ABSTRACT
Cardiac resynchronization therapy improves symptoms and survival of patients with congestive heart failure. Usually, the transvenous placement of the left ventricular lead is feasible, but in case of anatomic abnormalities of the coronary sinus, an unintended left phrenic nerve stimulation, a dislodgement of the percutaneous electrode, or a loss of capture of the electrode, surgical treatment should be considered. From January 2010 to September 2011, 15 patients underwent surgical implantation of the left ventricular lead after failure of transvenous placement. The MyoPore sutureless myocardial pacing lead (MSMPL) was implanted through a left minithoracotomy (~5 cm) under selective right lung ventilation. Time of surgery was 38.5 ± 3.0 minutes, and no surgical complications or early deaths are reported so far. After 10.7 ± 8.3 months of follow-up, no cases of late mortality, dislodgement, or loss of capture of the electrode are described. The use of the MSMPL is not novel, although the association with a minimally invasive approach may represent an alternative for a high-risk population. The screw-in of the lead ensures low impedance and threshold of stimulation (1.1 ± 0.6 V at 0.5 milliseconds) both in early and medium terms. In conclusion, in case of failure of the transvenous approach, the MSMPL may be easily implanted through a left minithoracotomy, and the results are noteworthy.
Subject(s)
Cardiac Pacing, Artificial , Heart Failure/therapy , Heart Ventricles/surgery , Prosthesis Implantation/methods , Thoracotomy/methods , Aged , Cardiac Pacing, Artificial/methods , Electrodes, Implanted , Female , Follow-Up Studies , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/methods , Risk Assessment , Risk Factors , Treatment OutcomeSubject(s)
Electrocardiography/methods , Heart Block/diagnosis , Aged , Diagnosis, Differential , Humans , Incidental Findings , MaleABSTRACT
BACKGROUND: The term concealed ventricular extrasystoles defines a phenomenon in which premature beats have a cyclical distribution and manifest after a predictable number of intervening sinus beats. The extent of its spontaneous variability as well as the stability of its orderly distribution, however, have not been defined yet. The aim of this study was to assess whether there is any difference between the variability of concealed ventricular extrasystoles and their allorhythmic patterns. METHODS: The distribution of premature ventricular complexes (PVCs) was evaluated in 39 patients with frequent monomorphic PVCs (> 1000/die) during a baseline 24-hour ambulatory monitoring electrocardiogram. Patients were divided into two groups: group A had evidence of concealed ventricular extrasystoles, while in group B PVCs were randomly distributed. All patients underwent a second ambulatory monitoring electrocardiogram within 30-360 days. RESULTS: The overall number of PVCs did not differ between the groups. Patients of group A showed a very high spontaneous variability (p = 0.006) between the first and the second ambulatory monitoring electrocardiogram, whereas significant differences were not observed among patients of group B. CONCLUSIONS: Concealed ventricular extrasystoles are not casual and transient, but should be regarded as a marker of a "family" of PVCs that have the tendency either to maintain their orderly distribution for long periods or to disappear suddenly.
