Pacemaker Lead Placement via Transmural Approach in an Adult With Palliated Single Ventricle Heart Disease

Author(s):  
Robert D. Tunks ◽  
John L. Myers ◽  
Mark H. Cohen ◽  
Kevin Moser ◽  
Jason R. Imundo

Given the lack of systemic venous return to the heart, palliated single ventricle patients frequently require epicardial pacemaker implantation for management of dysrhythmias including sinus node dysfunction, atrial arrhythmias, and heart block. Repeated device hardware replacement, frequently required due to high lead thresholds or other device failure, is a challenging and significant problem for this population. 3-dimensional imaging can assist in delineating the cardiac anatomy allowing for novel approaches to intervention. We review a patient with extracardiac Fontan circulation who underwent placement of an endocardial atrial pacemaker lead via a transmural approach with a 3D-printed model used for procedural guidance.

2019 ◽  
Vol 1 (3) ◽  
pp. 391-393
Author(s):  
Dale A. Burkett ◽  
Pei-Ni Jone ◽  
Kathryn K. Collins

2021 ◽  
pp. 194589242110035
Author(s):  
Muhamed A. Masalha ◽  
Kyle K. VanKoevering ◽  
Omar S. Latif ◽  
Allison R. Powell ◽  
Ashley Zhang ◽  
...  

Background Acquiring proficiency for the repair of a cerebrospinal fluid (CSF) leak is challenging in great part due to its relative rarity, which offers a finite number of training opportunities. Objective The purpose of this study was to evaluates the use of a 3-dimensional (3D) printed, anatomically accurate model to simulate CSF leak closure. Methods Volunteer participants completed two simulation sessions. Questionnaires to assess their professional qualifications and a standardized 5-point Likert scale to estimate the level of confidence, were completed before and after each session. Participants were also queried on the overall educational utility of the simulation. Results Thirteen otolaryngologists and 11 neurosurgeons, met the inclusion criteria. A successful repair of the CSF leak was achieved by 20/24 (83.33%), and 24/24 (100%) during the first and second simulation sessions respectively (average time 04:04 ± 1.39 and 02:10 ± 01:11). Time-to-close-the-CSF-leak during the second session was significantly shorter than the first (p < 0.001). Confidence scores increased across the training sessions (3.3 ± 1.0, before the simulation, 3.7 ± 0.6 after the first simulation, and 4.2 ± 0.4 after the second simulation; p < 0.001). All participants reported an increase in confidence and believed that the model represented a valuable training tool. Conclusions Despite significant differences with varying clinical scenarios, 3D printed models for cerebrospinal leak repair offer a feasible simulation for the training of residents and novice surgeons outside the constrictions of a clinical environment.


Author(s):  
Martin Riesenhuber ◽  
Andreas Spannbauer ◽  
Marianne Gwechenberger ◽  
Thomas Pezawas ◽  
Christoph Schukro ◽  
...  

Abstract Background Transcatheter tricuspid valve intervention became an option for pacemaker lead-associated tricuspid regurgitation. This study investigated the progression of tricuspid regurgitation (TR) in patients with or without pre-existing right ventricular dilatation (RVD) undergoing pacemaker implantation. Methods Patients were included if they had implantation of transtricuspid pacemaker lead and completed echocardiography before and after implantation. The cohort was divided in patients with and without RVD (cut-off basal RV diameter ≥ 42 mm). TR was graded in none/mild, moderate, and severe. Worsening of one grade was defined as progression. Survival analyses were plotted for 10 years. Results In total, 990 patients were analyzed (24.5% with RVD). Progression of TR occurred in 46.1% of patients with RVD and in 25.6% of patients without RVD (P < 0.001). Predictors for TR progression were RV dilatation (OR 2.04; 95% CI 1.27–3.29; P = 0.003), pre-existing TR (OR 4.30; 95% CI 2.51–7.38; P < 0.001), female sex (OR 1.68; 95% CI 1.16–2.43; P = 0.006), single RV lead (OR 1.67; 95% CI 1.09–2.56; P = 0.018), mitral regurgitation (OR 2.08; 95% CI 1.42–3.05; P < 0.001), and enlarged left atrium (OR 1.98; 95% CI 1.07–3.67; P = 0.03). Survival-predictors were pacemaker lead-associated TR (HR 1.38; 95% CI 1.04–1.84; P = 0.028), mitral regurgitation (HR 1.34; 95% CI 1.02–1.77; P = 0.034), heart failure (HR 1.75; 95% CI 1.31–2.33; P < 0.001), kidney disease (HR 1.62; 95% CI 1.25–2.11; P < 0.001), and age ≥ 80 years (HR 2.84; 95% CI 2.17–3.71; P < 0.001). Conclusions Patients with RVD receiving pacemaker suffered from increased TR progression, leading to decreased survival. Graphic abstract


2011 ◽  
pp. 54-57
Author(s):  
Vladimir Mitov ◽  
Zoran Perišić ◽  
Aleksandar Jolić ◽  
Tomislav Kostić ◽  
Danijela Nikolić ◽  
...  

