Dorsal spinal cord injury as a cause of recurrent asystole requiring permanent cardiac pacing.

Numerous unusual causes of atrioventricular block (AVB) with cardiac pacemaker implantation have been documented including cough, deglutition, or other vagally mediated mechanism. In spinal cord lesions, only high cervical spinal cord lesion has been reported as a cause of severe bradycardia. We report a case with not cervical but dorsal vertebral trauma and persistent paroxysmal AVB requiring cardiac pacemaker implantation.

Effects of hyperbaric exposures on cardiac pacemakers.

Data on tolerance of cardiac pacemakers during diving are very scarce. The aim of this study was to test electronic and mechanical tolerances of pacemakers exposed to experimental reproductions of pressures encountered during diving. Two samples each of 20 different models of cardiac pacemakers were exposed to compression during continuous telemetric monitoring.

Right atrial sensing for VDD pacing through a persistent left superior vena cava.

This report describes a pacing lead insertion through a persistent left superior vena cava in the VDD pacing mode, with a large retrograde lead course allowing the optimal positioning of the sensing electrodes in the right atrium.

Intra-atrial thrombosis and pulmonary embolism complicating pacemaker leads for cardiac resynchronization therapy.

This is the first report of intracardiac thrombi and pulmonary embolism complicating pacemaker leads implanted for cardiac resynchronization therapy. Prompt diagnosis and successful therapy with a thrombolytic agent lead to a favourable outcome. This report suggests that long-term oral anticoagulation should be considered in patients with depressed left ventricular function undergoing cardiac resynchronization therapy in order to prevent this potentially serious complication.

[Interferences and cardiac pacemakers--defibrillators. Results of in vivo experiments and radio frequencies].

Interference with cardiac pacemakers and defibrillators by cellular phone and electronic article surveillance systems is shown in experimental studies with disparate findings. Interaction occurrence in real life is a convincing but rare experience. Device model, distance, power output and technology of the source are different and sometimes uncontrollable factors.

Pocket infection complicating inadvertent transarterial permanent pacing. Successful percutaneous explantation.

This report describes a patient admitted for the treatment of a pocket infection occurring 5 months after a dual chamber pacemaker implantation. The ventricular lead had been inadvertently placed into the left ventricle through the arterial system. After careful examination using transesophageal echocardiography and left heart angiogram, successful percutaneous extraction was performed without complication.

[Heart perforation following transvenous implantation of a cardiac pacemaker].

Objectives: We studied the incidence, clinical signs and severity of heart perforations occurring after transvenous pacemaker implantation.

Patients And Methods: A series of 16 consecutive cases of heart perforation observed in one cardiac pacing unit from 1989 to 1998 were reviewed.

Results: Heart perforation occurred after implantation in 9 cases; the verall incidence for all lead implantation was 0.

[Utilization of transcutaneous anesthetics during heart catheterization].

Objectives: Assess the efficacy of an anesthetic cream for cardiac catheterization.

Patients And Methods: Percutaneous anesthesia was studied in a series of 100 consecutive patients undergoing cardiac catheterization. The anesthesia was composed with an eutetic mixture of local anesthetics and applied precisely over the puncture area in a randomized controlled study.

Low-energy cardioversion of spontaneous atrial fibrillation. Immediate and long-term results.

Background: Recent studies have suggested that induced atrial fibrillation (AF) could be successfully terminated by using a two-catheter electrode system and low energy (< 400 V). This study evaluated the efficacy and safety of low-energy cardioversion in spontaneous chronic and paroxysmal AF.

Methods And Results: Forty-two consecutive patients with spontaneous AF underwent low-energy electrical cardioversion.

Prospective assessment of the minimum energy needed for external electrical cardioversion of atrial fibrillation.

This study demonstrates that shocks <200 J often are effective for transthoracic cardioversion of atrial fibrillation (AF). Lower energy shocks are more likely to be effective when the AF is <24 hours in duration or in patients with idiopathic AF.

[Use of percutaneous anesthesia in cardiac pacemaker implantation].

Objectives: Assess the efficacy of an anesthesic cream for pacemaker implantations.

Methods: Percutaneous anesthesia was studied in a series of permanent pacemaker transvenous implantations. The anesthesic cream composed of a mixture of lidocaine and prilocaine was applied precisely over operative areas after marking the skin.

Intrapulmonary artery coiling of a permanent pacing lead.

Intrapulmonary artery displacement of a permanent ventricular lead is reported to be a severe form of lead coiling and is attributed to the failure of the fixation procedure. The lead instability indicated a need for surgical correction.

