RESUMO
2-Octyl Cyanoacrylate (2-OCA) is a tissue adhesive developed for skin laceration closure that has not been previously evaluated for cardiac device implant wound closure. We reviewed 460 consecutive device implants with 475 incisions between November 1993 and May 2001. From November 1993 to December 1998, all patients (n 335) had a 3-layer reabsorbable suture closure with the application of topical bacitracin and dressing material. They were advised to avoid exposure to moisture for 10 days. From January 1999 to May 2001, the superficial suture layer was replaced with 2-OCA (n=125). No topical bacitracin or dressing was applied and patients were allowed to shower within 72 hours. The two groups did not differ significantly with respect to age (69 +/- 12 vs 70 +/- 13 years, P=NS), sex (59% vs 62% male, p=NS) or device type (77% vs 68% pacemakers/loop recorders, p=NS). All incisions were evaluated at 24 hours, 7-14 days, and 6-12 weeks postprocedure. The 2-OCA and suture groups did not differ significantly with respect to allergic reaction (0% vs 1.4%, P=NS), cellulitis (0% vs 0.9%, P=NS), and infection requiring explant (0.8% vs 0.3%, P=NS), respectively. Total adverse events occurred in 1 of 125 (0.8%) of the 2-OCA group versus 9 of 350 (2.6%) of the suture group (P=NS). In cardiac device implant closure 2-OCA obviated the need for topical antibiotics and dressing materials while facilitating wound care without increased complications.
Assuntos
Cianoacrilatos/uso terapêutico , Desfibriladores Implantáveis , Implantação de Prótese , Deiscência da Ferida Operatória/tratamento farmacológico , Adesivos Teciduais/uso terapêutico , Administração Tópica , Idoso , Arritmias Cardíacas/terapia , Cianoacrilatos/administração & dosagem , Feminino , Seguimentos , Humanos , Masculino , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos , Deiscência da Ferida Operatória/etiologia , Suturas/efeitos adversos , Fatores de Tempo , Adesivos Teciduais/administração & dosagem , CicatrizaçãoRESUMO
We present an initial report of Nocardia asteroides implantable cardioverter defibrillator infection. Systemic infection persisted despite pulse generator explant and several years of appropriate antibiotic therapy. Without epicardial lead system removal, chronic pleuropericardial disease developed.
Assuntos
Desfibriladores Implantáveis/microbiologia , Nocardiose/etiologia , Idoso , Anti-Infecciosos/administração & dosagem , Doença da Artéria Coronariana/cirurgia , Desfibriladores Implantáveis/efeitos adversos , Evolução Fatal , Humanos , Masculino , Nocardiose/tratamento farmacológico , Nocardiose/patologia , Nocardia asteroides/patogenicidade , Síndrome do Desconforto Respiratório/microbiologia , Combinação Trimetoprima e Sulfametoxazol/administração & dosagemRESUMO
The lead conductor integrity of implantable cardioverter defibrillator devices is inferred from impedance measurements; however, intermittent discontinuity can be difficult to detect or confirm. Newer devices can perform daily lead impedance self-testing, and some even have audible alarms that promptly warn patients of anomalies. In the present case, the audible alarms were solely responsible for the timely identification of an intermittent, otherwise clinically nonreproducible, form of potentially fatal implantable cardioverter defibrillator system failure.
Assuntos
Arritmias Cardíacas/terapia , Estimulação Cardíaca Artificial , Cardiomiopatias/terapia , Desfibriladores Implantáveis , Idoso , Morte Súbita Cardíaca/prevenção & controle , Falha de Equipamento , Feminino , HumanosRESUMO
BACKGROUND: We describe an unusual case of severe heart failure (HF) and rapid atrial fibrillation (AF) improved through ablation and pacemaker implant despite superior vena cava obstruction (SVCO). METHODS: SVCO precluded upper body venous access to the heart for procedural rate control. Both AV Junctional ablation and permanent endovascular lead placement were achieved through the inferior vena cava (IVC). RESULTS: Clinical improvement from NYHA Class IV to Class II HF was observed with effective nonpharmacologic ventricular rate control. CONCLUSIONS: HF patients with rapid AF and SVCO can achieve ventricular rate control through lower body venous access to the heart utilizing 100-cm endovascular defibrillator rate sensing leads.