ABSTRACT
Persistent left superior vena cava is the most common venous congenital malformation and is usually asymptomatic. Its presence could increase the difficulty for transvenous lead implantation. We report a 71-year-old woman with an idiopathic dilated cardiomyopathy, atrial fibrillation and heart failure that required biventricular resynchronization therapy. During the placement of the device a persistent left superior vena cava was detected. The device was placed without problems and the patient had a satisfactory postoperative evolution.
Subject(s)
Atrial Fibrillation/therapy , Cardiac Resynchronization Therapy Devices , Cardiac Resynchronization Therapy , Cardiomyopathy, Dilated/therapy , Heart Failure/therapy , Vena Cava, Superior/abnormalities , Aged , Female , HumansABSTRACT
Persistent left superior vena cava is the most common venous congenital malformation and is usually asymptomatic. Its presence could increase the difficulty for transvenous lead implantation. We report a 71-year-old woman with an idiopathic dilated cardiomyopathy, atrial fibrillation and heart failure that required biventri-cular resynchronization therapy. During the placement of the device a persistent left superior vena cava was detected. The device was placed without problems and the patient had a satisfactory postoperative evolution.
Subject(s)
Aged , Female , Humans , Atrial Fibrillation/therapy , Cardiac Resynchronization Therapy , Cardiac Resynchronization Therapy Devices , Cardiomyopathy, Dilated/therapy , Heart Failure/therapy , Vena Cava, Superior/abnormalitiesABSTRACT
We report a 26year old patient who had a single chamber pacemaker implantation one year before. During a routine pre-operative evaluation, pacemaker dysfunction was demonstrated due to sensing and pacing failure, associated to left pectoral muscle rhythmic contraction. Chest X-ray confirmed Twiddler syndrome, in which twisting or rotation of the device inside the pocket results in lead dislodgement and device malfunction.
Subject(s)
Adult , Humans , Male , Cardiac Pacing, Artificial , Equipment Failure , Foreign-Body Migration/complications , Pacemaker, Artificial , Muscle Contraction/physiology , SyndromeABSTRACT
BACKGROUND: The Cox MAZE III operation for the treatment of atrial fibrillation (AF) is complex and consumes significant operative time. Cryoablation of the pulmonary veins (CPV) is a simpler alternative for patients that require concomitant valvular surgery. AIM: To evaluate CPV in patients with AF submitted to valvular surgery. PATIENTS AND METHODS: Twenty one patients had simultaneous valvular surgery and CPV, 81 % of them had permanent AF for an average of 5 years. Twenty patients had mitral valve disease. The etiology was rheumatic in 14. Average left atrial diameter was 60 mm. In 7 patients the mitral valve was replaced, in 5 it was repaired, in 7 both mitral and aortic valve were replaced, in 1 the mitral valve was repaired and the aortic valve was replaced and in 1 only the aortic valve was replaced. A combined transeptal and superior approach was used for all patients. The CPV was performed after the valvular procedure with cryothermy at -60 degrees C for 2 minutes with two 15 mm cryoprobes applied simultaneously. RESULTS: CPV increased surgical time by 10 to 20 minutes. Operative mortality was 4.8% (1 patient). One patient developed a pericardial effusion and another a complete heart block that required a permanent pacemaker. All patients improved their functional class. At the end of an average 10.5 months of follow-up, 50% of patients were in normal sinus rhythm and 25% persisted in AF. The remaining patients were in some type of regular rhythm. CONCLUSIONS: CPV as a complementary procedure in patients with AF undergoing valvular surgery had good results to abate AF. It restored normal sinus rhythm in 50% of the cases, with low morbidity and mortality and little increment in surgical time.
