application of antibiotics was investigated and analyzed in 3 groups. RESULTS:For control group,intervention group one and intervention group two,the rates of rational type selection of antibiotics for prophylactic use were 7.25%,31.00% and 91.96%,respectively. The rates of rational medication timing of antibiotics for prophylactic use were 0,100% and 100%;average duration of prophylactic use decreased from (3.6 ± 1.2)d before intervention to(1.1±0.5)d and(1.0±0.2)d. There was no statistical significance in the incidence of postoperative infection(P>0.05). Compared with control group,average drug cost,antibiotics cost and drug ratio decreased significantly in in-tervention group,with statistical significane (P<0.05). CONCLUSIONS:Antibiotics special rectification is effective and improve the rational application of antibiotics in our hospital.

Pacing Indications and Modes in Bradyarrhythmia Patients: Gender Related Differences.

Gender differences are increasingly recognized in cardiology. It is also well known that women have higher complications and a higher mortality related to coronary procedures. In arrhythmias, gender-specific variations in the electrophysiological structure of the heart or hormonal effects may explain some of the gender differences. The aim of this study was to evaluate gender differences according to their risk factors, indications and modes of pacing. A total of 267 patients who had pacemaker implantation for bradyarrhythmia indications were enrolled in our study. A pre-designed questionnaire was filled to record their baseline characteristics, clinical indications and mode of pacing. Out of 267 patients 190 were male and 77 were female. Data was analyzed with SPSS 16.0 software (SPSS, Chicago, IL, USA) The pacemaker implantation requirement was 31% significantly lower among males compared with females who were hypertensive (RR=0.69, 95%CI=0.58-0.82, p=0.0001) and 1.57 times (RR=1.57, 95%CI=1.32-1.87, p=0.0001) significantly higher among male patients than females who were the tobacco user in any form. The single chamber requirement was 1.41 times significantly (RR=1.41, 95%CI=1.16-1.71, p=0.0001) higher in males than females. The risk analysis showed that complete heart blockage (p= 0.02) and sick sinus syndrome (p= 0.01) were significantly higher in males as compared with females. In conclusion male patients had more CHB, sick sinus syndrome and syncope as primary pacemaker indication, compared with female patients. Smoking was the most prominent risk factor in male and hypertension in female and most importantly there were significant gender differences in indications leading to pacing.

Ankylosing Spondylitis with Complete Atrioventricular Block and Aortic Regurgitation / 日本心臓血管外科学会雑誌

Ankylosing spondylitis is chronic, progressive, inflammatory disease involving the spine, peripheral joints, and periarticular structures. Cardiac abnormalities associated with ankylosing spondylitis are well recognized, but a case with DDD pacemaker implantation for complete atrioventricular block and aortic valve replacement for aortic regurgitation has not been previously reported. We report a case of a 66-year-old man with ankylosing spondylitis who was successfully treated by DDD pacemaker implantation for complete atrioventricular block and aortic valve replacement for severe aortic regurgitation.

Implantación de un marcapaso a través de una vena cava superior izquierda persistente: Utilidad del registro de actividad eléctrica endocavitaria / Implantation of a pacemaker through persistent left superior vena cava

La presencia de una vena cava superior izquierda persistente es una variante congénita poco frecuente. Es, sin embargo, la anomalía más común del sistema venoso torácico. Su prevalencia ha sido estimada en 0.6 a 1.0% durante la implantación de marcapasos. Este hallazgo, frecuentemente incidental, puede dificultar la progresión del electrodo del marcapaso a través de los abordajes yugular o subclavio izquierdos. En este reporte presentamos la exitosa implantación de un marcapaso a través de una vena cava superior izquierda persistente. Las dificultades técnicas durante el procedimiento fueron resueltas usando el cable del marcapaso a manera de electrodo unipolar. El registro del electrograma endocavitario nos ayudó a guiar el electrodo a través de la anatomía difícil. Una posición estable final se logró mediante la utilización de un sistema de fijación activa.

Persistent left superior vena is a relatively rare congenital variant. It is, however, the most common variation of the thoracic venous system. Prevalence is estimated in about 0.6 to 1.0% during pacemaker placement. This finding, often incidental, can difficult the lead progression through the left jugular or subclavian routes. This report describes a case of successful pacemaker implantation through a persistent left superior vena. Technical difficulties were overcome using the pacemaker electrode as unipolar lead. Endocavitary ECG recording helped us to guide the lead through the tortuous anatomy. A stable lead position was finally achieved by means of the active fixation system of the pacemaker electrode.

Two Neonatal Cases of Pacemaker Implantation in Congenital Complete Atrioventricular Block

Congenital complete atrioventricular heart block(CCAVB) is a rare disease of the newborn that carries significant mortality and has a heterogenous etiology. It may occur as a result of the presence of maternal autoantibodies that are transferred to the fetus and affect the fetal heart or be associated with a congenital structural abnormality of the heart. Infants with CCAVB are at risk of diminished cardiac output and the subsequent development of congestive heart failure. We report two cases of CCAVB in newborns treated with pacemaker implantation after birth. The first case revealed CCAVB with patent ductus arteriosus and anti- Ro(SS-A) antibody in both of the mother and the newborn. The second case was accompanied with mitral regurgitation and tricuspid regurgitation, but anti-Ro(SS-A) antibody was absent in both of the mother and the newborn. Pacemaker implantation was performed for both cases and the result was favorable. We concluded that our experience supports that the pacemaker implantation in the newborn is feasible and beneficial in the treatment of CCAVB.