Heart Views ◽  
2013 ◽  
Vol 14 (4) ◽  
pp. 182 ◽  
Author(s):  
Nagaraja Moorthy ◽  
Naveen Garg

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
S. Ram Kumar ◽  
Nathan Noh ◽  
Novell Castillo ◽  
Brian Fagan ◽  
Grace Kung ◽  
...  

Background: We have previously shown that neonates in profound cardiogenic shock due to severe Ebstein’s anomaly can be successfully salvaged with fenestrated right ventricular (RV) exclusion and systemic to pulmonary shunt (modified Starnes procedure). The long-term outcome of single ventricle management in these patients is not known. Methods: We retrospectively reviewed the records of 26 patients who underwent neonatal Starnes procedure between 1989 and 2011. Patient demographics, clinical variables and outcome data were collected. Data is presented as mean ± standard errors or median (interquartile ranges). Results: 26 patients (12, 46% boys) underwent Starnes procedure at 7 (5-9) days of life. All were intubated and on prostacyclin infusion, 24 (92%) were inotrope-dependent and 23 (88%) had no antegrade flow from the RV. Two patients had had prior intervention (one tricuspid annuloplasty and one shunt alone). Three patients underwent non-fenestrated RV exclusion, two (67%) of whom died. Of the remaining 23, 3 (13%) died during the same hospitalization. The 21 neonatal survivors have been followed for 7 (6-8) years. One patient died after Glenn. The remaining 20 have successfully undergone Fontan completion with an indexed pulmonary resistance of 1.8 (1.2-2.3) W/m2 and mean pulmonary pressure of 12 (9-18) mm Hg. At last follow-up, all patients have normal left ventricular function, and all but one patient are in NYHA Class I symptoms. Two patients have required pacemaker implantation, while the rest are in sinus rhythm. Survival at 1, 5 and 10 years are 81±4%, 77±3% and 77±3%, respectively. Conclusion: Long-term single ventricle outcomes amongst neonatal survivors of modified Starnes procedure are excellent. There is reliable remodeling of the excluded RV and excellent function of the left ventricle.


2021 ◽  
Author(s):  
Alessia Longoni ◽  
Jun Li ◽  
Gabriella C.J. Lindberg ◽  
Jelena Rnjak-Kovacina ◽  
Lyn M. Wise ◽  
...  

Abstract There remains a critical need to develop new technologies and materials that can meet the demands of treating large bone defects. The advancement of 3-dimensional (3D) printing technologies has allowed the creation of personalized and customized bone grafts, with specific control in both macro- and micro-architecture, and desired mechanical properties. Nevertheless, the biomaterials used for the production of these bone grafts often possess poor biological properties. The incorporation of growth factors (GFs), which are the natural orchestrators of the physiological healing process, into 3D printed bone grafts, represents a promising strategy to achieve the bioactivity required to enhance bone regeneration. In this review, the possible strategies used to incorporate GFs to 3D printed constructs are presented with a specific focus on bone regeneration. In particular, the strengths and limitations of different methods, such as physical and chemical cross-linking, which are currently used to incorporate GFs to the engineered constructs are critically reviewed. Different strategies used to present one or more GFs to achieve simultaneous angiogenesis and vasculogenesis for enhanced bone regeneration are also covered in this review. In addition, the possibility of combining several manufacturing approaches to fabricate hybrid constructs, which better mimic the complexity of biological niches, is presented. Finally, the clinical relevance of these approaches and the future steps that should be taken are discussed.


EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
G Panchal ◽  
S Ahmad ◽  
C Spencer ◽  
C Barr ◽  
A Arya ◽  
...  

