Technical difficulties during electronic cardiac device implantation in patients with persistent left superior vena cava.

We report a case of persistent left superior vena cava (PLSVC), discovered by chance during the cardiac electronic device placement procedure. PLSVCs are congenital anomalies of the thoracic vasculature, during which remnants of the left superior vena cava drain into the right atrium through the coronary sinus. PLSVCs can vary in their location and overall anatomy. In patients with PLSVC, implantation of a cardiac electronic device is associated with an increased risk of technical difficulties the entire procedure.

Iatrogenic tracheal rupture after extubation in the context of acute decompensated heart failure and cardiac device implantation: a case report.

Iatrogenic tracheal rupture is a life-threatening airway complication. It has a very low reported incidence and is more prevalent in women and patients over 50 years of age. The most frequent clinical manifestations of tracheal injury are subcutaneous emphysema and respiratory distress. We report a case of a 65-year-old woman with cardiac resynchronization therapy defibrillator implantation under general anesthesia. Shortly after extubation, dyspnea and subcutaneous emphysema appeared. The X-ray showed pneumomediastinum, pneumopericardium and pneumoperitoneum. The tracheal rupture was confirmed by bronchoscopy. After conservative treatment, the patient's well-being improved, and she was discharged from the hospital in a satisfactory condition.

Bochdalek Hernia As A Cause Of Intermittent AV Block.

Congenital diaphragmatic hernia is very rare cause of AV block. We report such a patient with sick sinus node syndrome and previous AAIR pacemaker implantation, in which intermittent AV block was diagnosed by 24-hours ECG monitoring and upgrade of pacing system to DDDR was suggested.

Duration of the A(H)-A(Md) interval predicts occurrence of AV-block after radiofrequency ablation of the slow pathway.

PURPOSE: Modification of the slow pathway (SP) of the atrio-ventricular node by radiofrequency ablation is the most effective treatment to cure AV nodal reentry tachycardia (AVNRT). However, this therapy may be complicated by AV-block (AVB). We sought to evaluate the predictive value of the A(H)-A(Md) interval-the electrical delay between atrial signals on the His- and the ablation-catheter-upon development of AVB during SP ablation. METHODS: The associations between A(H)-A(Md) interval, occurrence of ventriculo-atrial block (VAB) during junctional activity (JA) and transient or permanent AVB were analyzed retrospectively for 1585 RF applications at the SP in 393 patients diagnosed with AVNRT. The value of A(H)-A(Md) was further tested prospectively in 118 AVNRT patients, who were only ablated at targets with intervals >20 ms. RESULTS: Forty-six RF deliveries resulted in transient or permanent AV-conduction disturbances. Shorter A(H)-A(Md) intervals were associated with the occurrence of VAB during JA (p < 0.001) and AVB (p < 0.001). A(H)-A(Md) was the strongest predictor for VAB or AVB in multivariate regression analyses, followed by the radiological distance between the catheters. In the prospective study, permanent high-degree AVB was not observed when the A(H)-A(Md) at the ablation site was >20 ms. CONCLUSION: The A(H)-A(Md) interval is a better predictor for occurrence of conduction block during ablation for AVNRT than the radiological distance between the His- and the ablation-catheter. The risk of permanent AVB can be minimized, if only sites with an A(H)-A(Md) longer than 20 ms are targeted for ablation.

Long-term results of high vs. normal impedance ventricular leads on actual (Real-Life) pacemaker generator longevity.

AIM: The long-term effects of high impedance vs. standard impedance pacing leads on actual generator longevity were studied. METHODS AND RESULTS: In 40 patients (21 females, age 73 +/- 13 years) with standard dual-chamber pacemaker indication, bipolar standard impedance ventricular leads and high-impedance leads were implanted in a randomized fashion. Identical pacemaker generators and atrial pacing leads were implanted in all patients. Patients were observed during a mean follow-up of 89.8 +/- 8.8 months before pacemaker replacement. Initially, the patients who received the high-impedance leads had a lower current drain as compared with standard pacing impedance leads, and the estimated pacemaker longevity was significantly prolonged, too. But this pattern disappeared after 6 years of follow-up, and finally the actual pacemaker generators' replacement time was 86.7 +/- 6.8 months in standard impedance lead group vs. 91.2 +/- 10.3 months in high-impedance lead group (P = 0.17). CONCLUSION: Implantation of high pacing impedance leads for ventricular stimulation does not result in a benefit with respect to pacemaker longevity as compared with standard impedance leads.