Leadless pacemaker – potential indications for use based on real life cases

2018 ◽  
Vol 1 (46) ◽  
pp. 31-35
Author(s):  
Aleksandra Woźniak
Keyword(s):  
Real Life ◽  
Venous Access ◽  
Everyday Practice ◽  
Pacemaker Potential ◽  
Leadless Pacemaker ◽  
Indications For Use ◽  
Conventional Pacemakers ◽  
Clinical Cases

Implantation of leadless pacemakers is associated with significantly fewer complications when compared to conventional pacemakers due to elimination of transvenous leads, which are among the weakest components of the pacing system. There are patients in whom implantation of a conventional transvenous pacemaker is very troublesome and problematic or associated with a higher risk of complications, including infectious, as a result of a very limited venous access or use of central veins for other purposes (for example haemodialysis or administration of drugs). We present two real life clinical cases as examples of potential indications for use of leadless pacemakers in everyday practice.

Suffering of the Spouses of Narcissistic Perverts: About Two Cases

2017 ◽  
Vol 41 (S1) ◽  
pp. S711-S711
Author(s):  
S. Ben Saadi ◽  
O. Moula ◽  
O. Zerriaa ◽  
S. Chebli ◽  
R. Ghachem
Keyword(s):  
Life Experience ◽  
Real Life ◽  
Clinical Validity ◽  
Personality Problem ◽  
Common Life ◽  
Her Family ◽  
Competing Interest ◽  
Good Agreement ◽  
Clinical Cases ◽  
At Home

IntroductionThe narcissistic perversion is a psychoanalytical term resulting from the association of 2 Freudian notions: perversion and narcissism. The concept of narcissistic pervert has no clinical validity. The companions of the narcissistic perverts undergo moral suffering, often unknown by their entourage.ObjectivesWe suggest studying the trajectory of life of two wives of narcissistic perverts.AimsEmphasize the peculiarities of the narcissistic perverse personality.MethodsWe are going to postpone 2 clinical cases of spouses of narcissistic perverts.ResultsCase 1: Mrs. A., 60-year-old, divorced once. Mother of a girl. She met her current husband during the marriage of her daughter. At the beginning of their common life, Mr. M. was loving and in the small care with his wife. After three months of the marriage, Mrs. A. reported the change of character of her husband who became aggressive, decreasing her and taking her away from her family. He seized all her goods. She is actually getting a divorce.Case 2: Mrs. R., 27-year-old, married Mr. C. after 9 months of knowledge. At the beginning of their marriage, they had a good agreement. Forced to stay at home to take care only of domestic spots, she reported a real-life experience of neglect and emotional carelessness, she felt belittled and isolated. At present engaged in a divorce procedure after been physically assaulted threatened with death.Both women consulted for depression.ConclusionThe narcissistic perversion is a personality problem which affects as well the person involved but especially his entourage. When you are in connection with a narcissistic pervert, even after leaving him, you never recover from it.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Simultaneous placement of leadless pacemaker and dialysis catheter in patient with exhausted vasculature

2019 ◽  
pp. 112972981989408
Author(s):  
Dawid Bednarczyk ◽  
Wiktor Kuliczkowski ◽  
Krzysztof Letachowicz ◽  
Marcin Dzidowski ◽  
Tomasz Witkowski ◽  
...  
Keyword(s):  
Vascular Access ◽  
Electronic Device ◽  
Cardiac Pacemaker ◽  
Cardiac Pacing ◽  
Venous Access ◽  
Cardiac Implantable Electronic Device ◽  
Leadless Pacemaker ◽  
Access Problem ◽  
Arteriovenous Access

The problem with limited venous access may occur in patients receiving long-term hemodialysis treatment with no possibility of arteriovenous access or in patients with cardiac implantable electronic device–related infection leading to the removal of cardiac implantable electronic device. We present a case report where both situations occur simultaneously. Using recent development in cardiac pacing—leadless cardiac pacemaker—we manage to overcome the vascular access problem. The described case emphasizes the necessity of multispecialty collaboration and gains of new pacing technology in patients who need placement of vascular access for hemodialysis and cardiac implantable electronic device where vascular access is scarce.

scholarly journals MGuard Embolic Protection Stent – The Importance of Thrombus Management in ST-elevation Myocardial Infarction Primary Percutaneous Coronary Intervention

2014 ◽  
Vol 9 (3) ◽  
pp. 168
Author(s):  
Katrina Mountfort ◽  
Ricardo Costa ◽  
Alexandre Abizaid ◽  
Jean Fajadet ◽  
Chaim Lotan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Real Life ◽  
Clinical Trial Data ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Embolic Protection ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Clinical Cases