[Percutaneous venoplasty for the implantation of a dual-chamber cardiac pacemaker].

During reoperation for pacemaker implantation, venous catheterisation of the homolateral subclavian vein encountered obstruction at the brachiocephalic vein. Balloon angioplasty of the severe brachiocephalic stenosis was performed via the femoral vein. After repeat subclavian venous catheterisation two new pacing wires could be introduced without difficulty followed by active fixation in the atrium and passive fixation in the ventricular apex.

Noninvasive transcutaneous cardiac pacing: modern instrumentation and new perspectives.

Noninvasive transcutaneous cardiac pacing has evolved from a simple stand alone unit with no ventricular sensing to a complete cardiac arrest resuscitation system combining synchronous pacing and defibrillation capabilities and using a single set of multifunction electrodes. In current instrumentation, four configurations exist including stand alone unit, modular configuration, built-in monitor and recorder, and built-in monitor, recorder and defibrillator. In present day devices, ventricular sensing, extensive programmability, and large surface electrodes are general features.

[Thoracic transcutaneous cardiac pacing].

Transcutaneous cardiac pacing was abandoned when endocardial pacing was developed, but it has now come back, with a new methodology, in cardiological intensive care. Its safety and efficacy have been improved by 50 to 100 sq. cm electrodes, impulses of 20 to 40 ms duration and programmed energy.

[Then hemodynamic efficacy of transcutaneous cardiac stimulation].

Bradyarrhythmia or asystole is the most common rhythm disturbance with ventricular fibrillation and tachycardia, for 30-40% of patients admitted in intensive coronary care units. Already use in the therapy of bradyarrhythmia or asystole, as a method of emergency, immediately in place, the external pacing is very useful in an out of hospital therapy with personnel skilled in its use until the initiation of support therapy in coronary care units. Actually, with less significant side effects (no severe pain, no strong muscular contractions, no skin burns) and a best innocuity and tolerance based on the employment of larger adhesive pre-gelled patches, temporary transcutaneous cardiac stimulation is not only confined to unconscious patients but also in case of severe bradycardia, complete AV block in conscious patients.

Three-dimensional electrocardiography of cardiac pacing.

Electrocardiographic evaluation of modern pacing systems requires sustained documentation during iterative programming procedures, exercise testing or Holter monitoring. Documentation of a prolonged period of time in standard electrocardiography is based on horizontal compression. The value and limitations of a vertical compression with no change in horizontal chronology and waveform morphology are evaluated.

Left ventricular pressure measurement during noninvasive transcutaneous cardiac pacing.

In a pacemaker-dependent patient, the hemodynamic response during external transcutaneous and endocardial sequential pacing was evaluated by left ventricular pressure monitoring. A single ventricular pacing mode with hemodynamic effect of atrioventricular asynchrony was shown during external pacing.

[Angina accelerated under betablockers].

An observation of angina aggravated in a concomitant manner with the introduction of treatment with beta blockers is reported. The exacerbation of a vasospastic component with this treatment is evoked on clinical, electrical and coronarographic grounds.

[Symptomatology of hydatid cyst of the heart. Study of a continuous series of 13 cases and value of x-ray computed tomography].

Thirteen consecutive cases of cardiac hydatic cyst were studied. The cysts were usually multiple, predominantly left ventricular. There were two cases of rupture of left ventricular cysts with systemic embolism, and three ruptures of right ventricular cysts causing pulmonary embolism.

[Contribution of complementary examinations in the diagnosis and treatment of emboligenic cardiopathies. Retrospective study apropos of 46 cases].

The aim of this prospective study was to assess the value of complementary investigations in the diagnosis and follow-up of embolic heart disease. Forty-six patients having presented a systemic embolism cardiac origin underwent a standard work up which included clinical examination, ECG, chest X-ray and 2D echocardiography. Other investigations were carried out in some patients: CT cardiac scan (11 cases), gamma scintigraphy with Indium III labelled platelets (6 cases) and angiocardiography (12 cases).

[Parietal rupture of the heart in the acute phase of a postero-inferior myocardial infarction. Echocardiographic diagnosis, surgical cure].

A 58 year old patient with no previous cardiac history developed a postero-inferior myocardial infarction, complicated at the 6th hour by parietal rupture leading to acute tamponade. This was diagnosed by echocardiography which showed a compressive pericardial effusion containing large thrombi. Surgery under cardiopulmonary bypass was successful and led to good quality survival, maintained for over 6 months.