Symptomatic occlusion of the access vein after pacemaker or ICD lead extraction.
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Constriction, Pathologic↗
Biomedical subjects
L M Van Gelder
Publications and source records attributed to L M Van Gelder.
Malfunction of endocardial defibrillator leads and lead extraction: where do they meet?
AIMS: The development of new extraction techniques has improved the success rate of intravascular extraction of pacemaker and defibrillator leads, and hence the practice of extraction is expanding. However, the indications for lead extraction of malfunctioning leads in patients with an implantable cardioverter defibrillator (ICD) are still not well established. METHODS AND RESULTS: We reviewed the literature concerning structural complications of ICD leads. The clinical presentation and detection of malfunction is discussed as well as the consequences for adequate defibrillation therapy. An overview of the current published experience of intravascular extraction of ICD leads is provided including a brief discussion of our own experience. CONCLUSION: From this overview we conclude that malfunctioning pace-sense or ICD leads can be left in situ if there are no uncovered insulation defects. Inserting a new pace-sense or ICD lead is preferable in this situation given the current known complication rate of lead extraction. Lead extraction should be reserved for damaged leads in which interference with proper detection or defibrillation of newly inserted leads cannot be excluded.
Arrhythmias, Cardiac↗
Undersensing in VVI-pacemakers detected by Holter monitoring.
Episodic failure to sense cardiac activity, with emission of pacemaker stimuli, was unexpectedly found on Holter monitoring of two asymptomatic patients who had had normal function of a VVI pacemaker on direct ECG recording. Pectoral muscle movement was then demonstrated to cause pacemaker noise reversion. After decrease of input sensitivity the phenomenon stopped.
Aged↗
Magnet application, a cause of persistent arrhythmias in physiological pacemakers. Report of 2 cases.
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Arrhythmias, Cardiac↗
Chronic ventricular pacing with ventriculo-atrial conduction versus atrial pacing in three patients with symptomatic sinus bradycardia.
Three patients with symptomatic sinus bradycardia due to sick sinus syndrome were treated with permanent ventricular pacing for periods ranging from 2.5 to 4 years. All three patients had ventriculo-atrial conduction on routine electrocardiography. Although ventricular pacing was effective, they complained of fatigue, lightheadedness, and near syncope. Hemodynamic studies revealed the presence of regular cannon waves in the right atrium as well as in the pulmonary artery wedge pressure curves. Temporary atrial pacing resulted in disappearance of the cannon waves and a significant rise in cardiac output (32-48%). After normal atrio-ventricular conduction was confirmed by rapid atrial stimulation and His bundle electrocardiography, the pacing mode was changed to permanent atrial pacing on demand. The effort tolerance of the patients markedly improved, and the previously mentioned symptoms disappeared. Control hemodynamic studies 9 to 12 months after implantation of the atrial demand pacemaker showed that the improvement in cardiac performance was maintained.
Aged↗
Externally induced irreversible runaway pacemaker.
An implanted ventricular demand pulse generator started firing at a rate of 1200 ppm during routine pacemaker follow-up utilizing the Vitatron VA 1000 pacemaker analyzer. This resulted in complete loss of capture; fortunately the patient had an intrinsic heart rate of 50 bpm and remained asymptomatic. Emergency replacement of the pulse generator resulted in re-establishment of effective ventricular pacing. An artificial origin of the impulses from the measuring equipment was excluded. To the best of our knowledge this is the first report of an externally induced irreversible runaway pacemaker.
Adams-Stokes Syndrome↗