Abstract Introduction Temporary transvenous pacing (TPW) is a very useful procedure to control symptoms and/or correct significant hemodynamic compromise secondary to acute bradycardia as well as ventricular arrhythmias. It can be associated with significant complications (14-40%) e.g., loss of capture, displacement, infection, perforation, venous thrombosis, pulmonary embolism, or rarely, even death. The 2018 ACC/AHA/HRS guidelines on the management of bradycardia give a Class IIa indication for externalised pacemakers (ExPPM) in patients requiring prolonged TPW support while the 2015 ESC guidelines on ventricular arrhythmias and sudden cardiac death give a Class IIa indication for overdrive pacing in the setting of acute coronary syndromes. However, published evidence for the former indication is modest (Level of evidence: B-NR) and lacking for the latter (Level of evidence: C).  Aim To describe the experience of use of ExPPM in a high volume single tertiary non device extraction cardiac center over 45 months.  Methods   Retrospective study of medical records from January 2016 - September 2019.   Results  N = 34 during which the centre undertook 1341 new simple and complex device implants. Mean age: 73 ± 12 years, 20/34 (58.8%) males. Indication: symptomatic sinus node disease: 7/34 (20.6%), AV node disease: 23/34 (67.6%%), overdrive pacing for ventricular arrhythmias: 4/34 (11.8%) - late monomorphic VT secondary ST elevation myocardial infarction 2/4, polymorphic VT secondary to methadone toxicity 1/4, ventricular fibrillation secondary to bradyarrhythmia 1/4. Majority (27/34, 79.4%) had an ExPPM  because of sepsis (pneumonia 12/27; unknown focus 3/27,  TPW site infection 2/27, biliary sepsis, necrotising fasciitis, urinary tract infection, sternal wound infection, endocarditis, thrombophlebitis 1 each. Mean duration of implantation: 13.9 ± 11 days. Right internal jugular vein was the most common site (22/34, 64.7%) for introduction of the active fixation lead. Type of ExPPM: single chamber (VVI): 32/34 (94.1%), dual chamber (DDD): 2/34 (5.9%). 13/15 (38.2%) underwent permanent pacemaker implantation and 2/15 (13.3%) cardiac resynchronisation therapy - defibrillator following an ExPPM. Complications: 1/34 (2.9%) bleeding from the puncture site requiring transfusion. Six patients died during the course with deterioration in co-existing medical condition. Conclusion In our experience, ExPPM are not only a very useful intervention in patients who require prolonged support for bradyarrhythmias but can also be used to stabilise patients with recurrent tachyarrhythmias who need overdrive suppression, buying vital time before proceeding to definite therapy. They are associated with a low complication rate. We recommend that centers should have a low threshold for implanting such devices at the outset, in preference to TPW, in those patients where prolonged stabilisation of the heart rhythm is anticipated.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Kondo ◽  
M Kimura ◽  
M Nakayama ◽  
O Matsuda

Abstract Background Although sinus node dysfunction (SND) coexists with atrial fibrillation (AF) in some cases, SND in patients with Non-paroxysmal AF (Non-PAF) could not be estimated in conventional electrophysiological study. Atrial low voltage zone (LVZ), which may be surrogate for atrial fibrosis, is although reported to present in patients with Non-PAF, the association between SND and right atrial LVZ (RA-LVZ) has not been fully evaluated. The aim of the present study was to assess the relationship between SND and RA-LVZ in patients with Non-PAF. Method Eighty-six Non-PAF patients underwent high density voltage mapping of right atrium (RA) during AF before ablation procedure. We defined LVZ as that with electrogram amplitude <0.1 mV in order to delineate strongly damaged area in RA. We evaluated the surface are of the RA-LVZ in Non-PAF patients with and without SND. Results Twenty-seven of 86 patients (31.4%) presented with SND after AF termination. There were no significant differences between patients with and without SND in variables such as age, sex, AF duration, left atrial diameter, and left ventricular ejection fraction. The mean value of RA-LVZ of all the patients was 12.1±11.4%, and RA-LVZ was significantly larger in patients with SND than in those without SND (22.8±14.6 vs 7.2±4.2%; P<0.001). In multivariate logistic regression analysis for the incidence of subsequent pacemaker implantation (PMI), only RA-LVZ was a significant predictor of subsequent PMI (odd ratio 1.306; 95% confidence interval 1.159 - 1.473; P<0.001). Receiving-operating characteristic curve for PMI following ablation procedure indicated cut-off value 10.5% for RA-LVZ with 85.2% sensitivity and 88.1% specificity (area under curve = 0.924, P<0.001). Kaplan-Meier analysis of the incidence of PMI after AF termination showed that freedom from pacemaker implantation was significantly better in patients with RA-LVA <10.5% than in those with RA-LVZ ≥10.5% (log-rank test; P<0.001). Conclusions Broad RA-LVZ measured during AF was strongly associated with SND and PMI after AF termination in patients with Non-PAF. Evaluation of RA-LVZ during AF could be a potential target in predicting SND requiring PMI in patients with Non-PAF.


Sign in / Sign up

Export Citation Format

Share Document