scholarly journals Difficulty removing a leadless pacemaker in a post-transfusion patient

2021 ◽  
Vol 14 (10) ◽  
pp. e246625
Author(s):  
Atomu Tajima ◽  
Yoshiaki Mizutani ◽  
Masaaki Kanasiro ◽  
Tetsuya Amano
Keyword(s):  
Atrial Fibrillation ◽  
Blood Cell ◽  
Pacemaker Implantation ◽  
Red Blood Cell Transfusion ◽  
Correct Position ◽  
Blood Tests ◽  
Leadless Pacemaker ◽  
History Of ◽  
Sheath Insertion ◽  
The Right

A 99-year-old woman with atrial fibrillation bradycardia and symptomatic long pauses underwent a leadless pacemaker implantation after red blood cell transfusion due to anaemia. The patient’s blood tests after transfusion showed hypercoagulability; haematocrit, haemoglobin and fibrinogen levels were increased from 24.5% to 33.2%, 76 g/L to 111g/L, and 346 mg/dL to 646 mg/dL, respectively. Blood tests showed no hereditary hypercoagulability disorder and she had no history of thrombophilia. A leadless pacemaker was implanted in the correct position in the right ventricle. Heparin was administered after sheath insertion and the leadless pacemaker system was thoroughly flushed with heparinised saline before the tether was cut; however, removing the tether after leadless pacemaker implantation was difficult because clots had formed on the tether.

scholarly journals Red Blood Cell Transfusion in the Emergency Department: An Observational Cross-Sectional Multicenter Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2475
Author(s):  
Olivier Peyrony ◽  
Danaé Gamelon ◽  
Romain Brune ◽  
Anthony Chauvin ◽  
Daniel Aiham Ghazali ◽  
...  
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Cross Sectional Study ◽  
Red Blood Cell Transfusion ◽  
Cross Sectional ◽  
Acute Bleeding ◽  
History Of ◽  
Rbc Transfusion

Background: We aimed to describe red blood cell (RBC) transfusions in the emergency department (ED) with a particular focus on the hemoglobin (Hb) level thresholds that are used in this setting. Methods: This was a cross-sectional study of 12 EDs including all adult patients that received RBC transfusion in January and February 2018. Descriptive statistics were reported. Logistic regression was performed to assess variables that were independently associated with a pre-transfusion Hb level ≥ 8 g/dL. Results: During the study period, 529 patients received RBC transfusion. The median age was 74 (59–85) years. The patients had a history of cancer or hematological disease in 185 (35.2%) cases. Acute bleeding was observed in the ED for 242 (44.7%) patients, among which 145 (59.9%) were gastrointestinal. Anemia was chronic in 191 (40.2%) cases, mostly due to vitamin or iron deficiency or to malignancy with transfusion support. Pre-transfusion Hb level was 6.9 (6.0–7.8) g/dL. The transfusion motive was not notified in the medical chart in 206 (38.9%) cases. In the multivariable logistic regression, variables that were associated with a higher pre-transfusion Hb level (≥8 g/dL) were a history of coronary artery disease (OR: 2.09; 95% CI: 1.29–3.41), the presence of acute bleeding (OR: 2.44; 95% CI: 1.53–3.94), and older age (OR: 1.02/year; 95% CI: 1.01–1.04). Conclusion: RBC transfusion in the ED was an everyday concern and involved patients with heterogeneous medical situations and severity. Pre-transfusion Hb level was rather restrictive. Almost half of transfusions were provided because of acute bleeding which was associated with a higher Hb threshold.

Cardiac Arrhythmia Caused by a Kirschner Wire inside the Heart

1997 ◽  
Vol 22 (3) ◽  
pp. 402-404 ◽  
Author(s):  
T. A. T. HAAPANIEMI ◽  
U. S. HERMANSSON
Keyword(s):  
Atrial Fibrillation ◽  
Thoracic Surgery ◽  
Cardiac Disease ◽  
Kirschner Wire ◽  
Previous History ◽  
Kirschner Wires ◽  
Left Hand ◽  
Plain Chest ◽  
History Of ◽  
The Right

A 45-year-old woman with no previous history of cardiac disease woke up one morning with an irregular heartbeat and fatigue. An electrocardiogram showed atrial fibrillation and plain chest radiographs revealed the presence of a metallic pin at the position of the heart. A 24 mm-long metallic pin was removed by open thoracic surgery from within the right ventricle of the heart. Postoperative examination of the pin showed it to be one of the 0.8 mm Kirschner wires that had been used for finger osteosynthesis in her left hand 31 months previously.