Distal embolisation of atherothrombotic material is a frequent consequence of percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI). This causes microvascular occlusions, leading to a further reduction in myocardial reperfusion. The MGuard™ embolic protection stent (EPS) features a unique polymer micronet mesh coating. When used in acute STEMI, the MGuard EPS shows significant improvement in myocardial flow and ST resolution, even in complicated clinical cases vs the standard approach with conventional bare metal or drug-eluting stents. Data from the andomised Safety and Efficacy Study of MGuard Stent After a Heart Attack (MASTER II) trial and from a real-life registry have shown the efficacy and safety of the MGuard in primary PCI. This report of the proceedings of a symposium at EuroPCR, 20–23 May 2014, Paris, France, discussed clinical trial data, as well as a number of clinical cases, illustrating the utility of the MGuard EPS in difficult situations.

scholarly journals The Large Right Heart Is Associated with the Prolongation of the Procedure Time of Leadless Pacemaker Implantation

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 685
Author(s):  
Naoya Kataoka ◽  
Teruhiko Imamura ◽  
Takahisa Koi ◽  
Hiroshi Ueno ◽  
Koichiro Kinugawa
Keyword(s):  
Confidence Interval ◽  
Right Atrium ◽  
Odds Ratio ◽  
Pacemaker Implantation ◽  
Right Atrial ◽  
Procedure Time ◽  
Right Heart ◽  
Leadless Pacemaker ◽  
The Right ◽  
Conventional Pacemakers

Background and objectives: Leadless pacemakers are less invasive but are as effective as conventional pacemakers and are increasingly implanted in elderly patients. However, the implantation procedure is sometimes challenging in patients with abnormal anatomy, particularly those with an enlarged right heart. We aimed to determine the right heart parameters that were associated with longer procedure times for leadless pacemaker implantation. Materials and Methods: Among 19 consecutive patients in whom Micra leadless pacemakers (Micra TPS, Medtronic, Minneapolis, MN) were implanted, the diameter and area of both the right atrium and right ventricle were measured by transthoracic echocardiography before the procedure. The right heart parameters that were associated with a procedure time > 60 min were investigated. Results: In the 19 patients (median 81 years old, 10 male) who underwent implantation of the Micra system, 6 (32%) required a procedure time > 60 min. Among the baseline right heart echocardiographic parameters, right atrial diameter and area were significantly associated with a procedure time > 60 min (odds ratio 11.3, 95% confidence interval 1.09–1.17, p = 0.042; and odds ratio 1.57, 95% confidence interval 1.05–2.34, p = 0.029, respectively) at a cutoff of 4.0 cm and 17.0 cm2, respectively. Conclusions: Patients with an enlarged right atrium may not be good candidates for leadless pacemakers given the longer procedure time, and conventional pacemakers should perhaps be recommended as an alternative.

scholarly journals Left femoral venous access for leadless pacemaker implantation: patient characteristics and outcomes

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Jelisejevas ◽  
A Breitenstein ◽  
D Hofer ◽  
S Winnik ◽  
J Steffel ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Patient Characteristics ◽  
Venous Access ◽  
Femoral Access ◽  
Funding Sources ◽  
Leadless Pacemaker ◽  
Leadless Pacing ◽  
Procedural Success ◽  
The Right ◽  
Transfemoral Tavi

Abstract Funding Acknowledgements Type of funding sources: None. Background Leadless pacing has become an alternative approach for patients requiring a single-chamber pacemaker. Conventionally, Leadless Micra Transcatheter Pacing System (TPS) pacemakers are implanted via a right femoral venous access. However, due to various reasons, a left sided femoral venous approach may benecessary. We hypothesized that a left sided femoral venous approach is as safe and effective as compared to a right sided approach. Objective We assessed indications, procedural characteristics, safety and mid-term outcomes of Micra TPS implantation via a left femoral venous approach as compared to the conventional right sided approach. Methods and Results: In this retrospective single-center analysis, 143 consecutive patients undergoing Micra TPS implantation were included. 87% (125/143) underwent Micra TPS implantation via a right, and 13% (18/143) via a left femoral venous access. The mean age at implantation was 79.8 ± 7.5 years. Acute procedural success, mean procedure and fluoroscopy times as well as device parameters at implantation and follow-up (mean 15 ± 11.5 months) were similar between the two groups. Five major complications (3.5%) were encountered, all using a right-sided approach. After a transfemoral TAVI procedure, left femoral venous access was used in 42% of cases as compared to 8% in the remaining population (p = 0.003). Final leadless pacemaker position within the right ventricle was mid-septal in 82% (102/125) for right femoral access vs 72% (13/18) for left femoral access (p = 0.16).  In the remaining cases (28 %, 5/18), the device was placed infero-septal following a left femoral venous access, as compared to 14% (18/125) for a right sided approach (p = 0.19). No repositioning was needed in 68% (85/125) using a right femoral access vs 72% (13/ 18) patients with a left femoral access (p = 0.84). Conclusions A left femoral venous access for Micra TPS implantation is safe and effective with an excellent implantation success rate similar to a conventional right femoral venous access without longer implantation and fluoroscopy times. The most frequent reason for choosing left- vs. right femoral venous access was a previous transfemoral TAVI procedure.