Subject(s)
Atrial Fibrillation/surgery , Cardiac Surgical Procedures/methods , Catheter Ablation/methods , Cryosurgery/methods , Pulmonary Veins/surgery , Adult , Aged , Atrial Fibrillation/mortality , Cardiac Surgical Procedures/mortality , Catheter Ablation/mortality , Female , Follow-Up Studies , Heart Atria/surgery , Heart Valve Prosthesis Implantation , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
We report a 59 year-old woman who had recurrent episodes of paroxystic supraventricular tachycardia despite pharmacologic therapy. A previous electrophysiological study (EPS) was done two years earlier without induction of any sustained arrhythmia. A new EPS was performed, during which atrial and ventricular programmed stimulation failed to induce tachycardia, and only by fast ventricular stimulation during intravenous isoproterenol infusion, a typical atrio ventricular nodal reentrant tachycardia (AVNRT) was induced. We successfully ablated the slow nodal pathway. After ablation the tachycardia was not inducible. We comment the occasional difficulties to induce AVNRT and the importance of a complete induction protocol to avoid false negative studies during the EPS.
Subject(s)
Cardiac Pacing, Artificial , Tachycardia, Atrioventricular Nodal Reentry/diagnosis , Tachycardia, Supraventricular/diagnosis , Atrioventricular Node , Diagnosis, Differential , Female , Humans , Middle Aged , Recurrence , Stimulation, Chemical , Tachycardia, Atrioventricular Nodal Reentry/etiologyABSTRACT
Background: The Cox MAZE III operation for the treatment of atrial fibrillation (AF) is complex and consumes significant operative time. Cryoablation of the pulmonary veins (CPV) is a simpler alternative for patients that require concomitant valvular surgery. Aim: To evaluate CPV in patients with AF submitted to valvular surgery. Patients and Methods: Twenty one patients had simultaneous valvular surgery and CPV, 81 percent of them had permanent AFfor an average of 5 years. Twenty patients had mitral valve disease. The etiology was rheumatic in 14. Average left atrial diameter was 60 mm. In 7patients the mitral valve was replaced, in 5 it was repaired, in 7 both mitral and aortic valve were replaced, in 1 the mitral valve was repaired and the aortic valve was replaced and in 1 only the aortic valve was replaced. A combined transeptal and superior approach was used for all patients. The CPV was performed after the valvular procedure with cryothermy at -60°C for 2 minutes with two 15 mm cryoprobes applied simultaneously. Results: CPV increased surgical time by 10 to 20 minutes. Operative mortality was 4.8 percent (1 patient). One patient developed a pericardial effusion and another a complete heart block that required a permanent pacemaker. All patients improved their functional class. At the end of an average 10.5 months of follow-up, 50 percent of patients were in normal sinus rhythm and 25 percent persisted in AF. The remaining patients were in some type of regular rhythm. Conclusions: CPV as a complementary procedure in patients with AF undergoing valvular surgery had good results to abate AF. It restored normal sinus rhythm in 50 percent of the cases, with low morbidity and mortality and little increment in surgical time.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Atrial Fibrillation/surgery , Cardiac Surgical Procedures/methods , Catheter Ablation/methods , Cryosurgery/methods , Pulmonary Veins/surgery , Atrial Fibrillation/mortality , Cardiac Surgical Procedures/mortality , Catheter Ablation/mortality , Follow-Up Studies , Heart Atria/surgery , Heart Valve Prosthesis Implantation , Treatment OutcomeABSTRACT
We report a 59 year-old woman who had recurrent episodes of paroxystic supraventricular tachycardia despite pharmacologic therapy. A previous electrophysiological study (EPS) was done two years earlier without induction of any sustained arrhythmia. A new EPS was performed, during which atrial and ventricular programmed stimulation failed to induce tachycardia, and only by fast ventricular stimulation during intravenous isoproterenol infusion, a typical atrio ventricular nodal reentrant tachycardia (AVNRT) was induced. We successfully ablated the slow nodal pathway. After ablation the tachycardia was not inducible. We comment the occasional difficulties to induce AVNRT and the importance of a complete induction protocol to avoid false negative studies during the EPS.
