Pacemaker implantation

A decision to refer for permanent pacemaker implantation for loss of atrioventricular synchrony due to first degree AV nodal block is challenging. In the setting of normal conduction in the ventricles, the improvement that may be gained by improving atrioventricular synchrony must be weighed against... 

Manolis AG, Katsivas AG, Lazaris EE, Vassilopoulos CV, Louvros NE. Ventricular performance and quality of life in patients who underwent radiofrequency AV junction ablation and permanent pacemaker implantation due to medically refractory atrial tachyarrhythmias. J. Interv. Card. Electrophysiol. 1998 2 71-6. 

Patients with underlying sinus node dysfunction tend to have signihcant worsening of nodal function, frequently requiring pacemaker implantation. Corneal microdeposits develop in most adults receiving amiodarone. As many as 10% of patients complain of halos or blurred vision. The corneal microdeposits are reversible with stoppage of the drug. 

A 52-year-old man with a serum lithium concentration of 4.58 mmol/1 had sinus node dysfunction with multiple atrial extra beats and an intraventricular conduction delay, which normalized following hemodialysis (132). Two patients, a 58-year-old woman and a 74-year-old woman, developed sick sinus syndrome while taking lithium but were able to continue taking it after pacemaker implantation (135,136). 

Soon after the start of donepezil treatment three patients with Alzheimer s disease developed cardiac syncope (52). In two cases, a bradydysrhythmia was documented and pacemaker implantation was considered justified rather than donepezil withdrawal. 

Otherwise, heart transplants would not be possible (or at least would necessitate a simultaneous pacemaker implantation), since there is... 

The use of permanent pacemakers is beyond the scope of this book. In an emergency, AV conduction may be improved by atropine (antimuscarinic vagal block) (0.6 mg i.v.) or by isoprenaline (p-adrenoceptor agonist) (0.5-10 micrograms/min, i.v.). Temporary pacing wires may be needed prior to referral for pacemaker implantation. 

Timolol was withheld and a temporary pacemaker was inserted. Rechallenge with timolol was associated with recnrrence of third-degree AV block. She subseqnently had a permanent dnal chamber pacemaker implanted. 

Carpeutier O, Dubost-Brama A, Martin De Lassalle E, Piette F, Delaporte E. Rhabdomyosarcome sur site d implan-tation d un stimulatem cardiaque. [Rhabdomyosarcoma at site of pacemaker implantation.) Ann Dermatol Venereol 2000 127 (10) 837-40. 

It is unclear whether topiramate played any role in rare cardiovascular events. These included symptoms of Raynaud s phenomenon in three patients, and third-degree atrioventricular block requiring emergency cardiac pacemaker implantation in one patient with preexisting right bundle branch block (SEDA-21, 76). 

Many uses of platinum depend on its chemical inactivity. For example, some people need to have artificial heart pacemakers implanted into their chests. An artificial pacemaker is a device that makes sure the heart beats in a regular pattern. It usually replaces a body part that performs that function but has been damaged. Artificial pacemakers are usually... 

Figure 3.35 Four sets of leads with basal ECG (left) and after pacemaker implantation in the RV (right) in a patient without ischaemic heart disease. Note the negative T wave in sinus rhythm complexes after implantation due to cardiac memory phenomenon. Characteristically, in case...

Cardiac catheterization, including balloon angioplasty Implanted cardiac pacemakers, implanted defibrillators, and coronary stents... 

The application of polymeric materials in medicine is a fairly specialized area with a wide range of specific applications and requirements. Although the total volume of polymers used in this application may be small compared to the annual production of polyethylene, for example, the total amount of money spent annually on prosthetic and biomedical devices exceeds 16 billion in the United States alone. These applications include over a million dentures, nearly a half billion dental fillings, about six million contact lenses, over a million replacement joints (hip, knee, finger, etc.), about a half million plastic surgery operations (breast prosthesis, facial reconstruction, etc.), over 25,000 heart valves, and 60,000 pacemaker implantations. In addition, over AO,000 patients are on hemodialysis units (artificial kidney) on a regular basis, and over 90,000 coronary bypass operations (often using synthetic polymers) are performed each year (]J. 

Prosthetic valve, coronary artery bypass, other open-heart surgery, pacemaker implant... 

Pacemakers affected by interference typically respond with temporary loss of output or temporary reversion to asynchronous pacing (pacing at a fixed rate, with no inhibition from intrinsic cardiac events). The usual consequence for the patient is a return of symptoms that originally led to the pacemaker implant, and pacemaker-dependent patients are placed at clinical risk. Pacemaker manufacturers provide extensive information on interference issues via their websites and technical service phone centers. 

Figi 1.43 Contrast venography of both subclavian veins in a patient with superior vena cava syndrome. He carried a monocatheter pacing system on the left (implanted 4 years earlier) and had two abandoned leads on the right (the pacemaker, implanted 21 years earlier, had been removed from the right pocket due to local infection). Subocclusive obstruction between the right subclavian and innominate veins (a). Total obstruction is visible in the first tract of the superior vena cava arrow). Occlusive obstruction visible in the middle tract of the left subclavian vein h) arrow)... 

Holmes DR Jr (1986) Permanent pacemaker implantation. In Furman S, Hayes DL, Holmes DR Jr (eds) A practice of cardiac pacing. Futura, Mount Kisco, pp 97-127... 

Ellestad MH, French J (1989) Iliac vein approach to permanent pacemaker implantation. Pacing Clin Electrophysiol 12(7 Ptl) 1030-1033... 

Korkeila P, Nyman K, Ylitalo A et al (2007) Venous obstmc-tion after pacemaker implantation. Pacing Clin Electrophysiol 30(2) 199-206... 

Klug D, Wallet F, Lacroix D et al (2004) Local symptoms at the site of pacemaker implantation indicate latent systemic infection. Heart 90 882-886... 

Da Costa A, Kirkorian G, Cucherat M et al (1998) Antibiotic prophylaxis for permanent pacemaker implantation a meta-analysis. Circulation 97 1796-1801... 

Goto Y, Aabe T, Sekine S et al (1998) Long-term thrombosis after transvenous permanent pacemaker implantation. Pacing Clin Electrophysiol 21 1192- 1195... 

Mathur G, Stables RH, Heaven D et al (2001) Permanent pacemaker implantation via the femoral vein an alternative in cases with contraindications to the pectoral approach. Europace 3 56-59... 

Pacemaker (implant) 1958 200 000 Polyurethane, silicone (lead insulation)... 

This study demonstrates that in situ somatic reprogramming can stimulate proper chronotropic heart function in a large-animal model of complete heart block. The gene delivery techniques were consistent with routine clinical practice in which venous access is considered the safest route for electronic pacemaker implantation [44]. The TBX18 biological pacemaker was superior to an electronic pacemaker in its responsiveness to the circadian rhythm and autonomic regulation, showing features of the native SAN. 

The use of electrosurgery on patients with metallic implants or cardiac pacemakers may pose problems. Metallic implants are usually considered not to be a problem if the form is round and not pointed, Etter et al. (1947). The pacemaker electrode tip is a small area electrode, where relative small currents may coagulate endocardial tissue. The pacemaker catheter positioning should therefore not be parallel with the electrosurgery current density lines. This is illustrated in Figure 10.22 for a heart pacemaker implant. 

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