Cardiac Pacing in Sub-Saharan Africa: JACC International.

Many parts of the developing world, especially Sub-Saharan Africa, completely lack access to cardiac pacing. The authors initiated a multinational program to implement cardiac pacing in 14 countries in Sub-Saharan Africa (1996 to 2018), aiming to eventually build self-sustainable capacity in each country. This was based on an "on-site training" approach of performing procedures locally and educating local health care teams to work within resource-limited settings, with prospective evaluation of the program. In 64 missions, a total of 542 permanent pacemakers were implanted. In 11 of these countries, the first pacemaker implant in the country was through the mission. More than one-half of those initially listed as suitable died before the mission(s) arrived. The proportion of implantations that were completely handled by local teams increased from 3% in 1996 to 98% in 2018. These findings demonstrate the feasibility and effectiveness of a proctorship-based approach to the development of local cardiac pacing capabilities in Sub-Saharan African nations.

Assessing the safety of implantable cardioverter-defibrillator reuse-A retrospective case-control study.

AIMS: The safety of pacemaker reuse has been proven by numerous studies in the last two decades. With the exception of one research paper, the safety of reuse of implantable cardioverter-defibrillators has not been properly investigated. Our aim was to establish whether resterilized implantable cardioverter-defibrillators are as safe as new devices in relation to functionality and infection rates. METHODS: All the patients (n = 271) implanted with a new or a donated, used implantable cardioverter-defibrillator (ICD) at the Institute of Cardiovascular Disease Timisoara Romania between January 2001 and December 2012 were included in the study. The patients had class I indication for ICD implantation. One hundred fifty-seven patients received reused ICDs and 114 patients received new ICDs. Complications were defined as infections that required reintervention, device malfunction, and replacements due to untimely or unexpected battery depletion. RESULTS: Complications occurred in 4.38% of the patients in the new ICD group and in 1.91% of the reused ICD group. The difference was not considered statistically significant (odds ratio 0.28, 95% confidence interval 0.04-1.82, P = .18). CONCLUSION: According to our data, properly verified and resterilized ICDs are as safe as new devices, when risk of infection or malfunction rates are assessed. Due to the high costs of new ICDs, their safe reuse has profound humanitarian and financial implications.

Reuse of pacemakers, defibrillators and cardiac resynchronisation devices.

OBJECTIVE: Access to pacemakers remains poor among many patients in low/middle-income countries. Reuse of explanted pacemakers is a possible solution, but is still not widespread because of concerns regarding outcomes, especially infection. Our objective was to study early outcomes with implants using reused devices and compare them with those with implants using new devices. METHODS: We studied all patients who underwent implantation of a new or reused pacemaker, cardiac resynchronisation therapy (CRT) device or implantable cardioverter defibrillator (ICD) in the last 5 years at a single institution. We analysed outcomes related to infection, device malfunction and device-related death within 6 months after initial implantation. RESULTS: During the study period, 887 patients underwent device implant, including 127 CRT devices or ICDs. Of these, 260 devices (29.3%) were reused and the others were new. At 6 months, there were three device-related infections in implants using a new device. There were no infections among patients receiving a reused device. There were no device malfunctions or device-related deaths in either group. CONCLUSIONS: We found no difference in rate of infection or device malfunction among patients getting a reused device as compared with those with a new device. This study reinforces the safety of reusing devices for implant including CRT and ICDs.

Câncer na proximidade de um marcapasso: soluções possíveis / Câncer in the proximity to a pacemaker: the predictable solutions

Quando um câncer, em geral de mama, ocorre próximo a um marcapasso, usualmente se deve proceder a retirada do gerador, que não pode ser mantido em uma zona que será irradiada ou será alvo de cirurgia para extirpar o tumor. Este trabalho reúne 6 casos clínicos ilustrando diversas táticas operatórias. Em alguns, marcapasso e eltrodos foram mantidos em funcionamento, ligados a conectores que permitem a travessia pré-esternal. A substituição de todo o material requer uma intervenção mais onerosa e de maior porte, com risco adicional de deslocamento dos cabos-eletrodos

As armadilhas da autocaptura / The autocapture downfalls

Relata-se o caso de um paciente de 37 anos de idade, portador de transposição corrigida dos grandes vasos da base e bloqueio atrioventricular, submetido a implante de marcapasso de dupla-câmara com sensor e programação de autocaptura. Na evolução, apresentou falhas na estimulação ventricular, atribuídas ao aumento do limiar ventricular ou a defeito na programação da autocaptura. Para elucidação do problema, houve necessidade de intervenção de um técnico da empresa, para discutir o caso com o estimulista

O uso de flebografia na escolha da estratégia operatória em uma paciente poliestimulada / The use of flebography when choosing the surgical strategy in case of a polystimulated patient

Apresenta-se a evolução de uma paciente jovem submetida três vezes à cirurgia cardíaca em um intervalo de 21 anos, inicialmente para correção de uma CIA ostium secundum, em seguida para reparação de uma CIA ostium primum, e, finalmente, para plastia tricúspide. Dezoito meses após a última cirurgia, apresentou bradiarritmia sintomática e necessitou de implante de marcapasso. Problemas anatômicos, limiares inconstantes de estimulação e desproporção do gerador por uma estimulação epi-endocárdica biventricular que também ajudou o controle clínico da disfunção ventricular. As peculiaridades da evolução do caso justificam sua divulgação entre aqueles ue participam da rotina da estimulação cardíaca artificial, pois mostra a efetividade da flebografia constrastada para orientar o posicionamento dos cabos-eletrodos previamente implantados