Subject(s)
Female , Humans , Middle Aged , Cardiac Pacing, Artificial , Tachycardia, Atrioventricular Nodal Reentry/diagnosis , Tachycardia, Supraventricular/diagnosis , Atrioventricular Node , Diagnosis, Differential , Recurrence , Stimulation, Chemical , Tachycardia, Atrioventricular Nodal Reentry/etiologyABSTRACT
Cardiac resynchronization therapy is a non-pharmacological treatment for patients with dilated cardiomyophaty and congestive heart failure. The success of this therapy depends of permanent biventricular stimulation. We report an 84 year-old man, with intermittent loss of biventricular pacemaker stimulation despite having adequate sensing and stimulation thresholds in the right atrium and both ventricles. The problem was solved after correcting some programming parameters.
Subject(s)
Cardiac Pacing, Artificial , Cardiomyopathy, Dilated/therapy , Heart Failure/therapy , Aged, 80 and over , Cardiomyopathy, Dilated/physiopathology , Electrocardiography , Equipment Failure , Heart Block/therapy , Humans , MaleABSTRACT
Background: Electrode lead design and materials influence their performance, stability and manipulation characteristics. In our laboratory, we use straight intracardiac, active fixation, steroid eluting leads. These features are shared by three brands of pacemarker distributors. Aim: To compare the short term results of three brands of leads used in our laboratory in patients requiring the implant of a pacemarker of cardioverter. Material and methods: One hundred and four patients (mean age 70 years, 59 males) subjected to a pacemarker or cardioverter implant were studied and followed during the first three months post implant. In these patients, 49 Guidant Flextend® 4087 or 4088, 27 Saint Jude Tendril® 1488T and 10 Medtronic Capsurefix® 5076 leads were implanted in the right atrium and 60 Guidant Flextend® 4087 or 4088, 29 Saint Jude Tendril® 1488T and 19 Medtronic Capsurefix® 5076 leads were implanted in the right ventricle. Results: Implant parameters were adequate for all leads. A sub-acute rise in ventricular stimulation threshold was detected in one Flextrend® lead. Three atrial leads (two Flextend® and one Capsurefix®) and one Capsurefix® ventricular lead experienced an acute displacement. One patient with a Flextend® lead, had a cardiac tamponade caused by an atrial perforation. Conclusions: The three brands of leads tested can be successfully implanted with comparable parameters and without differences in the evolution of patients during the first three months.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Arrhythmias, Cardiac/therapy , Defibrillators, Implantable , Pacemaker, Artificial , Equipment Design , Follow-Up Studies , Retrospective StudiesABSTRACT
Cardiac resynchronization therapy is a non-pharmacological treatment for patients with dilated cardiomyophaty and congestive heart failure. The success of this therapy depends of permanent biventricular stimulation. We report an 84 year-old man, with intermittent loss of biventricular pacemaker stimulation despite having adequate sensing and stimulation thresholds in the right atrium and both ventricles. The problem was solved after correcting some programming parameters.
Subject(s)
Aged, 80 and over , Humans , Male , Cardiac Pacing, Artificial , Cardiomyopathy, Dilated/therapy , Heart Failure/therapy , Cardiomyopathy, Dilated/physiopathology , Electrocardiography , Equipment Failure , Heart Block/therapyABSTRACT
The prevalence of congestive heart failure has increased in the world. Despite advances in pharmacological treatment, some patients have progression of the disease and deterioration of their functional class. In this group of patients cardiac resynchronization therapy has been accepted as a treatment option. However, some patients are non-responders to cardiac resynchronization, and others who respond favorably, will experience reappearance of their symptoms. For these patients, multisite stimulation with the implant of a second electrode in the right ventricle has been published as a new option. We report a 76 year-old woman with a dilated cardiomyopathy, who was treated with resynchronization therapy with good clinical response during two years, but symptoms of congestive heart failure reappeared and her functional class deteriorated to NYHA class IV. She was successfully treated with right ventricular multisite stimulation, with a reduction of symptoms that has lasted during the two months of follow up after the procedure.
