6 research outputs found
Trends In Permanent Pacemakers’ Implantation: Where Do We Stand?
No full textObjective: To determine the Trends In Permanent Pacemakers’ Implantation: Where Do We Stand?
Methodology: The study was conducted at cardiology department of Pakistan Institute of Medical Sciences, Islamabad. Study duration was two years from April 2010 to March 2018. In this study the retrospectively data was analyzed to see the trend in the rate of annual implantation of permanent pacemaker’s and patient’s demographics. Data for the study was extracted from the hospital records of cardiac devices implantation. All the information was recorded via study proforma. Analysis of the data was done by the SPSS version 20.
Results: Total 1670 procedure were analyzed retrospectively. Mean age of patients at the time of implantation was 60.47 ± 16.357 Std Deviation. Single chamber devices were 1030 and dual chambers pacemakers remained 535 in the study population. Complication rate remain 2.2% during the procedure. 62.8% devices were implanted on payment from patients and the rest 37.2% on donation from various resources. The trend of single and dual chamber devices remain constant in the study period. However dual chamber devices implantation ratio increased in 2017 due to donation of devices and government sponsorship scheme.
Conclusion: There is a significant increase in the implantation of cardiac devices, the trend closely follows the financial status of patients and the supply of devices from various donor agencies
Our Nuts and Bolts in The Permanent Pacemakers’ Explanation Techniques
No full textObjective: Our goal is to share our two decades of experience with implantable electrical device explanation at our electrophysiology centre at Hayat Abad Medical Complex in Peshawar.
Methodology: After baseline patient were brought nil by mouth to catheterization laboratory (Cath: lab). A temporary pacemaker (TPM) implanted for backup. In case of box change, a new device is attached after checking the integrity of the lead and device placed in the same pocket. But if of lead extraction was also needed, then stylet was put inside the lead and with twisting movement and mild traction the lead removed and new lead implanted with Seldinger,s technique, battery attached and wound closed in layers.
Results:Â Out of 1670, there were 1535 (91.9%) new implantations and 135 (8.08%) repeat procedures. The pulse generator was replaced without lead replacement in 59 (3.5%) patients. In 36 (2.15%) patients, the ventricular lead or atrial lead was successfully reposition. A total of 32 (1.9%) successful explanations were performed in the study period.
Conclusion: The explanation of devices like implantation needs special gadgets and training for the safe and successful procedure
Venous puncture in permanent pacemakers implantation, when easy become difficult
No full textObjective: To share our experience in the field of device implantation with particular emphasis on the venous punctures.Methodology: This study was conducted in Cardiology Department at Hayat Abad Medical Complex Peshawar. All those patients who presented to Cardiology department Hayat Abad Medical Complex Peshawar for implantation of permanent pacemakers due to any reason were brought to catheterization laboratory after explaining the procedure. Chest scrubbed and draped and after venogram of the desired side axillary vein was punctured by Seldinger technique and if there was failure to puncture the vein after a few attempts, the position of the vein reconfirmed with venogram and reattempted. In few cases vein used to change its path after the initial failed attempts. After venous access skin incision was made superolateral to the puncture side, pocket constructed and lead position and pulse generator attached and wound closed in layers.Results: A total of 484 pacemakers were implanted in the study period. Dual chamber pacemakers were 136 (28.09%) and single chamber pacemakers were 348 (71.90%). There were left sided persistent SVC in 2 cases and totally obstructed vein on both side in one patient. Procedure was shifted to right side in 10 patients due to unsuitable veins on left side. Vein change its tract in 07 cases.Conclusion: Sound anatomical understanding venous course is crucial for safe venous puncture and successful PPM implantation
Incidence of Radial Artery Loss Among Cases After Coronary Angiography
No full textObjective: To evaluate the incidence of radial artery loss among patients following coronary angiography.
