Parameters Influencing Distal Tip Loading of Pacemaker and Defibrillator Leads

2013 ◽  
Author(s):  
Donna Walsh ◽  
Beth Stephen ◽  
Nandini Duraiswamy ◽  
Oleg Vesnovsky ◽  
L. D. Timmie Topoleski
Keyword(s):  
Pulse Generator ◽  
Superior Vena ◽  
Vena Cava ◽  
The United States ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Wall ◽  
Active Fixation ◽  
Passive Fixation ◽  
Cardioverter Defibrillators ◽  
Heart Implantation

More than 235,000 pacemakers and 130,000 implantable cardioverter defibrillators (ICD) were implanted in the United States in 2009 [1] for the treatment of various cardiac arrhythmias. Traditional pacemakers and ICDs deliver therapy to the patient through a transvenous lead that extends from a subcutaneously-implanted pulse generator, through the subclavian or cephalic vein, the superior vena cava (SVC), and into the heart. Attachment of the distal tip of the lead into the cardiac muscle is accomplished through either an active fixation mechanism where a metal helix is screwed into the cardiac wall at the time of implantation, or a passive fixation mechanism where silicone tines are ensnared by the fibrous trabeculae within the heart. Implantation of both active and passive leads is aided by the insertion of a stylet, or thin wire, into the lead to provide additional stiffness and steerability as the device is pushed through the vasculature and to the implant site.

scholarly journals Heart of Lymphoma: Primary Mediastinal Large B-Cell Lymphoma with Endomyocardial Involvement

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Elisa Rogowitz ◽  
Hani M. Babiker ◽  
Ravitharan Krishnadasan ◽  
Clint Jokerst ◽  
Thomas P. Miller ◽  
...  
Keyword(s):  
B Cell ◽  
Cardiac Mri ◽  
Cell Lymphoma ◽  
Superior Vena ◽  
Vena Cava ◽  
B Cell Lymphoma ◽  
Vascular Wall ◽  
Cardiac Wall ◽  
Hemodynamic Compromise ◽  
Large B Cell

Primary mediastinal B-cell lymphoma (PMBCL) is an uncommon aggressive subset of diffuse large B-cell lymphomas. Although PMBCL frequently spreads locally from the thymus into the pleura or pericardium, it rarely invades directly through the heart. Herein, we report a case of a young Mexican female diagnosed with PMBCL with clear infiltration of lymphoma through the cardiac wall and into the right atrium and tricuspid valve leading to tricuspid regurgitation. This was demonstrated by cardiac MRI and transthoracic echocardiogram. In addition, cardiac MRI and CT scan of the chest revealed the large mediastinal mass completely surrounding and eroding into the superior vena cava (SVC) wall causing a collar of stokes. The cardiac and SVC infiltration created a significant therapeutic challenge as lymphomas are very responsive to chemotherapy, and treatment could potentially lead to vascular wall rupture and hemorrhage. Despite the lack of conclusive data on chemotherapy-induced hemodynamic compromise in such scenarios, her progressive severe SVC syndrome and respiratory distress necessitated urgent intervention. In addition to the unique presentation of this rare lymphoma, our case report highlights the safety of R-CHOP treatment.

scholarly journals Management of Chronic Pacemaker Lead Infection, Superior Vena Cava Obstruction and Tricuspid Valve Endocarditis (Operative Technique and a Case Report

2015 ◽  
Vol 22 (1) ◽  
pp. 45-51
Author(s):  
Husain H. Jabbad
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Pulse Generator ◽  
Superior Vena ◽  
Median Sternotomy ◽  
Vena Cava ◽  
Cardiac Pacemaker ◽  
Low Grade ◽  
Pacemaker Lead ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker

A 73 year old female presented with the diagnosis of infected cardiac pacemaker. She had complete heart block 2.5 years ago, a permanent dual chamber pacemaker was inserted via a left subclavian approach and the pulse generator positioned in the left clavipectoral fascia. In the early post operative period she developed fever with a clear pacemaker pocket infection, treated with intravenous antibiotics. The initial pacemaker was removed, the pocket cleaned and closed and a new dual-chamber pacemaker inserted in the right clavipectoral area via right subclavian approach. She was kept on a prolonged antibiotics course of vancomycin and gentamicin because of sepsis and blood cultures results of Pseudomonas aeruginosa. On presentation she had diabetes insipidus, recurrent low grade fever and impaired renal function, the pacemaker was functioning well and she was still on IV vancomycin. Investigations revealed a large intra-atrial clot attached to the pacemaker lead, the pacemaker and infected intravascular component were removed via median sternotomy and new pacemaker inserted with epicardial atrial and ventricular leads. The intra-operative cultures grow Pseudomonas aeruginosa treated with 6 weeks of intravenous Tazocin, follow-up for 9 months with no recurrent pocket or deep infection and good functioning pacemaker.  