Subject(s)
Cardiac Pacing, Artificial/methods , Cardiomyopathy, Dilated/therapy , Ventricular Dysfunction, Right/therapy , Aged , Cardiomyopathy, Dilated/physiopathology , Disease Progression , Electrocardiography , Female , Humans , Treatment Outcome , Ventricular Dysfunction, Right/physiopathologyABSTRACT
Background: Since February 2002, Flextend® electrode catheters are used at the Cardiovascular Unit of the Catholic University Clinical Hospital. These transvenous catheters have an IS-1 connector, silicone coating, active fixation and retractile helix with dexamethasone acetate. Aim: To report early and one year results using Flextend® catheters. Material and methods: Retrospective analysis of all patients that received an implant of a Flextend® catheter in the Unit. Results: Forty one Flextend® catheters were implanted in 24 patients, without acute displacement or clinical pericarditis. In 18 electrode catheters located in the right atrium the mean values for p wave, stimulation threshold and impedance at the moment of placement, were 2.9±1.4 mV, 0.8±0.4 V and 522±86 Ohms, respectively. The figures 24 hours after placement were 3.6±2.1 mV, 0.8±0.3 V and 612±69 Ohms, respectively. In 23 electrode catheters in the right ventricle, mean values at the moment of placement for R wave, stimulation threshold and impedance were 11.3±3.6 mV, 0.8±0.2 V and 756±108 Ohms, respectively. The figures 24 hours after placement were 3.6±2.1 mV, 0.8±0.3 V and 612±69 Ohms, respectively. In one patient, the stimulation threshold increased two months after placement and required a new intervention. Conclusions: Flextend® catheters ca be placed successfully with a low rate of complications and stable function parameters on follow up.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Electric Stimulation , Electrodes, Implanted/standards , Pacemaker, Artificial , Technology Assessment, Biomedical , Arrhythmias, Cardiac/therapy , Cardiography, Impedance , Follow-Up Studies , Heart Conduction System , Retrospective Studies , Sensory ThresholdsABSTRACT
Persistent left superior vena cava and absent right superior vena cava is an uncommon anatomical association. This is a challenging situation for permanent pacemaker implantation. We report three patients with this anomaly and a permanent pacemaker successfully implanted through the left superior vena cava and coronary sinus, without acute or chronic complications.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Arrhythmia, Sinus/therapy , Cardiac Pacing, Artificial/methods , Pacemaker, Artificial , Tachycardia/therapy , Vena Cava, Superior/abnormalities , Vena Cava, SuperiorABSTRACT
The prevalence of congestive heart failure has increased in the world. Despite advances in pharmacological treatment, some patients have progression of the disease and deterioration of their functional class. In this group of patients cardiac resynchronization therapy has been accepted as a treatment option. However, some patients are non-responders to cardiac resynchronization, and others who respond favorably, will experience reappearance of their symptoms. For these patients, multisite stimulation with the implant of a second electrode in the right ventricle has been published as a new option. We report a 76 year-old woman with a dilated cardiomyopathy, who was treated with resynchronization therapy with good clinical response during two years, but symptoms of congestive heart failure reappeared and her functional class deteriorated to NYHA class IV. She was successfully treated with right ventricular multisite stimulation, with a reduction of symptoms that has lasted during the two months of follow up after the procedure.
