scholarly journals A case report of inappropriate inhibition of ventricular pacing due to a unique pacemaker electrogram storage feature

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Habib R Khan ◽  
William K Chan ◽  
Juliana Kanawati ◽  
Raymond Yee
Keyword(s):  
Rare Case ◽  
Storage Capacitor ◽  
Ventricular Pacing ◽  
Dual Chamber ◽  
Holter Monitor ◽  
Case Summary ◽  
Ventricular Lead ◽  
Internal Function ◽  
Third Degree Atrioventricular Block

Abstract Background Modern permanent pacemakers (PPMs) have individual features designed to identify cardiac rhythm abnormalities and improve their performance. Inappropriate pacing inhibition may be an undesired outcome from these features and cause symptoms in patients who require frequent pacing, leading to dizziness, and syncope. Inappropriate inhibition can be difficult to identify in circumstances that are intermittent and difficult to reproduce. Case summary A 57-year-old female underwent a mitral valve replacement (MVR) for severe mitral stenosis. One month following MVR, she presented with symptomatic third-degree atrioventricular block, and a dual-chamber PPM (Advisa™, Medtronic, Minneapolis, USA) was implanted and programmed DDD 50–130 b.p.m. At the 3-month follow-up, she reported frequent episodes of lightheadedness. She was found to have intermittent ventricular pacing inhibition on a 48-h Holter monitor due to an internal function of the Advisa™ series of PPMs that attempts to store an electrogram (EGM) every 1 h and 30 s. During the EGM storage, an amplified signal from the storage capacitor can result in oversensing by the ventricular channel and inappropriate pacing inhibition. Discussion To rectify the issue, the ventricular lead sensitivity value was increased from 0.9 mV to 1.2 mV. No instances of inappropriate ventricular pacing inhibition were noted on follow-up. To our knowledge, this is a rare case of inappropriate ventricular pacing inhibition caused by a combination of PPM self-adjusting sensitivity algorithm and oversensing every 1 h and 30 s from an amplified storage capacitor. Physicians should be aware of this possible complication and differentiate it from device or lead malfunction.

Twiddler’s syndrome with occult lead insulation damage in a child with epicardial pacemaker leads

2020 ◽  
Vol 30 (6) ◽  
pp. 890-891
Author(s):  
Peter Kramer ◽  
Felix Berger ◽  
Björn Peters
Keyword(s):  
Rare Case ◽  
Pacemaker Lead ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Ventricular Lead ◽  
Insulation Defect ◽  
Pacemaker Leads ◽  
Twiddler’S Syndrome ◽  
Lead Testing

AbstractWe present a rare case of incidentally diagnosed Twiddler’s syndrome in a child 7 years after implantation of a dual-chamber pacemaker system with epicardial leads. During revision, an insulation defect of the ventricular lead was evident, despite unremarkable prior pacemaker lead testing. The lead was repaired and a new generator was suture-fixated to prevent re-occurrence of generator manipulation.

scholarly journals A case of cardiac strangulation following epicardial pacemaker implantation

2020 ◽  
Vol 68 (12) ◽  
pp. 1499-1502
Author(s):  
Chihiro Miyagi ◽  
Yoshie Ochiai ◽  
Yusuke Ando ◽  
Manabu Hisahara ◽  
Hironori Baba ◽  
...  
Keyword(s):  
Pulmonary Stenosis ◽  
Pacemaker Implantation ◽  
Complete Atrioventricular Block ◽  
Dual Chamber ◽  
Congenital Complete Atrioventricular Block ◽  
Ventricular Lead ◽  
Cardiac Silhouette ◽  
The Right ◽  
Complete Atrioventricular

AbstractAn 8-year-old boy had undergone permanent epicardial pacemaker implantation with a Y-shaped bipolar ventricular lead on day 6 after birth for treatment of congenital complete atrioventricular block. He was found to have pulmonary stenosis and mitral stenosis by follow-up echocardiography. Further studies including computed tomography and cardiac catheterization revealed that the pacemaker lead had completely encircled the cardiac silhouette and was in a state of “cardiac strangulation”. We removed the previous pacing leads and generator and implanted a new epicardial dual-chamber pacing system in the right atrium and right ventricle. Additionally, an expanded polytetrafluoroethylene sheet was placed between the new leads and the heart to prevent recurrence of cardiac strangulation.