Methodsology: A prospective cohort study was carried out at Cardiology Department of PIMS from January 2022 to December 2023. Patients aged 18 years old or above, both gender who were undergoing coronary angiography radial route for various indications in cardiac center at PIMS were included. All patients had radial artery cannulation with 6 French sheath. Patient who had only coronary angiography, their sheaths were removed just after completion of the procedure. Patients who had PCI their sheaths were removed after 4 hours of completion of procedure. Patients who had PCI were loaded with antiplatelet medications. Patients were followed in OPD after 2 to 3weeks. All of the information was entered and analyzed using SPSS version 26.
Results: Mean age of the patients was 56.52+10.69 years. Male were 70.3%, and females were 29.7%. Left radial artery was not palpable in 0.2% (1 patient). For the right radial artery, 10.3% had a non-palpable artery. Overall, this data indicates that 10.8% of the patients had a non-palpable right radial artery after the procedure. There was no significant association found of radial artery loss with age, gender, diabetes, hypertension and smoking history (p=>0.05), however its incidence observed significantly higher among patients who underwent PCI (p-0.001).
Conclusion: The incidence of asymptomatic complication of radial artery loss observed to the be 10.8% among patients undergoing coronary angiography via radial route. However, PCI was noted to be a significant predictor
Angiographic Severity of CAD in Diabetic Versus Non-Diabetic Patients Presenting with STEMI
No full textObjective: To determine the angiographic severity of CAD in diabetic versus non-diabetic patients undergoing primary PCI for STEMI.
Methodology: This cross-sectional observational study was carried out in the Cardiology unit of Hayatabad Medical Complex Peshawar from January, 2021 to August 2021. All patients undergoing primary PCI for STEMI at cardiology unit of HMC were included in the study after a thorough history, examination and informed consent. Patients were divided into two categories on the basis of diabetes status. Furthermore, patients were also classified on the basis of number of vessels with significant coronary stenosis. Continuous variables were described as means and standard deviations whereas categorical variables were described as frequencies and percentages. Chi-square test was applied to determine the significance of categorical variables.
Results: A total of 68 patients with a mean age of 52±4.5 years were included in the study. Of these, 49 were males and 27 patients had diabetes. In the diabetes group, 20 patients had a history of anterior wall MI whereas 19 patients had history of anterior wall MI in the non-diabetes group. Similarly, 15 patients in the diabetes group and 11 patients in the non-diabetes group had inferior wall MI (p: 0.095). Furthermore, the number of patients who had TVCAD, DVCAD and SVCAD in the diabetic group was 15, 5 and 7 compared to 7, 15 and 19 in the non-diabetic group respectively (X2=11.039, p:<0.01). Two patients in the diabetes group had stent thrombosis whereas only 1 patient had stent thrombosis in the non-diabetes group. One patient died in the cath lab in the diabetic group whereas there was no mortality in the non-diabetic group.
Conclusion: Diabetic patients presenting with STEMI is having more severe and extensive CAD during primary PCI as compared to non diabetic patients
Efficacy and safety of semaglutide in patients with heart failure with preserved ejection fraction and obesity.
No full textBACKGROUND: Semaglutide, a once-weekly glucagon-like peptide-1 receptor agonist, has shown promise in weight management and cardiovascular outcomes in other populations. This study aimed to evaluate the efficacy of semaglutide in heart failure with preserved ejection fraction (HFpEF) patients with obesity.
METHODS: A retrospective study analyzed 318 patients with HFpEF, of which 104 received semaglutide and 214 received placebo. Primary endpoints included evaluating changes in exercise capacity and weight management.
RESULTS: Semaglutide treatment led to significant improvements in the primary endpoints. Patients in the semaglutide group demonstrated substantial enhancements in exercise capacity, as measured by the 6-min walk distance, compared to the placebo group (mean difference 15.1 meters, 95% CI 5.8 to 24.4, p = 0.002). Additionally, semaglutide resulted in substantial weight loss compared to placebo (mean difference -2.9%, 95% CI -4.1--1.7, p = 0.001). Several secondary endpoints, including reductions in C-reactive protein levels and improvements in other clinical parameters, further supported the efficacy of semaglutide. Adverse events were generally well-tolerated, with no unexpected safety concerns.
CONCLUSION: Semaglutide demonstrated significant clinical benefits in HFpEF patients with obesity, as evidenced by improved symptoms, physical function, and weight reduction
