Novel experience of laser-assisted 'inside-out' central venous access in a patient with bilateral subclavian vein occlusion requiring pacemaker implantation.

Aim: This new laser facilitated 'inside-out' technique was used for transvenous pacemaker insertion in a pacemaker-dependent patient with bilateral subclavian occlusion and a failed epicardial system who is not suitable for a transfemoral approach.

Method And Results: Procedure was undertaken under general anaesthesia with venous access obtained from right femoral vein and left axillary vein. 7F multipurpose catheter was used to enter proximal edge of the occluded segment of subclavian vein via femoral approach, which then supported stiff angioplasty wires and microcatheters to tunnel into the body of occlusion.

Time to manual activation of implantable loop recorders--implications for programming recording period: a 10-year single-centre experience.

Aim: A new generation of commercially available implantable loop recorders (ILRs) has improved arrhythmia detection algorithms but reduced manually activated ECG storage duration. We investigated the effect that this would have had on symptom-arrhythmia correlation in a retrospective patient cohort.

Method And Results: Retrospective review of all patients receiving a Medtronic Reveal 9525/9526 for the investigation of unexplained syncope or pre-syncope in our centre between 1998 and 2008.