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1.
Medicina (Kaunas) ; 58(10)2022 Oct 07.
Article in English | MEDLINE | ID: covidwho-2066254

ABSTRACT

Irreversible electroporation (IRE) ablation is a novel treatment option for localized prostate cancer. Here, we present a case of an abrupt and fatal arrhythmia during the IRE procedure in a prostate cancer patient with an implanted permanent pacemaker. A 78-year-old male patient with a pacemaker due to sick sinus syndrome and syncope was scheduled for IRE prostate ablation surgery under general anesthesia. He had a history of recovering from coronavirus disease 2019 (COVID-19) after having been vaccinated against it and recovered without sequalae. Pacemaker interrogation and reprogramming to asynchronous AOO mode was carried out before surgery, however, sinus pause occurred repeatedly during ablation pulse delivery. After the first sinus pause of 2.25 s there was a decrease in continuous arterial blood pressure (ABP). During the delivery of the second and third pulses, identical sinus pauses were observed due to failure to capture. However, the atrial-paced rhythm recovered instantly, and vital signs became acceptable. Although sinus pause recovered gradually, the duration thereof was increased by the delivery of more IRE pulses, with a subsequent abrupt decrease seen in blood pressure. The pacemaker was urgently reprogrammed to DOO mode, after which there were no further pacing failures and no hemodynamic adverse events. For patients with pacemakers, close cardiac monitoring in addition to the interrogation of the pacemaker during the electromagnetic interference (EMI) procedure is recommended, especially in the case of having a disease that may aggravate cardiac vulnerability, such as COVID-19.


Subject(s)
COVID-19 , Pacemaker, Artificial , Prostatic Neoplasms , Male , Humans , Aged , Prostatic Neoplasms/surgery , Prostate , Pacemaker, Artificial/adverse effects , Postoperative Complications , Electroporation/methods
2.
Am J Cardiol ; 176: 105-111, 2022 08 01.
Article in English | MEDLINE | ID: covidwho-1866798

ABSTRACT

New-onset left bundle branch block (NLBBB) is the most common complication after transcatheter aortic valve implantation (TAVI). Expert consensus recommends temporary transvenous pacemaker (TTVP) support for 24 hours in these patients. To date, no study has examined TTVP use during the index hospitalization in detail. Therefore, we aimed to assess TTVP use in patients with TAVI who developed NLBBB. In this prospective observational study, we performed a detailed analysis of 24-hour telemetry in patients who developed NLBBB during TAVI. Baseline characteristics and procedural and postprocedural data were recorded. The primary outcome was pacing by the TTVP. We evaluated inappropriate TTVP use, electrophysiology study findings, permanent pacemaker (PPM) implantation, and NLBBB resolution. A total of 83 patients (74.4 ± 8.7 years, 41% female) developed NLBBB during TAVI. During index hospitalization, 1 patient (1%) required TTVP because of complete heart block and received a PPM. Five of the 83 (6%) patients were inappropriately paced, and 1 patient (1%) had ventricular fibrillation, likely secondary to TTVP. A total of 34 patients (41%) underwent electrophysiology study during hospitalization, with 4 of 83 (5%) subsequently receiving a PPM. One (1%) patient died during hospitalization, and 9 patients were lost to follow-up because of the COVID-19 pandemic. Of the remaining 73 patients with a 30-day follow-up, NLBBB had resolved in 36 (49%) at 30 days, and 2 (3%) were readmitted with complete heart block and received PPM. In conclusion, in patients with TAVI who develop NLBBB, temporary pacing is rarely necessary, may carry additional risks to the patient, and prolong hospitalization time.


Subject(s)
Aortic Valve Stenosis , Atrioventricular Block , COVID-19 , Pacemaker, Artificial , Transcatheter Aortic Valve Replacement , Aortic Valve/surgery , Aortic Valve Stenosis/complications , Arrhythmias, Cardiac/therapy , Atrioventricular Block/etiology , Bundle-Branch Block/epidemiology , Bundle-Branch Block/etiology , Bundle-Branch Block/therapy , COVID-19/epidemiology , Cardiac Pacing, Artificial/adverse effects , Female , Humans , Male , Pacemaker, Artificial/adverse effects , Pandemics , Postoperative Complications/epidemiology , Transcatheter Aortic Valve Replacement/adverse effects , Treatment Outcome
3.
Minerva Cardiol Angiol ; 70(3): 298-302, 2022 06.
Article in English | MEDLINE | ID: covidwho-1841791

ABSTRACT

BACKGROUND: Permanent cardiac pacing is the therapy of choice for treating severe and/or symptomatic bradyarrhythmia. During the COVID-19 outbreak, it has been reported a decrease in the incidence of acute coronary syndrome, but few data are available about pacemaker implantation rates. This study aimed to analyze patients referred to our center with permanent cardiac pacing indication during the COVID-19 outbreak. METHODS: We compared the number, the characteristics and the outcomes of patients who underwent urgent pacemaker implantation between March and April 2019 (Group I) with those performed in the corresponding 2020 period (Group II). RESULTS: A total of 27 patients (Group I) were implanted in March-April 2019 and 34 patients (Group II) in the corresponding 2020 period. In both groups, about half of the patients received a dual-chamber pacemaker. No significant differences in baseline patients' characteristics were observed. The most frequent indication was advanced atrio-ventricular block with a prevalence of 78% and 62% in Group I and II, respectively. The rate of procedural complications, the in-hospital and 1-month mortality were also similar between the two groups. CONCLUSIONS: In our regional referral center, we observed a routine activity in terms of urgent pacemaker implantations for the treatment of symptomatic bradyarrhythmia during the COVID-19 outbreak.


