Risk Mitigation of Pacemaker Pocket Erosion in Thin Patients.

The aging population, particularly the thin and frail, has an increased risk of long-term cardiac implantable electronic device complications. This case is that of an elderly, thin-skinned patient who presented with a pacemaker pocket erosion 4 years after elective generator change, potentiated by a small pocket size with a superficial suture fixating the generator in the subcutaneous pocket. The risk for device erosion may have been mitigated during the generator change by increasing the size of the pocket, using a submuscular pocket, and potentially an absorbable antibacterial envelope.

Quality of Life and Health Care Utilization in the CIRCA-DOSE Study.

Objectives: This study evaluated the impact of contact force-guided radiofrequency ablation versus cryoballoon ablation on quality of life and health care utilization.

Background: Traditional outcome parameters, such as arrhythmia-free survival, are insufficient to evaluate the clinical impact of atrial fibrillation (AF), as it fails to the capture patient- and health system-level differences in treatment approaches.

Methods: The CIRCA-DOSE (Cryoballoon Vs.

Clinical assessment of AF pattern is poorly correlated with AF burden and post ablation outcomes: A CIRCA-DOSE sub-study.

Background: Contemporary guidelines recommend that atrial fibrillation (AF) be classified into paroxysmal and persistent AF based on clinical assessment, with these categorizations forming the basis of therapeutic recommendations. While pragmatic, clinical assessment may introduce misclassification errors, which may impact treatment decisions. We sought to determine the relationship between AF classification, baseline AF burden, and post-ablation arrhythmia outcomes.

Evaluation of common suturing techniques to secure implantable cardiac electronic device leads: Which strategy best reduces the lead dislodgement risk?

Implantable cardiac electronic device lead dislodgment is a relatively common complication and carries significant comorbidities. A potential cause of lead dislodgement includes inadequate anchoring along the lead suture sleeve at the venous insertion site. We assessed which of the 3 commonly applied knot-tying techniques results in the most effective anchoring of a pacing lead along its suture sleeve, which could be associated with minimized lead motion postimplant.

The use of dronedarone for recurrent ventricular tachycardia: a case report and review of the literature.

Background: Dronedarone is a benzofuran derivative resembling amiodarone that was intended to reduce the iodine-associated tissue deposition and organ toxicity seen with the latter. The utility of dronedarone for patients with ventricular arrhythmias has not been thoroughly evaluated. We present our experience with its use to treat refractory ventricular tachycardia storm and review the literature.

Troubleshooting during a challenging high-risk pacemaker lead extraction: a case report and review of the literature.

Background: The use of cardiac implantable electrical devices continues to increase with the validation of new beneficial indications. While the risks of device implantation decreased significantly over time, significant risk remains associated with their extraction when indicated. A high-risk pacemaker lead extraction case is described, wherein a chronically implanted lead that had perforated the right atrium was successfully removed without the need for cardiopulmonary bypass.

The utility of pocket-sized echocardiography to assess left ventricular systolic function prior to permanent pacemaker implantation.

Background: A subset of patients receiving first-time permanent pacemakers (PPM) may also benefit from an implantable cardioverter defibrillator (ICD) based on the presence of left ventricular systolic dysfunction (LVSD). Routine screening using pocket-sized echocardiography (PSE) may be useful in identifying such patients.

Objective: To determine whether PSE can be used by an inexperienced sonographer to adequately screen for LVSD in a patient population receiving a first-time PPM.

Getting by with less - the "frugal tie".

The ability to tie surgical knots efficiently and effectively is an essential surgical skill for medical procedures, especially pacemaker implantation. Device generators and their leads need to be safely anchored with sutures during implantation to prevent dislodgement and inadequate packaging in the pacemaker pocket. With most knot tying techniques, a generous amount of suture slack is required.

Non-invasive bedside assessment of central venous pressure: scanning into the future.

Background: Noninvasive evaluation of central venous pressure (CVP) can be achieved by assessing the Jugular Venous Pressure (JVP), Peripheral Venous Collapse (PVC), and ultrasound visualization of the inferior vena cava. The relative accuracy of these techniques compared to one another and their application by trainees of varying experience remains uncertain. We compare the application and utility of the JVP, PVC, and handheld Mini Echo amongst trainees of varying experience including a medical student, internal medicine resident, and cardiology fellow.

