1,721,453 research outputs found
Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation
No full textTo the Editor: Pluymaekers et al. (April 18 issue)(1) evaluated the occurrence of spontaneous cardioversion in patients with recent-onset (<36 hours) atrial fibrillation. The proposed wait-and-see approach included cardioversion within 48 hours in the absence of spontaneous resumption of sinus rhythm, and delayed cardioversion was actually necessary in 28% of the patients randomly assigned to this strategy. We think that the idea of waiting for spontaneous cardioversion of atrial fibrillation is interesting, but for practical reasons, better patient targeting would be required. In two previous prospective, randomized trials, we found that in patients with recent-onset atrial fibrillation, spontaneous cardioversion can . .
Phrenic stimulation management in CRT patients: are we there yet?
No full textPURPOSE OF REVIEW:
Phrenic stimulation may hinder left-ventricular (LV) stimulation and prevent cardiac resynchronization therapy (CRT) delivery. We reviewed the literature to address its prevalence and clinical implications in CRT patients.
RECENT FINDINGS:
Phrenic stimulation prevalence ranges from 20 to 33% of patients when a posterolateral LV lead placement is aimed. False-negatives are common during implantation, sensitivity being about 60-80%. Symptoms may dictate repositioning the LV lead, meaning risk of lead dislodgement, decreased CRT efficacy, or high LV threshold. CRT turn-off occurred in 2% of patients because of refractory phrenic stimulation. Several strategies have been used to manage phrenic stimulation: whereas lead repositioning was the only one available in early CRT experience, the use of bipolar/multipolar leads combined with cathode programmability enabling several pacing configurations has made possible targeting the optimal LV pacing sites in nearly all patients.Despite technological improvements, phrenic stimulation symptoms are sporadically reported by 6-8% of patients at follow-up, meaning that there is still an unmet need to address this problem.
SUMMARY:
Phrenic stimulation needs to be carefully managed at implantation and follow-up. Use of bipolar/multipolar leads and of multiple pacing configurations is mandatory to increase the chances of managing phrenic stimulation. Active fixation LV leads, hopefully bipolar, could further increase the success rate
Transvenous cardioverter-defibrillator implantation in a patient with tricuspid mechanical prosthesis
No full textBackground. A 64-year-old woman was referred to our center because of poorly tolerated ventricular tachycardia (VT) at 210 bpm due to an old myocardial infarction. The patient had been operated on at age of 20 for mitral valve commissurolysis, at age of 49 for ductal carcinoma, at age of 56 for mitral valve replacement, and at age of 61 for tricuspid valve replacement. Left ventricular EF was 31%. The patient was in permanent atrial fibrillation (AF) since the age of 53. She had undergone three cardiac surgery procedures, ending with two prosthetic mechanical valves. The cardiac surgery team advised against an epicardial ICD implantation. Results. We achieved a fully transvenous implant, with a screw-in defibrillation coil in the low right atrium and a bipolar pacing/sensing lead in a posterolateral branch of the coronary sinus. Pacing/sensing parameters were reliable, and effective defibrillation occurred at 20 J by a stepdown protocol. During 16-month follow-up, three VT episodes at 210 bpm were terminated by antitachycardia pacing (ATP) therapy. Left ventricular pacing/sensing was stable at long term. Conclusion. Thanks to technologic improvements, transvenous ICD implantation is feasible and safe in patients with a tricuspid mechanical prosthesi
Left ventricular pacing rate lower than expected during manual pacing threshold test in a biventricular defibrillator.
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Atrial fibrillation: it is better to be alone than in bad company!
No full textComment on:
Potpara TS, Stankovic GR, Beleslin BD, Polovina MM, Marinkovic JM, Ostojic MC, Lip GY
A 12-year follow-up study of patients with newly diagnosed lone atrial fibrillation: implications of arrhythmia progression on prognosis: the Belgrade Atrial Fibrillation study.
Chest. 2012 Feb;141(2):339-47.
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Uneventful right ventricular perforation with displacement of a pacing lead into the left thorax.
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