Physiological Pacing: A New Road to Future

2021 ◽  
pp. 263246362097804
Author(s):  
Vanita Arora ◽  
Pawan Suri
Keyword(s):  
Side Effects ◽  
Fibrous Tissue ◽  
Cardiac Pacing ◽  
His Bundle ◽  
Anatomy And Physiology ◽  
Long Term Follow Up ◽  
Pacing Lead ◽  
The Right

Anatomy and physiology are the basis of human body functioning and as we have progressed in management of various diseases, we have understood that physiological intervention is always better than an anatomical one. For more than 50 years, a standard approach to permanent cardiac pacing has been an anatomical placement of transvenous pacing lead at the right ventricular apex with a proven benefit of restoring the rhythm. However, the resultant ventricular dyssynchrony on the long-term follow-up in patients requiring more than 40% ventricular pacing led to untoward side effects in the form of heart failure and arrhythmias. To counter such adverse side effects, a need for physiological cardiac pacing wherein the electrical impulse be transmitted directly through the normal conduction system was sought. His bundle pacing (HBP) with an intriguing alternative of left bundle branch pacing (LBBP) is aimed at restoring such physiological activation of ventricles. HBP is safe, efficacious, and feasible; however, localization and placement of a pacing lead at the His bundle is challenging with existing transvenous systems due to its small anatomic size, surrounding fibrous tissue, long-learning curve, and the concern remains about lead dislodgement and progressive electrical block distal to the HBP lead. In this article, we aim to take the reader through the challenging journey of HBP with focus upon the hardware and technique, selective versus nonselective HBP, indications and potential disadvantages, and finally the future prospects.

Transcatheter closure of defects within the oval fossa using the Amplatzer® Septal Occluder

2002 ◽  
Vol 12 (3) ◽  
pp. 224-228 ◽  
Author(s):  
Haifa Abdul Latiff ◽  
Mazeni Alwi ◽  
Hasri Samion ◽  
Geetha Kandhavel
Keyword(s):  
Transcatheter Closure ◽  
Standard Procedure ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Term Outcome ◽  
Long Term Follow Up ◽  
One Year ◽  
The Right

This study reviewed the short-term outcome of transcatheter closure of the defects within the oval fossa using an Amplatzer® Septal Occluder. From January 1997 to December 2000, 210 patients with defects within the oval fossa underwent successful transcatheter closure. We reviewed a total of 190 patients with left-to-right shunts, assessing the patients for possible complications and the presence of residual shunts using transthoracic echocardiogram at 24 h, 1 month, 3 months and one year. Their median age was 10 years, with a range from 2 to 64 years, and their median weight was 23.9 kg, with a range from 8.9 to 79 kg. In 5 patients, a patent arterial duct was closed, and in 2 pulmonary balloon valvoplasty performed, at the same sitting. The median size of the Amplatzer® device used was 20 mm, with a range from 9 to 36 mm. The median times for the procedure and fluoroscopy were 95 min, with a range from 30 to 210 min, and 18.4 min, with a range from 5 to 144 min, respectively. Mean follow-up was 20.8 ± 12.4 months. Complete occlusion was obtained in 168 of 190 (88%) patients at 24 h, 128 of 133 (96.2%) at 3 months, and 103 of 104 (99%) at one year. Complications occurred in 4 (2.1%) patients. In one, the device became detached, in the second the device embolized into the right ventricular outflow tract, the lower end of the device straddled in the third, and the final patient had significant bleeding from the site of venupuncture. There were no major complications noted on follow-up. We conclude that transcatheter closure of defects within the oval fossa using the Amplatzer® Septal Occluder is safe and effective. Long-term follow-up is required, nonetheless, before it is recommended as a standard procedure.

scholarly journals Side Effects Following Administration of the First Dose of Oxford-AstraZeneca’s Covishield Vaccine in Bangladesh: A Cross-Sectional Study

2021 ◽  
Vol 13 (4) ◽  
pp. 888-901
Author(s):  
Nishat Jahan ◽  
Fahad Imtiaz Rahman ◽  
Poushali Saha ◽  
Sadia Afruz Ether ◽  
ASM Roknuzzaman ◽  
...  
Keyword(s):  
Side Effects ◽  
Rapid Development ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Post Vaccination ◽  
Long Term Follow Up ◽  
Larger Sample

In response to the raging COVID-19 pandemic, Bangladesh started its vaccine administration in early 2021; however, due to the rapid development and launch of the vaccines in the market, many people had concerns regarding the safety of these vaccines. The purpose of this study was to evaluate the side effects that were experienced by the Bangladeshi residents after receiving the first dose of the Oxford-AstraZeneca’s Covishield vaccine (ChAdOx1nCoV-19). The study was conducted using both online and printed questionnaires and the data were analysed using SPSS. The results included the responses of 474 vaccine recipients from March–April 2021. Pain at the site of injection, fever, myalgia, fatigue and headache were the most commonly reported symptoms, and the overall side effects were found to be significantly more prevalent in the younger population (p ≤ 0.05). These findings were consistent with the results indicated by the clinical trial of ChAdOx1nCoV-19. Logistic regression analysis further revealed that compared to people aged 70 years or above, the incidence of reported side effects was significantly higher in people aged 18–30 years (odds ratio (OR) = 8.56), 31–40 years, (OR = 5.05), 41–50 years (OR = 4.08), 51–60 years (OR = 3.77) and 61–70 years (OR = 3.67). In addition, a significantly higher percentage of female participants suffered from post-vaccination side effects compared to males (OR = 1.51). It was concluded that the Covishield vaccine was well-tolerated among people of different age groups. Nevertheless, further long-term follow-up study with a larger sample size is warranted to establish the long-term safety of the COVID-19 vaccine.

