Early pacemaker twiddler syndrome.

Twiddler's syndrome is a well-known complication of pacemaker treatment. It was first described by Bayliss et al. when a patient manipulated and rotated the pulse generator in the pocket so many turns that it resulted in lead dislodgment, diaphragmatic stimulation and loss of capture.

Alternative to the transvenous approach in pediatric pacing - long-term experiences with bipolar epicardial pacing leads.

Cardiovascular anatomy and limited venous access may preclude the implantation of endocardial pacing systems in children as well as adults with congenital heart disease. Thus, the implantation of myo/epicardial pacing leads is required in these patients. The less favorable long-term results experienced in the past with myocardial screw-in leads are often used to justify the transvenous approach whenever possible, even in infants.

Thin co-radial bipolar leads: technology and clinical performance.

While bipolar leads offer advantages such as better sensing performance than unipolar leads, their use has been limited by a larger lead diameter and reports about a high failure rate of several bipolar lead models. This has led to the development of thin bipolar leads using a special technology which aims at improving lead safety. Leads with monofilar thin conductors (drawn filled tube) which are individually coated with a very resistant material (ETFE) have been developed.

[Atrial fibrillation--new knowledge yields new therapeutic possibilities].

Atrial fibrillation (AF) is the most common cardiac arrhythmia prompting treatment. Advances in our knowledge of the pathophysiology of AF provide the basis for new and improved treatment modalities. Thus, focal excitation and localised impulse conduction defects are possible trigger factors which can be counteracted by focal ablation and pacing synchronisation, respectively.

The patient alert system--pilot study of built-in warning systems for pacemakers.

Malfunction of a pacing system can be life-threatening for a pacemaker-dependent patient. It would be desirable for implantable pulse generators to have a built-in automatic warning system capable of alerting the patient as soon as a potentially dangerous disorder is detected. In this study, seven patients (mean age, 72.