scholarly journals Gradually increasing impedance in patients with pacemakers and implantable defibrillators: a watchful waiting strategy

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Maass ◽  
M Klingenberg ◽  
HF Groenveld ◽  
BA Mulder ◽  
Y Blaauw ◽  
...  
Keyword(s):  
Watchful Waiting ◽  
Short Interval ◽  
Impedance Sensing ◽  
Funding Sources ◽  
Lead Fracture ◽  
Shock Impedance ◽  
Patient Database ◽  
Waiting Strategy ◽  
Watchful Waiting Strategy

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Pacing impedance measurements are important in the surveillance of pacemaker and implantable cardioverter/defibrillator (ICD) devices. Whereas sudden changes in impedances can reflect lead fracture or isolation defects, gradually increasing impedances are thought to occur because of calcifications at the endomyocardial interface. In many cases, these leads are replaced prophylactically but this has not been studied systematically. Purpose We aimed to identify the outcome of right ventricular (RV) electrodes with high impedances that were left active in this single center study. Methods All patients in the electronic patient database were screened for impedances >1200Ohms. 41,201 individual recordings led to 207 individual patients. 161 patients were excluded from the analysis due to sudden impedance increase, temporarily high impedances or wrong entry. Of the remaining 46 patients, baseline characteristics as well as pacing impedance, sensing values, pacing thresholds, and shock impedance in case of ICDs were recorded. Results There were 17 pacemaker and 29 ICD patients, 68 ± 15 years old, 70% were male. Glomerular filtration rate at baseline was 81 ± 22 ml/min/1.73m2. Baseline RV impedance was 597 ± 123Ohms. During follow-up impedances increased to 1875 ± 682Ohms (p < 0,001). Pacing thresholds increased from 0,6 ± 0,4V to 3,0 ± 1,9V (p < 0,001). Sensing remained stable. The median time from implant to  impedance rise >1000Ohms was 5,5 (3,4-7)years and median follow-up thereafter 2,4 years (1,2-4,2). During follow-up, no intervention was performed for 33 leads (72%). No events occurred. 13 leads (28%) were replaced , 9 prophylactically (mostly because of ICD advisory leads), 3 because of high pacing thresholds and high percentage pacing and one lead because of noise oversensing, probably unrelated as it occurred 7 years after impedance increase. Conclusions A watchful waiting strategy appears to be a safe option for patients with ICDs and pacemakers with low percentage pacing. As impedance increase cannot be used for surveillance for imminent lead fracture, other means such as short interval counts and non-sustained oversensing have to be employed and should be combined with remote monitoring.

1294: Watchful Waiting Strategy for Selected Patients with Renal Masses: Updated Results and Long-Term Follow Up

2007 ◽  
Vol 177 (4S) ◽  
pp. 426-426
Author(s):  
Tamer M. Abou Youssif ◽  
Waseem Kassouf ◽  
Jordan Steinberg ◽  
Armen Aprikian ◽  
Michael Laplante ◽  
...  
Keyword(s):  
Watchful Waiting ◽  
Renal Masses ◽  
Long Term Follow Up ◽  
Waiting Strategy ◽  
Watchful Waiting Strategy

scholarly journals A Case of Secondary Epiretinal Membrane Spontaneous Release

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Andrey N. Andreev ◽  
Alexey V. Bushuev ◽  
Sergey N. Svetozarskiy
Keyword(s):  
Visual Acuity ◽  
Epiretinal Membrane ◽  
Retinal Edema ◽  
Vein Occlusion ◽  
Case Summary ◽  
History Of ◽  
Waiting Strategy ◽  
Watchful Waiting Strategy ◽  
Retinal Photocoagulation

Purpose. To report a rare case of secondary epiretinal membrane (ERM) spontaneous separation with subsequent visual restoration. Case Summary. We are reporting a case with the history of branch retinal vein occlusion, peripheral retinal neovascularization, and retinal photocoagulation. Our examination revealed secondary ERM associated with relatively high visual acuity (0.6), and a watchful waiting strategy was chosen. During the follow-up, slight visual deterioration, progressive deformation of the retinal profile, and an increase in diffuse retinal edema were observed. No surgical or laser treatment was performed. On the next visit, the spontaneous ERM separation with residual parapapillary fixation, the increase in visual acuity (0.9), and the decrease in retinal thickness were revealed. Conclusion. Such cases present additional evidence to a deferral surgical strategy for the management of patients with ERM and relatively high visual acuity.

scholarly journals Postoperative Longitudinal Outcomes in Patients with Residual Disc Fragments after Percutaneous Endoscopic Lumbar Discectomy

2018 ◽  
Vol 1 (21;1) ◽  
pp. E457-E466
Author(s):  
Chi Heon Kim
Keyword(s):  
Study Design ◽  
Watchful Waiting ◽  
Lumbar Discectomy ◽  
Longitudinal Outcomes ◽  
Complete Group ◽  
Disc Tissue ◽  
Disc Material ◽  
Waiting Strategy ◽  
Endoscopic Lumbar Discectomy ◽  
Watchful Waiting Strategy