Subject(s)
Aged , Female , Humans , Cardiac Pacing, Artificial/methods , Cardiomyopathy, Dilated/therapy , Ventricular Dysfunction, Right/therapy , Cardiomyopathy, Dilated/physiopathology , Disease Progression , Electrocardiography , Treatment Outcome , Ventricular Dysfunction, Right/physiopathologyABSTRACT
BACKGROUND: Electrode lead design and materials influence their performance, stability and manipulation characteristics. In our laboratory, we use straight intracardiac, active fixation, steroid eluting leads. These features are shared by three brands of pacemaker distributors. AIM: To compare the short term results of three brands of leads used in our laboratory in patients requiring the implant of a pacemaker or cardioverter. MATERIAL AND METHODS: One hundred and four patients (mean age 70 years, 59 males) subjected to a pacemaker or cardioverter implant were studied and followed during the first three months post implant. In these patients, 49 Guidant Flextend 4087 or 4088, 27 Saint Jude Tendril 1488T and 10 Medtronic Capsurefix 5076 leads were implanted in the right atrium and 60 Guidant Flextend 4087 or 4088, 29 Saint Jude Tendril 1488T and 19 Medtronic Capsurefix 5076 leads were implanted in the right ventricle. RESULTS: Implant parameters were adequate for all leads. A sub-acute rise in ventricular stimulation threshold was detected in one Flextrend lead. Three atrial leads (two Flextend and one Capsurefix) and one Capsurefix ventricular lead experienced an acute displacement. One patient with a Flextend lead, had a cardiac tamponade caused by an atrial perforation. CONCLUSIONS: The three brands of leads tested can be successfully implanted with comparable parameters and without differences in the evolution of patients during the first three months.
Subject(s)
Arrhythmias, Cardiac/therapy , Defibrillators, Implantable , Pacemaker, Artificial , Adult , Aged , Aged, 80 and over , Equipment Design , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Background: The costs of medical care increase along with technological advances. Therefore, highly complex and expensive procedures should be performed in a limited number of institutions. Aim: To report the initial experience on electrophysiological studies performed to beneficiaries of a public health insurance system in Chile (FONASA). Material and methods: An agreement was reached between the Electrophysiology Unit of the Clinical Hospital of the Catholic University and FONASA, to perform electrophysiological studies at a minimal cost, that only considered disposable materials and hospital stay. Thirty patients with supraventricular arrhythmias or ventricular arrhythmias without an associated cardiopathy, were attended using this agreement at the unit. Results: In all treated patients, arrhythmias disappeared. Costs remained within the assigned budget, excepting occasional complementary tests. Conclusions: This pioneering experience demonstrated that it is possible that public health insurance systems can buy complex and expensive procedures to private hospitals.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Arrhythmias, Cardiac/diagnosis , Electrophysiologic Techniques, Cardiac/economics , Insurance, Health/economics , National Health Programs/economics , Arrhythmias, Cardiac/economics , Chile , Electrocoagulation , Follow-Up Studies , Health Benefit Plans, Employee/economics , Health Care Costs , Hospitals, Private , Hospitals, Public , Hospitals, University , Pilot ProjectsABSTRACT
Ventricular tachycardia is one of the most feared complications after surgical repair of Tetralogy of Fallot and it is associated with sudden death. We report a 26 years old female with a history of surgical repair of Tetralogy of Fallot at age of 4 year-old, who developed sustained ventricular tachycardia despite antiarrhythmic drugs. She was successfully treated with radiofrequency catheter ablation. Radiofrequency catheter ablation is a valid treatment for these patients.
Subject(s)
Adult , Female , Humans , Catheter Ablation , Postoperative Complications/surgery , Tachycardia, Ventricular/surgery , Tetralogy of Fallot/surgery , Amiodarone/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Electrocardiography , Postoperative Complications/drug therapy , Tachycardia, Ventricular/drug therapy , Tachycardia, Ventricular/etiologyABSTRACT
We report three patients with pre-excitation syndrome that resembled an acute coronary syndrome. A 65 years old woman, consulting in the emergency room for palpitations and retrosternal pain. EKG showed regular tachycardia and ST depression that reverted spontaneously after an episode of vomiting. A subsequent EKG demonstrated a pre-excitation syndrome and the accessory pathway was fulgurated. A 18 years old male presenting with tachycardia and chest pain elicited during exercise. An EKG showed a pre-excitation syndrome and ST segment elevation in V2 and V3. A coronary angiogram was normal. The accessory pathway successfully fulgurated. A 63 years old woman that presented tachycardia while exercising. She was subjected to an electrical cardioversion. An electrophysiological study showed an accessory pathway that was successfully fulgurated.
