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A Case of Bilaterally Inaccessible Subclavian Veins.

Cureus

November 2024

Cardiac Intensive Care Unit, Open Heart, Tbilisi, GEO.

Article Synopsis
  • A 69-year-old woman with a history of heart issues was scheduled for a cardioverter-defibrillator implantation, but faced complications during the procedure.
  • The procedure was complicated by a thrombus obstruction in the left subclavian vein and an acute angling issue in the right subclavian vein, making it difficult to place the leads.
  • This case highlights the need for thorough preoperative planning and consideration of alternative strategies when dealing with complex vascular anatomies.
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Article Synopsis
  • * A case study is presented involving a 68-year-old woman with hippocampal sclerosis who experienced IA and mesial temporal lobe epilepsy.
  • * There's limited evidence linking IB/IA to sudden unexpected death in epilepsy, and pacemaker treatment is not commonly used; the focus of care is primarily on reducing seizures and preventing falls.
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Article Synopsis
  • The study investigates the incidence, mechanisms, and predictors of sudden death (SD) in patients with cardiac amyloidosis, a serious heart condition.
  • It analyzed data from 784 patients with either ATTR or AL cardiac amyloidosis, finding that SD is more common in AL patients compared to those with ATTR.
  • Key risk factors for SD include previous pacemaker implantation for ATTR patients and the use of beta-blockers and advanced heart failure symptoms (NYHA III-IV) for AL patients.
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Background and objectives Leadless pacemakers, known for their safer clinical profile, offer significant advantages for elderly patients at a higher risk of complications associated with transvenous pacemaker procedures, particularly those susceptible to high-risk bleeding and infections related to cardiac implantable electronic device interventions. This study explores an alternative use of leadless pacemakers without removing existing transvenous systems, deviating from conventional generator replacement and lead re-interventions. Methods This study was conducted with full approval from the Institutional Review Board, Medical Ethical Committee, Centro Hospitalar Conde São Januário, Macau.

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