Deborah L Paul

Texas Heart Institute, Houston, Texas, United States

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Publications (8)16.08 Total impact

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    ABSTRACT: Introduction: The frequency of device implantation is increasing in younger patients as our ability to diagnose long-QT syndrome, hypertrophic cardiomyopathy, Brugada Syndrome, and other life-threatening disorders earlier has improved. Similarly, use of cardiac resynchronization therapy and ICD therapies has increased in cardiomyopathy patients. Methods and results: Device implantation in young women has unique considerations. Standard pectoral implants lead to excessive scar formation due to skin tension and interfere with purse straps, bra straps, and seat belts. There are also privacy and body image concerns as the subclavian region is exposed with many contemporary fashions. Results: Over an 11-year period, we implanted pacemakers, implantable converter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices (defibrillators or pacemakers) in 60 women, aged 13-70 years, using a 2-incision submammary approach. Follow-up surveys were performed using the Florida Patient Acceptance Survey (FPAS). Women with submammary device placement reported significantly greater device acceptance (M = 92.41, SD = 6.46) than women with standard implant technique (M = 70.29, SD = 17.85); t (54) =-6.08, P < 0.001, on the FPAS. Across subscales on the FPAS, women with submammary device placement also reported significantly less body image concern (P < 0.001), less device-related emotional distress (P < 0.001), and greater confidence in returning to life appropriately (P = 0.01) than women with standard device placement. Conclusion: We present here our technique for submammary device implantation.
    No preview · Article · Oct 2012 · Journal of Cardiovascular Electrophysiology
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    ABSTRACT: Many institutions restrict the use of ibutilide because of the potential risk of polymorphic ventricular tachycardia (PMVT). Over a 5-year period from June 2000 to May 2005, 238 patients, 151 men and 87 women, with a mean age of 67.1 years (range, 22-94 years), received intravenous ibutilide at our institution. Ibutilide was administered by nurses or physicians in 4 clinical settings: emergency department (n = 80), intensive care unit (n = 11), patient room on telemetry (n = 107), and in the cardiac catheterization/electrophysiology laboratory (n = 40). Conversion to sinus rhythm occurred in 59% of patients outside the catheterization/electrophysiology laboratory. The incidence of PMVT was 1.7%. Three patients had brief nonsustained PMVT and 1 patient had a sustained PMVT. There was no difference in outcome whether a physician was present at the time of ibutilide administration. Our data suggest that ibutilide is a safe and efficacious drug when ordered by experienced physicians in properly selected patients in a variety of monitored settings.
    No preview · Article · Aug 2008 · The Journal of cardiovascular nursing
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    ABSTRACT: The electrocardiogram (ECG) patterns during pacing from the great cardiac vein (GCV) and the middle cardiac vein (MCV) are not well known. We recorded 12-lead ECGs during GCV and MCV pacing in 26 patients undergoing implantation of a cardiac resynchronization device. The left ventricular (LV) lead was passed down the GCV (n = 19) or MCV (n = 7) prior to moving it to a lateral or posterolateral vein for permanent implantation. Pacing within the GCV resulted in a left bundle branch block (LBBB) morphology with no or minimal R-wave in V(1) in 14 patients and a right bundle branch block (RBBB) pattern (R > S in lead V(1)) in four patients. In one patient, lead V1 during GCV pacing was isoelectric (R = S). A more distal pacing site in the GCV yielded a LBBB pattern in all the patients. All leads placed in the MCV resulted in a LBBB configuration. An ECG pattern with a RBBB pattern was invariably recorded during LV pacing in 125 consecutive outpatients with biventricular pacemakers and LV leads in the posterolatral and lateral coronary veins. Knowledge of the ECG patterns from various pacing sites in the coronary venous system may be helpful for troubleshooting all types of pacing systems, especially those where the coronary venous pacing site is unintentional.
    No preview · Article · Nov 2007 · Pacing and Clinical Electrophysiology
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    ABSTRACT: Over a 5-year period, 112 patients (89 male/23 female, mean age 65 years) underwent right ventricular outflow tract (RVOT) placement of permanent active-fixation transvenous pacing/defibrillating leads. At implantation, the pacing threshold was 0.6 +/- 0.3 V at 0.5 ms pulse duration and R wave amplitude was 10.9 +/- 4.9 mV. The defibrillation threshold (DFT) of right-sided implants was 17.7 +/- 3.4 J while that of left-sided implants was 16.1 +/- 3.3 J. Patients were followed at 1 and 3 month postimplant and at six-month intervals thereafter. At mean follow-up of 22.5 +/- 17.5 months (range 1-47 months) there were no lead dislodgments, unsuccessful shock therapies, or failure to sense or pace for bradycardia or tachycardia. Death was not sudden in the 17 patients who died. We conclude that RVOT pacing-defibrillation lead implantation is safe, efficacious, and potentially attractive because preliminary evidence suggests that it may not be associated with the adverse hemodynamic effects of pacing at the right ventricular apex.
    No preview · Article · May 2004 · Pacing and Clinical Electrophysiology
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    ABSTRACT: The study evaluated all patients undergoing permanent pacemaker and ICD implantation over a 4-year period to determine if anticoagulated patients required normalization of coagulation factors in the periprocedural period. The study included 1,025 (597 men, 428 women, age 24-100 years, mean 72 years) consecutive patients who underwent device implantation using mostly a percutaneous subclavian approach. The procedures were performed without reversal of anticoagulation in 470 patients with INRs >or= 1.5 at the time of the procedure (mean INR 2.6 +/- 1.0, range 1.5-7.5). The complication rate in the anticoagulated group was similar to those in patients with a normal INR. Routine normalization of coagulation factors prior to pacemaker/ICD placement may not be necessary.
    No preview · Article · Mar 2004 · Pacing and Clinical Electrophysiology
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    ABSTRACT: This report describes a case of an active-can ICD placed in the thigh. A 74-year-old man on chronic renal dialysis had no venous access from cephalic, subclavian, or jugular approaches. Using long active-fixation leads the device was placed from a femoral approach with good sensing, pacing, and defibrillation parameters.
    Preview · Article · Jun 2003 · Pacing and Clinical Electrophysiology
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    ABSTRACT: Right ventricular outflow tract pacing has been shown to increase cardiac output compared with apical pacing. The relation between the baseline QRS duration and paced QRS duration suggests that right ventricular outflow tract pacing utilizes the native conduction system.
    No preview · Article · Feb 2003 · The American Journal of Cardiology
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    ABSTRACT: Cardiac output was measured in 89 patients using transthoracic continuous-wave echo Doppler comparing right ventricular outflow tract pacing with the right ventricular apex at the time of permanent pacemaker implantation. Overall, cardiac output improved 18.8% (p <0.0001) and cardiac index 21.0% (p <0.0001) with outflow tract placement; patients with a lower baseline cardiac index had a greater percent improvement with outflow tract placement.
    No preview · Article · Jan 1997 · The American Journal of Cardiology

Publication Stats

262 Citations
16.08 Total Impact Points


  • 2012
    • Texas Heart Institute
      Houston, Texas, United States
  • 2004-2008
    • Genesis Medical Center
      Davenport, Iowa, United States
    • Tampa General Hospital
      Tampa, Florida, United States