-
[show abstract]
[hide abstract]
ABSTRACT: In cardiac resynchronisation therapy, failure to implant a left ventricular lead in a coronary sinus branch has been reported in up to 10% of cases. Although surgical insertion of epicardial leads is considered the standard alternative, this is not without morbidity and technical limitations. Endocardial left ventricular pacing can be an alternative as it has been associated with a favourable acute haemodynamic response compared with epicardial pacing in both animal and human studies. In this paper, we discuss left ventricular endocardial pacing and compare it with epicardial surgical implantation. Ease of application and procedural complications and morbidity compare favourably with epicardial surgical techniques. However, with limited experience, the most important concern is the still unknown long-term risk of thromboembolic complications. Therefore, for now endovascular implants should remain reserved for severely symptomatic heart failure patients and patients at high surgical risk of failed coronary sinus implantation.
Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 11/2011; 20(3):118-24. · 1.44 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We describe the implantation via the femoral vein of a dual-chamber pacing system with lumenless, catheter-delivered pacing leads in a patient in whom subclavian access on both sides was obstructed. (Neth Heart J 2010;18:42-4.).
Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 01/2010; 18(1):42-4. · 1.44 Impact Factor
-
Heart (British Cardiac Society) 12/2003; 89(11):1348-9. · 4.22 Impact Factor
-
F A Bracke
Indian pacing and electrophysiology journal 02/2003; 3(3):101-8.
-
[show abstract]
[hide abstract]
ABSTRACT: A 63-year-old man with chronic atrial fibrillation and heart failure had a biventricular pacing system implanted. The pulse generator was a standard DDDR pacemaker, using the atrial channel for the right ventricular lead and the ventricular channel for the left ventricular lead. During final adjustment of the pacing parameters, a pacemaker tachycardia triggered by T wave oversensing from the right ventricular lead was recorded.
Pacing and Clinical Electrophysiology 01/2002; 24(12):1819-20. · 1.35 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This case report describes a patient with heart failure in whom a biventricular pacing system was successfully implanted. During control of the pacing system, three morphologies of the paced QRS complex could be elucidated. Right ventricular stimulation, biventricular stimulation, and biventricular pacing with additional stimulation from the anodal electrode of the right ventricular lead determined the morphologies.
Pacing and Clinical Electrophysiology 08/2001; 24(7):1165-7. · 1.35 Impact Factor
-
Heart (British Cardiac Society) 04/2001; 85(3):254-9. · 4.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Occlusion of the subclavian or brachiocephalic vein in pacemaker or defibrillator patients prohibits ipsilateral implantation of new leads with standard techniques in the event of lead malfunction. Three patients are presented in whom laser sheath extraction of a non-functional lead was performed in order to recanalise the occluded vein and to secure a route for implantation of new leads. This technique avoids abandoning a useful subpectoral site for pacing or defibrillator therapy. The laser sheath does not affect normally functioning leads at the same site.
Heart (British Cardiac Society) 07/2000; 83(6):E12. · 4.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Three patients from different centers with pacemaker or ICD leads endocardially implanted in the left ventricle are described. All leads, two ventricular pacing leads and one ICD lead, were inserted through a patent foramen ovale or an atrial septum defect. The diagnosis was made 9 months, 14 months, and 16 years, respectively, after implantation. All patients had right bundle branch block configuration during ventricular pacing. Chest X ray was suggestive of a left-sided positioned lead except in the ICD patient. Diagnosis was confirmed with echocardiography in all patients. One patient with a ventricular pacing lead presented with a transient ischemic attack at 1-month postimplantation. During surgical repair of the atrial septum defect 14 months later, the lead was extracted and thrombus was attached to the lead despite therapy with aspirin. The other patients were asymptomatic without anticoagulation (9 months and 16 years after implant). No thrombus was present on the ICD lead at the time of the cardiac transplantation in one patient. We reviewed 27 patients with permanent leads described in the literature. Ten patients experienced thromboembolic complications, including three of ten patients on antiplatelet therapy. The lead was removed in six patients, anticoagulation with warfarin was effective for secondary prevention in the four remaining patients. In the asymptomatic patients, the lead was removed in five patients. In the remaining patients, 1 patient was on warfarin, 2 were on antiplatelet therapy, and in 3 patients the medication was unknown. After malposition was diagnosed, three additional patients were treated with warfarin. In conclusion, if timely removal of a malpositioned lead in the left ventricle is not preformed, lifelong anticoagulation with warfarin can be recommended as the first choice therapy and lead extraction reserved in case of failure or during concomitant surgery.