scholarly journals Long-term follow-up of heart transplant patients treated with permanent pacemaker: a monocentric study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
L Tua ◽  
A Turco ◽  
M Acquaro ◽  
L Scelsi ◽  
A Greco ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Left Ventricular ◽  
Permanent Pacemaker ◽  
Ventricular Pacing ◽  
Long Term Outcomes ◽  
Dual Chamber ◽  
Single Chamber ◽  
Long Term Follow Up

Abstract Funding Acknowledgements Type of funding sources: None. Background and purpose Permanent pacemaker implantation (PPMi) is needed in about 5% of patients following heart transplant (HTx) primarily due to sinus node dysfunction (SND), which commonly occurs in an early phase, or to atrio-ventricular block (ABV), which is common later on. Currently, data on rate of ventricular pacing (VP) is lacking and little is known on long-term outcomes after PPMi. Methods This was a retrospective, monocentric study. Among 1123 patients treated with HTx, all with biatrial technique, from november 1985 to march 2019 at our institution, 61 (5.4%) patients needed PPMi. PM parameters, clinical and echocardiographic data were collected at 1 month and at 1-3-5-10 years follow-up. The primary aim was to analyse the percentage of right ventricular pacing in the overall population and in subgroups stratified by the timing of PPMi and by pacing indication. Secondary endpoints were to analyze long-term outcomes according to the percentage of ventricular pacing and to the type of implanted PM (single vs. dual chamber).  Results Among patients treated with PPMi (68.9% single-chamber), 62.2% were implanted for SND and 36% for AVB. Early PPMi (< 3 months after HTx), occurred in 34.4% of patients, mainly due to SND, while late PPMi (> 3 months after HTx) occurred in 65,6% with an equal distribution between SND and AVB. Median follow-up time from HTx was 140 months and 82 months from PPMi. Overall mean rate of VP was 21%. Rate of VP was higher in patients implanted early rather than late after HTx, both at 1 month (91% vs 2%, P = 0,002) and at 1 year after the procedure (43 vs 1, P = 0,037). Patients with AVB had a greater rate of VP compared to those implanted for SND, irrespective of timing of implantation and these findings were still present at 3 and 5 years follow-up (62 vs 1%, P = 0,011 at 3 years and 80 vs 6%, P = 0,002 at 5 years). VP declined progressively after PPM implantation. No differences were observed in terms of 10-years mortality between early vs late PPMi, dual vs single-chamber and mean VP > 21% vs ≤ 21%. Conclusions Patients treated with PPMi after HTx show on average low percentage of VP over long-term follow-up. AV block indication and early implantation are associated with a higher percentage of VP. The rate of VP, the timing of PPMi and the use of single vs dual chamber PM do not affect overall prognosis or left ventricular systolic function. Our data may justify implantation of a single-chamber PPM, which bears less complications and procedural time, in the majority of HTx patients needing PPMi.

Abstract 12776: Long Term Mortality With Right Ventricular Apical Versus Septal Pacing

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Chance M Witt ◽  
Charles J Lenz ◽  
Henry H Shih ◽  
Elisa Ebrille ◽  
Andrew N Rosenbaum ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Pacemaker Implantation ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Lead Position ◽  
Ventricular Lead ◽  
Significant Difference ◽  
Long Term Mortality

Introduction: Right ventricular apical (RVA) pacing appears to have detrimental effects on cardiac function and long term outcomes. Right ventricular non-apical (RVNA) pacing, especially in the septal position, has been postulated as an alternative that may lead to less morbidity and mortality. Prior studies have shown conflicting results and been limited by small numbers and short follow-up. We aimed to determine if right ventricular septal lead position was associated with a reduction in long-term mortality compared to RVA lead position. Methods: Patients who underwent dual-chamber pacemaker implantation from 2004 through 2013 were evaluated for right ventricular lead position based on chest radiographs. Lead positions were divided in to apical or non-apical. Non-apical lead positions were subdivided to isolate a septal lead position group. Mortality was compared between these groups. Results: During the study period, 3456 patients underwent dual-chamber pacemaker placement and had images appropriate for lead position evaluation. The group was 53.5% male with a mean age of 74 ± 13 years. RVNA lead position was found in 976 (28.2%) patients, including 243 (7.0%) with a septal position. There was no significant difference in age or prior heart failure diagnosis between groups. Kaplan-Meier survival analysis did not reveal a significant difference in mortality between patients with RVA versus RVNA lead position during 5 year follow-up (p = 0.82). However, septal lead position was associated with a significantly lower mortality compared with RVA position (p = 0.03) (figure). Conclusions: Right ventricular septal lead position is associated with a lower long-term mortality than RVA lead position. This has substantial implications regarding the preferred site for ventricular pacing lead placement.