Subject(s)
COVID-19 , Pacemaker, Artificial , Aged , Bradycardia/epidemiology , Bradycardia/etiology , Bradycardia/therapy , COVID-19/epidemiology , COVID-19/therapy , Cardiac Pacing, Artificial/adverse effects , Humans , Pacemaker, Artificial/adverse effects , Pandemics
4.
Pacing Clin Electrophysiol ; 45(4): 574-577, 2022 04.
Article in English | MEDLINE | ID: covidwho-1794593

ABSTRACT

A middle-aged woman presented with symptomatic complete heart block and underwent an uneventful dual chamber pacemaker implantation. Three weeks post procedure, she developed left arm pain and weakness, with neurological localization to the lower trunk of left brachial plexus. Possibilities of traumatic compression by the device/leads or postoperative idiopathic brachial plexopathy were considered. After ruling out traumatic causes, she was started on oral steroids, to which she responded remarkably. This case highlights the importance of recognizing this rare cause of brachial plexopathy following pacemaker implantation, because not only does an expedited diagnosis and medical treatment lead to prompt recovery with minimal neurological deficits, but it also circumvents an unnecessary surgical re-exploration.


Subject(s)
Brachial Plexus Neuropathies , Brachial Plexus , Pacemaker, Artificial , Brachial Plexus Neuropathies/diagnosis , Brachial Plexus Neuropathies/etiology , Female , Humans , Middle Aged , Pacemaker, Artificial/adverse effects
5.
Cardiovasc J Afr ; 33(1): 36-40, 2022.
Article in English | MEDLINE | ID: covidwho-1771671

ABSTRACT

Pacemaker endocarditis is rare and symptoms may be misleading. If missed, it carries significant morbidity and mortality, particularly in the elderly. Advances in multi-modality imaging in recent years have emphasised its role in clinical decision making. This case highlights the ability of multi-modality imaging techniques to individualise diagnosis, management and prognosis in patients with suspected cardiovascular implantable electronic device (CIED) endocarditis.


Subject(s)
Defibrillators, Implantable , Echocardiography, Three-Dimensional , Endocarditis , Pacemaker, Artificial , Prosthesis-Related Infections , Aged , Defibrillators, Implantable/adverse effects , Endocarditis/diagnostic imaging , Endocarditis/etiology , Endocarditis/therapy , Humans , Pacemaker, Artificial/adverse effects , Prosthesis-Related Infections/diagnostic imaging , Prosthesis-Related Infections/etiology , Prosthesis-Related Infections/therapy , Tomography
6.
J Infect Dev Ctries ; 15(9): 1277-1280, 2021 09 30.
Article in English | MEDLINE | ID: covidwho-1478148

ABSTRACT

INTRODUCTION: The estimated infection rate after permanent endocardial lead implantation is between 1% and 2%. Pacemaker lead endocarditis is treated with total removal of the infected device and proper antibiotics. In this case report, we present a patient with delayed diagnosis and treatment due to the COVID-19 outbreak. CASE REPORT: An 88-year-old, pacemaker dependent woman with diagnosed pacemaker pocket infection was admitted to the University Cardiovascular institute. The patient had a prolonged follow-up time due to the COVID-19 outbreak. She missed her routine checkup and came to her local hospital when the generator had already protruded completely, to the point where she held it in her own hand. Transthoracic echocardiogram showed possible vegetations on the lead. Transesophageal echocardiography was not performed due to the COVID-19 pandemic. On the day after the admission the patient underwent transvenous removal of the pacemaker lead using a 9 French gauge rotational extraction sheathe (Cook Medical). The extracted lead was covered in a thin layer of vegetations. Further follow-ups showed good recovery with no complications. CONCLUSIONS: A case showing delayed treatment of pacemaker pocket infection, due to delayed follow-up time during the COVID-19 pandemic. This patient underwent successful transvenous removal of the infected pacemaker lead, along with adequate antibiotic therapy, which has proven to be the most effective method of treating cardiac device-related endocarditis.


Subject(s)
Device Removal , Pacemaker, Artificial/adverse effects , Prosthesis-Related Infections/diagnosis , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , COVID-19 , Female , Humans , Prosthesis-Related Infections/therapy , Time-to-Treatment
7.
Arch Osteoporos ; 16(1): 129, 2021 09 09.
Article in English | MEDLINE | ID: covidwho-1471836

ABSTRACT

PURPOSE: In patients with a cardiac pacemaker, pocket-related complications such as nerve impairment or bone fractures are infrequent. We present a man with a fracture of the 4th rib several months after pacemaker implantation. CASE PRESENTATION: A 74-year-old man, with a left prepectoral pacemaker implanted 13 months ago, presented complaining of chest pain. The pain started after a sudden trunk rotation and right arm flexion movement with a crack. There was tenderness to palpation and crepitation over the left upper ribs. Computed tomography identified a non-displaced fracture line in the anterior aspect of the left 4th rib. After kinesiotaping and activity restriction, pain alleviated. CONCLUSION: Pacemaker implantation might have caused shoulder dysfunction and pectoral tightness resulting in reduced flexibility of the trunk. Consequently, a reaching motion of the arm with a trunk rotation might have directed rotational force vectors towards the osteopenic left 4th rib causing a fragility fracture. In elderly with a pacemaker, osteopenia and concomitant sarcopenia may create a predisposition to this atypical complication.


Subject(s)
Pacemaker, Artificial , Rib Fractures , Aged , Humans , Male , Movement , Pacemaker, Artificial/adverse effects , Rib Fractures/diagnostic imaging , Rib Fractures/etiology , Ribs/diagnostic imaging , Tomography, X-Ray Computed
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