Pacing and Clinical Electrophysiology 06/2000; 23(5):877-83. · 1.35 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The left internal mammary artery was severed and an arteriovenous fistula created during extraction of pacemaker leads with a laser sheath.
Pacing and Clinical Electrophysiology 06/1999; 22(5):833-4. · 1.35 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The learning curve characteristics of lead extraction with a laser sheath were examined in 19 patients. Forty-two leads were removed: five leads were removed by traction alone, five required a femoral approach as a primary procedure and a laser sheath was used in 32 lead extraction attempts. Primary laser success was achieved in 26 attempts (81%). A femoral approach was successfully applied as a back-up procedure in five of the failures. Overall, 26% of the leads were removed by the femoral approach. The overall success rate was 98% (41 of 42 leads). No variables related to the patients, leads, or extraction techniques were significantly related to failure of laser sheath extraction. There was a distinct learning curve with all but one failure occurring in the first half of our cases. All failures occurred with leads implanted from the right subclavian vein. In four, a sharply angled curve at the subclavian vein-superior vena cava junction could not be passed with the laser sheath. The ability to smooth this curve improved the results during the learning curve. All procedures were performed in the operating room for safety reasons. This precaution was lifesaving in a case of acute tamponade after laser extraction of an atrial lead. In another case the left internal mammary artery was torn after laser sheath extraction, causing the formation of a false aneurysm. New pacing leads were introduced in nine patients during the same procedure. The mean procedure time was 255 +/- 110 min. reflecting the complexity of these procedures.
Pacing and Clinical Electrophysiology 12/1998; 21(11 Pt 2):2309-13. · 1.35 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Fractional flow reserve (FFR), defined as the ratio of maximum flow in the presence of a stenosis to normal maximum flow, is a lesion-specific index of stenosis severity that can be calculated by simultaneous measurement of mean arterial, distal coronary, and central venous pressure (Pa, Pd, and Pv, respectively), during pharmacological vasodilation. The aims of this study were to define ranges of FFR values, whether associated with inducible ischemia or not, and to investigate FFR in normal coronary arteries.
In 60 patients accepted for percutaneous transluminal coronary angioplasty (PTCA) of single-vessel disease, with a positive exercise test (ET) < 24 hours before PTCA, FFR was determined during adenosine-induced hyperemia just before and 15 minutes after angioplasty. Pa was measured by the guiding catheter, Pd by an 0.018-in fiber-optic pressure-monitoring wire, and Pv, by a multipurpose catheter. The ET was repeated after 5 to 7 days, and only if this second ET had reverted to normal was the pre-PTCA value of FFR definitely considered to be associated with inducible ischemia and the post-PTCA value not. Myocardial FFR (FFRmyo) increased from 0.53 +/- 0.15 before PTCA to 0.88 +/- 0.07 after PTCA. Coronary FFR increased from 0.38 +/- 0.19 to 0.83 +/- 0.12. In all patients, values of FFRmyo definitely associated with ischemia were < or = 0.74, whereas all except two values not associated with inducible ischemia exceeded 0.74. Moreover, FFRmyo in 18 coronary arteries in 5 normal patients equaled 0.98 +/- 0.03.
A value of FFRmyo of 0.74 reliably discriminates coronary stenosis, whether associated with inducible ischemia or not. Therefore, FFRmyo is a useful index to determine the functional significance of an epicardial coronary stenosis and may facilitate clinical decision making in patients with an equivocal coronary stenosis.
