Epicardial pacing system implantation

A woman with congenital heart disease and atrial and ventricular arrhythmias managed by an implanted cardioverter defibrillator, epicardial pacing and amiodarone 400 mg daily, experienced deterioration in the control of her condition. She developed palpitations and experienced a shock from the defibrillator. Her amiodarone serum levels were 40% lower than 2 months previously, and her A-desethylamiodarone levels were undetectable. It was noted that 5 weeks earlier rifampicin 600 mg daily had been started to treat an infection of the pacing system. The amiodarone dose was doubled, but the palpitations continued. Amiodarone and A-desethy-lamiodarone levels increased after rifampicin was discontinued. Rifampicin is a potent enzyme inducer and it may have increased the metabolism and clearance of amiodarone. This case suggests that combined use of amiodarone and rifampicin should be well monitored. 

Kleine P, Gronefeld G, Dogan S et al. Robotically enhanced placement of left ventricular epicardial electrodes during implantation of a biventricular implantable cardioverter defibrillator system. PACE 2002 25 989-991. 

Fig. 4.41 Location of surgical incisions for placement of epicardial systems. The common median sternotomy is not shown. (From Belott PH, Reynolds DW. Permanent pacemaker implantation. In Ellenbogen KA, Kay N, Wilkoff BL, eds. Clinical cardiac pacing. Philadelphia WB Saunders, 1995, with permission.)...

---