ABSTRACT
Implantable cardioverter defibrillators (ICD) are used as standard therapy to prevent sudden cardiac death in heart failure patients. Today, physicians in emergency and intensive care medicine are often confronted with problems of ICD therapy in these patients. We report a case of a patient suffering from recurrent ventricular tachycardia (VT) requiring antiarrhythmia treatment with amiodarone. With an increasing drug loading, the VT cycle length was progressively prolonged resulting in a slow VT undetectable for the ICD. Subsequently, the patient was scheduled for VT ablation after which the patient became free of arrhythmia recurrences.
Subject(s)
Defibrillators, Implantable , Equipment Failure , Tachycardia, Ventricular/therapy , Aged , Amiodarone/administration & dosage , Anterior Wall Myocardial Infarction/complications , Anterior Wall Myocardial Infarction/physiopathology , Anti-Arrhythmia Agents/administration & dosage , Atrioventricular Node/physiopathology , Catheter Ablation , Electrocardiography , Heart Rate/physiology , Humans , Imaging, Three-Dimensional , Male , Recurrence , Signal Processing, Computer-Assisted , Software , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/physiopathology , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/physiopathologyABSTRACT
Eight own cases of the so-called pacemaker twiddler's syndrome in pervenously implanted pacemaker-electrode-systems are reported. A scheme to classify that syndrome is proposed mentioning the grade of distinction and mechanism. Furthermore preconditions, therapy, and steps that will have been taken to prevent a pacemaker twiddler's syndrome are discussed.
Subject(s)
Pacemaker, Artificial/adverse effects , Aged , Arrhythmias, Cardiac/therapy , Electrodes , Humans , Middle Aged , Recurrence , SyndromeABSTRACT
From 1965 to 1976, implantations of 502 pacemaker electrodes were performed. In 59 patients the first lead had to be changed. In December 1976, 355 patients were under our control. At this time, 11.7 percent were no longer paced via their first lead. Dislocations of the lead, increased threshold, insulation defect, skin perforation of the lead, myocardial perforation, adaptor defects, fracture, infection, and loops of the electrode were the reasons. In cases of exit block alone, you should try to take a high output pacemaker. In cases of entrance block, a pacemaker with increased input-impedance will do its work. If those two kinds of treatment will fail, you may speak about a lead out of function. Considering extraction of the electrode, except in cases of infection, you should exercise restraint, for severe complications may result. An electrode out of function has to be protected against disappearing in a safe way. A synopsis of electrode complications including cause, therapy, and prevention is given.
Subject(s)
Pacemaker, Artificial , Electrodes, Implanted , Humans , Methods , Pacemaker, Artificial/adverse effects , Time FactorsABSTRACT
From February 1974 to December 1975 we performed 295 pacemaker operations. 165 of those were primary implantations of pervenous leads for permanent cardiac pacing. The X-ray examination time was between 0.1 and 17.0 minutes, their mean value was 2.6, their median 1.7 minutes. In those 165 cases there was a dislocation of the lead in 10.9 percent. Although our X-ray examination time was extremely short however in comparison with the literature we found no arise of our dislocation rate. Some hinces to keep radiation small are discussed.
Subject(s)
Pacemaker, Artificial , Electrodes, Implanted , Humans , Radiation Dosage , Radiography, Thoracic , Time Factors , VeinsABSTRACT
In a patient with transvenous cardiac pacemaker a piece of tissue, 5,5 cm in length, was removed from the wall of the right heart during the extraction of a "shouldered" electrode (Biotronik IE 85-K-O). Histologically it consisted of fibrous tissue as usually found around transvenous electrodes, tricuspid valve tissue, chordae tendineae, and myocardium. Detrimental consequences to the patient following this complication were not observed. Some problems caused by trapped endocardial electrodes and adequate therapeutic possibilities are discussed.
Subject(s)
Heart Injuries/etiology , Pacemaker, Artificial/adverse effects , Tricuspid Valve/injuries , Electrodes, Implanted , Humans , Male , Middle AgedABSTRACT
As smaller the inputimpedance of a QRS-inhibited or synchronous pacemaker as higher the necessary energy for regulation. A method for measurement of inputimpedance of pacemakers is described. These impedances from several types are determined. It is a necessity to lead an intracardial ECG with a loading resistor like the used pacemaker.
