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New method for cardiac resynchronization therapy: Transapical endocardial lead implantation for left ventricular free wall pacing. For these patients, epicardial pacing lead implantation is the most. Could persistency of current of injury forecast successful active-fixation pacing lead implantation? Presence of adequate current of injury COI was recognized as a sign of favorable pacemaker lead outcome.

Little is known regarding the value of its dynamic behavior. We sought to test whether persistency of COI could predict active-fixation pacing lead performance. COI was monitored up to 10min after right ventricular RV pacing electrode fixation.

Lead implantation was attempted for times in patients age Acute lead failures occurred 43 times. Independent predictors of acute lead failure were RV enlargement odds ratio [OR] 1. There were 12 lead failures during A precipitous decline in COI may require more attention to make sure of the lead performance. All rights reserved. Directory of Open Access Journals Sweden. A new quadripolar LV lead increases the rate of successful biventricular stimulation. Lower pacing threshold and freedom from PNS are maintained at follow-up.

Acquired tricuspid valve stenosis associated with two ventricular endocardial pacing leads in a dog. Acquired tricuspid valve stenosis TVS is a rare complication of endocardial pacing lead implantation in humans that has only been described once previously in the veterinary literature in a dog with excessive lead redundancy. A 12 yr old terrier presented with right-sided congestive heart failure 6 mo after implantation of a second ventricular endocardial pacing lead.

The second lead was placed due to malfunction of the first lead , which demonstrated abnormally low impedance. Transthoracic echocardiography identified hyperechoic tissue associated with the pacing leads as they crossed the tricuspid valve annulus as well as a stenotic tricuspid inflow pattern via spectral Doppler interrogation.

Medical management was ultimately unsuccessful and the dog was euthanized 6 wk after TVS was diagnosed. The authors report the first canine case of acquired TVS associated with two ventricular endocardial pacing leads. Bipolar leads for use with permanently implantable cardiac pacing systems: a review of limitations of traditional and coaxial configurations and the development and testing of new conductor, insulation, and electrode designs.

The unacceptable rate of mechanical failures, threshold problems, and recalls experienced with many coaxial bipolar cardiac pacing lead designs are reviewed in detail.

To address these problems, redundant insulation coradial atrial and ventricular tined leads AL and VL, respectively with iridium oxide electrodes were developed and subjected to extensive accelerated testing. There were no mechanical failures. The new lead body design proved to be much more durable than widely used trifilar MP35N configurations.

The data reviewed and early and current test results are strongly supportive of tightly coupled insulation being a major factor in improving lead durability as long as the insulating material is not stressed. In addition to improving flex life, insulation adherence to the conductor may reduce the potential for ionic degradation.

Pacing and sensing thresholds in animal studies of the new leads were within the reported range for leads with steroid eluting electrodes. A multicenter Canadian clinical trial was initiated with the first implant in early January Primary indications for pacing were AV block in 61 patients, sick sinus syndrome in 53, vasovagal syncope in 4, and congestive heart failure in 7. Many patients had associated or primary tachyarrhythmias, including with supraventricular and 12 with ventricular.

Three perioperative complications occurred, including displacement of one AL 1. There were no subsequent mechanical. Postmortem analysis of encapsulation around long-term ventricular endocardial pacing leads. To analyze the site and thickness of encapsulation around ventricular endocardial pacing leads and the extent of tricuspid valve adhesion, from today's perspective, with implications for lead removal and sensor location.

None of the patients had died because of pacemaker malfunction. The observations ranged from encapsulation only at the tip of the pacing lead to complete encapsulation along the entire length of the pacing lead within the right ventricle. The firmly attached leads could be removed only by dissection, and in some cases, removal was possible only by damaging the associated structures. No specific optimal site for sensor placement could be identified along the ventricular portion of the pacing leads ; however, the fibrotic response was relatively less prominent in the atrial chamber.

Extensive encapsulation is present in most long-term pacemaker leads , which may complicate lead removal. The site and thickness of encapsulation seem to be highly variable. Tricuspid valve adhesion, which is usually underestimated, may be severe. In contrast to earlier reports, our study demonstrates that the extent of fibrotic encapsulation may not be related to the duration since lead implantation. Moreover, we noted no ideal encapsulation-free site for sensors on the ventricular portion of long-term pacing leads.

Minimal invasive epicardial lead implantation : optimizing cardiac resynchronization with a new mapping device for epicardial lead placement. To optimize resynchronization in biventricular pacing with epicardial leads , mapping to determine the best pacing site, is a prerequisite. A port access surgical mapping technique was developed that allowed multiple pace site selection and reproducible lead evaluation and implantation.

Pressure-volume loops analysis was used for real time guidance in targeting epicardial lead placement. Even the smallest changes in lead position revealed significantly different functional results. A comparison of single- lead atrial pacing with dual-chamber pacing in sick sinus syndrome. In patients with sick sinus syndrome, bradycardia can be treated with a single- lead pacemaker or a dual-chamber pacemaker.

Previous trials have revealed that pacing modes preserving atrio-ventricular synchrony are superior to single- lead ventricular pacing , but it remains unclear if there is any Cardiac pacing systems and implantable cardiac defibrillators ICDs : a radiological perspective of equipment, anatomy and complications. Cardiac pacing is a proven and effective treatment in the management of many cardiac arrhythmias.

