Cardiac Pacing in Sub-Saharan Africa: JACC International.

Many parts of the developing world, especially Sub-Saharan Africa, completely lack access to cardiac pacing. The authors initiated a multinational program to implement cardiac pacing in 14 countries in Sub-Saharan Africa (1996 to 2018), aiming to eventually build self-sustainable capacity in each country. This was based on an "on-site training" approach of performing procedures locally and educating local health care teams to work within resource-limited settings, with prospective evaluation of the program.

Assessing the safety of implantable cardioverter-defibrillator reuse-A retrospective case-control study.

Aims: The safety of pacemaker reuse has been proven by numerous studies in the last two decades. With the exception of one research paper, the safety of reuse of implantable cardioverter-defibrillators has not been properly investigated. Our aim was to establish whether resterilized implantable cardioverter-defibrillators are as safe as new devices in relation to functionality and infection rates.

Reuse of pacemakers, defibrillators and cardiac resynchronisation devices.

Objective: Access to pacemakers remains poor among many patients in low/middle-income countries. Reuse of explanted pacemakers is a possible solution, but is still not widespread because of concerns regarding outcomes, especially infection. Our objective was to study early outcomes with implants using reused devices and compare them with those with implants using new devices.

[Non-valvular cardiac devices endocarditis].

The risk of infective endocarditis on pacemaker or ICD is not negligible and has increased in recent years. Several host-related, procedure-related, or device-related risk factors have been recognized. Owing to its potential severity, the possibility of infective endocarditis should be envisaged in patients with repeated pulmonary infections or documented bacteremia and transesophageal echocardiography should then be used.

[Cardiac stimulation in the infant and young child].

This study evaluates the problems and the evolution of cardiac stimulation in infants (aged < 3.5 years) by comparing the endocavity and epicardial routes in a retrospective series of 37 patients. Thirty seven patients aged 1.

[Isolated congenital complete atrio-ventricular block].

The objective of this work was to study the long term evolution of a retrospective series of 54 patients affected with congenital isolated complete atrio-ventricular block (CAVB) and to analyse the value of the different methods used for surveillance. Our series included 54 patients affected with isolated CAVB, without associated cardiopathy, diagnosed at an average age of 5.3 +/- 5.

[Relevance of in vitro studies for the immunity of cardiac implants in an electromagnetic field environment]].

The object of this article is to show the contribution of the vitro experimental approach, based on the basic rules of electromagnetic compatibility (EMC), as a complementary tool to the clinical studies. Results can be obtained by a experimental approach in vitro with electromagnetic phantoms associated to a bench of "standard" test to allow a possible comparison between various studies. After describing the protocol developed for the cardiac implants (pacemakers and defibrillators), examples of partial results are presented by way of illustration.

[Interferences in the everyday life of the patient with a cardiac pacemaker or an implantable defibrillator].

The electromagnetic sources of interferences being able to deteriorate the operation of cardiac pacemakers or implantable defibrillators are numerous. This potential risk has been known since the release, 40 years ago, of pacemakers incorporating a detection circuit. Many papers, reviewed in this article, have been published about these conflicts.

[Characteristics and causes of death in 283 patients with implanted defibrillators].

Unlabelled: The implantable automatic defibrillator has proved its superiority over pharmacological treatments for preventing mortality by serious ventricular arrhythmia. We studied the cause of death in a population of 283 consecutive patients implanted between February 1988 and December 2000 (age at implantation: 58 +/- 14.7 years; extremes: 15-78 years, 45 females, ejection fraction: 0.

[New pacemaker functions: which ones represent real progress and which are only gadgets?].

Modern pacemakers, and particularly dual chamber models, include a broad array of therapeutic and diagnostic features. Some are designed to increase safety, whereas others are either designed to avoid unnecessary pacing, reduce the current drain and increase the pacemaker longevity, or to improve the hemodynamics. Diagnostic features are more elaborate, more or less automatic, and easier to extract from the pacemaker memory.

Influence of high-energy photon beam irradiation on pacemaker operation.

In this paper, we determine the influence of high-energy photon beam irradiation used for external radiotherapy on pacemakers, at different doses and dose rates. Ninety-six pacemakers of various origins and ages underwent in vitro high-energy photon irradiation under technical conditions close to external radiotherapy, using a linear accelerator delivering photons of high energy (18 MV). Various dose levels (up to 200 Gy for certain particularly resistant pacemakers) were delivered to pacemakers located in a water-equivalent phantom with several dose rates (from 0.

Effects of radiofrequency catheter ablation on patients with permanent pacemakers.

The objective of this study was to assess the effects of radiofrequency energy application on implanted pacemaker functions. Radiofrequency (RF) catheter ablation may cause pacemaker dysfunction due to electromagnetic interferences. The effects of RF on pacemaker behavior were studied in a series of 38 pacemakers, implanted 18 +/- 26 months prior to a RF procedure using either a right ventricular approach (AV node ablation, n = 35) or a left ventricular approach (left concealed accessory pathway ablation, n = 1; VT ablation, n = 2).