Abstract 16831: Provoked PFO Shunt And Posterior Circulation Stroke: An Underrecognized Association

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Muhammad Hamza Saad Shaukat ◽  
Mamoon Ahmed ◽  
Terezia Petraskova ◽  
Alex Georgiev ◽  
Orvar Jonsson
Keyword(s):  
Atrial Fibrillation ◽  
Valsalva Maneuver ◽  
Sympathetic Innervation ◽  
Paradoxical Embolism ◽  
Posterior Circulation ◽  
Saline Injection ◽  
Atrial Size ◽  
Acute Infarct ◽  
History Of ◽  
The Right

Case Presentation: A 50 year old man presented with nausea and weakness. MRI brain showed a small acute infarct in the right pons. CT angiography of the head and neck was unremarkable. No thrombus, vegetation, or inter-atrial communication was seen on transthoracic echocardiogram: LVEF was 55-60% with normal left atrial size. No history of atrial fibrillation, hypertension, diabetes or drug abuse was reported; lower extremity duplex was negative for deep venous thrombosis. TSH was normal. Transesophageal echocardiography showed an aneurysmal atrial septum: agitated saline injection did not demonstrate an inter-atrial communication (figure 1). Repeat saline injection during the same procedure with Valsalva maneuver demonstrated a moderate-sized, provoked right-to-left, patent foramen ovale (PFO) shunt (figure 2). Discussion: Physiologically decreased sympathetic innervation spares posterior cerebral circulation from Valsalva-induced vasoconstriction. The disproportionate increase in posterior cerebral blood flow when venous return/cardiac output increases in the immediate post-strain period explains the association of provoked PFO shunt and paradoxical embolism to posterior circulation. Although the association has been described in literature, it remains underappreciated. Recognition of the association expedited secondary prevention of stroke in this non-elderly patient by circumventing the need to exclude atrial fibrillation on ambulatory rhythm monitoring (3-6 months) before referral for PFO closure.

scholarly journals Determinants of development of permanent atrial fibrillation and its treatment

EP Europace ◽  
1999 ◽  
Vol 1 (1) ◽  
pp. 35-39 ◽  
Author(s):  
L. Gianfranchi ◽  
M. Brignole ◽  
C. Menozzi ◽  
G. Lolli ◽  
N. Bottoni
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Risk Group ◽  
Pacemaker Implantation ◽  
Structural Heart Disease ◽  
High Risk Group ◽  
Symptom Duration ◽  
Permanent Atrial Fibrillation ◽  
History Of

Abstract We evaluated the rate of progression of permanent atrial fibrillation (AF) and identified clinical factors that predict this event in 63 consecutive patients who had undergone AV junctional ablation and DDDR pacemaker implantation for drug-refractory paroxysmal atrial fibrillation/flutter. Immediately after ablation, anti-arrhythmic drugs were discontinued in all cases. Permanent AF was con-sidered to have developed if AF was present on two consecutive 6-monthly examinations with no interim documented sinus rhythm. During a mean follow-up of 23±16 months, 22 (35%) of the 63 patients developed permanent AF. The actuarial estimate of progression of permanent AF was 22%, 40% and 56%, respectively, 1, 2 and 3 years after ablation. Age and underlying heart disease were independent predictors of progression of permanent AF. Only one (6%) of 16 patients with idiopathic AF had permanent AF (low risk group). Among the 47 patients with structural heart disease, permanent AF developed in 18 (62%) of the 29 who were aged >75 years or had >12 arrhythmic episodes per year and a symptom duration >4 years (high risk group), but only in three (17%) of the remaining 18 patients who did not (intermediate risk group). In conclusion, during a 3-year follow-up period, about half of the patients with a history of drug-refractory paroxysmal AF did not develop permanent AF after AV junctional ablation and dual-chamber pacemaker implantation, even in the absence of anti-arrhythmic drug therapy. Moreover, subgroups of patients whose risk of permanent AF progression differed were identified on the basis of simple baseline clinical variables. The results of this study form the necessary background for the correct management of patients after AV junction ablation and for the planning of future trials in this field.

scholarly journals Chronic atrial fibrillation in patients with paroxysmal atrial fibrillation, atrioventricular node ablation and pacemakers

EP Europace ◽  
1999 ◽  
Vol 1 (1) ◽  
pp. 30-34 ◽  
Author(s):  
J. M. McComb ◽  
G. M. Gribbin
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Pacemaker Implantation ◽  
Atrioventricular Node ◽  
Chronic Atrial Fibrillation ◽  
Atrial Arrhythmias ◽  
Av Node ◽  
Surface Ecg ◽  
History Of ◽  
Atrial Rhythm

