Biomedical subjects

Harry G Mond

Publications and source records attributed to Harry G Mond.

6 recordsLinked to original sources

PubMed2004

The subpectoral pacemaker implant: it isn't what it seems!

The traditional pulse generator implantation site lies subcutaneous on the fascia of the pectoralis major muscle. This article describes a subpectoral pocket approach, which on anatomic investigation is actually "intrapectoral" and offers a much improved cosmetic result with the potential advantage of less erosion. In the authors' experience with over 1000 initial pacemaker implants and pulse generator replacements, the potential concerns of neurovascular and muscular damage have not been realized. There has been no pulse generator damage from the ribs, serious loculated hematomas, or unusual postoperative or chronic pain. From experience with pulse generator recalls, the replacement procedure has not been significantly more difficult than with the subcutaneous approach. The intrapectoral approach has now become the authors' routine in patients without significant adipose tissue overlying the pectoralis major muscle.

Cardiac Catheterization↗

PubMed2003

Pacemaker ventricular block.

Pacemaker ventricular block is a rare and poorly recognized electrocardiographic abnormality usually identified in terminally ill pacemaker patients. Because the patient is frequently moribund and the phenomenon transient, it is probably overlooked and not well documented. It is characterized by an altered temporal relationship between the pacemaker stimulus artifact and the subsequent paced QRS. The most common presentation is a delay or latency between the stimulus artifact and the QRS called first-degree pacemaker ventricular block. This can then deteriorate to periodic episodes of failure to capture the myocardium referred to as second-degree pacemaker ventricular block that may manifest as a classical Wenckebach or higher levels of block. Any further deterioration results in a third-degree pacemaker ventricular block, which is failure to capture the ventricle and asystole. This article describes electrocardiographic examples of this phenomenon.

Aged↗

PubMed2003

Biventricular pacing: it isn't always as it seems.

Cardiac desynchronization therapy has established benefits in the management of symptomatic heart failure patients, although left ventricular lead placement remains challenging. We present a case report involving apparent biventricular pacing via the great cardiac vein, which through an appreciation of the surface ECG, revealed dual site right ventricular pacing.

Aged↗

PubMed2002

The challenge of endocardial right ventricular pacing in patients with a tricuspid annuloplasty ring and severe tricuspid regurgitation.

On occasion, patients with a tricuspid annuloplasty ring may require permanent cardiac pacing. Although it is technically possible to pass a ventricular transvenous lead through a tricuspid valve with an annuloplasty ring, the procedure is complicated by considerable chamber enlargement and mechanical distortion of the tricuspid valve often with severe residual tricuspid regurgitation. Over a 25-month period, transvenous ventricular lead placement following insertion of a tricuspid annuloplasty ring was successfully performed in five patients (three women). The patient mean age was 66 years (range 55-77 years). Four cases had slow atrial fibrillation and another paroxysmal atrial fibrillation requiring His-bundle ablation. Two patients had mitral valve replacement and two aortic and mitral valve replacements. All patients had residual severe to torrential tricuspid regurgitation. Seven ventricular steroid-eluting screw-in leads were used. Single leads were used in three cases, whereas in two others, two ventricular leads were attached to a dual chamber pulse generator. Although technically difficult, ventricular lead placement was successful using standard guidewires with broad curvatures. Satisfactory acute and follow-up stimulation thresholds and sensing were obtained with the only complication being an intraoperative lead dislodgement, prompting a second ventricular lead. Successful transvenous lead placement across a tricuspid annuloplasty ring is possible.

Aged↗

PubMed2002

Anatomy of a murder: telemetric footprints.

A man with complete heart block received a Pacesetter Affinity pacemaker, programmed DDD. Two months later, the patient was beaten to death and the coroner requested telemetric information. Pacemaker stored Event Records for the previous 40 hours were retrieved and using the zoom scale, the events leading to death were examined. This included sinus tracking during the beating followed by atrial and ventricular pacing interpreted as an unconscious vagal response associated with profound blood loss. Then followed a chaotic rapid ventricular activity or terminal ventricular fibrillation. The telemetric footprints provided valuable time stamps on the events preceding the victim's death.

Aged↗

PubMed2002

Ventricular pacing in the presence of tricuspid valve disease.

Pacemaker implantation following tricuspid valve surgery remains challenging, but recent developments in lead technology have significantly improved the options for ventricular pacing. In the presence of significant tricuspid regurgitation, steroid-eluting active-fixation leads should be used routinely, and in patients with a tricuspid prosthesis, the use of a dedicated cardiac venous pacing system is likely to be the best option.

Ebstein Anomaly↗