scholarly journals Superior Vena Cava Duplication: The Red Herring of Central Line Placement

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Karin Gunther ◽  
Carmen Lam ◽  
David Siegel
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Catheter ◽  
Venous Access ◽  
The United States ◽  
Central Line ◽  
Central Venous ◽  
Central Venous Access Lines

5 million central venous access lines are placed every year in the United States, and it is a common surgical bedside procedure. We present a case of a central venous catheter placement with port for chemotherapy use, during which a duplication of a superior vena cava was discovered on CTA chest after fluoroscopy could not confirm placement of the guidewire. Due to its potential clinical implications, superior vena cava duplication must be recognized when it occurs.

Trends in the Use and Outcomes of Implantable Cardioverter-Defibrillators in Patients Undergoing Dialysis in the United States

2011 ◽  
Vol 58 (3) ◽  
pp. 409-417 ◽  
Author(s):  
David M. Charytan ◽  
Amanda R. Patrick ◽  
Jun Liu ◽  
Soko Setoguchi ◽  
Charles A. Herzog ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Implantable Cardioverter Defibrillators ◽  
Cardioverter Defibrillators

scholarly journals Serial Case of Twiddler Syndrome

2017 ◽  
pp. 30-7
Author(s):  
Pipiet Wulandari ◽  
Sunu B Raharjo ◽  
Dicky A Hanafy ◽  
Lina Haryati ◽  
Yoga Yuniadi
Keyword(s):  
Ejection Fraction ◽  
Pulse Generator ◽  
Pacemaker Implantation ◽  
Muscular Activity ◽  
Left Ventricular ◽  
Implantable Cardioverter Defibrillators ◽  
Systolic Left Ventricular Function ◽  
Chest X Ray ◽  
Cardioverter Defibrillators ◽  
Twiddler Syndrome

Background: Twiddler syndrome is an infrequent but potentially dangerous complication of device therapy for dysrhythmias. This syndrome results from manipulation of implanted pulse generator by the patient, leading to traction and subsequent lead dislodgement. It can also occur spontaneously. It has been increasingly reported with pacemaker or implantable cardioverter-defibrillators (ICDs). In this reports, we describe two patients with Twiddler syndrome with substantial retraction of their lead who denied any manipulation of their device.Case Illustration: The first patient was a 56 year-old man with single-chamber ICD due to dilated cardiomyopathy (DCM) with congestive heart failure and severe systolic left ventricular dysfunction (ejection fraction 18%). The dislodged lead causing rhythmical twitching of left pectoral muscles and abdominal pulsations. The second patient was a 69 year-old man with dual-chamber pacemaker due to total atrioventricular block with normal systolic left ventricular function (ejection fraction 70%). It manifested as dyspnea on effort, and he also underwent pacemaker implantation. They underwent primary devices implantation at April 2016 and reposition of generators and its leads in December 2016. The first and second patients denied of manipulating the generator of ICD or pacemaker and rotated their left arm and right arm, respectively, after implantation.Summary: Other unconscious arm abduction during sleep or increased muscular activity of the shoulder and arm might have led to repetitive motions within the pocket and dislodge the device. Adequate individualized patient and family education and regular evaluation every 6 month of the leads position with fluoroscopy or chest X-ray is advisable.

scholarly journals Position of Subcutaneous Implantable Cardioverter-Defibrillators and Possible Interference on Myocardial Perfusion Imaging

2017 ◽  
Vol 44 (3) ◽  
pp. 223-225
Author(s):  
Omar Ray Kahaly ◽  
Fereidoon Shafiei ◽  
Charles Hardebeck ◽  
Mahmoud Houmsse
Keyword(s):  
Sudden Cardiac Death ◽  
Myocardial Perfusion Imaging ◽  
Myocardial Perfusion ◽  
Perfusion Imaging ◽  
Cardiac Death ◽  
Pulse Generator ◽  
Implantable Cardioverter Defibrillators ◽  
Nuclear Myocardial Perfusion Imaging ◽  
Attenuation Artifact ◽  
Cardioverter Defibrillators

Implanted cardioverter-defibrillators can prevent sudden cardiac death in at-risk patients. In comparison with conventional transvenous systems, entirely subcutaneous implantable cardioverter-defibrillators have produced similar reductions in the rate of sudden cardiac death but with fewer sequelae. An infrequently reported drawback of subcutaneous devices, however, is the potential for generating attenuation artifact during nuclear myocardial perfusion imaging. We had concerns about potential attenuation artifact in a 65-year-old man with coronary artery disease but found that having positioned the pulse generator in the midaxillary zone avoided problems.

Sign in / Sign up

Export Citation Format

Share Document