Background: Residual disc fragments are observed on immediate postoperative magnetic resonance imaging (MRI) in 2.8–15% of patients after percutaneous endoscopic lumbar discectomy (PELD). Considering the known postoperative longitudinal outcomes in patients with residual disc tissue, a ‘watchful waiting’ strategy may be preferable to immediate re-operation in patients with asymptomatic residual disc material. Objectives: The aim of the present study was to compare the longitudinal clinical outcomes between PELD patients in whom the complete removal of disc fragments was achieved (complete group) and those in whom residual disc fragments were observed on postoperative MRI (residual group). Study Design: Retrospective nested case-control study. Methods: A total of 225 patients were included (complete group, n=187 and residual group, n=38). Clinical assessments were performed using the visual analog pain score for the leg (VAS-L, x/10) and back (VAS-B, x/10) and the Korean version of the Oswestry Disability Index (K-ODI, x/45). A linear mixed-effects model was used to analyze changes during the first 24 postoperative months. Results: One month after surgery, significant improvements in the VAS-L, VAS-B and K-ODI values were observed and were maintained during the first 24 postoperative months. No differences in these changes were noted between the groups. Early reoperation (during the first 3 postoperative months) was performed in 3 patients in the residual group (7.9%) and in 4 patients in the complete group (2.1%) (P = 0.10). Limitations: First, the study design was retrospective. Moreover, the number of patients was relatively small and therefore insufficient to achieve robust statistical power. Second, we did not explore the radiological outcomes in patients with asymptomatic residual disc material because follow-up MRI was only obtained to document symptom recurrence. Conclusion: When residual disc tissue is observed in asymptomatic patients, a ‘watchful waiting’ strategy may be preferable to immediate re-operation. However, an increased early re-operation rate is expected for patients with residual disc tissue. Key words: Discectomy, endoscopes, longitudinal studies, patient-reported outcome, percutaneous, reoperation, spine, residual disc

scholarly journals Neck and supraclavicular lymphadenopathy secondary to 9-valent human papillomavirus vaccination

2019 ◽  
Vol 12 (11) ◽  
pp. e231582 ◽  
Author(s):  
Miguel Paiva Pereira ◽  
Pedro Flores ◽  
Ana Serrão Neto
Keyword(s):  
Human Papillomavirus ◽  
Watchful Waiting ◽  
Clinical Findings ◽  
Parental Anxiety ◽  
Human Papillomavirus Vaccination ◽  
Recent Infection ◽  
First Case ◽  
Minor Adverse Event ◽  
Waiting Strategy ◽  
Watchful Waiting Strategy

We present two clinical cases of lymphadenopathy after vaccination with the human papillomavirus (HPV) 9-valent vaccine: an asymptomatic 11-year-old boy with inferior cervical and supraclavicular lymphadenopathy, and a 13-year-old girl who presented with lymphadenopathy. In both cases, medical history was unremarkable and there was no recent infection, or other clinical findings. Both adolescents had received the HPV 9-valent vaccine in the previous week. In the first case, blood tests, ultrasonography and biopsy were performed, while in the second, a watchful waiting strategy was adopted. In both cases, the lymphadenopathy resolved spontaneously. The boy received the second dose of the vaccine 6 months later and lymphadenopathy reappeared. The Naranjo scale was applied, classifying the events as definite (in the case of the boy) and probable (girl) adverse drug reactions. The vaccine is safe, but recognising this minor adverse event is important to prevent unnecessary investigation and reduce patient and parental anxiety.

The Effect of Watchful Waiting on the Management and Treatment of Inguinal Hernias in a Community Setting

2015 ◽  
Vol 81 (3) ◽  
pp. 300-304 ◽  
Author(s):  
Zachary F. Williams ◽  
Alexa Mulrath ◽  
Ashley Adams ◽  
W. Borden Hooks ◽  
William W. Hope
Keyword(s):  
New England ◽  
Online Survey ◽  
Watchful Waiting ◽  
Community Setting ◽  
Electronic Survey ◽  
Inguinal Hernias ◽  
Asymptomatic Patients ◽  
Waiting Strategy ◽  
Watchful Waiting Strategy ◽  
Landmark Study

A landmark study by Fitzgibbons et al. reported the safety of watchful waiting in men with minimally symptomatic inguinal hernias. The extent to which this study has changed practice patterns is unknown. The purpose of our study was to survey physicians caring for patients with hernia in our community to determine if the Fitzgibbons report impacted their medical practices. We sent an electronic survey containing questions regarding physician background and familiarity with the 2006 New England Journal of Medicine report on watchful waiting to physicians in our community. The online survey was accessed by 77 physicians; 74 completed the survey. Of 74 participants, surgeons accounted for 15 per cent, family/internal medicine 42 per cent, and 13 other specialties 43 per cent. Nonsurgeons were less familiar with the Fitzgibbons report. All surgeons had heard of the study, and 73 per cent had read it compared with 3 per cent of nonsurgeons. In nonsurgeon physicians, 38 per cent preferred letting patients with inguinal hernia decide treatment after counseling, 30 per cent sent all patients to a surgeon, and 25 per cent sent only symptomatic patients to a surgeon. Surgeons let patients decide after counseling in 73 per cent and chose watchful waiting for asymptomatic patients/offered surgery to symptomatic patients in 27 per cent. Based on our survey, Fitzgibbons’ watchful waiting report does not appear to have significantly impacted practice and referral patterns in our community, although the watchful waiting strategy outlined in the study is practiced. Our study illustrates the challenge of translating research outcomes into clinical practice. Further research on ways to disseminate important surgical information to nonsurgeons seems warranted.

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