scholarly journals Case Report: A Rare Case of Nasal Forehead Mass in Kimura's Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
He Zhao ◽  
Zhi-wei Cao ◽  
Zhao-wei Gu
Keyword(s):  
Rare Case ◽  
Systemic Treatment ◽  
Good Prognosis ◽  
Kimura’S Disease ◽  
Immune Disease ◽  
Local Hospital ◽  
Case Summary ◽  
Second Resection ◽  
Painless Mass

Background: Kimura's disease is a rheumatic immune disease and head and neck lymph nodes are often involved. A mass occurring in the nasal forehead is rare. Good prognosis after surgical resection by glucocorticoid therapy is more rare.Case Summary: We report the rare case of a nasal forehead mass in a 45-year-old male patient with Kimura's disease. The patient underwent resection of the mass in October 2018 in a local hospital and the postoperative pathology was unclear. He then underwent a second resection in our department in December 2019 mainly because growth of the mass was affecting his appearance. Postoperative pathology confirmed that the patient had Kimura's disease, and he accepted systemic treatment with prednisone. We followed the patient for 10 months after surgery. He is now recovering well and continues to be closely monitored during follow-up.Conclusion: It is rare that the painless mass in the nasal forehead is diagnosed as a Kimura's disease.After completely resection of the mass and systemic treatment with prednisone, the patient had a good outcome. We provide experience for the treatment of Kimura's disease in nasal forehead.

scholarly journals A life-threatening spontaneous ascending aortic rupture due to a small penetrating aortic ulcer

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110377
Author(s):  
Yasuhito Nakamura ◽  
Kiyoshi Doi ◽  
Syojiro Yamaguchi ◽  
Etsuji Umeda ◽  
Osamu Sakai ◽  
...  
Keyword(s):  
Rare Case ◽  
Aortic Wall ◽  
Aortic Rupture ◽  
Ascending Aorta ◽  
Bleeding Site ◽  
Penetrating Aortic Ulcer ◽  
Postoperative Course ◽  
Life Threatening ◽  
Aortic Dissections

We reported a rare case of spontaneous frank rupture of a small (4 mm) penetrating aortic ulcer in the ascending aorta resulted in catastrophic bleeding. The ulcer only created a pinhole wound in the adventitia without saccular aneurysms, intramural hematomas, or aortic dissections. Notably, the wound could be directly closed because the aortic wall was intact only 5 mm away from the bleeding site. The postoperative course was uneventful, and the patient was discharged on the 11th postoperative day. After 8 months, follow-up computed tomography showed no abnormality of the aortic wall at the repair site.

A rare case of hypokalaemia and hypophosphataemia secondary to geophagia

2021 ◽  
Vol 14 (5) ◽  
pp. e239322
Author(s):  
Charmaine Schmidt ◽  
Jonathan Oxley Oxland ◽  
Robert Freercks
Keyword(s):  
Creatine Kinase ◽  
Iron Deficiency ◽  
Phosphate Binder ◽  
Rare Case ◽  
Potassium Level ◽  
Serum Potassium Level ◽  
Electrolyte Abnormality ◽  
Distal Muscle

We report a case of severe hypokalaemia and moderate hypophosphataemia from clay ingestion. A 60-year-old woman presented with flaccid paralysis. Investigations revealed a serum potassium level of 1.8 mmol/L, phosphate level of 0.56 mmol/L and creatine kinase level of 30 747 IU/L. She had marked proximal and distal muscle weakness due to severe hypokalaemia and concurrent hypophosphataemia, which likely contributed to the onset of rhabdomyolysis. The patient subsequently admitted to significant pica, most likely secondary to an associated iron deficiency. We conclude that the ingested clay acted as a potassium and phosphate binder. Although we did not investigate the content of the clay in this case, it has been reported that clay can bind potassium in vitro and is rich in minerals such as aluminium that could play a role in the binding of phosphate, although the exact mechanism remains unclear. The patient recovered fully and outpatient follow-up at 6 months and again at 40 months confirmed no electrolyte abnormality, myopathy nor any further geophagia.

Sign in / Sign up

Export Citation Format

Share Document