Abstract Aims This study examined the factors associated with the development of chronic (or permanent) atrial fibrillation (AF) in patients who had undergone atrioventricular (AV) node ablation with permanent pacing because of paroxysmal AF. Methods A retrospective review of case notes of all 65 consecutive patients identified as having had paroxysmal atrial arrhythmias, AV node ablation and permanent pacemaker implantation was performed. Atrial rhythm was established from all pacing records and from the surface ECG. Treatment with anti-arrhythmic drugs and with warfarin was recorded. A multivariate analysis was undertaken, using atrial rhythm on final ECG and chronic AF as outcome measures. Results During a mean follow-up of 30 months, 42% of patients with paroxysmal AF had developed chronic AF. Multivariate analysis showed that increasing age, history of electrical cardioversion and VVI pacing all contributed to the development of chronic AF. 25/62 patients were taking warfarin, and four had had strokes (2·5%/year). Conclusions The majority of patients with paroxysmal atrial arrhythmias treated with AV node ablation and pacing develop chronic AF eventually. Stroke remains a risk, particularly in those who develop chronic AF.

scholarly journals A case report of unusually long episodes of asystole in a severe COVID-19 patient treated with a leadless pacemaker

2020 ◽  
Vol 4 (FI1) ◽  
pp. 1-6
Author(s):  
Ivan Cakulev ◽  
Jayakumar Sahadevan ◽  
Mohammed Najeeb Osman
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Pacemaker Implantation ◽  
Av Block ◽  
Leadless Pacemaker ◽  
Case Summary ◽  
Cardiac Manifestations

Abstract Background Experience has been emerging about cardiac manifestations of COVID-19-positive patients. The full cardiac spectrum is still unknown, and management of these patients is challenging. Case summary We report a COVID-19 patient who developed unusually long asystolic pauses associated with atriventricular block (AV) block and atrial fibrillation who underwent leadless pacemaker implantation. Discussion Asystole may be a manifestation of COVID-19 infection. A leadless pacemaker is a secure remedy, with limited requirements for follow-up, close interactions, and number of procedures in a COVID-19 patient.

Abstract 12750: Atrial Tissue MicroRNAs 411-5p, 21-5p, 409-3p and 320a Are Associated With Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Menhel Kinno ◽  
Nada Esa ◽  
Raghava S Velagaleti ◽  
Amir Y Shaikh ◽  
Honghuang Lin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Remodeling ◽  
Tissue Samples ◽  
Elective Cardiac Surgery ◽  
Atrial Tissue ◽  
Prior Literature ◽  
History Of ◽  
Artery Disease ◽  
The Right ◽  
Age And Sex

Introduction: Atrial Fibrillation (AF) is the most common arrhythmia in clinical practice. MicroRNAs (miRs) are small RNAs that play a role in regulating cardiac remodeling and have been implicated in cardiac arrhythmogenesis. However, few studies have examined the association of atrial miR expression to AF. Hypothesis: Changes in miR expression (estimated as fold-difference in the delta cycle threshold compared to global mean) in human atria can be associated with AF. Methods: Thirty-one consecutive patients undergoing elective cardiac surgery were divided into 2 groups: those with history of AF (n=19) and those with no history of AF who stayed in sinus rhythm post-operatively (n=12). Atrial tissue samples were obtained from the right atrium in all but one (left atrium). Based on pilot data and prior literature, the expression of 82 miRs was assessed using high-throughput quantitative reverse-transcriptase polymerase chain reaction. We used logistic regression adjusting for age and sex to detect the associations between levels of atrial miRs and AF. Results: The mean age of the sample was 65 years (±13) and 71% were men. A history of coronary artery disease and heart failure was present in 42% and 36%, respectively. Among AF subjects, the age- and sex- adjusted odds ratios for the expression of miRs 411-5p, 21-5p, 409-3p and 320a were 0.08 (p= 0.02), 0.20 (p=0.02), 0.13 (p= 0.04) and 0.04 (p=0.048), respectively, compared to no AF. The fold-difference in atrial expression of miRs 411-5p, 21-5p, 409-3p and 320a were -0.567, -0.588, -0.375 and -0.427, respectively, in those with AF compared to no AF. Conclusion: In our study, the atrial expression of miRs 411, 21, 409 and 320 was lower in AF patients compared to those with no AF. Notably, these miRs regulate genes involved in atrial fibrosis, apoptosis, and ion channel function. Our findings further implicate miRs as important mediators of pathological atrial remodeling and suggest their usefulness as biomarkers in detecting AF.

