Baylor College of Medicine, Houston, Texas, United States

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Publications (3)3.39 Total impact

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    ABSTRACT: Recent reports have raised doubts regarding the safety and efficacy of the blind subclavian venipuncture technique for intracardiac lead implantation. To permit a more lateral entry, we used a simple subclavian venogram performed through the brachial vein of the ipsilateral arm of 22 consecutive unselected patients undergoing lead implantation (19 permanent pacemakers and 3 intracardiac defibrillators). A total of 35 leads were implanted (31 left pectoral and 4 right pectoral). Lead insertion by venogram technique was used successfully in all patients. Two inconsequential arterial punctures occurred. There were no pneumothoraces infections, or other complications. Lateral placement should facilitate lead manipulation and minimize "subclavian crush." The method of ipsilateral venogram guided lead insertion appears to be safe and reliable and deserves consideration in patients who require permanent lead placement via the subclavian vein approach.
    Pacing and Clinical Electrophysiology 04/1998; 21(3):499-502. DOI:10.1111/j.1540-8159.1998.tb00090.x · 1.13 Impact Factor
  • Dennis W.x. Zhu · Huabin Sun · Rita Hill · Robert Roberts
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    ABSTRACT: Fifty-three consecutive patients with hypertrophic cardiomyopathy (HCM) and no history of sudden death underwent electrophysiology (EP) study. Sustained polymorphic ventricular tachycardia (VT) or ventricular fibrillation (VF) was induced in 19 patients (35%). Patients with prior syncope or near syncope had a higher incidence of VT/VF inducibility. An implantable cardioverter defibrillator (i.c.d.) was placed in 14 of the 19 patients. Of the remaining 5 patients with inducible VT/VF, three refused ICD implantation, while two underwent septal myectomy and VT/VF was no longer inducible after the operation. None of the patients received antiarrhythmic drugs. During a mean follow-up period of 47 +/- 31 (2-117) months, no events occurred in the 34 patients with negative EP study. Three events occurred among the 19 patients with inducible VT/VF. One patient died suddenly, one developed wide complex tachycardia which required resuscitation, and one patient received an appropriate ICD shock. In conclusion, sustained polymorphic VT/VF was inducible in about one-third of patients with HCM. Noninducibility of VT/VF appeared to predict a favorable prognosis. Although the overall event rate was low in patients with inducible VT/VF, prophylactic ICD implantation in patients with multiple risk factors may be appropriate.
    Pacing and Clinical Electrophysiology 02/1998; 21(1 Pt 2):299-302. DOI:10.1111/j.1540-8159.1998.tb01109.x · 1.13 Impact Factor
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    ABSTRACT: By pacing both atria simultaneously, one could reliably predict and optimize left-sided AV timing without concern for IACT. With synchronous depolarization of the atria, reentrant arrhythmias might be suppressed. We studied four male patients (73 ± 3 years) with paroxysmal atrial fibrillation and symptomatic bradyarrhythmias using TEE and fluoroscopy as guides; a standard active fixation screw-in lead (Medtronic model #4058) was attached to the interatrial septum and a standard tined lead was placed in the ventricle. The generators were Medtronic model 7960. The baseline ECG was compared to the paced ECG and the conduction time were measured to the high right atrium, distal coronary sinus and atrial septum in normal sinus rhytbm, atrial septal pacing, and AAT pacing. On the surface ECG, no acceleration or delay in A V conduction was noted during AAI pacing from the interatrial septum as compared with normal sinus rhythm. The mean interatrial conduction time for all 4 patients was 106 ± 2 ms; the interatrial conduction time measured during AAT pacing utilizing the atrial septal pacing lead was 97 ± 4 ms (P = NS). During atrial septal pacing, the mean conduction time to the high right atrium was 53 ± 2 ms. The mean conduction time to the lateral left atrium during atrial septal pacing, was likewise 53 ± 2 ms. We conclude that it is possible to pace both atria simultaneously from a single site using a standard active fixation lead guided by TEE and fluoroscopy. Such a pacing system allows accurate timing of the left-sided AV delay.
    Pacing and Clinical Electrophysiology 10/1997; 20(11):2739 - 2745. DOI:10.1111/j.1540-8159.1997.tb05431.x · 1.13 Impact Factor