DDD pacing in hypertrophic cardiomyopathy: a multicentre clinical experience.

Background: DDD pacing has been advocated as an effective treatment for drug refractory obstructive hypertrophic cardiomyopathy. This study reports the outcome of pacing in 56 patients with refractory symptoms referred to four tertiary centres.

Methods: Core data on symptoms, drug burden, and left ventricular outflow tract gradient were recorded.

[Clinical aspects of implantable defibrillators: indication].

The rapidity of technological progress has now made available a device which was only a dream a few years ago, a nearly ideal implantable defibrillator. Despite the persistence of a number of technical and clinical problems, the fourth generation defibrillators are multiprogrammable, with antitachycardia and antibradycardia functions, implantable by the endocavitary approach in most cases thanks to the introduction of biphasic shocks, fitted with constantly improving systems of telemetry, and are progressively smaller in size. The selection of a defibrillator device requires consideration of the patient's needs and the technical characteristics of the defibrillator.

[Results, complications and long-term follow-up of percutaneous ablation of atrioventricular conduction. Apropos of 85 cases].

This retrospective study reports the immediate and long-term results of percutaneous ablation of atrioventricular conduction. Between July 1983 and January 1992, 85 consecutive patients (51 men, age 64 +/- 10 years, range 43-84 years) presenting with supraventricular arrhythmias (atrial fibrillation n = 53; atrial flutter n = 50; atrial tachycardia n = 17; junctional tachycardia n = 6) resistant to antiarrhythmic therapy (number of drugs used: 4 +/- 1.3, range 1-6) underwent interruption of atrioventricular conduction by fulguration (n = 65) or radiofrequency energy (n = 13) or by an association of the two methods (n = 7).

[Value of permanent cardiac pacing in hypertrophic and obstructive cardiomyopathies resistant to medical treatment].

The authors report their experience of long-term dual-chamber pacing in the treatment of hypertrophic and obstructive cardiomyopathy. Between August 1990 and March 1993, 16 patients (8 men, average age 53.5 +/- 18.

[Left-sided His bundle ablation after failure of right-sided approach: technique and initial results].

Although interruption of atrioventricular conduction has been widely used over the last decade in patients with supraventricular arrhythmias and rapid conduction resistant to antiarrhythmic therapy, the incidence of atrioventricular block obtained by delivering the energy at the tricuspid ring ranges from 45 to 92%. Failure of this technique is usually related to the inhability to record endocavitary electrogrammes compatible with probable success by the right-sided approach. The authors report four cases of interruption of atrioventricular conduction in 4 men (average age 61.

[Implantable defibrillator using epicardial and endocardial leads. Results of 36 implantations].

The authors report their experience of implantable defibrillators over a 5 year period. Between February 1988 and July 1992, 36 patients (25 men, 11 women, average age 51 +/- 11 years, range 18 +/- 71 years) underwent implantation of an automatic defibrillator with epicardial (n = 13, Group I) or endocardial leads (n = 23, Group II) without patch electrodes (n = 7), with subcutaneous patch electrodes (n = 12) or epicardial patch electrodes (n = 4). Three serious early complications were observed: 2 cardiogenic shocks in Group I, one of which died on Day 1 and one case of infection which required explanation of the defibrillator on Day 23 in Group II.

[Irreversible auriculo-ventricular block of viral origin].

Transitory disturbances of atrioventricular conduction are an usual feature of the acute phase of viral myocarditis. In contrast, the onset of complete heart block is rarer. The authors report a case of permanent heart block of progressive onset in a context of infectious mononucleosis in a 29-year-old male, requiring fitting with a permanent pacemaker.

Electronic article surveillance: a possible danger for pacemaker patients.

In order to evaluate if antitheft devices commonly designed as electronic article surveillance (EAS) systems can be dangerous for pacemaker patients, in vitro and in vivo studies were made in close cooperation between a pacemaker center and an EAS designer. Three types of EAS radiation including radiofrequency, magnetic, and pulsed electromagnetic fields were applied to various pacemakers. The in vitro study consisted of exposing to the EAS fields 28 pacemakers connected to unipolar leads.

[Rate-responsive cardiac pacing].

The term "synchronous pacemaker (SPM)" is used to describe all pacemakers of which the frequency can be accelerated by means of a sensor other than the sinus node. The most commonly used system is the detection of changes in physical activity by means of a quartz crystal included in the casing. Changes in respiratory volume, the respiratory rate, the QT interval or central temperature have been less successfully used.

[Cardiac stimulation in children. 20 years' experience].

Between July, 1967 and December, 1987, 71 children and adolescents (43 boys, 28 girls) aged from 9 days to 20 years (mean 7.8 years) underwent pacemaker implantation. In 91 p.