P1096Cardioneuroablation changes the type of vaso-vagal response in patients with asystolic reflex syncope

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
R Piotrowski ◽  
A Zuk ◽  
J Baran ◽  
A Sikorska ◽  
T Krynski ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Postgraduate Medical Education ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Heart Rate Variability Parameter ◽  
History Of ◽  
The Right ◽  
The Impact

Abstract Funding Acknowledgements Centre of Postgraduate Medical Education No. 501-1-10-14-19 Background. Cardioneuroablation (CNA) - ablation of ganglionated plexi (GP) to eliminate or reduce parasympathetic overactivity, has been recently proposed as a new therapeutic method in patients with vaso-vagal syncope (VVS) due to cardioinhibitory or mixed mechanism. Purpose. To assess the impact of CNA on the type of VV response during tilt testing (TT). Methods. The study group consisted of the first 20 patients (7 males, mean age 38 ± 9 – year – old) enrolled in the ongoing prospective Roman study (NCT 03903744). All patients had a history of ECG documented syncope due to asystole and confirmed asystolic form of VVS at baseline TT. CNA was performed using electroanatomical system Carto 3 and radiofrequency applications delivered in the right and left atrium at the right anterior GP and right inferior GP sites. The second TT was performed three months later. Resting heart rate (HR) and heart rate variability parameter (SDDN) were also assessed. Results. At baseline TT, nineteen patients had cardioinhibitory syncope (asystole ranging from 3 to 60 s)  (sinus node arrest – 17 patients, A-V block – 2 patients) and 1 had mixed form of VVS (asystole lasting 3 s preceded by hypotension). During three-month follow-up no syncopal episodes were noted. At the 3-month TT, 6 (30 %) patients had no syncope whereas the remaining 13 (65 %)  had syncope – twelve (60 %) due to vasodepressor mechanism and only one (5 %) due to asystole - as before CNA. One patient did not have TT because of pregnancy. Mean resting HR after CNA was significantly faster and SDNN significantly lower than before the procedure (82 ± 9 vs 69 ± 11 beats/min, p = 0.0004 and 74 ± 22 vs 143 ± 40 ms, p = 0.00003, respectively) and these changes were was similar in those who fainted during second TT and those who did not (82 ± 11 vs 81 ± 4 beats/min, p = NS and (75 ± 2 vs 77 ± 18 ms, p = NS, respectively). Conclusions. CNA profoundly affects the type of VV reaction causing normalization of the response to tilting or changing cardiodepression to vasodepression. These effects are also depicted by changes in HR and heart rate variability. Elimination of TT-induced reflex asystole may prevent clinical recurrences of syncope during short-term follow-up. These findings encourage to conduct further studies involving CNA since this method appears to be effective and obviates the need for pacemaker implantation in young people with reflex asystolic syncope.

Nonocclusive Ischemic Colitis: Analysis of Risk Factors for Severity

2014 ◽  
Vol 80 (5) ◽  
pp. 454-460 ◽  
Author(s):  
Eran Sadot ◽  
Dana A. Telem ◽  
Leslie Cohen ◽  
Manjit Arora ◽  
Celia M. Divino
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Ischemic Colitis ◽  
Severe Disease ◽  
Multivariate Logistic Regression ◽  
Logistic Regression Models ◽  
History Of ◽  
N 93 ◽  
The Right

The purpose of this study was to identify risk factors predictive of severe nonocclussive ischemic colitis (IC) requiring operation or resulting in mortality. One hundred seventeen patients with nonocclussive IC were identified and divided into two groups: those with severe disease (n = 24) and those with disease that resolved with supportive care (n = 93). Univariate and multivariate logistic regression models were used. The splenic flexure was the most common involved segment (57.3%), whereas the right colon was involved in 17.9 per cent of patients. Multivariate logistic regression identified three independent risk factors for severe disease: leukocytosis greater than 15 3 109/L (odds ratio [OR], 5.7; confidence interval [CI], 1.5 to 21), hematocrit less than 35 per cent (OR, 4.5; CI, 1.1 to 17), and history of atrial fibrillation (OR, 15; CI, 1.3 to 190). Right-sided IC and chronic renal insufficiency did not affect severity. Special attention should be given to patients with the following risk factors for a severe course: atrial fibrillation, elevated white blood cell count, and anemia. These factors might enable earlier identification of patients who may benefit from early operation. Further prospective studies focusing on subgroups of IC (occlusive and nonocclusive) are required.

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