Circulation 01/1996; 92(11):3183-93. · 14.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A 45-year-old male had a VVI pacemaker implanted 20 years ago because of complete heart block. Because of perforation of the lead the pulse generator was removed after 4 weeks and a second lead was implanted from the contralateral side. Recently, the patient presented with symptoms of lightheadedness and syncope associated with prolonged pauses in the electrocardiogram. From the ECG, the ECG interpretation channel, and intracardiac electrogram telemetry, it was concluded that the VVI pacemaker was inhibited by P waves. The most likely explanation for this phenomenon was an insulation defect in the functioning lead caused by friction with the abandoned lead at the level of the high right atrium.
Pacing and Clinical Electrophysiology 03/1995; 18(2):370-3. · 1.35 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In this report, a patient is described with an occluded left circumflex artery, in whom the corresponding myocardium was protected at rest by sufficient collateral circulation. Because of angina pectoris class III, a PTCA of that occluded vessel was performed, complicated by a large dissection. Recruitable collateral flow, assessed from pressure calculations by a new technique, suddenly decreased at the very moment of dissection. This was accompanied by resting pain and ischemia on the ECG. This case report confirms the hypothesis that the collateral circulation can be damaged by PTCA and emphasizes that every PTCA implies a definite risk, even in case of an occluded coronary artery filled by collaterals.
Catheterization and Cardiovascular Diagnosis 02/1995; 34(1):61-4.
-
[show abstract]
[hide abstract]
ABSTRACT: A 58-year-old man with an implanted minute ventilation rate adaptive DDD pacemaker underwent RF ablation of the AV junction because of symptomatic supraventricular tachyarrhythmias. Immediately after ablation, while the pacemaker was programmed in the DDDR mode, AV sequential pacing at upper rate was observed. After programming the pacing system to the DDD mode and repeated ablation, no abnormalities were observed. It was concluded that AV sequential upper rate pacing was caused by false interpretation of the RF current by the sensor measuring transthoracic impedance as an indicator for minute ventilation.
Pacing and Clinical Electrophysiology 09/1994; 17(8):1437-40. · 1.35 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Two patients who had recently undergone pulse generator replacement in which an adapter had been used to connect a preexisting lead to a VS1 and IS1 3.2-mm connector presented with noncapture. The adapter set-screw was found to be protruding from the insulation sleeve to short-circuit with the pulse generator can. During episodes of noncapture the telementered impedance was < 100 ohms.
Pacing and Clinical Electrophysiology 10/1993; 16(10):1961-5. · 1.35 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Holter recording of a patient with an implanted dual chamber rate responsive pacemaker revealed an electrocardiogram, where ventricular depolarization seemed to be initiated by the atrial stimulus. In a second patient with a VVI pacemaker, Holter recording showed delay of the pacemaker impulse that was registered after the onset of ventricular depolarization. Misalignment in one of the recorder heads of the display system was responsible for this phenomenon, which in case of dual chamber pacing could have been easily misinterpreted as pacemaker malfunction.
Pacing and Clinical Electrophysiology 06/1991; 14(5 Pt 1):760-3. · 1.35 Impact Factor
-
-
[show abstract]
[hide abstract]
ABSTRACT: In the last few years, comprehensive endovascular techniques have been developed to extract chronically implanted pacemaker and defibrillator leads. It is important that referring physician have knowledge of the advantages and limitations of the different techniques. In this paper we discuss the techniques and results of the currently used endovascular extraction techniques.
-
[show abstract]
[hide abstract]
ABSTRACT: The use of lead extraction is expanding with the introduction of new endovascular extraction techniques. Indications for extraction of chronically implanted pacemaker leads have been classified as mandatory, necessary or discretionary, but their rationale is often based on clinical judgement without corresponding support from the literature. We reviewed the literature of pacemaker lead-related complications as a starting point for discussing the indications for lead extraction.