Absent right and persistent left superior vena cava: troubleshooting during a challenging pacemaker implant: a case report.

Background: Venous anomalies of the thorax can occur in isolation or in association with complex congenital heart disease. The incidence of an absent right superior vena cava in the setting of a persistent left superior vena cava is very rare in the general population with only a dozen cases documented in the medical literature. Such venous anomalies can make for very challenging electronic cardiac device implantation.

Eosinophilic myocarditis: two case reports and review of the literature.

Background: Eosinophilic myocarditis is a rare and often under-diagnosed subtype of myocarditis with only around 30 cases published in the medical literature. In this article we present two patients with eosinophilic myocarditis with the aim to demonstrate the often elusive nature of the disease and present the current scientific literature on this topic.

Case Presentation: A 76 years old Caucasian gentleman and a 36 years old Aboriginal gentleman both presenting with heart failure symptoms were eventually diagnosed with eosinophilic myocarditis after extensive evaluation.

Successful ablation of idiopathic left ventricular tachycardia in an adult patient during extracorporeal membrane oxygenation treatment.

Idiopathic ventricular tachycardia (VT) is usually a benign arrhythmia with good prognosis that can be managed with antiarrhythmic agents and is often cured using ablation. There is, however, a malignant potential in a subset of patients with idiopathic VT as was the case for our patient whom we discuss in this case report. After a review of the medical literature, and to our knowledge, this is the first case of a successful idiopathic VT ablation in an adult while extracorporeal membrane oxygenation was being used.

Reduced hospitalizations in severe, refractory congestive heart failure with peritoneal dialysis: a consecutive case series.

Background: Peritoneal dialysis (PD) for long-term management of diuretic resistant volume overload in heart failure (HF) may provide potential benefit with few adverse consequences. We examined the impact of PD on clinical status hospitalizations, and complications of therapy in severe end-stage HF.

Methods: A consecutive case series of 10 transplant ineligible patients receiving PD solely for HF volume management between 2007 and 2011 was evaluated with clinical data reviewed pre- and post-PD initiation.

Cardiac lipofibromatosis.

We present a case of cardiac lipofibromatosis associated with atrial fibrillation and complete heart block requiring permanent pacemaker implantation. Multimodality cardiac imaging including transthoracic echocardiography and cardiac magnetic resonance were useful for tissue characterization of this rare cardiac diagnosis.

Integrative approach to quality assessment of medical journals using impact factor, eigenfactor, and article influence scores.

Background: Impact factor (IF) is a commonly used surrogate for assessing the scientific quality of journals and articles. There is growing discontent in the medical community with the use of this quality assessment tool because of its many inherent limitations. To help address such concerns, Eigenfactor (ES) and Article Influence scores (AIS) have been devised to assess scientific impact of journals.

Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and metaanalysis.

Background: Nearly 30% of all exacerbations of COPD do not have a clear etiology. Although pulmonary embolism (PE) can exacerbate respiratory symptoms such as dyspnea and chest pain, and COPD patients are at a high risk for PE due to a variety of factors including limited mobility, inflammation, and comorbidities, the prevalence of PE during exacerbations is uncertain.

Methods: A systematic review of the literature was performed to determine the reported prevalence of PE in acute exacerbations of COPD in patients who did and did not require hospitalization.

The prevalence and reliability of visibility aid and other risk factor data for uninjured cyclists and pedestrians in Edmonton, Alberta, Canada.

This study was conducted to determine the prevalence and reliability of risk factors collected on uninjured cyclists-pedestrians in Edmonton, Alberta, and what characteristics predict cyclist-pedestrian visibility. At randomly selected locations from July 2004 to August 2004, two independent observers recorded cyclist-pedestrian characteristics such as age, sex, clothing color, use of reflectors, flags, helmets, and a subjective impression of visibility. Data were collected on 836 individuals; most were either walking/jogging (approximately 63%) or cycling (approximately 33%).