scholarly journals Technical feasibility of leadless left bundle branch area pacing for cardiac resynchronisation: a case series

2021 ◽  
Author(s):  
Mark K Elliott ◽  
Peggy Jacon ◽  
Baldeep Singh Sidhu ◽  
Lucy Jarrett Smith ◽  
Vishal Mehta ◽  
...  
Keyword(s):  
Case Series ◽  
Cardiac Resynchronisation Therapy ◽  
Venous Access ◽  
Left Ventricular ◽  
Technical Feasibility ◽  
Leadless Pacemaker ◽  
First Case ◽  
Cardiac Resynchronisation ◽  
Endocardial Pacing ◽  
Endocardial Electrode

Abstract Background Left bundle branch area pacing (LBBAP) is a novel form of conduction system pacing which can reverse left bundle branch block and deliver cardiac resynchronisation therapy (CRT). The WiSE-CRT system delivers leadless endocardial pacing with symptomatic and left ventricular (LV) remodelling improvements following intervention. We report the technical feasibility of delivering leadless LBBAP using the WiSE-CRT system. Case Summary In case 1, a 57-year-old male with ischaemic cardiomyopathy and complete heart block underwent implantation of the WiSE-CRT system, using a retrograde trans-aortic approach, after failed conventional CRT. Temporary left bundle stimulation from the LV septum achieved superior electrical resynchronisation and equivalent haemodynamic response compared to endocardial pacing at the lateral LV wall. In case 2, an 82-year-old gentleman with tachyarrhythmia-induced cardiomyopathy underwent WiSE-CRT implantation via a trans-septal intra-atrial approach, with the endocardial electrode successfully deployed in the LV septum. Discussion Here we report the first case of deployment of the WiSE-CRT endocardial electrode in the LV septum, and demonstrate the technical feasibility of leadless LBBAP. Entirely leadless CRT is an attractive option for patients with venous access issues or recurrent lead complications and has previously been successful using the WiSE-CRT system and a leadless pacemaker in the right ventricle. Further studies are required to assess long-term efficacy and safety of leadless LBBAP.

Left femoral venous access for leadless pacemaker implantation: patient characteristics and outcomes

EP Europace ◽  
2021 ◽  
Author(s):  
Julius Jelisejevas ◽  
Alexander Breitenstein ◽  
Daniel Hofer ◽  
Stephan Winnik ◽  
Jan Steffel ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Patient Characteristics ◽  
Venous Access ◽  
Leadless Pacemaker ◽  
Alternative Approach ◽  
Leadless Pacing ◽  
Procedural Success ◽  
Transfemoral Tavi ◽  
Frequent Reason

Abstract Aims Leadless pacing has become an alternative approach for patients requiring a single-chamber pacemaker. Conventionally, leadless Micra Transcatheter Pacing System (TPS) pacemakers are implanted via a right femoral venous access. However, due to various reasons, a left-sided femoral venous approach may be necessary. We hypothesized that a left-sided femoral venous approach is as safe and effective when compared with a right-sided approach. We assessed indications, procedural characteristics, safety and mid-term outcomes of Micra TPS implantation via a left femoral venous approach when compared with the conventional right-sided approach. Methods and results In this retrospective single-centre analysis, 143 consecutive patients undergoing Micra TPS implantation were included. 87% (125/143) underwent Micra TPS implantation via a right, and 13% (18/143) via a left femoral venous access. The mean age at implantation was 79.8 ± 7.5 years. Acute procedural success, mean procedure and fluoroscopy times as well as device parameters at implantation and follow-up (mean 15 ± 11.5 months) were similar between the two groups. Five major complications (3.5%) were encountered, all using a right-sided approach. After a transfemoral TAVI procedure, left femoral venous access was used in 42% of cases when compared with 8% in the remaining population (P = 0.003). Conclusions A left femoral venous access for Micra TPS implantation is safe and effective with an excellent implantation success rate similar to a conventional right femoral venous access without longer implantation and fluoroscopy times. The most frequent reason for choosing left vs. right femoral venous access was a previous transfemoral TAVI procedure.

scholarly journals Use of and patient-reported complications related to midline catheters and peripherally inserted central catheters

2020 ◽  
Vol 41 (5) ◽  
pp. 608-610 ◽  
Author(s):  
Erica H. Lescinskas ◽  
Barbara W. Trautner ◽  
Sanjay Saint ◽  
John Colozzi ◽  
Katherine Evertsz ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Venous Access ◽  
Patient Experiences ◽  
Peripherally Inserted Central Catheters ◽  
Primary Indication ◽  
Patient Reported ◽  
Difficult Venous Access ◽  
Central Catheters ◽  
Indications For Use

AbstractWe conducted a prospective observational study of indications for use and patient experiences with midline catheters (n = 50) compared to peripherally inserted central catheters (n = 63). The primary indication for patients with midline catheters was difficult venous access. Patients with midline catheters reported fewer complications than patients with peripherally inserted central catheters.

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