Implantable cardiac defibrillators ICDs are beneficial for certain patient groups with a history of serious, recurrent ventricular dysrhythmias, with a high risk of sudden cardiac death. Pacemaker devices take many forms and are highly visible on the chest radiograph.

The radiographic appearances of ICDs and pacemakers can be similar and are subject to similar complications. The anatomical approach to the implantation , the type of device used and anatomical variations will all affect the appearance of these devices on the chest film. Pacemaker complications identified radiographically include pneumothorax, lead malpositioning, lead displacement or fracture, fracture of outer conductor coil, loose connection between the lead and pacemaker connector block, lack of redundant loops in paediatric patients and excessive manipulation of the device by the patient Twiddler's syndrome.

This pictorial review highlights the role of chest radiography in the diagnosis of post-cardiac pacing and ICD insertion complications, as well as demonstrating the normal appearances of the most frequently implanted devices.

Antitachycardia pacing programming in implantable cardioverter defibrillator: A systematic review. Implantable cardioverter defibrillator ICD programming involves several parameters. In recent years antitachycardia pacing ATP has gained an increasing importance in the treatment of ventricular arrhythmias, whether slow or fast.

It reduces the number of unnecessary and inappropriate shocks and improves both patient's quality of life and device longevity. There is no clear indication regarding the type of ATP to be used, except for the treatment of fast ventricular tachycardias bpm bpm where it has been shown a greater efficacy and safety of burst compared to ramp; 8 impulses in each sequence of ATP appears to be the best programming option in this setting. Beyond ATP use, excellent clinical results were obtained with programming standardization following these principles: extended detection time in ventricular fibrillation VF zone; supraventricular discrimination criteria up to bpm; first shock in VF zone at the maximum energy in order to reduce the risk of multiple shocks.

The MADIT-RIT trial and some observational registries have also recently demonstrated that programming with a widespread use of ATP, higher cut-off rates or delayed intervention reduces the number of inappropriate and unnecessary therapies and improves the survival of patients during mid-term follow-up.

Permanent pacing in infants and children: A single center experience in implantation and follow up. Conclusion: Permanent pacing in pediatric age group is relatively safe. However, there is substantial higher incidence of suboptimal pacing parameters and pacing system failures especially in younger and smaller children.

Epicardial steroid eluting leads are comparable to endocardial steroid eluting leads in performance. Permanent pace maker implantation through axillary vein approach. Device implantation is an integral part of interventional cardiology particularly electrophysiology. In this study, we are going to share our experience of device implantation technique at electrophysiology department Hayatabad Medical Complex, Peshawar. Methods: the study was conducted from June to December Axillary vein was used to implant the devices but in some cases when this rout was not convenient due to any reason then subclavian vein was entered through the Seldinger technique.

Fluoroscopy time was less than 10 minutes and total procedure time was not more than 45 minutes. Electric cautery was used only in two cases. Pressure dressing was used in a few cases. Results: Total numbers of permanent pacemakers PPM remain during the study period. There were single chamber pacemakers and dual chambers pacemakers. No case of any major bleeding was documented and in very few cases there was mild ooze from the procedure site after the operation which was tackled with pressure dressing.

Four cases of pneumothorax were noted during the study period and in three cases chest intubation were done and one patient was kept on conservative management. Patient were followed after one month of discharge from the hospital and then yearly. Eight cases of lead dislodgment were documented during the study period. Conclusion: Axillary vein approach for implantation of permanent pacemakers is a safe and less time-consuming technique.

Epicardial left ventricular lead placement for cardiac resynchronization therapy: optimal pace site selection with pressure-volume loops. Patients in heart failure with left bundle branch block benefit from cardiac resynchronization therapy. Usually the left ventricular pacing lead is placed by coronary sinus catheterization; however, this procedure is not always successful, and patients may be referred for surgical epicardial lead placement. The objective of this study was to develop a method to guide epicardial lead placement in cardiac resynchronization therapy.

Eleven patients in heart failure who were eligible for cardiac resynchronization therapy were referred for surgery because of failed coronary sinus left ventricular lead implantation. Minithoracotomy or thoracoscopy was performed, and a temporary epicardial electrode was used for biventricular pacing at various sites on the left ventricle.

Pressure-volume loops with the conductance catheter were used to select the best site for each individual patient. In contrast, biventricular pacing at a suboptimal site did not significantly change left ventricular function and even worsened it in some cases.

To optimize cardiac resynchronization therapy with epicardial leads , mapping to determine the best pace site is a prerequisite. Pressure-volume loops offer real-time guidance for targeting epicardial lead placement during minimal invasive surgery.



New method for cardiac resynchronization therapy: Transapical endocardial lead implantation for left ventricular free wall pacing. For these patients, epicardial pacing lead implantation is the most. Could persistency of current of injury forecast successful active-fixation pacing lead implantation? Presence of adequate current of injury COI was recognized as a sign of favorable pacemaker lead outcome. Little is known regarding the value of its dynamic behavior. We sought to test whether persistency of COI could predict active-fixation pacing lead performance. COI was monitored up to 10min after right ventricular RV pacing electrode fixation.


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