Choice of Antenatal Steroids for Prevention of Complications of Prematurity: Betamethasone Versus Dexamethasone

2021 ◽  
pp. 097321792110483
Author(s):  
Tanushree Sahoo ◽  
Abhishek Somasekhara Aradhya ◽  
Kanya Mukhopadhyay
Keyword(s):  
Side Effects ◽  
Early Onset ◽  
Lower Cost ◽  
Antenatal Steroids ◽  
Term Adverse Effect ◽  
Early Onset Sepsis ◽  
Poor Neurological Outcome ◽  
Long Term Follow Up

Antenatal steroids (ANS) are proven strategies to maximize outcomes of premature neonates without any major maternal side effects. Their use results in decreased incidence of neonatal mortality and major morbidities (respiratory distress syndrome, early onset sepsis, necrotizing enterocolitis, and intraventricular hemorrhage). However, due to concerns of long-term adverse effect (early onset hypertension and poor neurological outcome), a close follow-up is required. Similarly, due to lack of long-term follow-up data and potential risk of hypoglycemia, a cautious use is recommended in late preterms and elective cesareans. There is currently no consensus regarding preferential use of one ANS over the other. The current review therefore tried to address these issues for use of ANS in Indian prospective in light of recent emerging evidence. Due to better safety profile, lesser side effects, lower cost, and easy storage, we recommend dexamethasone as a steroid of choice for antenatal prophylaxis.

Early and late outcomes of surgical repair of double-chambered right ventricle: a single-centre experience

2020 ◽  
Vol 30 (3) ◽  
pp. 409-412
Author(s):  
Murat Surucu ◽  
İlkay Erdoğan ◽  
Birgül Varan ◽  
Murat Özkan ◽  
N. Kürşad Tokel ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Right Ventricle ◽  
Septal Defect ◽  
Surgical Intervention ◽  
Systolic Pressure ◽  
Presenting Symptoms ◽  
Long Term Follow Up ◽  
The Right

AbstractObjective:Double-chambered right ventricle is characterised by division of the outlet portion of the right ventricle by hypertrophy of the septoparietal trabeculations into two parts. We aim to report our experiences regarding the presenting symptoms of double-chambered right ventricle, long-term prognosis, including the recurrence rate and incidence of arrhythmias after surgery.Methods:We retrospectively investigated 89 consecutive patients who were diagnosed to have double-chambered right ventricle and underwent a surgical intervention from 1995 to 2016. The data obtained by echocardiography, cardiac catheterisation, and surgical findings as well as post-operative follow-up, surgical approaches, post-operative morbidity, mortality, and cardiac events were evaluated.Results:Median age at the time of diagnosis was 2 months and mean age at the time of operation was 5.3 years. Concomitant cardiac anomalies were as follows: perimembranous ventricular septal defect (78 patients), atrial septal defect (9 patients), discrete subaortic membrane (32 patients), right aortic arch (3 patients), aortic valve prolapse and/or mild aortic regurgitation (14 patients), and left superior caval vein (2 patients). The mean follow-up period was 4.86 ± 4.6 years. In these patients, mean systolic pressure gradient in the right ventricle by echocardiography before, immediately, and long-term after surgical intervention was 66.3, 11.8, and 10.4 mmHg, respectively. There were no deaths during the long-term follow-up period. Surgical reinterventions were performed for residual ventricular septal defect (2), residual pulmonary stenosis (1), and severe tricuspid insufficiency (1).Conclusion:The surgical outcomes and prognosis of double-chambered right ventricle are favourable, recurrence and fatal arrhythmias are unlikely in long-term follow-up.

scholarly journals Leiomyosarcoma of the Right Ovarian Vein: a Case Report with Multimodality Management and Long-Term Follow-Up

2019 ◽  
Vol 10 (3) ◽  
pp. 523-526
Author(s):  
Virendra Rajpurohit ◽  
Pooja Mehta ◽  
Nirupama Kothari ◽  
Sanjay Nathani
Keyword(s):  
Case Report ◽  
Ovarian Vein ◽  
Long Term Follow Up ◽  
The Right

scholarly journals Oncocytic cyst of the larynx: a rare finding

2019 ◽  
Vol 12 (1) ◽  
pp. bcr-2018-227214 ◽  
Author(s):  
Samantha Baird ◽  
Halina Mann ◽  
Cesar M Salinas-La Rosa ◽  
Halil Ozdemir
Keyword(s):  
Social History ◽  
Granular Eosinophilic Cytoplasm ◽  
Eosinophilic Cytoplasm ◽  
Long Term Follow Up ◽  
History Of ◽  
The Right ◽  
False Vocal ◽  
Columnar Cells

