Intravascular extraction of chronic pacemaker leads: efficacy and follow-up.

Extraction of chronic pacemaker leads has been recommended for infections, prevention of venous thrombosis, migration, and possible perforation. Success with constant traction techniques has been variable, and the cost and morbidity of open chest surgical procedures are prohibitive. Efficacy of a new system for lead extraction using intravascular techniques was analyzed. The system (Cook Pacemaker) uses a locking stylet, which is secured at the distal electrode by counterclockwise rotation to reinforce the lead and facilitate traction, and dilator sheaths that are used to free the lead from adhesions in the venous system. In a series of 56 patients (ages 19-88) who presented for lead extraction because of erosion (5), infection (14), lead replacement (35), or other (2), 86 leads were extracted. Thirty-two were atrial leads and 54 ventricular; 23 had active fixation and 63 passive. Average duration of implant was 58 +/- 42 months (range 1-264). Eighty-four leads were totally removed and two partially removed. For these two leads, the distal tip was not removed; in both cases the locking stylet was not secured at the distal electrode due to obstruction within the lead. Two patients developed arm edema following the procedure, which resolved with elevation. One patient developed a subclavian thrombosis, which resolved with warfarin anticoagulation. Four patients have expired due to unrelated causes. In conclusion, this intravascular approach for extraction of chronic leads is effective, and the procedure is safe when performed by experienced personnel.

Preservation of regional myocardial function during coronary angioplasty with an autoperfusion balloon catheter: a case report.

Echocardiographic assessment of regional myocardial function was performed during standard balloon coronary angioplasty followed by autoperfusion balloon angioplasty of a proximal left anterior descending artery stenosis. Septal and apical akinesis occurred within 60 seconds of standard balloon inflation, but regional function was well preserved during prolonged autoperfusion balloon inflation.

Characteristics and clinical effects of myopotential signals in a unipolar DDD pacemaker population.

Myopotential signals were recorded from atrial and ventricular leads during isometric exercise in 25 patients who had chronically implanted dual chamber pacemakers using the electrogram telemetry capability of the pacemakers. Average electrogram amplitude on the atrial channel was 0.92 mV (range 0.3 to 1.9) and on the ventricular channel was 0.98 mV (range 0.3 to 2.2); the difference was not significant. There was a strong correlation (R = 0.82) between the amplitude of myopotentials on the atrial and ventricular leads for individual patients. Myopotential sensing caused ventricular output inhibition in two patients (8%) and ventricular tracking in sixteen patients (64%). Pacemaker reprogramming abolished ventricular myopotential inhibition in all patients and stopped ventricular myopotential tracking in seven patients. We conclude that myopotentials can be analyzed and their effects ameliorated by a multiprogrammable pacemaker with electrogram telemetry capability.

Mycobacterium fortuitum mastoiditis.

Improved techniques of bacteriologic identification have led to increasing recognition of the clinical significance of the atypical or anomymous mycobacteria. Mycobacterium fortuitum, included in group IV of Runyon's classification because of its characteristic rapid growth, is widespread in nature as a saprophyte. Its facultative pathogenicity has received increasing attention in the literature recently with reports of a number of isolated infections, epidemics, and deaths. We report a case of mastoiditis due to M fortuitum and discuss the pathogenesis and treatment. This is the first known report of the organism causing otolaryngologic disease.