A 75-year-old woman presented with an 18-month history of severe, slowly worsening dysphonia. She was a smoker and known to have multiple benign cystic thyroid lesions. She reported no associated symptoms and other medical and social history was unremarkable. Fibreoptic nasendoscopy revealed a right-sided supraglottic cyst appearing to arise from the right false vocal cord. Further bedside examination was unremarkable. She underwent microlaryngoscopy and biopsy which showed a cyst originating from the right anterior ventricle, successfully removed without rupture using cold steel. Formal histopathology revealed a 14×10×7 mm unilocular, completely excised cyst lined by oncocytic epithelium and composed of columnar cells with darkly stained nuclei and abundant granular, eosinophilic cytoplasm. Three weeks postoperatively the patient’s voice had returned to normal. To date, 11 months postoperatively, there is no evidence of recurrence, and she will continue long-term follow-up.

scholarly journals Thirteen-year follow-up of parasellar intravascular papillary endothelial hyperplasia successfully treated by surgical excision: case report

2015 ◽  
Vol 15 (4) ◽  
pp. 384-391 ◽  
Author(s):  
Sook Young Sim ◽  
Yong Cheol Lim ◽  
Keun Soo Won ◽  
Kyung Gi Cho
Keyword(s):  
Surgical Excision ◽  
Subtotal Resection ◽  
Intravascular Papillary Endothelial Hyperplasia ◽  
Long Term Follow Up ◽  
History Of ◽  
Papillary Endothelial Hyperplasia ◽  
The Right ◽  
Frontal Skull Base

Intracranial intravascular papillary endothelial hyperplasia (IPEH) is very rare, and to our knowledge long-term follow-up results have not been previously published. An 11-year-old boy presented with a 6-month history of progressive visual impairment in the right eye. Magnetic resonance imaging revealed a well-enhanced, large parasellar mass involving the cavernous sinus, right frontal skull base, and ethmoid and sphenoid sinuses. Frontotemporal craniotomy and subtotal resection were performed, and the diagnosis of IPEH was confirmed. The mass increased in size during the following 3 months. A second operation was performed via frontotemporal craniotomy combined with a transsphenoidal approach, and gross-total resection of the tumor was achieved. Adjuvant radiotherapy (5040 cGy) and chemotherapy with interferon were administered. The patient's visual symptoms improved, and there was no recurrence during a 13-year follow-up period. The results of this case indicate that intracranial IPEH can recur with subtotal resection; however, optimal resection with multimodal adjuvant treatment can control the disease for many years, if not permanently.

scholarly journals Long-term follow-up of the use of maintenance antibiotic therapy for chronic antibiotic-dependent pouchitis

2018 ◽  
Vol 9 (2) ◽  
pp. 154-158 ◽  
Author(s):  
Jonathan P Segal ◽  
Stephanie X Poo ◽  
Simon D McLaughlin ◽  
Omar D Faiz ◽  
Susan K Clark ◽  
...  
Keyword(s):  
Side Effects ◽  
Antibiotic Therapy ◽  
Antibiotic Use ◽  
Safety And Efficacy ◽  
Pouch Failure ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Term Maintenance

ObjectiveRestorative proctolectomy is considered the procedure of choice in patients with ulcerative colitis who have failed medical therapy. Chronic pouchitis occurs in 10%–15% of patients, which often require long-term antibiotics to alleviate symptoms. Safety and efficacy of long-term maintenance antibiotics for chronic pouchitis has yet to be established. We aimed to assess the long-term safety and efficacy of maintenance antibiotic therapy for chronic pouchitis.DesignThis was an observational study. We followed up patients who were diagnosed with chronic antibiotic-dependent pouchitis.SettingData were collected from our single specialist pouch centre.PatientsPatients with chronic antibiotic-dependent pouchitis who had been maintained on antibiotics continuously for at least 1 year with a least one follow-up visit.Main outcome measureDevelopment of pouch failure defined by the need for an ileostomy, patient-reported side effects of antibiotics and development of antibiotic resistance found on stool coliform testing.ResultsLong-term use of antibiotics achieve remission in 21% of patients over a median follow-up of 102 (range 9–125). Pouch failure in association with chronic pouchitis after a median follow-up of 8.5 years occurred in 18%. Side effects of long-term antibiotic use occurred in 28% of patients, with resistance to antibiotics from at least one stool sample occurring in 78% patients.ConclusionsAlthough the use of antibiotics in chronic pouchitis may be justified, the use of long-term antibiotics must be weighed against potential complications associated with pouchitis and antibiotics.

Sign in / Sign up

Export Citation Format

Share Document